[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 healthmanagement.com 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symptoms, they’re withdrawn, they pull away, they shut down, they can’t learn.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.