Hablar más de la marihuana con las familias y el personal

(En inglés)

Talking More About Marijuana with Families and Staff 

Melissa Lin: On today's webinar, we have Anne Auld presenting. Anne Auld will introduce herself in a moment. We also have with us today Amy Hunter from the National Center for Health, Behavioral Health, and Safety, who will moderate the Q&A discussion later on. Next slide, please. 

Anne Auld: All right. Well, thank you. My name is Anne Auld. I'm a deputy director with Illuminate Colorado, joining you today through the National Center of Health, Behavioral Health, and Safety. So excited today to continue our conversation around cannabis use, marijuana. What are those conversations look like? 

This is a part two. I'm going to do a quick review of some slides that we went over last time. But also know that if there's more that you would like to know about these slides and didn't see part one or would like to go back and review part one, we'll have those links available to be able to go back and review part one. It is available as a recording. In our time today we'll do a little recap, but again know that if you're like, oh, I want more about those first few slides that there's an entire presentation with those. Then we'll spend some time on talking about developing and understanding policies about cannabis use when we're thinking about both staff and families and how behaviors associated with cannabis use can affect child safety – and then really around how to talk about safety concerns related to cannabis use both by families and staff. 

We're going to go ahead and hop into part one. Again, this is just a review of things that happened in the first presentation. We talked about some criminalization – what's that look like – enforcement, legalization, different types and usage around cannabis, and then some nuance – excuse me – around policy and some research findings. We'll spend a little bit of time again just refreshing our memory around this. 

What is cannabis? When we think about cannabis, it's the entire plant that we are talking about when that term is used. Cannabis has hundreds of cannabinoids. There's over 600 cannabinoids chemicals, including 80 cannabinoids. One of those cannabinoids is THC. THC is the psychoactive or mind-altering component of cannabis. You also have things that are a cannabinoid that is CBD, which is not psychoactive. When we think about products that are available on the market more often than not, the ones that we are talking about that would give somebody that psychoactive or mind altering or a high would contain THC. 

Ones that are just CBD – although there are some new ones out there that are available, not through marijuana or cannabis regulated stores that are being labeled as CBD. There are some effects that those are having, but more often than not, your CBD is not giving somebody a high. Then we have hemp, which is a product. That is when we think of – we take wood and turn it into paper, we can take hemp and turn that into a fabric. We can turn it into paper as well. It is really used – it's kind of an industrial sense. Then, marijuana – that term refers to the flower or the bud itself. Just getting some kind of language pieces around that. 

The key piece that I want us to be thoughtful about as we continue through today is really around potency. THC levels – again, that piece that psychoactive. The differences between what is in today's product compared to what was in a product 20, 30, 40 years ago is vastly different. When we look at the levels of THC just in the 80s and 90s, we're looking at it below 10% level of THC. Whereas today, whether it is something that is being purchased legally or illegally, that the level of THC is at least 20% to 30%. There are products that you can purchase that are 50%, 80%, 90% THC. When we think about the high that someone may be getting off of cannabis use that it looks very different in today's terms than it would have years ago. 

CBD products, the ones that you are purchasing in most stores … Again, there's a new product that's out there that I'm not going to spend a ton of time on because there's just not a lot of it nationally. But CBD products in general may have a small THC content to it, or they may not have any at all. When you are buying something, whether it will be labeled the CBD content. If it has any THC in it, it will be labeled with that amount as well. If it's purchased through a dispensary, it will have all of that on the container as well. 

One of the things to keep in mind around that potency when we think about what we know about impact to body and brain and to people's behaviors is that the longitudinal research that we have is based on those lower-level THC studies. There are current studies in place right now that are looking at what are those impacts based on today's current potency. Because longitudinal we need 20, 30 years to be able to get that together, we don't have full longitudinal studies with that THC at the higher levels. Not yet. 

Methods of use. Some of the things that we want to think about is there's different ways that cannabis products can be ingested or topical or inhaled. When we think about the raw cannabis plant, so the plant itself found in the wild, it doesn't have a psychoactive component to it. For THC to actually become active, it needs to burn in some way. Whether it's cooked or it's smoked … When we think about edibles, we are looking at a product that has been cooked to make it an edible. 

There are things that have to happen before it can be psychoactive. There's also differences in how we are going to be able to process any product, whether it's smoked or eaten or applied topically. When we think about inhalation – something that is smoked or vaped or dabbing is actually even a form of you're ingesting a smoke – those all are happening really fast. Those are getting into the bloodstream fast. They are immediately getting into people's systems. When we think about how fast something happens, it's really quick when something is inhaled. 

When we compare that to an edible, which is something that is eaten just like anything else we eat or medications, or you think about when you take a Tylenol. It takes a while for that Tylenol to actually become active and useful in your system. It's the same with edibles. It takes about 30 to 45 minutes for it to become active in somebody's system. The main difference to keep in mind between something that's ingested and something that's inhaled is that when it is ingested, it actually remains active in someone's system longer. 

Inhalation, it's faster kind of with that initial high, but that also goes away sooner. Ingestion, it will take a lot longer for it to become active or to give that high, but that stays in the system for hours afterwards. When we think about what does safe driving look like, or what does safe caregiving look like when it comes to terms of edibles is that someone could be in an actively high situation for hours longer than if it were smoked. Then, when we look at topical lotions or salves, a lot of CBD products really come across in lotions or salves. Oftentimes, there's not like a psychoactive component that's happening with those, but that is a way that some of those products can also be purchased. 

All right. Nuances, really thinking about policy. What do we need to think about around the implications of that? Cannabis use is still federally illegal. It may be legal in your state. It may be legal in your state medically, but not recreationally. It may be legal in your state both medically and recreationally. It may be that it has been decriminalized, which means it's not legal, but it doesn't mean that someone would get arrested for it. They're not actively going out to arrest people. It has been decriminalized. But again, that's not the same thing as being legal. 

Understanding what is happening within your own state is important. We've got some references at the end and ways that you can check about what's going on in your own state. Understanding that even if it is legal within your state, that can shift from county to county, from district to district. Being sure that you understand what is actually happening within your state and within your area is super important. 

Also, thinking through child maltreatment definitions. I am from the state of Colorado. It has been legal here for a very, very long time. And there was a lot of work around … Cannabis and marijuana use is still considered a Type II when it comes to substance use. That is something that had been an immediate … It would immediately open a child welfare case. As it became legal in Colorado, there was a lot of work around this is now a legal product even though it's still federally listed like this, how are we thinking about those definitions within our state? That's certainly something to be thoughtful around also within your state of: Is use in and of itself still a child welfare issue? We're going to talk about what the behaviors we should be thinking about when it comes to child safety as opposed to just the use. 

As employees of a federal program, what does that mean for you and the work that you are doing and perhaps your personal use of a product that is illegal still federally? We'll spend a little bit of time digging more into that in this presentation. 

This is just … Again, you have access to this in today's slides and also in the previous presentation around: There are risks associated with use, and there are things that we just don't quite know yet. When we talk about the fact that product is stronger than it was before. That people's reactions to it may look different than they did 20, 30, 40 years ago when we don't exactly know how it is impacting a fetus. We know that it crosses through the placenta. We know that THC is stored in body fat. When we think about developing fetuses and babies who are receiving breast milk where there's lots of fat stored and babies are made up of a lot of fat. There's just not enough information right now to give some concrete … We know this, but we know that those things are happening. 

Because of that, the conversations that we want to have around use by a caregiver, we want to take into account that those things are happening and even though we aren't exactly sure what those impacts may be, we know that there are impacts. How are we talking about the transfer of those to babies through breast milk, through second-hand smoke? We just want to be able to talk about those. We want to be able to err on the side of safe development and understand that part of that may need to be the relationship building with the parent to understand why use is happening because more often than not, that folks are using substances – all substances – for a reason. 

Is it medical? Is it therapeutic? Is it to just be able to check out for a little while? Many of us will go home after this, or you're already home. Maybe in the evening, you'll have a glass of wine or a beer. When we think about the impacts that those have on our ability to take care of the people in our house and certainly our ability when we show up the next day for work, we want to be thoughtful about what those impacts are and how those impact the behaviors that are showing up as a result of the use. We'll spend a little bit more time on that. This is a great starting place for some conversations around … Like even if we don't know all the things, we know enough to know that there certainly is an impact on development and ongoing brain growth for adolescents. 

What does this all mean? We're going to hop into some new territory. If you feel like I want to know a whole lot more about all the things you just said, remember there's an entire one hour on those. Today and for the rest of our time together, let's talk about some policies, what we need to be thoughtful about when it comes to policies around families and around staff, dig into some of those behaviors that we may see that we want to be thoughtful about, and how to talk about those safety concerns related to that. At the end, we'll have a bunch of resources be able to share with you as well. 

All right. Let's concentrate on families for the moment. I want you just to think about where you work and the things going on at your work when it comes to policies or procedures at your site for suspicion of impaired driving or a parent arriving or leaving impaired. Separate from marijuana or cannabis, just in general, what are some of those policies or procedures of a parent that there's a concern that they may be arriving or leaving impaired? Feel free to pop those in the chat if you've got those, or just make a mental note of those. 

It may be that your answer is “I'm not really sure what our policy is around those things.” Yes, so we try to find another reliable driver. I know there's a bunch of you probably typing all at once. I want to give you a second to put those into the webinar chat. How can we keep the child at site? Reach out to emergency contact. Impaired can't leave with child. There's things that you already have when it comes to impaired driving. 

I would say the No. 1 thing that I have heard as we've had these conversations across the nation around cannabis use is really about somebody comes in and they smell like marijuana. What do we do? What I want to be able to do is take a step back from that question and think about what are the other things that we already have in place when it comes to impaired driving. We're going to talk a little bit more around why someone may or may not smell like marijuana because there may be reasons other than them being actively impaired. This isn't a separate conversation. The conversation should really be around impaired driving as opposed to whether or not somebody smells like something. 

I want you to think about the policies that you already have. It may be that you are not in a role where changing policies is something that is available for you to do. But these are certainly conversations to bring back to your sites to elicit more conversation about what is it that we are doing and how are we thinking about this? What continued discussions need to happen? What modifications may need to happen to the policies you have to include cannabis-related concerns? 

As you are doing that, I want you to really be thoughtful about bias. Looking at your policies and thinking through: Are we making determinations about just how somebody looks like, their clothes? Are we making determinations just based on how somebody smells? Are we making determinations around how someone is acting as opposed to how they are looking? How are we making some of those determinations? Because what we should be looking at to ensure that we are not making some decisions based on outward appearances, which we know especially looking at child welfare data that we have a very unbalanced amount of children who – Black, brown, Indigenous children – who are not white who are involved in child welfare. Oftentimes, those policies … When we look at some of those policies and practices, there's a lot of built-in bias. It's super important that, as you all are looking at your policies, that you are keeping some of those components in mind as well, and we are looking at behavior. 

Are there signs of impairment? Did somebody walk in and they were stumbling? Is their speech slurred? Is there something that they are doing that is making us suspicious above and beyond smelling like cannabis? I know another safety concern is exposure to second-hand smoke. What if the kids are smelling like cannabis? What I want you to think about there is there are times that kids are coming in and they're smelling like nicotine. That's another legal substance. 

Oftentimes, I have asked folks in the last presentation I think we even talked about that smelling like nicotine and what do you do in those situations. There are already policies in place around that, or there are certainly practices in place. Being sure that we're not completely pulling out marijuana use as something separate and different than the things that we are already doing or talking about with parents around safety concerns. 

What are we hearing? What are we seeing? What are those conversations that we can have with parents if the concern is that the child is smelling like this? How are we talking to families around where is the substance use happening? Are they using in the garage, and that's just where all the coats are kept? Are they using in the house with the kids. There is another primary caregiver who is there and available, but because it has a pungent smell, the clothes are smelling like that. 

I think oftentimes, we're jumping to conclusions around like they've all been in the car hotboxing, and that may be happening. But as we build those relationships and start with just some basic conversations with parents in the same way that you all are already having difficult conversations with families around nicotine use or around perhaps clothes, just like … Perhaps someone is in a financial situation and the clothes aren't getting cleaned, and so kids are coming to Head Start with dirty clothes. Those are already difficult conversations you are having. You already have the skill set and are already doing really great work with parents around those. You are building in those same types of conversations around the substance use as well. 

I see some of these chats in there that they are smoking on the way to school, or if they're doing it already in the house. Like again, if we have someone who is actively smoking or drinking in a car with children in it, our concern there is around the safety around the driving. Those would certainly be conversations that we would need to have, but we wouldn't want to jump to a conclusion that that's what's happening without some sort of conversation with those families, really around “I am concerned about this behavior because …” When we come from that place of I am concerned about this behavior, we're taking a little bit of that judgment out around the use because we don't know what the intent is around that use, because oftentimes, there is a reason that people are doing and using substances. 

But ensuring that we are having those safe conversations that again that you all are having in many, many other different spaces. Somehow, we just kind of pull this one out and make it feel like it's different. But it's really a lot of the same ways that you are having conversations around safety in general with families. 

Identifying what that concerning behavior is and also understanding that there may be someone who is using who has a medical recommendation for cannabis use. A recommendation – I will reiterate – is not the same thing as a prescription. A recommendation comes from a doctor. It's like there's a recommendation that someone would use this for … In many states there's pre-determined uses of things like cancer, or there's … Depending on your state, if you have medical legalization, you probably have some pre-conditions. You can be recommended that. 

The reason that folks would continue to use a medical card as opposed to my state has recreational. Why would I continue to use a medical card? It's usually because it is in the long run less expensive to use because the taxes are oftentimes different and the amounts that someone could receive are different. But ideally, they are under the care of a doctor who has recommended that use. But do know that part of a conversation if someone is saying they're using this medically can be around: Are you under the care of a doctor. 

Also, it's not like a prescription where you can think about any prescription that you have in your house right now. It tells you when to take it. It tells you how much of it to take. It tells you whether or not you can do certain things on this medication. That is not what happens with a recommendation. They are recommended use. Then it's kind of on the person to have a conversation with their budtender or not around how much they should take, how often they should take it. 

Part of that conversation can also be let's understand that maybe you chose to do edibles because that felt like that was a less risky product, or somehow it wasn't going to have the smell in it. But know that stays in your system longer. Did you know that? 

When we think about driving, that you may be impaired longer driving with an edible. Or this may impact care taking after the child is coming home. Again, we're looking at up to eight hours of being active with an edible. Just kind of having some basic understanding of how substances can impact someone, but then really looking for those behaviors to focus on what the behavior is that you're concerned with to continue that conversation with families. 

As I think about those conversations, I want to acknowledge that they can be complicated. But we need to realize a couple of things. Substance use in and of itself does not mean there is an unsafe situation. We can have folks who are using substances, and the children have another primary caregiver. There is someone else who is taking care of them. They're using when kids are at grandparents' house. In and of itself substance use does not automatically mean there's a safety concern. 

On the flip side of that, I want to acknowledge that nondetected use and I say nondetected because there has to be a certain amount of a substance in someone's system to be able to have it detected through a screen or a test. Nondetected use also doesn't mean that the situation is safe. I'm sure you can all think of lots of times where children have been exposed to a safety concern, and substance use wasn't involved whatsoever. 

That's why we want to be really thoughtful about what are the behaviors that we are seeing that are concerning us because – whether it is use of a legal substance, an illicit substance, a prescription – we want to be thoughtful about what is the behavior that is concerning us and sitting in that with the discussion with families. 

Because substance use is a spectrum. We have everything from no use all the way up to a substance use disorder. We can have somebody who uses one time a year, but every time they use, they end up in jail, or they end up in some sort of a confrontation. Or we can have somebody who has a prescription an actual prescription who is misusing that prescription or is not using it as intended that could be impacting their behavior. Or I think about just Benadryl in general. Benadryl is an over-the-counter, but if you give that to me, I am passed out on the couch. I absolutely should not be driving. 

We want to be thoughtful that use can look all kinds of different ways. Instead of getting stuck in the use or stuck in the actual substance, we want to be keeping our eyes on those behaviors and being able to talk about those. I'm going to take a second. I know that there's a whole ton of stuff that has come through in the chat box. Before I move on to some staff-related things, I want to take some time and … Amy, I don't know if you've been keeping an eye on the chat box, or things that have just been going fast and furious on my end. 

I do want to take some time, though, and acknowledge some of the questions in the chat. 

Amy Hunter: Hi, everyone. Yes, we have lots of questions. I love it that you're taking a pause to reflect on those a little bit. Lots of questions. I would say maybe one of the themes is just around the smell, and you've been addressing that, and you've been talking about that. I don't know if you have a few more comments. Sometimes, I see a fair amount of comments related to just it's disturbing to others. I can think of the analogy that you offered already around the smell of cigarette smokes is disturbing to some people. I wonder if you want to just spend a little more time with that. 

Anne: Yes, absolutely. There was one that I just saw that was around: Could reporting that you think you smell smoke endanger someone? There's a couple of things here around smelling like smoke. Let's sit with those. There's a lot of reasons that someone could smell like cannabis. They could be actively using. They could have been actively using four days ago but are wearing the jacket that they were wearing while using because that scent will linger until it's washed. 

We could have someone who works in a dispensary. If you are working either in a retail store or you are working in a greenhouse, you will absolutely continue to have the smell that people associate with marijuana and cannabis. There's lots of reasons that someone could smell like it. When we think about that being a smell that is distracting or impacting the classroom setting, again, I would just reiterate how is it that you deal with that when there's other smells that are happening that are distracting or impacting the setting, like nicotine or perhaps underwear that hasn't been washed or just has things haven't been cleaned or someone who is coming in and just has a lot of perfume on that then lingers. There are ways that you all, again, are already either washing the clothes when the kids come there … You're taking that upon yourselves as if you are a site that has the ability to be able to wash things. You are doing that. But you're also having some conversations with parents around like, “Hey, what kind of support do you need around …” A, B, or C that's happening, especially when it's something that the child is … The smell is associated with something that's going on with the child. 

Those are difficult conversations, but they're wrapped up in support. They're wrapped up in what kind of help do you all need. My guess is that sometimes those conversations go to are you needing financial assistance around: Is your water turned off? Like what kinds of things can we do to be helpful around ensuring that they have access to or financial pieces associated with laundering. When I say things like that, my guess is that you all have a list of it either in your head, or your site has a list that you are sharing with families of the things around financial assistance, around here's where the food banks are. You all know those. 

You know those in your community. You know if someone is having a problem with some financial things – either A, B, or C, – you know how to refer families to those things. You're pulling in those same resources and those same conversations into this conversation around there is the smell. Here's what's happening. Here's how it's impacting. What is it that we can do to help support you and your family and the kiddos and ensuring that that's not something that continues to kind of impact our classroom setting? 

Can the … I'm just looking at “can it trigger asthma?” There's lots of things that can trigger asthma, but certainly any type of smoke is going to, depending on the child, trigger an asthma reaction. But we could say that about dust. We can say that about cigarette smoke. We can say that about wildfires. Just again, thinking through that there's lots of things, but smoke in general is one of them. 

Amy: Ann, there's a few questions that center around the theme related to how do you tell if someone's impaired. I mean, so this issue of there might be other reasons. You're so good about helping us think through lots of different reasons or causes and helping us to think about behavior. There may be different reasons why someone might be slurring. I think there's a question here about maybe someone's having a stroke. Maybe they have a medical concern. 

How you tell if they might be under the influence or if something is concerning? If the behavior is such that we should be worried about sending a child home with them? There's a few different kind of questions on variations on the theme of that. Like how would you tell if it's not safe to have a child go home with someone? 

Ann: I would actually say that you all actually know that because there are times when someone who is coming in who is under the influence of alcohol or perhaps another substance, you all are recognizing that. There's a difference, though, between recognizing that someone is stumbling, somebody is slurring, somebody is like … Things just aren't making sense, or they are looking like something else is going on. We can talk about pupils, but pupils may look different depending on what the substance is. They may look different if they're having a stroke. 

There's not necessarily like a telltale like, “These are the four things you should like … This is what somebody looks like that's on or has used marijuana.” There's not necessarily a list like that I want people to sit in. What I want you to sit in is: There's something going on that's making you think outside of how they smell, or perhaps they came in smelling like that. Now you are looking. Are there other things that are happening that I'm worried about and being able to, in your mind, articulate what those are? 

What am I concerned about? Am I concerned about how they came in? Am I concerned about how it is that they are talking? Am I concerned about how it is that they are walking back out to their car? What is it that's actually making you think that there may be some impairment there and being able to articulate what that looks like? Because whether or not it's a substance or it's a stroke, that's something that needs to be addressed. 

You don't have to be the doctor who figures out what it is. But if somebody comes in and they're stumbling or somebody is coming in and their speech is slurred, being able to take a moment and articulate just within yourself and then with the family that like, “Hey, I noticed you stumble in the door. Like is everything OK? Can you talk to me about what's going on there? What happened?” Because it may be, especially if it's a medical emergency, they may not be aware of what's happening there. But it opens up a relationship, a continued relationship with the families that you were working with when you notice that there's a difference between what they looked like today and what they look like tomorrow. 

Is there something that has changed? Is there a behavior that has changed that is leading you to believe that there is something going on. Not having to pinpoint what's going on to exactly what it is, but to pinpoint that there is a concern here and articulating that. If your concern is great enough that you don't think that somebody should be driving with them, then you're absolutely moving forward with some of those policies that you already have in place or you're going to continue to talk about. 

Those are continued conversations that I want you to have within your sites around: What are we looking for, how are we determining that there's not a bias built into this, and whether or not it's medical or substance – like something's going on? We want to make sure that we are taking that time to connect with that family to ensure that, if there is a safety concern, that we can address that we're addressing it, or that there's a concern that's impacting the classroom that we're talking about how that's impacting the classroom so that parents know how they can be supportive in diminishing that impact. 

I know that that's not exactly the answer that people want. In this PowerPoint, there are some notes around like here are some things to look out for. I want to be really careful with checklists. Checklists make me nervous because people either want to make sure that we've checked all these things before we do something or that it has to be like, “We only have one thing. Is it really like worth a conversation?” I want you to be careful with checklists when it comes to what impairment looks like because it can look so different from person to person. 

You all spend enough time with these kids, or you all have been on this planet long enough that if there are things that are sticking out that are concerning, the key is to acknowledge those, to articulate what the concern is, and to be able to have some conversations around that. 

Amy: I love that. I feel like you're giving us a message of trust your gut, trust your relationships, and also check your own biases. I really appreciate that. I don't know how much more time you want to spend on questions. Now, you certainly have …

Anne: Yeah, I will just move on. I'll move on to staff because there may be some of the same questions here because as we talk about practices, policies, and procedures for staff, the first thing I want to say is that staff are people too. We can have all of these conversations that we want to around what it is that it looks like to talk about the families, but understand the staff who are working for Head Start are also a part of family systems, are also dealing with many of the same stressors and histories and perhaps traumatic events that the families that we are working with are also facing. 

When we think about staff, there's a couple of places that I want us to be thoughtful about. When it comes to policies and procedures that … I'm sure there is already some policies and procedures around showing up to work impaired and why that is not a good thing, especially when we have children.

There's definitely ones around bus drivers, ensuring that anyone who is in charge of driving children around – that we are being really thoughtful about what that looks like. I would say for teachers and administration, those may look different. I'm not really sure that they should.

Again, some conversations within your sights around: What are our policies and procedures around substance use? What are our policies depending on someone's role and should those be different, or if the end game is that we want to make sure kids are safe, that we should have some standardized policies around impairment regardless of what someone's role is. You may already have those. You may not. Again, that's a thing to bring back to have some conversations around. 

The other piece of this is around not everybody lives their job 24/7. Some of us go home and have personal lives. What does that mean when it comes to cannabis specifically because you all work for an organization that is federal, and it is still illegal federally. What are your policies around the use of marijuana products regardless of whether or not it is legal or illegal in your state? I don't have an answer for you on that one. There is not like an overarching … Here's what you all should do, but it is certainly conversations. 

I will say in part one, most of the questions that I received were around staff use. Will I get in trouble if I do this? Or I've been using this for medical reasons – am I going to get in trouble? I don't know the answer to that. I am telling you that those were the questions that came out because that told me that staff don't know what the policies and procedures are around marijuana use as an employee of Head Start. 

I will tell you that it will impact your federal funding. It is a reason that in many states, even though it may be legalized, you may not be able to have foster parents who can use cannabis products because their money is federal money when it comes to paying foster parents. These are some big conversations to be having with staff around what the expectations are around their use, not only on the time when they show up, but if they're using in their off time, is that going to impact their employment? Then, I see this about submitting drug test results. Drug tests tell us a point in time. 

If I know that I have a drug test on Tuesday, you know what I'm not going to do between now and Tuesday, or at least Sunday to Tuesday? Drug test only tell us a certain piece of information. They tell us in that moment in time when somebody peed on a stick, or if we went all the way to a blood test, it only tells me in that time period whether or not somebody was using. They're a good tool to have. I get why folks use them. I get why that's an important thing to have, but know that we need to be more thoughtful about what are the impacts, what are the behaviors, what are those things that we need to be thoughtful about above and beyond drug screens. 

How is it that we are supporting staff? If all of these things kind of set up to be able to support families, how are we incorporating those into how we're supporting staff? When I talk about substance use, so often, is something that is being used, whether consciously or not as a way to escape, as a way to deal with past trauma, as a way to deal with current trauma, as a way to just relax at the end of the day. How are we as an organization, how is Head Start, how are your individual sites supporting healthy alternatives. Or how is it we are ensuring that there isn't a stressful environment that is perhaps leading to substance use? How are we wrapping around those staff as they are going home and being with their families or just in their communities? 

What are we doing to impact their well-being in a positive way that is supporting the prevention of some of these things. All right. I'm going to go through a couple more of these just quick slides give you the resources, and then we'll have a chance to do some more questions because I know that there's some staff ones that came in. 

There is a training that we provide twice a month that is … You all can … The next screen will have a QR code on it. We added a bunch more. It's a four-hour training on the conversation guide for professionals on substance use, children, and families. It is four hours of what does it look like to have those conversations. How are we practicing those? How are we doing those in ways that don't bring our judgments, our biases into those conversations? You get some supplies out of that including a safe storage bag. That's a great way to just have a prompt to start a conversation about substance use. What are the things that we can put in here, but also really building on the skill set that you all already have around having difficult conversations and how are we adding safe storage to those?

Safety concern is around impairment means that you may not be able to do this. If you are at home and you have a 2-year-old, who's at the top of the stairs or a toddler. When you're impaired, you are slower. Your reaction speeds don't look the same. Do you have the ability to get up off the couch to be able to mitigate a toddler who's potentially falling down the stairs? Thinking through what does it look like to talk about the behavior that we're concerned with. The behavior is: You may not be able to get off the couch to get the kid at the top of the stairs. We're talking about that as opposed to why are you just using and some of those places where the judgment can feel more pronounced. 

I'll leave this up for a second if you want to get the QR code for that and head over and just kind of keep that. But again, you will have access to these slides, so you'll be able to get that. That's a free training that's … Again, we're scheduled through … I think the schedule is up through June even, if not farther out into the year. But we'll continue to add to that. 

This is another resource. This is a Head-Start-specific resource, and this has some really great things in it. It has some links to videos that were created through Head Start around recovery, some great resources around additional tough conversations, but a great place to be able to get a lot of substance-use-related information all together in one place. Be sure to take some time to dig into that because that is something that was made specifically for you all. 

I'm going to come back to this question slide, but I just want to let you know that this is some additional resources. If you're looking for more information on breastfeeding and pregnancy, second-hand smoke and what are those impacts of second-hand smoke around substance use, just some general information around marijuana and cannabis. Then, there's an entire campaign that came out of Colorado, where “Responsibility Grows Here” – just some great preventative information there, but I just wanted to pre-show that so you all knew that was something that you had access to. 

Questions. Got a couple of minutes for some more questions. I did see a question that I thought was interesting around: Why are we seeing it so much more now than we did before? I was like …

[Crosstalk]

Amy: Yeah, I saw that in the chat and in the Q&A. I just think it's really interesting. I don't know if you had this question before. 

Anne: I will say because there has been widespread legalization … I will say that when Colorado legalized we were not prepared. We had not thought about so many things. It's just like legalize it, and then we're kind of doing … We did a lot of backtracking for a lot of years and then probably are still doing some backtracking to be completely honest as a state. 

When I think about alcohol and I think about how prevalent alcohol is, I can't go to a restaurant without seeing alcohol. I can't drive down my main street without seeing liquor stores. I live in Colorado. I can't drive down my main street without seeing a liquor store connected to a dispensary. There is something about alcohol that has become we don't see it as much anymore as a substance. It's just because it's become part of our culture. But there's also been massive campaigns that have happened, national campaigns … I think about MADD, so Mothers Against Drunk Driving. 

There has been more national attention towards: It is not OK to drive while drinking. There is more understanding around the impacts of alcohol than I think that there is understanding around marijuana and part of that is because we have decades worth of research around alcohol. We don't have the same amount of research. 

My thought process is, and my hope is that as time goes on and we get more of that data, that there's going to be increased awareness around the impacts. Whether it's legal or not like that's I mean … I'm staying out of that conversation, but understanding that the impacts look different when it comes to … The impacts don't look different. The impacts are actually very similar. But the education around it, the social norming around it looks different when we think about some legalized substances and some that aren't that are legalized but maybe aren't legalized. 

I do think that some of that's going to shift in time as more people are talking about some prevention efforts or talking about just some great information around what does this look like. We actually had huge funding cut in the state of Colorado around a lot of these campaigns, and we saw an increase in children admittance to emergency rooms around edibles. 

We can’t say for sure, but there's certainly a correlation of when our education pieces as at a state level stopped and that increase happened in emergency rooms. Just you all having conversations with your families around safe storage, around “hey, I know you think that that edible is something that's going to be less problematic or somehow is more bougie than smoking it, but understanding that you're actually higher longer. It may impact you in a way that you didn't know about. Or if you're taking four of them because nothing happened in the first 45 minutes, you're going to be really, really, really high after that. 

I think there is something around the legalization happened, and people were like, “Oh, it's legal. I'm just going to start using it now.” The messaging hasn't caught up quite yet around where it is and isn't OK for adults to be adults and use substances that are legal as they decide. 

Amy: Yeah. Anne, is this true also that because it has been illegal or classified as a certain substance for so long, the research wasn't able to be had as much, and now that maybe there's more legalization in certain places they're able to do more research?

Anne: I would in the State of Colorado the University of Colorado, and one of our health hospitals about 10 years ago started a whole bunch of research based on today's levels of THC. I know that there are other hospitals nationwide and health departments that are doing that work, but we're still at 10 years. When we look at what longitudinal research really is, it's 20 years. We've got stuff. We know that it's crossing … We know things, but we don't have the same levels of research nationwide, especially like we do around alcohol. 

We know alcohol is problematic. Please be talking to families about alcohol because we certainly are seeing less conversations around alcohol, but we see way greater impacts. I know that we are close to time. Melissa has popped on which seems to be my cue to move the slides along, but know that I will have access to these questions. If there are some of them that we can put together and share back out with folks to answer some of them that we will do that as well. But I will pass it back to you, Melissa. 

Melissa: Thank you so much, Anne. Thank you, Amy, for this really rich conversation. Thank you to all of you for entering your questions. If you have more questions, you can go to my chat or MyPeers or right to health@ecetta.info. At this time, we're going to pop the evaluation URL into the chat. It will also appear when you leave the Zoom platform. The URL and QR code on this slide will also bring up the evaluation. 

We take this evaluation survey seriously. Your feedback helps us to improve future training and technical assistance offerings. Remember after you submit your evaluation, you will see a new URL. This link allows you to access, download, save, and print your certificate. 

Next slide, please. 

Man: Ann, that's your cue to move the slide. Sorry. 

Ann: I got lost in answering questions. My bad. Is this the one, or did I go to there we go. 

Melissa: Yeah, this one is good. We want to make you aware of the proposed changes to the Head Start Program Performance Standards. The Office of Head Start is soliciting feedback on the significant changes proposed to Head Start Program Performance Standard in a Notice of Proposed Rulemaking in the Federal Register. 

The proposed changes, if enacted, will stabilize the Head Start workforce and improve the quality of the comprehensive services that Head Start families count on. Learn more about the proposed policies and how to share your feedback on the Federal Register using this QR code and on the ECLKC website. The public comment period closes in 60 days after publication. For questions, email ohs_nprm@acf.hhs.gov. Next slide, please.

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Thank you much for today's presentation and for being with us. You can find our resources in the health section of the ECLKC, or again, write to us at health@ecetta.info.