DAVID FEINBERG: Hey, everyone.
It's David Feinberg, and I'm really, really excited
about the conversation we're about to have.
I'm with a dear friend of mine, a colleague,
and somebody who I had the honor of to be involved in training.
Dr. Patricia Lester, a child psychiatrist, a child
and adolescent psychiatrist.
So let me say hi, Patricia.
It's so great to be with you.
And tell me what you've been thinking,
what you've been working on, and how your work, I think,
kind of dovetails right into this.
PATRICIA LESTER: Sure.
Well, first of all, it's great to see you, David.
It's been too long, and we miss you.
I really look back at it with fond memories,
on your leadership here at UCLA.
But in terms of our work with families and strengthening
family and youth resilience, we've been pretty busy.
I think a lot of things have come up
that have drawn upon our work with the military, actually,
and thinking about how to support families
during times of uncertainty and times of danger and worries
about safety and risk.
As you know, our work is really focused
on the concept of family resilience,
really how to strengthen family relationships
and family functioning in the context of stress, trauma,
adversity.
Not only to help families make it through, but really
even to be able to thrive and grow.
And it's really a different construct
than individual resilience, in that it
is so focused on relationship and thinking
about families in the context of the systems in which they live.
So some of those systems are education,
and some are health care.
There may be other social support systems.
And then our collective communities around them.
DAVID FEINBERG: Explain the program,
and then let's talk how it is with COVID.
Just because your results have been spectacular,
and I just want to people get to know what you're talking about.
PATRICIA LESTER: Absolutely.
So our program is called Families Overcoming
Under Stress, which the acronym is FOCUS.
And really, our approach has been, in participation
with military installations, military families,
military providers, we adapted, in a very intentional way,
our programs that support families in all kinds
of contexts, and non-military ones as well.
And so when we built FOCUS, it was really
meant to be skills-based training that really focused
on strengthening these relationships,
whether they are were co-parenting or parent-child,
couples relationships, sibling relationships,
and really thought about the family as a whole.
Not to say you have a problem, but to say, you have strengths,
but how can we build upon those strengths.
DAVID FEINBERG: What kind of skills
do you give them when you say communication or resilience,
that you're building on strengths.
Like what are some of the--
pretend I'm one of those people.
What would you be telling me?
Hey, you're good at this, and if you practice this,
you get better?
PATRICIA LESTER: Right.
Well, there is several core components.
So one of the things we do is we personalize what we do.
So we screen people and use real-time, customized feedback
to work with that family to pick out
what it is that their family may be already
doing well and something that they may need to work on.
At the heart of our work in FOCUS
is helping the family build a story,
make meaning out of adversity.
I think that's a really important lesson for right
now too.
So we individually work with the families
to help them reflect on what they've
been through in the past, because we
know that stress accumulates, but resilience accumulates too.
But also to look at where they are right now
and make a family plan.
So being able to do that reflection,
to have empathy and listening, reflective listening,
across the whole family system, to allow the children to tell
their story, is often really important in helping
the family move forward and be able to problem
solve together, to be able to set goals together,
to be able to regulate all the ups and downs in terms
of their emotional life.
So we work a lot on skill development
around emotional regulation and emotional awareness
and how that informs communication.
We help families who have been through trauma and loss.
We help them work with trauma and loss reminders, the kinds
of things that really can split a family apart
and interrupt kids' development.
So some of the skills that we're teaching
are helping them to be able to have challenging conversations
and make a family plan to move forward.
DAVID FEINBERG: That's fantastic.
So think about it now today, let's say non-military,
these families all over the world
are scared about going outside.
They're scared about potential economic situations
with job loss.
A lot of families, especially the ones that
are working on our team here at Google,
have young kids at home, and schools are closed,
and so the kids are climbing on top of you,
and you have to do schooling and parenting and work.
And it's real anxiety and fear, because there is really
a tiger out there.
To those families, what could you
say to them to kind of work on their narrative
tonight at dinner?
How do you kind of do it yourself
to make sure we've learned those lessons that you've learned
in your work with FOCUS that I could bring to my family
or to other families.
PATRICIA LESTER: Right.
Well, I think for parents with kids,
some of the foundational components
are figuring out a language to talk about feelings.
As you said, they're real worries,
and they're real fears.
And being able to have a strategy for talking
about that, for acknowledging your own worry,
your own anxiety, the kind of ups and downs
and moods that we're hearing from everybody,
I think each day comes with its new burden
and kind of this unexpected feeling of the wear
and tear of going through all of this
and not knowing how and where it's going to end.
So I think for parents--
and I think this is true in couples too--
is to be able to have your own opportunity to reflect,
to allow yourself to appreciate that this is
a normal response to an abnormal situation,
and that we're kind of all experiencing this together.
And then to be able to talk with your kids
and even be able to model sharing those feelings.
This is the beginning of storytelling,
is being able to have that kind of communication
about your thoughts and feelings and then
be able to have activities that help support it.
I mean, in our program, we have a lot of structured narrative
activities, whether it's building
a time map or a timeline or making a family collage.
There's some great activities right now
for kids about doing a time capsule of this moment
and thinking about what you would want to include
and what you would want people to know about it.
But to do that as a family, I think,
might be a really useful kind of strategy.
But aside from those kinds of structured activities,
just that day-to-day, collective,
checking in, maintaining routines,
talking about your feelings, being
able to allow yourself to have space.
And also for parents to engage in some self-care.
That sometimes you need to step away.
Like you said, suddenly you're a teacher,
you're working at home, you're trying
to get food on the table in this way that's
very different than what you're used to
and really saying, I have to have time-outs from this.
I might not be able to do all this coping activities
that people are rolling out for me.
Maybe I'm not going to be able to make sourdough bread.
I'm hearing a lot of that from parents.
It's like, I can't do all this.
I really just have to take a break and take a walk,
maintain my sleep, maintain my routines.
Another group we're really thinking a lot about
and developing targeted services for
are first responders and our health care workers,
with the kind of exposure that they're getting.
And I think in some ways, unlike the military,
they're not really trained to run into danger.
And they're certainly not trained to run into danger that
might have an impact on their families,
their young children, et cetera, and to do that
without, perhaps, the kinds of equipment that they need.
And so we're really thinking a lot about how
to develop targeted strategies that support them specifically
in the kind of professional well-being needs they have
and the potential impact of moral distress
and professional burnout that we're seeing now,
sort of individual reports about.
Have you all been thinking about that too?
DAVID FEINBERG: We certainly have.
And so we focused a lot on that health care practitioner
and what can we do to provide them tools.
I'm thinking that post-COVID, there's
going to be a lot of folks with COVID-related medical
conditions that come to the health care system.
There's all the acute and chronic conditions
that have been delayed, but cancer
didn't go away, diabetes didn't go away,
that are going to come.
There's going to be this tsunami of mental health cases showing
up.
And the health care system is going to be totally depleted.
And a lot of them--
I don't mean to overgeneralize-- they're
going to have PTSD, right?
They had to make decisions on ventilators
that they never had to make before unless they
were in the military.
They never had to worry about not having basic equipment.
They didn't have to ever worry about bringing disorders home.
And they, like everybody else, were
worried because at home, there was job loss
and stress and kids at home.
I mean, it was a real double whammy.
And you're already seeing these health care systems,
particularly in the US, under incredible financial stress.
And it's just going to get worse.
So we're seeing that.
And so we think our response is, one,
make sure we get good, authoritative information,
YouTube and search.
A lot of practitioners come to us
before they do a lumbar puncture.
And they look at a YouTube, right?
So we want to make sure we have good information.
And then we want to build tools that
allow a nurse practitioner to function at a higher level
and spend time with the patients.
Technology has allowed the health care workers
not to have the burden of the electronic health record,
but rather a very simple user interface, that you can find
whatever you want, and it's really easy,
like we do with the rest of the world.
PATRICIA LESTER: Another group that we're
really quite involved in and worried about
and thinking about a lot are in Los Angeles--
but I think it's true for all of California--
is working with our education colleagues in the schools
and the incredible mental health burden
that they're going to see and thinking about how they can
help support a well-being, social, emotional functioning
in a tiered strategy for reaching kids and families
beyond the walls of the school.
And thinking about this as a disruptive moment,
perhaps, in how education is going to be delivered.
Just like in, perhaps, the way mental health care
is going to be delivered, in more
of a hybrid and virtually-enabled way.
But particularly for those kids who've kind of disappeared--
I don't know if you've seen the stories about kids
that have not checked in virtually, whether they don't
have Wi-Fi, they don't have the technology, the hardware to do
it, their immigration concerns.
It's a little unclear, the exact makeup of all the folks
who the schools have-- who really just don't even
know where they are, what's going on with them.
And that, layered on top of health disparities
and all the inequities for, I think,
the same population who already carry an adversity and trauma
burden.
We're quite worried about how to reach those kids
and support their well-being.
That's COVID-related, but also there's a long history.
DAVID FEINBERG: Everything else.
PATRICIA LESTER: It's everything else too.
Exacerbated, perhaps, by COVID.
DAVID FEINBERG: And oftentimes, a school,
whether a soccer coach or the piano teachers, the first one
that picks up bruises and protects a kid and calls
help when you're suspecting physical or sexual abuse
at home, those kids, there's more stress at home.
With the downturn of the economy,
there's going to be more of the disease of the despair,
and these kids are just at a higher risk.
So we've definitely got to find those kids
and make sure we love them and take care of them.
PATRICIA LESTER: Absolutely.
DAVID FEINBERG: Hey, this was so great to talk with you.
Congratulations on your amazing work.
I'm always amazed at how you've navigated the military.
You've been so successful.
And I know you really--
and the team-- have positively affected so many lives,
and so I'm grateful for that.
And it was so great to connect with you.
PATRICIA LESTER: Congratulations to you, too.
Thank you for all your good work and your leadership
in this area.