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Stanford Medcast Episode 19: Hidden and Here Miniseries Part 3

Learning Objectives
1. Evaluate the impact the COVID-19 pandemic on the East Palo Alto community as it relates to the challenges of remote learning for their students
2. Develop strategies to support the community so students and families feel connected and not marginalized
0.75 Credit CME

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Audio Transcript

Ruth Adewuya, MD: Hello, you're listening to Stanford Medcast, Stanford CME's Podcast, where we bring you insights from the world's leading physicians and scientists. If you're new here, consider subscribing to listen to more free episodes coming your way. I am your host, Dr Ruth Adewuya. We are back with Part Three of our Mini-series called Hidden and Here, presented in collaboration with Stanford Presence, a Stanford Medicine Center, and the Stanford Department of Psychiatry.

Today, we situate ourselves in East Palo Alto, California or EPA, which is located in resource-rich Silicon Valley, but has historically not been a beneficiary of the economic and technological boom in surrounding communities. EPA has been disproportionately impacted by COVID-19, experiencing rates of infection that are three to five times higher than surrounding communities. As with schools around the country, EPA schools have been hit hard by the pandemic. In addition to the general challenges of distance learning, EPA students and educators are grappling with high infection rates, and significant losses while operating with an educational systems that have been historically under-resourced and marginalized, and where students have faced this proportionally high rates of violence exposure, trauma, and adversity.

Dr Ryan Matlow will introduce us to leading educators in East Palo Alto. And will lead our Hidden and Hear conversation on schools and education in the world of COVID-19. He is joined by Sonoo Thadaney Israni from the Stanford Presence Center, and doctors Sheila Lahijani and Ranak Trivedi.

Ryan Matlow, PhD: Today we are going to take the time to hear the stories of students and teachers from East Palo Alto and what about the impact of COVID-19 in their lives. And we will consider the implications of these narratives for health care providers and for our community in general. First, we're going to hear from Amika Guillame, the Principal of East Palo Alto Academy High School, and a long-time educator in the community. I have with me today Principal Amika Guillame from East Palo Alto Academy. Principal Guillame, would love to just give you the chance to introduce yourself. Tell us a little bit about East Palo Alto Academy.

Amika Guillame (educator): Thank you so much for having me here today. And I really appreciate the opportunity to bring voice to our powerful little community here in East Palo Alto. We are a small community in terms of numbers and size, but we are powerful and mighty in terms of impact. We represent typically 85% of the Latinx and the Latinx Service Industry here on the Peninsula. We also have about 6% African-American students, about 8% Pacific Islander Polynesian students. And that about almost rounds us out if you add in the multi-racial families.

I think what makes us very special is that we are affiliated with the Stanford Graduate School of Education. And we also are affiliated with the East Palo Alto Foundation. So we have two incredible organizations that help us pursue what is our ambitious goal, which is to have what we call the ten-year promise. So a student can start as a ninth grader here at East Palo Alto Academy. They can be the first to graduate from high school. That's about 65% of our students are the first in their family to go to high school. And then they can go on and be the first in their families to go on to college and graduate from college, all within the same program that is the EPA and EPA Foundation Tenure Promise.

Ryan Matlow, PhD: I would just love to hear a little bit more about what you've seen in terms of how the pandemic and how distance learning has impacted students' day-to-day experiences.

Guillame: I think what is important to note is when you are in a predominantly black and brown community, the pandemic that is COVID-19 is putting a microscope on the other pandemic of racism, Anti-Black and Brown rhetoric, and just everything that has been a terrible challenge in ways that folks have thought we've gone beyond, but continue to be very harmful, challenging, and stressful. So I think one of the challenges during this time is helping our students really process that yes, there is just the raw and real problem of the disproportionality of COVID-19 in the City of East Palo Alto. The City of East Palo Alto right now today in January 2021 has a rate of about 12% of East Palo Alto residents have tested positive for COVID-19.

And that when you think vis-à-vis, Menlo Park, which I believe Menlo Park is at a percentage, I actually have the tables here for the most recent from the county, Menlo Park is at 3.8%. And Atherton is at 2%. And here we are East Palo Alto at 12.69% of our population. So there's the real and the raw of the fact that I have students who are calling because they're sick. They're worried about their siblings who are sick, their parents who are sick, or whoever the extended family with whom they share their home are sick. I think I'd get emotional about this. But for example, I had to do a home delivery of some materials, and it was actually ergo, stuff for students who are working from home and having some ergonomic needs that I want to make sure we can help.

Matlow: Trying to set up the right learning environment for them as best as possible at home, right?

Guillame: Precisely. We have so many students who are frankly learning from their bed because their bed is their only private space where they can have the least distractions. I was delivering one of these tables. And I know that this daughter is a primary caregiver for her younger siblings, and does a lot around the house because her mom works so much. And I approached the apartment and in the window, I see the student cooking and chatting up her mom. And she's just confidently in the kitchen doing her thing. And her mom looks exhausted. Her mom is laid out on the sofa, her feet up, and you could tell she just looks spent. And the son is climbing on the mom, sort of, “Mommy, mommy,” telling about his day.

And I have another student whose family owns a small business and he stepped in to help the family transition from an in-house restaurant to outdoors. And the dad was telling me about all his son's really good ideas. Unfortunately, as we know, the restaurant business is hit hard by this pandemic. And now the son, I can't believe he did this, but needless to say, he has to travel far to come to school during this time on his own. And he is supposed to be packing. He was supposed to be helping the family pack their home because they can no longer afford their home.

He came to school to help me do this interview that he had signed up for for our foundation, drove all the way to school. And I said, “Oh, are you going to get started for class? I know class starts in a little bit.” He says, “No, I have to drive back home. They're waiting for me to help pack.” So here's the student, finding a way to balance both his coursework demands, help his family not leave their business, but also packing their home. And by the way, helping us out, and somehow finding time for class.

This next story though is tricky because it's a little too much. We had a student who lost their head of household. Now, this is the person in the household who was responsible for the rent, for the contract for the rent. In many ways, even though it was the aunt, she was the head of household. Her mother relied on her sister very much so. So there's the student, her mother, and her aunt. That's the dynamic of who's in charge in this house. When this older aunt passed away, the mother is suddenly left with complete sorrow, complete just silence. She could not function. And who steps up to take care of the family at this time? The 15-year-old daughter.

And when I say take care of the family, we're talking about a very simple thing that needs to be solved. The aunt is in the hospital. She has passed away from COVID. “We need to pay the rent. And I'm being told that I cannot get my aunt's body out of the hospital until we pay $2,700.” And it is the 15-year-old daughter who was our point person in helping her work through this issue. And as part of this conversation, as part of this work, we're helping her understand, I know your aunt's wishes was to travel to Mexico, to be buried in Mexico.

Now, here's the reality. As part of COVID, her remains need to be. So by the regulations according to the hospital, the aunt's body needs to be cremated. So then we have to help them understand that this is what we have to do. And we have to pay for it. And then we have to figure out who's the adults who's going to sign for this release of the body. All of these highly adult, highly charged emotional heavy stuff is in the hands of a 15-year-old. These are the disproportionate challenges that my EPA students are contending with. And those are only three stories of many.

So essentially to answer that question about the impact of COVID on our students, it is very real. It is very profound. And I think it cannot be understated that this is not just a pandemic dealing with the reality of lack of health and stress, and taking on these adult responsibilities and feeling the housing insecurity. There's also that emotional toll of, does this world value my black or brown body

Matlow: We are telling, and this has been our goal is to tell real stories and there's real emotions connected to these stories. And these are heavy stories. And what you're naming here is the confluence or the intersection of multiple crises, multiple pandemics. And you've really illustrated how… Yeah, this is not just one thing. This is not just the health pandemic. This is a social justice, this is a racial justice, this is a societal values' pandemic or crisis that we're going through.

Guillame: It's interesting how the stories about connecting and building community are like a see-saw. Sometimes that teachers come to me with these most beautiful stories of, “It's so interesting. I didn't realize this student had a sibling. I didn't know that student loves anime. I didn't know that the student is such a good cook.” There's these beautiful stories sharing through this idea of, I have a portal into this child's life. And so in many ways there've been these super cute stories of kids really experimenting in ways that would've never been possible.

There's these beautiful moments where our school experience is falling into the home in really positive ways. And there are those students who will tell you that they don't want to come back to school because if they have high anxiety or social anxiety, they feel like they're just able to shine in this format. We also have students for homeschool and their friends. And this is the tricky thing is, they have friends that they perhaps fell into, but would like to leave, but they can't.

So they have these friends with whom they were possibly getting into more trouble than they should have in the past. And now they're able to just stay in their home, focused on their schooling and get the grades that all along. I've been telling them they're fully of earning and just doing brilliantly. So there are definitely these moments where we're figuring out, wow, what is it about this online experience for that kind of a student? What can we do when we come back on campus to ensure that those students still have the ability to succeed? Do we need to do some version of online learning as part of our master schedule?

The vast majority of our East Palo Alto Academy teachers are masterful veteran teachers. So they've been doing this for over a decade, or even over half a decade, which is a big deal for charter schools. And so I have these masterful veteran teachers who are completely fatigued because now they're suddenly first-year teachers again. And it's not even so much that they're first year teachers because when I think of myself, I coached first year teachers for five years and it was full-time job because they have this insecurity about how do I connect with my students? How do I discipline in a way that liberatory and still holds them accountable, but still keeps them human? And so there's all these first-year teacher challenges.

Imagine being a veteran teacher and having to relearn this in a new reality in addition to the fatigue of just screen time, what that represents the blue light, et cetera. There's the fatigue of why is this so hard? It was never this hard. It shouldn't be this hard. I'm just asking them the simple thing, submit this application. And suddenly it takes significantly longer. It takes so much more explicit directions. And for teachers who are really good at breaking things down and using slides and explaining it step-by-step, so methodically, they do better than some, but there are others who relied for so many years on things that are up in their classrooms. Relied for so many years and just walking up to the student and doing a few gestures and getting them on track. Now finding themselves that they can no longer rely on these best practices that were so part of their day-to-day. They now have to basically think aloud.

Matlow: It's hard to feel great. It's hard to feel like we're thriving in the context of this [inaudible 00:14:09] pandemic. But I think there's some important points. And you've talked about how there are new opportunities, new skills and strategies that folks are learning. And that in many ways, this is showing us that we don't want to go back to the old way, right? That we're learning that the way that we were operating, maybe it wasn't optimal. At the same time, there are things from a pre-COVID life that we miss incredibly, right? That we do want to be able to return to when we're able.

And you've spoken of the importance of connection, this issue of presence, and how important that is for social connection, for community connection, but also for education. That we're having to find new ways to be present with one another and maybe not ideal, not optimal ways of being present. That just again, this is something that we want to keep in mind that we want to return to how can we be connected, how can we be present with one another in the context of the pandemic and then as we move forward in heal and grow and recover. So thank you again for sharing the stories of your school community, of your family, of your students and teachers.

Guillame: Well, I just want to thank you for giving me this opportunity to share these stories. I think that as sad as some of them may be that the intent is not for pity at all. The intent is to show how very powerful we can all be, and how very special it can be, especially for myself to be privy to these stories and to share them always with a sensibility that they're shared to show others of the strength that is within so many folks. I'm really appreciative of the value of storytelling and how it can bring people together.

Matlow: Next, I'd like to share the stories from educators in The Primary School, which focuses on early education and engages students and families from birth onward. We have with us Dr Ryan Padrez, Medical Director, Cristina Matthews, who's a Senior Manager of Parent Wellness Coaching, and Susana Morales Lodis who's a Lead Parent Wellness Coach.

Ryan Padrez, MD: Great, thanks for having us, Ryan. Really pleasure to be here and share a bit more about our work in East Palo Alto. And so I'm a general pediatrician by training. I'm on faculty at Stanford and wear a couple of different hats. One being a community pediatrician at Gardner Packard Children's Clinic. But really drawn to opportunities to work in the community really, especially in interdisciplinary fields.

Had the privilege to join the founding team at The Primary School about five years ago, which The Primary School is a new school model that we're really trying to re-imagine what could a school look like to really support the life trajectory of children, most impacted by poverty and by our systemic racism, by other adversities that kids face? And how could this model really bring together all the adults working around the children's lives, including parents, educators, pediatricians, mental health providers starting at really a very young age?

And I'm really happy to be joined here by two of our phenomenal parent wellness coaches that work closely with our families. And I think they can tell a little bit more about this program and their experiences working during this really challenging time of the COVID pandemic.

Cristina Matthews, MA: My name is Christina and I work in the Parent Program. I'm one of the managers and I also hold a caseload of families. The real focus is, how do we address adult wellness in a realistic way that it keeps a family in mind, that keeps student wellness in mind? We're a team of 10 coaches. Each coach holds a caseload of families that they work closely with a really long-term-based. And so the idea is that our coaches stick with their families for the long haul, and as long as they'll have us, I like to say. So I'll stop there and I'll hand it over to Susana.

Susana Morales Lodis: My name is Susana Morales Lodis. I work as Lead Parent Wellness Coach in the Parent Program at The Primary Schools.

Padrez: I think what I really love that we're all working together to do is to think about how to do the work differently. And so if you put the hat on a pediatrician, our 15-minute well-child visits is really hard cadence to overcome some of the real health challenges that we faced to support our families. And so what we're trying to think about is, how can we leverage those touch points at the school, those touch points that pick up that we can really start to think how we can uncover the full story of what might be going on and how we might better support that family? And my favorite moments have when we've been able to find opportunities to pull in the pediatrician from our partner clinics to that conversation.

Matlow: With that, I'd love to turn towards thinking a little bit about what the impact, what the experience has been for your families, for your students, for parents and caregivers and for The Primary School in general during the COVID-19 pandemic. Can you share a little bit about students and families experiences, and maybe some of the ways that the pandemic and remote learning and distance learning has impacted them in their day-to-day lives?

Morales Lodis: This is a super inspirational history. This family lives in Santa Clara County. And last year, that was without work for several months. Mom was without work for the whole year. After a few weeks, mom recycled to sustain through different resources in this community for the resources, diaper resources. There is happy and struggling also with the language barrier because supporting their children's with teacher assignments with remote learning is even harder for them.

Matlow: Yeah, right. The challenges of learning the second language or being an English language learner that is enough adversity and stress in itself. And at the distance learning and the pandemic has just exacerbated that in some ways. And that's definitely some of the things that we're thinking about and highlight, and it's just the ways in which some challenges have been intensified by the pandemic in the ways that we're operating. So thank you for highlighting that.

Matthews: When I think about the student impact, I really think about the parent because learning is happening at home. We're thankful now that we're slowly being able to open up some classrooms, but at the beginning of the pandemic, when everything was shut down, we were in full shelter-in-place and everything was on onto, there was just such a steep learning curve for families. I think they leaned into it with just an incredible amount of strength and resilience. But it was hard at first and it was hard… We're also providers at home with our own families, maybe navigating some of the same things. And so there were tech issues, there was access to internet.

There was a lot to do in terms of understanding what are the resources available for internet? How do we get folks connected? Once they're connected, how do you just support the tech literacy piece? Which I think we're all going through, whether you were figuring out if you're on mute or not, or just how to log in. And how do you support your student now that they're in front of a screen? So there was, I think a lot of angst from families because they didn't want their children to fall behind. They really wanted their students to continue to thrive and do well. And so it required, I think deep partnership between teachers and families, but also I think for our team, it meant inviting parents to be honest about what was hard and asking them to share vulnerably.

Matlow: Just curious to hear a little bit more about what it's been like? You said that the response to the pandemic and supporting families in this time required a deeper engagement, right? And increased maybe openness to being vulnerable and sharing what was hard? So just curious to hear a bit about what that experience was like?

Morales Lodis: Before of course, working in our relationship on trying to have a close relationship with families, we showed some vulnerability. But right now is a theme that you need to work in everyday because every day things are changing. But in my case, with [inaudible 00:22:07] my families, it has been helping me to go deeper in these relationships.

Matthews: The love of creativity and resilience that has been birthed out of this experience is tremendous. But I will say that even though there was creativity and there was just this joining in on Zoom for doing our parent group work together, that parents did share like, “I miss being able to come and be together. I miss being able to have that human touch.” I think that there's been a really positive response parents sharing that feedback with us that they enjoy hearing that they're not alone.

Padrez: I'll just call out that challenges we had at school as I mentioned, we're an elementary school and a preschool. And so I think those are some of the hardest ages to move to a Zoom-based learning platform, especially the preschool where kids coming together and interacting for their social emotional growth is so dependent on that human interaction and it's very, very hard to replicate that over Zoom. And so I know that our teachers are longing for those interactions. Again, I know our students are longing for interactions and you even see it in the moments where they get to playing on the playgrounds a little bit. As our playgrounds have started open up, you see the joy in kids interacting with other kids, again, and it's palpable.

But the prevalence and community rates in East Palo Alto, as I think you've alluded to are four and five times that of the rest of the county, which we had to ride the ups and downs of surges and really be vulnerable, what is safe in terms of opening up classrooms for our community? Thinking about so many of our families are living in multiple family households. They have extended family with them, grandparents and other vulnerable elderly that might be there and really being of what could go in that home and thinking very thoughtfully and carefully about it? So trying to balance that tension of, desperately wanting to open up classrooms, feeling like the science's guiding us towards that direction, but really being mindful and safe about what's best for our community as well.

Matlow: Right. And recognizing that the circumstance and situation of families' so variable and somewhat unique in the East Palo Alto community that there are some special considerations, that there is additional sensitivity we need to have in making these decisions. So it's not a definitely not a one-size-fits-all recommendation.

Padrez: My vulnerability as a pediatrician medical director of the school and trying to make the best decisions for our school and community and it's a really hard tension to know what is best as the science of this was evolving so rapidly over the last nine months.

Matthews: Some of the families that I work with, there was this real balance of, how do I maintain safety, but also how do I still try and find work where I don't have a safety net of one employment, or I don't have the safety net of accessing the stimulus package? And so we got creative and we're trying to think through who's in your network of support, how can we leverage them?

Padrez: What our community has in this pandemic asks the families for quarantining and isolating when you've been a contact or when you have someone in the house who has it, or when you yourself has it is extremely hard for a lot of families in certain living situations. And so trying to get creative about being a thought partner with families, both as a pediatrician when I see them in clinic, or as part of The Primary School about how to adhere to these guidelines safely that creates a lot of hardships for families. And I just think back to when the pandemic was first playing out in East Palo Alto, just the disparities and the lack of testing resources that were available in East Palo Alto was something that really struck with me. And now vaccine distribution, keeping a really mindful eye on that and how that's going to play out in a community like East Palo Alto.

But in the beginning, it was extremely difficult to get a test. And so if you had a household who had a contact or someone at work or someone we were concerned about and where our recommendations to get a test, it was very difficult to do. And it still isn't easy. It's become easier. And then if you remember, it used to take sometimes up to seven or 10 days for the test result to come back. And so asking a family who was potentially the sole worker now in that household when barely making ends meet, they had a contact potentially, and their recommendations to get a test. But if they get a test, they didn't have to wait seven or 10 days out of work waiting for that test to come back and potentially they're asymptomatic. They don't really think they have it. You start to get a better understanding of why there was really not strong incentives to get a lot of testing done or others because the hardships that are created are so many in the community.

And that's what we felt as a school model were important investments in not only our parent wellness coaching and this concept, this belief that when parents are well, our kids thrive. And this pandemic has really, I think helped us to best understand where to lean in and best support, but also hopefully inspire other school models to think about how to invest in these types of supports as well because adversities and stresses on parents are not going to go away post pandemic. It's just a matter of how we think uniquely how to support them.

Second is our core belief of how we integrate with health like to emerge out of this pandemic, having a strong partnership with our medical homes, particularly Ravenswood Family Health Centers where most of our children and families go. It'll be really, really important to reopen the school safely. And never before has this interdependencies on health and education models working together have been illuminated. And I'm excited to continue to push on that further as we emerge from this pandemic.

I still at the core really believe in an interdisciplinary approach to challenges and to problems. And this has only helped me put fire to that belief around how we need to come together to help support each other. And really just the belief in the profound resilience of everyone around me, my own family and kids as we navigate through this COVID waters, the school community, how they have adopted it and changed in our students and families and seeing tremendous growth still through all of this has really given me a lot of hope, but also really excited to emerge from this someday soon and get back to seeing people in-person.

Matlow: Welcome Sheila, Sonoo, and Ranak to this virtual fireside chat about the effects of COVID-19 and distance education in historically under-resourced school communities. As we've listened to the stories and narratives told by our colleagues and partners at East Palo Alto Academy and at The Primary School, curious to hear from our team, what stood out in terms of the ways that COVID-19 has intersected with or magnified other pre-existing disparities or social crises that have been impacting our educational systems? Ranak, maybe we'll start with you.

Ranak Trivedi, PhD: Sure, Ryan. Thank you. This is such an important point that a lot of us have been hearing through the news media about the technological challenges faced by those who are distant learners, and how that has brought to light the disparities of access of technology of broadband and other tools that can support distance learning. And in hearing the interviews and the conversations that were had, I was really struck by the unique disparities that that can bring to under-resourced communities, and how the connections that were being talked about were not just about the distance learning itself, but the sense that it was harder to just connect with the community and connect with the students or the parents over the technological platforms, and how integral that connection is to the wellbeing of the community and the services that are being provided.

Sheila Lahijani, MD: In a similar vein, Ryan, I think what has taken place is the cloak has been removed. I think many people have had in some ways the fortune of not having to disclose a lot of their social circumstances, a lot of the challenges they may have at home. And these days, it's become harder to do that. So in a way it has caused, I think not only more challenges as it relates to access and all of the things Ranak just remarked upon, but I also think it's contributing to people feeling more ostracized and more marginalized. And I think that's something that we really need to pay attention to because, of course, it affects one sense of self, how one belongs to a community, whether it's a school, whether it's a one's own family. And so for me, and listening to the interview and reflecting on, what came out of some of those discussions is that people are feeling more exposed and with exposures, people are feeling more vulnerable.

Trivedi: I want to pick up on something that Sheila mentioned, Ryan, that struck me with just exposure and vulnerability. I have a first grader. And the policy when they get on Zoom, is they're not allowed to have a background. And I'm not really sure what the reason for this policy is, but I'm imagining kids in communities where they don't want people to observe what their background is, what their home life is, what their particular home situation is, especially they might be on Zooms with people who come from different backgrounds and may have more spectacular homes and backdrops. And I feel that that curtain being removed and not giving people the choice, kids in this case, or parents the choice of protecting their dignity in the way that they see best for them, is also something that in marginalizing for kids and parents in these communities.

Matlow: I think this speaks to a running theme that we've been talking about in our series is that there are no-one-size-fits all solutions. So having heard these stories and these interviews, what are some of the major key reflections? And Sonoo, I'd like to start with you.

Sonoo Thadaney, MBA: Thanks, Ryan. And thank you for the opportunity to share a revelation for me. I heard the stories of the students and teachers stepping into new roles and facing new challenges and the heroic aspect of these spaces. And for me, it brought me back to the fact that I am a first-generation student myself. And my parents as you know, were refugees into India and I'm an immigrant. And the story in our family life has been this one of, make lemonade out of lemons. Look for the silver lining. Here are constraints. Get creative.

I'm now 60 years old. And only after decades of therapy have come to realize that this mindset of making lemonade out of lemons made me the kind of person and there are others like me, where they take on problems and solve them even if they're not ours to solve. So when I was hearing these stories of heroism and heroics, the piece that stuck with me was, I do hope that these communities and the individuals involved while they deserve all the accolades for the work they're doing, I also hope that they find appropriate guidance and help from folks like yourself and Ranak and Sheila to think about how that which is our greatest strength can sometimes be a weakness and how not to make a lifetime of it.

Matlow: Thank you, Sonoo, for sharing that reflection so eloquently. Sheila, Ranak, curious to hear if you have any additional reflections on this theme.

Lahijani: Thanks, Ryan. To ducktail what Sonoo just remarked on, I think oftentimes people feel they have to be strong and be resilient, solve problems, and that mutually ought to exclude feeling down, feeling worried, feeling helpless. And I think it's important to acknowledge you can experience all of that at once. You can aim to solve problems, make your circumstances better, try to make lemonade out of lemons, but it doesn't necessarily mean you have to be less frustrated, less sad, less helpless, less anxious. These are all important points to make for everyone. But I think particularly when people are feeling more exposed and more vulnerable, the emotions are high. The amygdala and the brain is over-activated, it then can interfere with decision-making, it then can interfere with problem solving. And I think offering a validating supportive approach so that people can feel like it's okay to feel and still try to move on forward, is really something that I think can help a lot of people.

Matlow: I'd like to turn to thinking a little bit about our community of health care professionals. What are these issues of multi-layered impacts and a resilience admits considerable burden? What do they mean for health care professionals? What are the implications for service providers working with students, families, and schools that have been hit hard by COVID-19 and by the pandemic?

Lahijani: I think what this relates to in part is this topic of social determinants of health. We have to factor in what everyone's individual circumstances are, especially right now with respect to accessing food, clothing, shelter, financial resources. I have found myself asking more and more these questions during my encounters with patients. And sometimes they're a part of certain questionnaires that are administered that maybe people don't pay as much attention to when people respond. And these days we can't make any assumptions. Everyone is struggling in one way or another irrespective of how privileged or unprivileged someone may be. And I think it really behooves us as providers in the health care field to really be receptive to what circumstances people may be living in and what they are able to access and what is particularly challenging for them.

I have seen two people in the last two days who are living out of their cars. And this was not documented elsewhere. This was not part of the conversations that has taken place with some of their other providers. And I felt privileged that I was entrusted with this information, but I was partly entrusted with this information because I asked, because I wanted to know, because I felt it was important to have that context. And I couldn't give necessarily any blanket recommendations without having that knowledge and that information. So, all of this is to say is, it's best not to make any assumptions, especially these days. And we have a duty to really get to know the people and really get to know what choices they're having to make and what difficult choices they're having to make and how that affects the relationship and how that affects what we're trying to provide to the best of our ability as clinicians.

Trivedi: I also just want to encourage health care professionals to realize that there are different disciplines that are better versed and practiced and trained to assess the social context. So not every clinician doesn't need to feel that they have to be the one doing a thorough assessment of these issues. Social workers, psychologists are trained to get at the social and mental health context of people's social context, as well as the individual context. So recognizing that our health care system is not necessarily built to get into the in-depth stories of people, but that there are other disciplines who can compliment the primary medical visit, if you will, to provide that information. And we can develop that whole story through multiple providers.

Thadaney: Thank you, especially, Ranak, for pointing out what you did. And I'll had one more piece. There was a time, probably in our lifetime, certainly in my lifetime, where physicians and practitioners in medicine, when leaders in the community, not because they solve all the problems, but they sat at tables to help inform, understanding the problem, exploring the solutions and helping influence policy. So much of what we see in terms of disparities, for instance, is a function of historical racism, sexism, homophobia, you name it. So it's a foundational, organizational, institutional, societal set of issues.

And as you pointed out, Ranak, every clinician cannot be an expert at everything. That would make people producing pigs that also give you wool and beef which do not exist. But I do believe that clinicians have a role to play in terms of sharing the stories, like Sheila just did, at tables of power, at tables of decision-making, to help influence the needed change at societal, and economic, and organizational levels.

Matlow: Thank you all for joining me in listening and being present with the experiences and stories of our colleagues in East Palo Alto and thoughtfully, considering the experiences and difficulties of being a student or an educator in this time of COVID.

Adewuya: Thanks for tuning in. This podcast was brought to you by Stanford CME. To claim CME for listening to this episode, click on the Claim CME button below, or visit medcast.stanford.edu. Check back for new episodes by subscribing to Stanford Medcast wherever you listen to podcasts.

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The content of this activity is protected by U.S. and International copyright laws. Reproduction and distribution of its content without written permission of its creator(s) is prohibited.

Accreditation: In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit Designation Statement: Stanford Medicine designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Financial Support Disclosure: This CME Activity is supported in part by educational grants from Novartis.

Authors:

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

The content of this activity is not related to products or the business lines of an ACCME-defined ineligible company. Hence, there are no relevant financial relationships with an ACCME-defined ineligible company for anyone who was in control of the content of this activity.

Ruth Adewuya, MD

Managing Director, CME

Stanford University School of Medicine

Course Director, Faculty

Nothing to disclose

Amika Guillame, BA

Faculty

Disclosure Information Not Available

Sheila Chitsaz Lahijani, MD

Stanford Health Care

Faculty

Nothing to disclose

Ryan B Matlow, PhD

Stanford University

Faculty

Nothing to disclose

Cristina Matthews, MA

Faculty

Disclosure Information Not Available

Susana Morales Lodis, MA

Faculty

Disclosure Information Not Available

Ryan C Padrez, MD

Stanford University

Faculty

Nothing to disclose

Sonoo Thadaney Israni, MBA

Executive Director, Presence and Program in Bedside Medicine

Stanford University School of Medicine

Faculty

Nothing to disclose

Ranak B Trivedi, PhD

Assistant Professor of Psychiatry and Behavioral Sciences, Public Mental Health and Population Sciences

Stanford University

Faculty

Nothing to disclose

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