- [Narrator] Funding for this edition of One-On-One with Steve Adubato has been provided by The Healthcare Foundation of New Jersey.

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Johnson & Johnson.

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- This is One-On-One.

- I'm an equal American just like you are.

- The way we change Presidents in this country is by voting.

- A quartet is already a jawn, it’s just The New Jawn.

- January 6th was not some sort of violent, crazy outlier.

- I don't care how good you are or how good you think you are, there is always something to learn.

- I mean what other country sends comedians over to embedded military to make them feel better.

- People call me 'cause they feel nobody's paying attention.

-_ It’s not all about memorizing and getting information, it’s what you do with that information.

- (slowly) Start talking right now.

- That's a good question, high five.

(upbeat music) - Hi everyone, Steve Adubato here, and more importantly, welcome Dr. Zahava Friedman, who is Assistant Professor in the Department of Occupational Therapy at Kean University, one of our higher ed partners.

Doctor, good to have you with us.

- Thank you for having me today.

- Help us understand and define, if you will, occupational therapy, please.

- Sure, so occupational therapy is holistic science and therapy.

We serve people from cradle to grave, so as young as newborns and all the way till the end of life.

And we support and collaborate with them to complete whatever their daily activities are.

For a child, that might look like play.

For an adult, it might look like work, and for an older adult it might look like caring for themselves.

- (hums) There's an initiative that you're involved in called Raising Families.

What is the Raising Families Initiative and why is it so important?

- So, thank you for asking.

This is a project that's near and dear to me.

Raising Families is a grant-funded project, funded by the Healthcare Foundation of New Jersey.

It takes place within our occupational therapy clinic on campus, and it's a collaboration between four departments.

So I represent myself, the Department of Occupational Therapy, together with Kelly Sullivan, who's the director of the clinic.

I represent the Department of Physical Therapy.

So John Lee was the faculty member there.

Carrie Giardano from the Department of Advanced Studies in Psychology.

And in addition, I have colleagues from the speech therapy department.

These four departments came together to write a grant to serve specifically children and families who struggled during the COVID-19 pandemic.

So what we saw during the pandemic is parents were at home for long periods of time together with their young children.

And what was different from any other time in history is that these kids were now isolated from other kids their age.

They couldn't go to the park, they couldn't go to the pharmacy or outdoors, and the parents at this very vulnerable moment within their lives also didn't have access to each other.

So we saw a lot of loneliness.

We saw a lot of parent struggle and child struggle.

- Let's talk about that.

What exactly is needed?

You're describing the long-term implications of COVID on families, on parents, on children.

What are the most pressing needs that those children and those families have, please?

- That's a great question.

So the project serves what we see as the highest areas of needs.

So first of all, the children, we saw a tremendous amount of developmental lag, falling behind on milestones above and beyond what I had seen.

I was in school-based practice for 14 years, and I had never seen this amount of delay across many children, even who were typically developing- - I'm sorry for interrupting, Doctor.

I'm sorry for interrupting, give us an example of delay.

A delay of what?

- Yeah, so delay might mean that if a child who is one years old should be walking by that age range, they might be 15 months, 16 months, 18 months or two years, and not yet walking.

A child should be speaking the name of their mother, mama, dada.

They wouldn't show words at the time period where they're meant to show that.

And these milestones were either not appearing at all, so the children were not showing skill, or they were showing up like a year or two late, which has been unheard of in a typically developing population.

You might see it with children who have diagnoses, but we were seeing it across the population after COVID.

- It's interesting, you're a mom of five, correct?

- Yeah.

- I believe age five to up to 17 or 18, something like that.

- You got it.

- How much of this work is personal for you?

- Incredibly personal.

So during COVID, I had four children.

My four older children were in elementary school, and I basically had to set up a little red schoolhouse in my home because all of them were home from school.

And I saw, as a mother, the struggle.

I was an OT, I had worked for over a decade with children, but even I struggled with just keeping my kids engaged and busy and developing.

And then I imagined putting myself in the shoes of every other mother in America, some of whom were not as well equipped as I was to serve the needs of their children.

And what is interesting is my youngest, at that point was two, and he struggled the most.

So that drove this project for me because imagine someone who had worked with children for so many years professionally struggling with their child at home.

I'm thinking to put myself in the shoes of all these mothers with really young children, without the experience, and then needing to serve the needs of those children.

And just the loneliness and despair and this project aims to serve that segment of young parents in our county area.

- Talk to us, if you could, Dr. Friedman, about the mental health.

I know the Healthcare Foundation cares deeply about mental health.

We've done many programs in that regard.

However, the exacerbating of mental health issues and challenges for children, parents, families overall, but individuals who are part of those families.

What is our sense, what is your sense, an your colleagues in the field of occupational therapy as it relates to the mental health, the exacerbating of mental health problems and challenges vis-a-vis COVID?

Is it too soon?

- No, it's not too soon.

And I don't know if it will ever be too late.

So I'm not an expert, professionally, in multi-generational trauma.

I can speak to my personal family experience of that.

But what we have seen, and what I have read across many fields of literature is that the COVID-19 trauma was unique in that it was worldwide.

So you never see before something that impacts almost every population across the globe.

And it was intergenerational.

So from babies to older adults to parents, everyone was affected by the stay at home order.

Everyone was incredibly isolated.

And I think this prolonged isolation will have effects for years to come.

So, like I said, it's never too early to support people, but we might see effects in these children moving on, into elementary school and high school through the lag that they experienced as young children and the traumas of their families.

With mental health impacts, I would say it really can't be underestimated.

We know that it lives in the body and in the lives of anyone who has experienced that loneliness from COVID.

- We're talking depression, we're talking anxiety.

And is isolation in itself... That's not a mental health issue, but being isolated and feeling isolated contributes to, and I dare I use the word again, exacerbates issues of depression.

Is that too simplistic an explanation, doctor?

- No, no, it's not too simplistic.

I think it's one example of the system-wide effects that we're seeing.

So basically COVID revealed the cracks.

COVID revealed the fractures.

So across the population, being in socioeconomic factors or in developmental factors, which is my particular area of study, so what we see is people who were vulnerable became more vulnerable.

People who had resilience built up that resilience.

And if you're serving a population with a socioeconomic status which is challenged, those children anyway struggle to access healthcare practitioners.

But in COVID, they experienced greater challenges.

Children- - Worse.

- Exactly, worse challenges or greater challenges, however the nomenclature.

But it's the same thing with mental health and depression.

There were certain people who may have proclivities who had other experiences, but COVID revealed the cracks and made them more vulnerable to these things.

That's my perception of it.

- Well, your perception matters, doctor.

So parents watching right now, and they say, "Listen, I hear about this Raising Families Initiative going on at Kean University, along with other, not just your department as you described earlier, other departments and a very integrated approach.

I want to get involved, I want to learn more.

How can they do that?

- So we sent out... We did a major recruitment push in June and then again in September.

We have one cohort that completed, already in June, 12 weeks of this programming.

We have another cohort underway.

We sent out to- - How big is the cohort?

- So we take between 10 and 15 families, which means caregiver plus child dyad.

But we do accept families with multiple children.

So it's nice.

If you have our inclusion criteria as a child born just before during the pandemic, so if you have a child, any child born between 2018 and 2021, we sent out recruitment to early intervention.

We sent out to many of our partner offices across the Newark and Essex County and Union County areas to recruit these families.

I sent out to everyone I knew, put it on social media.

All my faculty partners and clinicians also went with a major recruitment push.

And if you have one child that falls within that age range and you're available for those 12 dates, we have accepted the whole family.

Sometimes they'll bring an older sibling to support that child and the parent comes and stays.

So it's a nice opportunity to come for free services, interprofessional services at a university setting, and get really an influx for yourself and for your child.

- Dr. Friedman, I wanna thank you very much for joining us, we appreciate it.

- Thank you, Steve, it's been my pleasure.

- You got it.

Stay with us, folks, we'll be right back.

- [Narrator] To watch more One on One with Steve Adubato find us online and follow us on Social media.

- We're now joined by Melanie Bieber, who's a mental health professional, and her colleague Ralph Pacifico.

He is a phys ed teacher at MKA Varsity Montclair Kimberley Academy.

They're the authors of "Aaron Daniel Henry Davis: Just Another Day at School."

Welcome folks.

- Thanks so much- - Welcome, Steve.

Thanks for having us.

- The essence of this book is about young people, students who deal with and suffer from ADHD.

What is it and what is the message in the book?

- Absolutely, so ADHD, attention deficit hyperactivity disorder, is a different way that the brain works.

And it can impact the way that a child or an adult addresses every aspect of their daily living.

And this book's mission is to help de-stigmatize so that children who have ADHD see themselves in a positive light, and those who don't better understand and don't judge children who do.

- Hmm, Ralph, you and Melanie working together on this book for a long time.

You and I are actually talking about this the other day.

Let me disclose, Ralph and I are golfing partners.

He beats me on a regular basis, but I just wanna get that out there.

Ralph, how about this?

This is personal for you as well as a professional endeavor.

Talk about the personal aspect for you.

- That's correct, Steve.

Well, when I was younger, there wasn't an ADHD label.

It was hyperactivity, and people just didn't understand, you know, the energy factor.

I would be in a classroom and hear a firetruck go by the school, and I would run to the window and knock people over to get to the window to see the firetruck.

So for me, it's a personal venture.

And Melanie understands that.

And I saw her working with the kids at our school and fell in love with her work ethic and what she did, so.

- You know what's interesting here, actually, in reading the book, there was actually a scene where Aaron Daniel Henry Davis is looking out in the classrooms, looking at the firetruck chaos in the room.

But you know what struck me at this?

And I'm gonna the back of the book, there are several, their activities, p.s., go on the website to find out more of their activities and things that we should know to be helpful to those students who are dealing with ADHD.

You know, what struck me is Mr. Nelson, the teacher in this class.

Melanie, talk to me about Mr. Nelson, the teacher who has particular sensitivity to Aaron, please.

- Yes, so Mr. Nelson is that teacher that every child dreams of having, the teacher who really understands who this child is, what makes them tick, and how to bring out the absolute best in them.

And when children who struggle have a Mr. Nelson in their life, they begin to thrive.

They begin to see themselves for the amazing, wonderful child that they truly are.

- Ralph, did you have that?

- Without a doubt.

I think it's the most important thing in anybody who's classified with ADHD is to have a teacher that understands them.

There's- - I'm sorry for interrupting, Ralph, did you have a Mr. Nelson?

- I did, Mrs. Evans, Jean Evans at Pleasantdale School, which now is Kelly Elementary in West Orange.

- And what did she do for you?

- It's a great question.

One of the strategies she used was letting me, when she would tip her nose, I would be able to leave the classroom and walk around and walk it off, like walk off my energy and get back.

And the walk seemed like I was gone for seven minutes, but it was more like a minute and a half, and I was ready to refocus when I returned back to class.

- It is awesome, and the strategies here.

I'm gonna go through a few of them.

Melanie, you and Ralph jump in back and forth.

Let me do this, before I do strategies, I'm gonna talk about some of the, ah, symptoms of ADHD: squirming and fidgeting a lot, difficulty staying seated, running and climbing at inappropriate times, difficulty playing or working quietly, blurting out answers, difficulty waiting and taking turns, making careless mistakes, et cetera, et cetera.

But strategies, that's where I wanna focus, Melanie.

Could you give us one strategy?

I know there are many more, that's why you should go on the website to find out more.

One strategy that will help teachers and parents who are dealing with and trying to be helpful to younger people with ADHD, please, Melanie?

- Absolutely, so one great strategy for teachers and parents is about routine.

Routine is one of the hardest things for children who struggle to organize their executive functioning.

Creating a visual for a child with ADHD of their routine with them in the pictures.

Step one, picture of Aaron getting dressed in the morning.

Step two, picture of Aaron brushing his teeth in the morning, so on and so forth.

Taking him through the morning routine, taking him through the transition in the morning in his classroom space, any routine throughout the day, creating that visual with a couple of words underneath it to describe exactly what we're talking about, that can help teachers and parents help their children tremendously.

- So interesting.

Ralph, I'm curious about this.

As a phys ed teacher, do you know, (clears throat) excuse me, do you know that a student is dealing with ADHD?

Are you told, do you have to pick it up, how does that work?

A, and B, how has this experience helped you be a better educator in the phys ed department?

- Steve, I think that the most important part of my job is to captivate, especially children with ADHD.

You have to keep them interested in the content.

That would probably mean, in a 30-minute phys ed class, doing five or six different activities for three to four minutes instead of doing something for 30 minutes that has a yawn effect on them and doesn't captivate them.

But I think that Melanie put out a good point, but the most important part of education in ADHD students is captivation, captivating the student and making them want to listen, making them want to be aware of what's going on in the class.

So you have to be a little bit dynamic.

- Stay on this, Melanie.

Ralph raised a great point.

In my other life as a communication coach and seminar leader around leadership and communication, I use the word engage.

Mary Gamba, my colleague doesn't like that.

I call it forcefully engaged.

What I mean by that is assertively engage people, because I won't get on my soapbox, but whether someone has ADHD or not, hearing a lecture doesn't work, and it's boring.

Never works.

- Yup.

- Engaging students versus lecturing, how the heck do you teach teachers to engage and not lecture?

Please, Melanie.

- So one of the best ways to do that is for teachers to learn about multi-sensory approaches to education.

What that means is, I know you're giving me that look, like, "I don't know that phrase," right?

- You've engaged me.

(chuckles) What does that mean?

- It means that we don't just learn by listening.

We learn by doing.

We learn by touching.

We learn by seeing.

We learn by hearing.

And the more of the senses that we can combine when we're teaching something new, the more dynamic we can make the learning, the more engaging it becomes.

When you're not just listening, but you're physically moving your body and you're reading and you're hearing and you're touching, all of the sudden your brain is activated in a completely different way.

And it makes the information what we call sticky.

- I love it.

Hey, real quick before I let you go.

Ralph, the hopes for this book are, moving forward?

- Just to create awareness and provide some knowledge to people, you know, dealing with children with ADHD.

- Melanie, any reason why this book should not be in the hands of teachers, educators, parents, and others, because there are so many?

I didn't do this.

Do we have any sense of how many young people are dealing with ADHD?

I'm sorry, Melanie, go ahead.

- You know, I don't have that number off the top of my head, but I can tell you that almost every classroom in America has at least one kiddo who either has or should be diagnosed with ADHD, even if they haven't been yet.

And so the reality is, it's around us everywhere we go.

And every child can benefit, because this isn't just a book for children who have ADHD, but also for children to learn about it.

- To Melanie, to Ralph, I cannot thank you enough for joining us.

It's such an important topic, and you helped educate all of us, thanks so much.

- Thank you.

- Thank you, Steve.

- Stay with us, we'll be right back.

- [Narrator] To watch more One on One with Steve Adubato find us online and follow us on Social media.

- We're now joined by Dr. Shai Gavi, who is Chief Medical Officer at Atlantic Health Group.

Good to see you, doctor.

- Thank you.

Good to see you as well.

- The relationship between a patient and their primary care physician is so important because?

- Sure.

Yeah.

It's critically important.

This is usually a longitudinal long-term relationship where the primary care physician is able to really get to understand the patient from the medical side, but also from their social side, their family, their social determinants of health, other family circumstances that would impact their health.

So it's critically important.

- But there is, unless I'm mistaken on this, a real shortage of primary care physicians.

So if that's the case, what advice do you have for viewers watching who are patients and family members who are patients?

- Sure, absolutely.

And yes, you're correct.

In the more recent years post pandemic, there's been shortage of healthcare providers throughout our country.

And so there are different models of care these days.

We do have our physicians, but also nurse practitioners and physician assistants and various models of care to try to meet the needs.

But yes, there is a shortage, but there are some newer models.

- Let me ask you this, everyone in the healthcare community that come on has experienced COVID in a way that's very different than for the rest of us.

Much closer to it, experienced it particularly early on in March, April, May of 2020 and beyond.

How do you believe, or what do you believe the long-term, the most significant long-term impact and implications of COVID are for the hospital/healthcare system, please?

- Sure, absolutely, so it's definitely taken a mental toll on individuals involved in the care of patients during COVID.

So certainly the mental toll has been there.

We've lost a significant number of staff who have left the hospital settings or are dealing with staff shortages and really recreating healthcare post pandemic.

What would that look like?

New staffing models, how do we work post pandemic with the current environment?

So it's had tremendous impact on our staffing, mental health, resilience.

- You know, it's interesting.

At a different competing healthcare system I teach in what is called the Physician Leadership Academy, and we teach a lot about communication and leadership.

And it's not so much doctor patient communication, but it's a physician being a leader of a department, having to run meetings, having to coach and train people, having to deal with conflict, et cetera.

You have been trained in the field of communication as well.

What specifically have you been trained in and how has that helped you as a physician, please?

- Sure, absolutely, so I've done a fair amount of training and communication, and it's a really critically important topic, and even more so now post pandemic, thinking about how do we work with individual team members, patients, and others to really listen and understand their perspectives, to mitigate conflict and differences in perspective and opinions, and making people feel valued.

Identifying emotions, naming emotions, so critically important communication skills to help our teams get through these current times.

- You know, it's interesting, health communication, particularly communication from public health agencies There are millions and millions of people across this country, large numbers in the region where we're viewed.

We're like, what do you mean this vac?

Is it a booster?

Is it a vaccine?

Do I really need it?

Which one is this?

And what about if there's a new variant?

How helpful is it's gonna be?

I'm gonna be sick for a day or two?

Point being, accurate, credible, public health information, whether it's from the CDC or any other entity that we look to for direction, has been questioned by many.

You say what to them right now?

- I'd say, you know, speak to their physician.

Going back to our initial discussion regarding primary care physicians, right?

These are physicians that know our values, know our potential health risks.

So really kind of balancing the risks and the benefits of these vaccines in light of our current state is important and regarding our values as well.

So back to really speaking with physicians, and as you stated, there are good resources like the CDC out there that provide valid up-to-date information.

- Before I let you go, you were a pharmacist professionally before you became a physician.

Why The switch?

- I enjoyed pharmacy, it was a wonderful opportunity and once I started spending some time in the healthcare environment in the hospitals, really fell in love with it more and wanted to be more involved and wanted to learn more.

And going on to medical school and doing research and other things was a great way just to get more involved and help out.

- Dr. Shai Gavi, Chief Medical Officer, Atlantic Health Group.

Good to see you, Dr.

Thanks for joining us.

We appreciate it.

- Thank you.

My pleasure, have a great day.

- You got it.

I'm Steve Adubato, stay healthy.

Thanks for watching us.

We'll see you next time.

- [Narrator] One-On-One with Steve Adubato has been a production of the Caucus Educational Corporation.

Funding has been provided by The Healthcare Foundation of New Jersey.

New Jersey Sharing Network.

Robert Wood Johnson Foundation.

The New Jersey Education Association.

Johnson & Johnson.

The North Ward Center.

The Port Authority of New York and New Jersey.

PSC.

And by New Jersey’s Clean Energy program.

Promotional support provided by NJ.Com.

And by BestofNJ.com.

- (Narrator) New Jersey is home to the best public schools in the nation, and that didn't happen by accident.

It's the result of parents, educators and communities working together year after year to give our students a world class education.

No matter the challenge, because parents and educators know that with a shared commitment to our public schools, our children can learn, grow and thrive.

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