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Dr. Sheryl Ryan is Professor of Pediatrics, Chief of the Division of Adolescent Medicine, and Director of Outpatient Adolescent Clinical Services at the Penn State Health Hershey Medical Center. She is a pediatrician who is board certified in both Adolescent Medicine and Addiction Medicine. 

Currently, she is focusing her research on the education of both school personnel and pediatricians in rural areas of Pennsylvania around screening and intervention for youth using alcohol and other substances – through a federally funded Project ECHO grant. She is also currently funded through an NIH HRSA grant to train addiction medicine fellows at Penn State, and increase the capacity of primary care and behavioral health care providers to treat individuals with substance use disorders. 

As a board-certified specialist in adolescent medicine, Dr Ryan also continues to be clinically very active in providing both outpatient and inpatient care to adolescents and young adults with complex medical and mental health issues. 

[00:01] Opening Segment

• Why Dr. Sheryl Ryan became interested in pursuing a career in pediatrics
• How did Sheryl realize that she could apply her pediatric skills to substance use?

[06:09] Current Data About Substance Use Among Kids

• Substance use among kids has declined over the past years
• Sheryl shares some data
• The importance of asking the right questions to determine substance use
• Screening tools that Sheryl suggests for at-risk kids and adolescents
• 
  

[16:43] The Impact of Legalizing Marijuana Use

• She shares her thoughts about making marijuana use legal
• The relation of substance use on an adolescent’s brain development
• The long-term effects of substance use among kids that doctors found out

[26:47] Influence of Parents on Their Kids

• Sheryl talks about the Cannabis use disorder
• Parents using substances or drinking alcohol have major influences on their kids
• Sheryl explains
• Don’t miss our interesting conversation about vaping

[36:50] Possible Interventions and Patient’s Consent

• The role of pediatricians in dealing with substance use among kids
• Listen to Sheryl’s insights
• The different interventions that pediatricians can utilize to address substance use
• Asking for consent from the patient regarding possible interventions is a must
• Here’s why

[46:02] Legislative Measures to Deal With Substance Use

• How to navigate this tricky situation of telling parents about their kids’ substance use
• The legislative measures being put into place to deal with substance use among kids
• Sheryl has an important message for her resident self, which you should not miss!

 [56:30] Closing Segment  

• Final takeaways
• Huge appreciation for Sheryl for joining us today
• Substance use has dropped since the 1990s
• Early use of substances may lead to a higher risk of substance use disorder and addiction
• The short-term effects of legalizing marijuana use
• There’s still so much to learn about the effects of substance use among kids and teens
• Cases of accidental ingestion of THC are increasing
• Safety measures available to patients
• Effects of cannabinoids on an adolescent’s brain development
• Possible long-term effects of substance use among kids
• What cute cannabinoid intoxication among teens may look like 
• The results of the Adolescent Brain...

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Trigger warning: This episode includes discussions about suicide and depression

Dr. Joanna Quigley is a Clinical Associate Professor of Psychiatry at the University of Michigan. She has also been on faculty at the University of Pittsburgh and trained in Pediatrics, General Psychiatry, and Child and Adolescent Psychiatry at the University of Kentucky. She engages in a number of collaborative efforts to support mental health care in the primary care setting, the care of children with chronic illness and mental health care needs, as well as for adolescents struggling with substance use. 

Dr. Quigley serves as a consulting child psychiatrist for the Michigan Child Collaborative Care (MC3) program at the University of Michigan providing outreach support to primary care pediatric, family medicine, and obstetric providers across the state of Michigan.  Dr. Quigley was the lead author on the 2019 AAP Policy Statement “Alcohol Use by Youth.”

[00:01] Opening Segment

• How serious is the problem of alcohol use among kids? Dr. Joanna Quigley shares her insights
• What pediatricians and patients should know about the CRAFFT questionnaire

[06:29] Screening Tools for Kids 

• How to screen kids the right way for alcohol use according to Joanna
• Joanna gives some tips to start a conversation with kids properly
• Why families should watch out for binge drinking

[16:55] Alcohol Use and Related Issues

• How mental health and substance abuse relates to alcohol use among kids
• Pediatricians should also consider their pre-conceived biases when screening kids: Here’s why
• These sectors have a high risk for alcohol use and substance use disorders: Listen to our discussion

[26:40] Family-Based Approaches on Alcohol Use

• Is there a connection between alcohol use and ADHD and autism spectrum disorders?
• The downsides of some resources in relation to substance and alcohol use abuse
• The importance of family-based approaches in treating alcohol use among kids

[36:28] The Right Way to Talk With Kids About Alcohol Use

• How to help the parents in talking with their kids about alcohol use
• The latest data about the parents’ perception of underage drinking
• The advantages of routine screening according to Joanna

 [41:21] Closing Segment  

• Final takeaways
• Acknowledgment of Joanna’s work for kids and pediatricians
• Alcohol use being a common issue among kids
• The evidence-based tool that pediatricians can use
• Administering questionnaires both written and verbal
• Substance Use Disorder transcends race, ethnicity, religion, gender, socioeconomic status, and sexual identity, among others
• Our definition of binge drinking
• An alternative way to talk about alcohol use with kids
• Relation of comorbidities to drinking
• Mental health and substance use disorder
• Kids with a high risk of alcohol use
• How treatment of alcohol use should be
• Joanna’s message for parents to prevent substance abuse among their kids
• Available resources below
• What should be the end goal for kids

Key Quotes:

“When we're seeing patients and thinking about who should we be ‘worried’ about…it's not just teenage boys…binge drinking is a problem for girls as well.” - Dr. Joanna Quigley

“Family-based work is often essential when we're addressing substance use disorders in adolescents…that is a big component of the care. ” -...

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Dr. V. Fan Tait is a pediatric neurologist with years of experience in child health and wellness, family-centered care in medical homes, children with special needs, health care delivery, and advocacy for children, families, and pediatricians. She earned a BS from the University of Alabama, her MD from the University of Kentucky Medical Center, and completed her pediatric residency and pediatric neurology fellowship at the University of Utah Medical Center. 

For more than 10 years, Dr. Tait directed the Department of Child Health and Wellness which included many of the strategic priorities of the academy: early brain and child development; the Institute of Healthy Childhood Weight; Bright Futures and the National Center on Early Childhood Health and Wellness, which addressed health in Head Start and Child Care. In addition, she led the Disaster Preparedness Advisory Council (DPAC) from its inception and continues to be actively involved in the national climate change initiatives.

[00:01] Opening Segment

• Dr. Fan Tait tells us the story behind her career as a pediatric neurologist
• She talks about the advocacy that she only realized when she became a pediatrician

[05:46] Becoming a Member of the American Academy of Pediatrics

• Here’s how Fan became a chapter president of the American Academy of Pediatrics
• What she loves the most about working with her fellow pediatricians in the Academy
• The main reason medical homes are a big issue for Fan
• Fan leaves a message for her fellow pediatricians

[15:57] Coping with the Effects of the COVID-19 Pandemic

• The effects of the COVID-19 pandemic on patients’ mental health
• Listen to Fan’s thoughts
• Fan shares some resources about how to address mental health issues
• Pediatricians should accept the fact that they can’t fix everything
• Here’s what they should focus on instead
• The importance of education according to Fan

[30:39] Pediatricians Taking Care of Themselves

• Why pediatricians should also take care of their health and wellness
• Listen to our interesting exchange about “moral injuries”
• Here’s our conversation about vaccines and vaccination programs
• What’s the difference between self-sacrifice vs. self-preservation?

[45:17] Dealing with Negative Self-Thoughts

• How pediatricians can deal with their negative self-thoughts
• Fan gives us a sneak peek about the 2022 Healthcare Workforce Rescue Package
• Link below
• Fan sends a message for her resident self
• Listen to her message!

 [54:33] Closing Segment  

• Final takeaways
• Acknowledgment for Dr. Fan’s contributions to the American Academy of Pediatrics
• How to start an advocacy campaign for kids
• The effects of the COVID-19 pandemic on our mental health
• Resources about the COVID-19 pandemic accessible to you
• Access to care services remains an issue
• What pediatricians can offer to families right now
• Screening for social determinants of health, depression, suicidal ideation, food insecurity, and housing
• Don’t fix everything alone
• Remember why we pediatricians are making sacrifices
• What is a “moral injury?”
• Dealing with burnout
• The metaphor of the oxygen mask
• The 2022 Healthcare Workforce Rescue Package
• The economic impacts of COVID-19 on patients and pediatricians
• Be honest about what you can and cannot do.
• You are enough, always

Key...

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It is challenging to manage kids with suicidal ideation and parents who rely on for you help with limited resources. In this episode, I share with you the best practices, resources, and tips that could help you manage your practice and avoid that stress so you could focus on giving your patients the best experience!

[00:30 - 14:30] Get Your Resources Ready!

• The best online resources you could turn to
• How to determine if you are ready
• Checklist to ensure you have an efficient process workflow 
• Sharing best practices: Meet with bodies that have a play on a child’s emotional health
• Managing the patient from home versus in an emergency room
• Why having a social worker in your practice is critical

Key Quotes:

So don't underestimate the power of your voice.” - Lia Gaggino

Resources mentioned:

• CALM: Counseling on Access to Lethal Means
• Ask Suicide-Screening Questions (ASQ) Toolkit
• Pediatric Meltdown Episode 38:  Suicide Prevention in Primary Care: Save a Life!

THANK YOU FOR YOUR SUPPORT!

Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.  

If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter or email me at [email protected] or [email protected]. To learn more about me visit https://www.medicalbhs.com/

LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being. 

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Dr. Scott Grant is an academic primary care pediatrician and hospitalist working in Southeast Michigan. He completed his medical school in El Paso, TX, and was a pediatric resident and chief resident at Phoenix Children’s Hospital in Arizona.

His primary clinical interest is in behavioral health, especially the interaction of childhood adversity and trauma with developmental and behavioral outcomes. He recently took on a role as a District CATCH Facilitator with the AAP, which helps pediatricians engage with their communities more directly through grant-supported community partnerships.

[00:01] Opening Segment

• Dr. Scott Grant shares the story behind his pursuit of pediatrics as a career
• Here’s the part of pediatrics that Scott enjoys the most

[04:18] Tolerable vs. Toxic Stress: What’s the Difference?

• Scott learned about this TED Talk that changed how he looked at pediatrics
• Link below
• The difference between tolerable and toxic stress
• Scott explains
• Scott talks about the importance of safe, stable, and nurturing relationships with patients
• Scott shares the signs of a meaningful conversation with patients

[15:50] Relationship-building Tips For Pediatricians

• Pediatricians need to make families feel that they’re humans too
• Scott tells us why
• How to build trust and relationships with families
• Scott shares his experience working with fathers

[25:18] Emotional Regulation: What Is It?

• Scott tells us how he decided to produce the Docs2Dads Podcast
• Link below
• What we should know about emotional regulation
• How to replace bad habits among kids
• Disciplinary actions are now changing

[35:43] Work-Life Integration is the Way to Go

• Scott prefers work-life integration over work-life balance
• He tells why
• He wants to normalize saying good things to your spouses and children
• What are its benefits?
• Scott sends a message for his resident self
• Listen to his message!

 [42:23] Closing Segment  

• Final takeaways
• Awareness of adverse childhood experiences
• Nadine Burke Harris on TED Talk
• Toxic stress is unbuffered stress
• Adverse events can become tolerable if they are buffered by safe, stable, nurturing relationships
• How to connect with patients and their families
• How to regulate emotions
• Why listen to the Docs2Dads Podcast
• The role of dads in a patient’s life
• Why silence and pauses are important too within patient conversations
• Serving as emotional containers
• Work-life integration

Key Quotes:

“Sometimes, before families need a physician, they need just a human being that understands that they're having the worst day of their life.” - Dr. Scott Grant

“You can't replace bad habits with no habits. You have to replace bad habits with good habits.” - Dr. Scott Grant

Resources mentioned:

• Journal Article: Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health
• Video: How childhood trauma affects health across a lifetime | Nadine Burke Harris
• Pediatric Meltdown...

https://302.buzz/PM-WhatAreYourThoughts

Dr. Phil Boucher is a direct care pediatrician in Lincoln, Nebraska, and father of 6.  He is also the host of two amazing podcasts. In Raising Good Parents Podcast, he focuses on helping parents enjoy parenthood more while in Pediatrics 2.0 Podcast, Dr. Boucher and his guests discuss the latest trends in pediatric practices from clinical updates to research advancements to revolutions in care delivery. 

He paid a visit to Pediatric Meltdown to talk about his journey to pediatrics, his reasons for going solo, and the need for pediatricians to use their voices to inform the general public and our legislators in shaping our healthcare system for the better.

[00:01] Opening Segment

• Dr. Phil Boucher talks about the story behind his pursuit of pediatrics
• The fun about the science of pediatrics that we both enjoy

[05:08] Launching a Direct Primary Care Practice

• The challenges that Phil needed to face early on in his pediatrics career
• His motivations for opening a solo pediatric direct primary care practice
• The difference between direct primary care from traditional practice
• The benefits of launching a solo practice according to Phil

[15:24] Creating Content for Both Parents and Patients

• The more difficult challenge brought about by the COVID-19 pandemic
• What’s more difficult than physical and financial challenges?
• Phil gives us an important reminder about our use of social media
• The lessons that listeners can learn from his 2 podcats

[25:12] A Pediatrician’s Role in Shaping the Healthcare System

• How pediatricians can use their expertise in sharing relevant information to the public
• The role that pediatricians can play in informing legislators about health-related issues
• Phil’s message for his younger self that you should hear too!

 [35:51] Closing Segment  

• Final takeaways
• Be brave and find what works for you
• Why Phil pursued solo practice
• Why create a podcast
• What pediatricians can learn from Phil’s podcast, Pediatrics 2.0
• Expert advice for parents that they can hear from Raising Good Parents Podcast
• The opportunity to build relationships with parents and patients
• Promoting our advocacies through social media
• Connecting with legislators to advance our advocacies
• Finding fellow advocates in your local community
• Why we should embrace change

Key Quotes:

“Direct [primary care] really means a direct relationship with patients and the physician rather than having the insurance middleman that kind of dictates care.” - Dr. Phil Boucher

“If you can provide good information, you are able to capture attention and change hearts and minds because of your relatability, your authenticity, and your credibility as a physician.” - Dr. Phil Boucher

Resources mentioned:

• Phil’s podcasts:
• Raising Good Parents Podcast
• Pediatrics 2.0
• Pediatrics 2.0 previous episode: Interview with Dr. Paul Offit

Email [email protected] to connect with Phil or check out

https://302.buzz/PM-WhatAreYourThoughts

Dr. Jane Meschan Foy has spent more than 35 years in pediatric primary care, public health, administration, and medical teaching. Her special interests include mental health services in pediatric primary care and school settings; access to health care for under-served populations; primary care of children with special health care needs; and residency training in mental health, community pediatrics, and advocacy.

Dr. Foy’s publications on mental health include 2 AAP textbooks (2018)—Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians and Promoting Mental Health in Children and Adolescents: Primary Care Practice and Advocacy; the AAP Policy Statement “Mental Health Competencies for Pediatric Practice” and Technical Report, “Achieving the Mental Health Competencies” (both Pediatrics, 2019).  

She recently edited a new publication to support clinicians at the front lines, Managing Mental Health Concerns in Pediatrics: A Clinical Support Chart. She currently serves as an associate editor of the AAP Textbook of Pediatric Care and as Associate Editor, Mental Health for Pediatric Care Online (PCO).     

[00:01] Opening Segment

• I introduce Dr. Jane Foy
• Her journey from pediatrics to mental health

[05:34] Multidiscipinary Model in Pediatric Mental Health

• An alarming observation from Jane about her patients’ childhood experiences
• Jane talks about the importance of tapping other disciplines in helping patients
• The reasons for building linkages with schools and communities
• Protocols in dealing with difficult behaviors among kids in school

[15:46] Mental Health Competencies

• Why it’s important to lay out mental health competencies
• The cultural change that is happening in the mental health space
• Jane shares the story about their advocacy on their Medicaid system
• The barriers they’ve broken with this advocacy
• Their mechanisms to ensure funds for mental health are being used appropriately

[30:27] Mental Health Monitoring Among Patients

• Psychopharmacology education among healthcare providers’
• Building trust between the therapist and the family
• The “cheer up” model
• A critical piece of anxiety treatment according to Jane
• How to set up office systems that to monitor patients

[45:53] Resolving Health Problems as a Community

• Jane’s advice for her resident self that you should also hear
• The power of resolving obstacles with a community, and not alone
• The truth about suicide prevention

 [47:39] Closing Segment  

• Final takeaways
• Jane’s vision on integrated behavioral health and collaborative mental health care
• Creating team models as key to our work
• Children who are not getting mental health care
• Cultural change in mental health work among pediatricians
• Our “pediatric advantage”
• Barriers to providing mental health care
• Systemic change is now ready to happen
• Approaching mental health issues as emergencies
• Brief interventions that pediatricians can offer
• How to use the “cheer up” model
• What you need to know about psychopharmacology
• Look for champions in your social circles right now
• You are not along. You’ve got this

Key Quotes:

“Listen to your instincts and also listen to your patients and follow them.” - Dr. Jane Foy

“When you do encounter obstacles in getting accomplished what...

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Dr. Kofi Essel is a board-certified community pediatrician at Children’s National Hospital (CNH) in Washington, D.C. He serves as Assistant Professor of Pediatrics, the Director of the George Washington University School of Medicine and Health Sciences Culinary Medicine Program, the Director of the GWU Community/Urban Health Scholarly Concentration, and the Director of the GWU Clinical Public Health Summit on Obesity.  

Dr. Essel has dedicated his career to advocacy/research around healthcare training, health disparities, and community engagement, with expertise and national recognition in the areas of addressing obesity and food insecurity in families. 

[00:01] Opening Segment

• Let’s get to know Dr. Kofi Essel
• He talks about his journey that brought him to pediatrics

[04:40] The Reality About Food Insecurity

• What pediatricians should understand about food insecurity
• Kofi shares the latest statistics
• How it relates to racism in the country
• COVID-19 is not an equalizer, but a magnifier of existing social issues
• Kofi explains
• The first step to resolve food insecurity
• Kofi breaks down what food sovereignty is

[17:53] Role of Poverty and Privilege in Food Insecurity

• The “humanistic ability” that people should be able to possess
• Why this is culturally relevant
• Does working hard solve food insecurity among people living in poverty?
• Listen to our exchange
• How poverty is expensive and privilege is blinding
• The connection between food insecurity and treatment approaches

[27:24] Screening Food Insecurity

• What the Hunger Vital Sign is and how to use it
• Privacy issues to consider when screening for food insecurity
• Shame and guilt are major concerns
• How to deal with food anxiety

[43:27] Holistic Approach to Resolve Food Insecurity

• Here’s a quick guide from Kofi for pediatricians
• Find an anti-hunger champion
• A team is still needed even if there’s a champion or advocate
• We talk about the evolution of pediatrics through the years
• The importance of holistic approach in giving treatments to patients

[53:57] An Important Message for Healthcare Providers

• A great resource for healthcare providers to resolve food insecurity
• Link below
• Kofi’s message to his younger self that you need to hear too
• Giving yourself a chance to do something you want to do

 [01:00:02] Closing Segment  

• Final takeaways
• Hungry kids in wealthy countries
• The problems magnified by the COVID-19 pandemic
• Food sovereignty
• Step-by-step goal-setting of food-insecure homes
• Poverty as the root cause of hunger
• “Work hard to succeed” is actually a myth
• Structural racism
• The pandemic is not the great equalizer
• The likelihood of a person or family going hungry
• Obesity paradox
• Putting the best foot forward
• Food insecurity and food anxiety
• The two-question hunger vital signs
• The importance of asking questions
• Talking with a parent alone away from the child
• My personal realizations while talking with Kofi
• Looking for an anti-hunger champion
• Use your voice to advance advocacies
• No child should be hungry, ever

Key Quotes:

“The ability to choose one's food is a humanistic ability and ability we should be able to provide to people.” - Dr. Kofi...

https://302.buzz/PM-WhatAreYourThoughts

Dr. John Straus is the Founding Director of the Massachusetts Child Psychiatry Access Program (MCPAP) and a 2020 Mom’s Inaugural winner of the Maternal Mental Health Hero Award. Dr. Straus is the mind and heart behind MCPAP, which has inspired and been the model for Maternal Mental Health doctor-to-doctor consultation programs across the U.S. 

Dr. Sheila Marcus, meanwhile, is a Clinical Professor at the University of Michigan, Section Chief for Child and Adolescent Psychiatry and Co-Director of the Infant and Early Childhood Clinic (IECC). Her areas of interest include intergenerational transmission of illness, maternal child attachment and early risk factors for childhood psychiatric illness including presentation of autism in toddlers.

[00:01] Opening Segment

• Let’s get to know Dr. John Straus and his role in the MCPAP
• Meet Dr. Sheila Marcus, a clinical professor at the University of Michigan 

[04:58] The Birth of the Massachusetts Child Psychiatry Access Program

• John’s role in making the Child Psychiatry Access Program possible
• Sheila’s motivation for joining and contributing to the Program
• John talks about the pediatricians’ engagement so far within the Program

[15:10] Accessible Child Psychiatrist Support

• The system in place to get help from a child psychiatrist
• What they mean by “rightsizing mental health”
• The limitations of psychiatry that psychiatrists should realize

[20:16] Sustainable Child Psychiatry Program

• A major concern on the primary care side according to Sheila
• The driving factors for states to adopt and sustain the child psychiatry program
• The role of health insurance
• The growth of the infant mental health lens
• Treating a mother’s pre- and post-partum illnesses

[30:00] Mental Health Screening in Prenatal Care

• We talk about the lack of mental health screening in prenatal care
• The assignments of obstetricians in prenatal care
• We have an interesting exchange about the specialty of pediatricians 

[35:01] The National Network of Child Psychiatry Access Programs

• The importance of offering substance use services
• What to consider in administering medications to kids
• The role of the National Network of Child Psychiatry Access Programs

[40:34] Distribution of Psychotherapeutic Resources

• There are no intrinsic mental health issues
• How patients and providers can capitalize on the Michigan program
• The next big step now is distributing psychotherapeutic resources
• Their message to their younger selves you’d want to hear too!

 [47:28] Closing Segment  

• Final takeaways
• The growth of a national child psychiatry program
• The risk of mental health issues among kids
• Mental health screening in prenatal care
• The variety of child psychiatry programs per state
• You’re not incompetent. Sometimes, cases are just hard to address
• The life-altering benefit of the MC3
• Diagnostic clarification is key
• The impact of trauma on patients
• Sending behavioral health consultants across Michigan
• Available resources and programs in your state
• The “Next Gen Training”
• The importance of time among pediatricians
• States with no child psychiatry access program yet
• Go to nncpap.org to know where your state program is
• Do what you love and enjoy the...

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Happy 2022! In this episode, we will discuss first what should be our priorities to help ourselves draw how we want this year to look like. We will also talk about the power of family and community not only to our personal growth but also to our individual health and why we should regularly make time for our loved ones. Lastly, we will be laying down all the important topics that are going to cover this 2022, topics that we feel should be talked about more in and out of the medical space.

[00:01] Here’s to a Fruitful 2022 For Everyone!

• My biggest challenge in the previous year
• Why resilience is key to overcoming the pandemic
• Take a leap and here’s why
• Follow your passion

[02:20] The 7 Priorities for the Self This Year

• How to build safe, nurturing, and stable relationships
• The 7 things we should prioritize for ourselves
• Why we should make time for our loved ones
• When to call a friend

[12:09] What to Look Forward to In 2022

• The underrated benefits of sleeping regardless of age group
• The important topics we will be talking about this year
• The guests that we will be bringing back this year

 [17:54] Closing Segment  

• Do you have topics in mind that you want me to discuss?
• Links below
• Final announcements

Key Quotes:

“I hope that there are those of you out there that want to take leadership roles and know that you deserve and belong there. Your voice is important because of what you do. You are an expert in your field. .” - Dr. Lia Gaggino

“Don't be afraid to take a leap. Sometimes it works. Sometimes it doesn't. But you have to try and follow your passion..” - Dr. Lia Gaggino

If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter or email me at [email protected] or [email protected]. To learn more about me visit https://www.medicalbhs.com/

LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.