Mental Health Crisis in Children – Part 2

mental health crisis in children

The mental health crisis in children has been a growing concern over the years. Children and adolescents are facing increasingly complex challenges in their daily lives, from academic pressures to social media influences, family dynamics, and societal expectations. As a result, many young individuals are experiencing heightened levels of stress, anxiety, depression, and other mental health disorders.

Join host, Renae Rossow, and today’s returning guest, Heidi Arthur, Principal of Health Management Associates, as they dive deeper into the current state of mental health in America’s youth.

To listen to part one of this podcast topic, listen here.

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      [Renae Rossow]: Hello everyone, this is Renee
      Rosso, VP of Marketing for Therapy Brands.

      [Renae Rossow]: Welcome to the show today. I’m
      here with Heidi Arthur for part two of our series, Mental Health Crisis
      in our Youth. Heidi is a principal of Health Management Associates, and I
      encourage you to go back to episode one of season two to hear her full
      bio. You can also visit to learn more about how they
      impact the healthcare industry overall. 

      [Renae Rossow]: Hello, Heidi, thanks for coming back
      to continue the conversation with me today.

      [Heidi Arthur]: Hello, Renee. Thank you for
      having me back.

      [Renae Rossow]: So I wanna jump right in. We
      quickly discovered we had a lot more to talk about after our last episode.
      And in preparation for today, I wanted to do a little bit more reading. I
      was really startled to find the prevalence of mental health and how it’s
      impacting our children in early childhood. So I wanted to kick off the
      conversation with asking you, how early do you think mental health begins
      to impact our youth?

      [Heidi Arthur]: That’s such a great question,
      Renee, and I think it’s such an important question because a lot of our efforts
      at the systems level really are waiting for problems to be very evident.
      You know, a lot of kids externalize their symptoms of poor mental health, their
      dysregulation is, you know, acting out behaviors very… oppositional defiance,
      they end up, you know, sort of having big explosive outbursts and behaviors and
      dysregulation that’s very evident, while other children are internalizing their
      symptoms, they’re withdrawn, they pull away, they shut down, they can’t learn.
      And there’s a real sort of, I think, a confluence of learning issues and behavioral
      health needs that often doesn’t get identified until kids go to school. and
      there’s sort of an external, you know, sort of a focus on their ability
      to learn with, you know, from a teacher or school, but we can identify
      that there are issues with dysregulation and issues with sensory vulnerabilities
      and sensitivities in infancy, in infancy. And so from, I would say the time
      that a person is pregnant, our best sort of upstream intervention to avoid
      the preventable behavioral health issues that we later deal with, ideally
      in elementary school. We often miss them there. Like I said, a lot of kids get
      overlooked. We’re not dealing with it until we’ve got juvenile issues and
      real difficult consequences for kids. in later adolescence and even beyond.
      So if we look at who’s in our homeless shelters, who’s in our criminal justice
      systems, a lot of times it’s folks who’ve had undiagnosed, untreated mental
      health concerns all throughout their young lives. But we can see, my child,
      we spoke about my child’s mental health issues.

       I had a baby that, she would
      cry so hard that I would shut the windows even in the middle of summer because
      I was afraid that people would think I was hurting my baby, There was no
      explanation for the screaming. And so, you know, you run up all the possible
      physical causes, got someone who can’t describe their dysregulation. And so
      learning how to comfort, how to soothe. And there are interventions, dyadic
      interventions that actually many states are beginning to cover with Medicaid
      funding that can really help parents and kids sort of co-regulate and begin
      to, you know, sort of learn some of those strategies to help kids avoid problems
      down the road.

      [Renae Rossow]: So even as early as while still
      in the womb. And so do we know anything about what it is that contributes
      to these factors? Is it just genetics? Is it just something neurological?
      Can mother’s well-being impact the baby’s well-being?

      Go in to that a little bit.

      [Heidi Arthur]: Certainly. So there’s definitely
      quite a bit of research on the impact of postpartum depression and maternal and
      paternal depression on child mental health and well-being. You can imagine
      when parents are themselves not able to regulate and sort of meet their own functional
      needs, it’s very difficult for them to meet the needs of an infant and be
      responsive. in the way that really does build healthy attachment, you know,
      sort of the understanding of, you know, sort of emotional states, helping
      children feel validated with their emotions.

      You know, when you’ve got sort of a dysregulated system, it’s almost like it’s an amplifying effect. And
      then if you have that dysregulated system within a dysregulated environment,
      and you’ve got impact from things like chronic stress, community violence,
      difficulty with poverty, housing insecurity, food insecurity. You can just
      imagine the knock on impacts. And we do, we talk about toxic stress and
      how those layered effects build and grow. And we end up with children who
      really are challenged because of their multiple adverse childhood experiences
      and their parents’ multiple. adverse childhood experiences, those ACEs really
      are kind of a pile on. And what we can do with some really amazing interventions
      like Healthy Steps, which is a zero to three national initiative, actually
      puts a specialist in child behavioral health into a pediatric clinic. So
      that from that very first, when you have your baby and you go into the doctor
      all the time for all of those well visits and follow ups. At each visit. Imagine,
      we each look back and imagine that during that well visit with the pediatrician,
      there was a check-in, you know, mom, how are you doing? You know, how are
      things going for you with this baby? Let’s talk through some strategies for how you can take care of yourself, how you can respond to this infant.
      What are some challenges with breastfeeding, with sleeping through the night?
      Those kind of basic things that, you know, a lot of people are referring to the internet or, you know, getting information from friends. But if you had a place where you were kind of going, where if there were needs identified
      in that family, they could be addressed with even referrals to a specialty mental health provider, referrals for housing support, for food assistance, for TANF benefits, for all the things that family needs to really wrap
      around the supports that could be helpful to them, you can imagine the impact
      that could have, not just for that family and its ability to meet that infant’s
      needs, But for that infant and feeling secure, stable, and having what he or
      she needs in order to grow and develop in healthy ways.

      [Renae Rossow]: So what is the government doing
      to ensure these types of programs like Healthy Steps are put in place across
      the country? Are we still at a state-by-state level? Is this something that has been mandated? Give us a little more detail.

      [Heidi Arthur]: Oh, I love that you asked that
      question, Renee. And my background is actually in federal grant writing. And
      so as a social worker, I did quite a bit of direct practice and quite a bit of work. It’s sort of like the systems level. And then I started really
      applying that, because there are multiple federal grant opportunities that enable
      institutions and organizations to apply for funding. to implement programming
      that does provide access to community health workers and to behavioral health
      specialists, just like those that implement the healthy steps model. Those
      often are evident and available in pockets of excellence or in areas where
      there’s really high need, high volume. And so it does tend to be a little
      bit of luck of the draw. You know, if a mother happens to go to one, hospital
      to deliver her baby versus another, it’s a bit of a crapshoot. You know,
      is she going to get access to, you know, a real wraparound set of services
      and that kind of like consistent, ongoing screening assessment and referral? However, as these pockets, you know, the federal government with the grant programs, basically
      they they they pilot and then they scale initiatives that work. And then as we start
      to see increasing evidence, it’s kind of a no-brainer that the states start to look at that and say, wow, we’ve really got something here that we want
      to institutionalize and create access for everybody. And that’s when it waiver programs
      through our state plan and amendments at the state level can actually build
      waivers into the Medicaid program that enable new services like this to be
      a part of a person’s actual Medicaid benefit. program based on their eligibility
      and the factors that necessitate those services being applied to them. And then
      you get the real lift because managed care organizations that are sort
      of overseeing that benefit have to ensure access for everybody to those services
      for which they’re eligible. And that’s when we really get some exciting
      scaling and real equitable access to those kinds of interventions.

      [Renae Rossow]: All right, wow. So talk to me
      a little bit about beyond zero to three. So what my understanding is from
      our conversation is that from zero to three, we’re really looking at the
      intervention of the pediatrician and some of these programs being in place.
      From three to six, let’s take that set. If you are a parent. or provider
      who is dealing with a child, what are some of the things that we need to
      be looking for that would indicate the need for intervention?

      [Heidi Arthur]: Oh, it’s such a, again, a great
      question. From three to six, that’s sort of the preschool ages. And I think
      that when kids are really evidently having a difficult time managing their
      emotional state and really being able to participate in activities with peers and
      feel joyful throughout the day, I mean, obviously with a toddler, you’re gonna
      see something that looks like. who looks like, we’ve said, you know, toddlers
      are like little drunk adults. So it’s hard to tease out, you know, especially
      when you’ve only got one kid and you’re not necessarily around other people.
      It’s hard to tell what’s normal and what’s like really kind of problematic.
      My kids, very seasoned pre-K teacher, I recall her saying, I have never seen
      a child scream so much for so long and apparently for no reason. And so that same
      kind of like inexplicable… dysregulation, just like what? And I can remember
      saying to my kid, stop screaming. Stop screaming, which of course is not helpful.
      If I could roll back the clock, I would say, I see you’re distressed. I’m
      with you in this moment. This will pass, let’s be here together. But looking
      back, I think it’s fairly evident to most people looking at a child’s sort of
      you know, experience in the world, parents will get a gut feeling. I had
      a gut feeling and I actually did have my kid, um, screened by early intervention
      and we were looking at speech there. We were, we were doing some of those
      things very much. It gets very fuzzy around.

      What’s developmental, what’s
      sensory, what’s emotional, what’s, and it’s really, there’s, I kind of imagined
      that there was a place where they could kind of like do some big diagnostic
      assessment and tease it out and tell me, you know, here’s what your kid had,
      you know, they, and that just, As far as I could tell, as a person really
      running it up the flagpole, going to like the best, you know, kinds of assessment
      centers, et cetera, that really didn’t exist.

      That really, we’re, we’re at
      a very early stage of understanding mental health and it is a big mismatch.
      And so you’ll get behavioral health, therapeutic pre- you know, preschools do
      exist, but you’re to, to kind of qualify for that. My kid didn’t even qualify
      for early intervention services. I mean, you’ve really got to have very obvious.
      behavioral issues to hit that threshold. But I think most parents will understand
      when there’s an issue and can seek mental health supports for themselves. There’s
      often a zero to five early mental health program and access for families through
      services like that where the treatment is actually for parents with the child and
      often strategies just to help the parent regulate so that they can regulate with
      their child.

      [Renae Rossow]: Yeah, I think what’s sticking
      out to me is I remember being a child of the 60s and 70s. For me, you know,
      I had a brother who was considered the difficult one. And you know, it was more
      I was raised in the military, my father was in the military, and it was
      more of a subdue him by physical punishment that was popular back in the time spanking
      and whatnot. And that’s how we were subdued and dealt with back in those
      times. As we evolve as a population, as we begin to reduce the stigma and
      educate more about mental health, I would imagine that this prevalence of needing
      to educate young and new parents even more is just going to become absolutely
      mandatory as we move forward because it’s not, oh, she’s just colicky, which
      you hear with many parents about screaming babies or, oh, you know, he’s
      just tired. You know, there’s often this ignorance that creates this lack of proper
      care. So speak to me a little bit about programs that are up and coming to just
      educate parents on what does it actually mean when this child is being difficult
      that it’s not. just colic or, you know, tiredness.

      [Heidi Arthur]: Yeah. You know, I think that
      increasingly, we’re the mental health system of the future is not going to
      be this separate thing because our bodies are not separate from our minds.
      And as we evolve as a population, it’s increasingly evident to all of us that when
      we’re centered and balanced in our bodies and minds, we are able to function
      more effectively and engage more appropriately and just sort of generally.
      you know, be effective and communicate well. And I think that increasingly,
      we’re gonna be seeing mental health integrated in primary care and in pediatric
      care. And I think that eventually their programs are not gonna be the separate
      thing that is reserved for those folks who are at risk or in need. When
      I had my pregnancies and my children, Nobody knocked on my door and offered
      a home visit or provided. That however is increasingly becoming an expected, a doula
      who is available to support people during pregnancy and to help them prepare for
      what it’s like because babies do scream and that’s normal. But helping them
      prepare for knowing what to look for and how to take care of themselves and
      to be taken care of during that. that sort of vulnerable period of peri
      and postnatal planning. So I think that increasingly that kind of well-being support
      is going to be more available to more of us. And I think that in the future
      there will be more of an understanding that when a parent says, you know,
      I’m concerned my child seems to be anxious. My three-year-old, my six-year-old
      nightmares are waking them up at night. They’re… they’re expressing a lot of
      concern to the point where they don’t want to go out with friends, they’re
      wanting to stay close to me and having trouble separating at the school, where
      that won’t be brushed under the carpet and swept away, but will be not
      pathologized and like, oh, you needed a referral to, but will be addressed with
      real evidence-based research informed interventions that can help make that easier
      and help. help kids build those skills and help parents build those strategies
      earlier on so we don’t have sort of chronically dysregulated kids in a state
      of kind of constant arousal being met with you’re doing it wrong, just
      listen, you know, get in line, you know, without having that kind of punitive
      response from the systems that are there meant to take care of them. That’s
      what I see in the future.

      [Renae Rossow]: I love that you said our physical
      and mental health will no longer be separate.

      That just rings so true to me.
      We’re actually beginning to see in healthcare new models of care pop up where
      we have multi-specialty practices where you have your pediatrician, your
      general practitioner, your behavioral health practitioner, and other specialists
      all practicing together as one practice. to your point, moving forward in
      the future, my guess is that will become much more prevalent and we’ll be
      able to go see the pediatrician with our child and him bring the behavioral
      health care provider right in to the appointment and provide care at the same
      time. That is something that I think is very exciting and very much necessary
      if we’re gonna continue to make progress. Any thoughts on that?

      [Heidi Arthur]: I agree, absolutely. We are
      co-locating mental health in primary care and pediatric care already. That’s
      happening. The other thing that’s happening is pediatricians and primary
      care providers are getting consultation support to do some screening and their
      own treatment of some conditions right there in the pediatric practice. I
      know when I asked my pediatrician, you know, my kid. is having stomach aches,
      they’re having, you know, really like episodes in the night where they wake
      up, they’re screaming and crying and vomiting. They were having serious panic
      attacks and major anxiety, but the pediatric, the sort of medical response
      to that is let’s run every test on the physical, let’s rule all of that out and
      then, oh, it’s anxiety. well, now you’re going to need to start in a whole
      new system and figure out what’s going to be helpful there. And I think in
      the future, that pediatrician will say, let’s start looking at anxiety and
      ways, strategies to help regulate while we also rule out the, so that because
      kids can’t wait, right? They’re developing and growing and, you know, having
      that experience in that moment. And for in kid time, it’s, it’s, it’s,
      it’s not good enough to wait. six months, you know, half a year to try to
      figure out what’s actually going on. And then moving to another system, it’s
      a lot of pediatricians don’t even have good referral resources for mental
      health providers. We got handed a list of people to call. None of them took our
      insurance. Our insurance was, you know, the, you know, finding an in-network
      provider. There’s a huge behavioral health workforce crisis. A lot of areas
      do not have these specialists. Parents are concerned, do I go to a psychiatrist?
      Do I go to a social worker? Do I go to a mental health counselor? What are even
      all of these different criteria? People don’t see little kids, people don’t…
      Increasingly, it will be a one stop where folks can have their needs met, regardless
      of which door they happen to walk through.

      [Renae Rossow]: Yeah, I couldn’t agree more.
      So, you know, moving forward, how would you hope to see mental health therapy
      for children evolve? How would you hope to see what we, what do we look
      like rather in, you know, 10, 20 years into the future?

      [Heidi Arthur]: When my grandkids go to school
      and hopefully there will be grandkids and there will be safe schools for them
      to go to. Schools will ideally, I hope, be safe places. Safe places where
      kids don’t have to do lockdown drills, where we’ve actually made some really
      important policy shifts in how we make sure we prioritize and protect child
      safety. So fundamentally that teachers feel safe and kids feel safe in schools.
      And there are some amazing interventions. Occupational therapy is a modality that I
      think is really under recognized in the mental health space. And there are
      some incredible interventions that help to identify, you know, which kids
      in this school have sensory needs and emotional and, you know, behavioral dysregulation
      issues that are triggered by things like. you know, too much noise or air
      blowing on them or, you know, how they’re engaged in the classroom. And schools
      can actually initiate real environmental adjustments that are mild but major when
      it comes to how the classroom is regulated. You know, those couple of few
      kids that can throw it off for everybody and you think, oh, bless that kid’s
      heart, but also my kid is being kind of set off by that. whole schools can
      as communities really embrace the needs of the entire population by helping
      the few and really creating some you know you’ve heard about you know the the
      the bench for um you know the kid who needs a friend on the playground you
      know so kids are socially integrating the You know what I’m talking about,
      that beautiful idea where there’s a place to sit if you want to be a friend
      or meet a friend. And you know, so like you’ve actually got teachers not just
      kind of letting it be a free for all for the social engagement, but really
      some incredible interventions where you know teachers will have, you know,
      who is your friend this week and can you privately and identify who doesn’t feel
      like they have a friend and then integrate, navigate those kinds of like
      whole of school efforts. can be huge. We’re doing a lot of anti-bullying.
      Let’s do pro-social, universal interventions. And then like we talked about
      last time, real mental health training, but which has effects for teachers
      and for staff, offer it for parents. So you’ve really just, you’re inoculating
      kids from the very earliest ages and helping them really understand and build
      strategies for emotional and mental wellness. I think that’s gonna be the…
      the biggest thing. And then for those kids who do have dysregulatory issues
      and mental health problems, because some of it is biological and really
      not avoidable, there will be in the future a care coordinator that supports
      families with a single plan of care, access to all the specialty providers
      and social and human service providers so that everybody is on the same page.
      A child has a voice. Family has a voice. It’s their choice how they proceed.
      and they’re supported and there’s not a lot of barriers, I hope, in the
      future to how things get paid. Because when we know when there’s coverage
      and access, increasingly certified community behavioral health centers are
      free and open to all, they’re increasingly available. Federal funds started
      with the grants, started with the demonstration, and then it’s baked into sort
      of the way publicly financed care is delivered. I think in the future. All of
      that access will be free and we know we save money when we can prevent the
      high cost use of emergency rooms and inpatient residential treatment.

      [Renae Rossow]: Yes, yes, yes. Well, Heidi,
      thanks so much again for coming back for part two, for sharing all of this
      amazing information with us and providing so much insight into where we’re
      headed and and the needs and the gaps that exist but are hopefully going
      to be filled. Anything else that you want to make sure that our listeners
      are hearing as we wrap up today’s episode?

      [Heidi Arthur]: I think it’s exciting if your
      listeners are folks who can make change in the systems, whether it’s the
      change in the system where they work or the change in the system where their
      kids go to school or where they themselves are engaged as a helper or provider,
      there’s always something that can be done to improve the system. We have
      a very, very much in process system of care and we have a lot of attention
      in this moment in time on how to improve it. And so I would just encourage
      people to. reach out and figure out who can help them figure out what is
      the most strategic intervention that I can be a champion for that can really
      kind of make the biggest impact possible in the near and the longterm. So
      I would hope that we all feel called to act and are prepared to do some
      little thing. It might be in your kid’s school, it might be in your place of
      work, it might be where you go to worship on the weekends. Wherever you live
      in your community, there’s something that we can all be doing.

      [Renae Rossow]: Thank you, Heidi, for joining
      us today. And thanks, everyone, for listening to Think Therapy.

      [Heidi Arthur]: Thank you, Renee.




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