Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / The keys to providing mental health for children -- and treating suicide ideation: Q&A with Dr. Helen Egger

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The keys to providing mental health for children -- and treating suicide ideation: Q&A with Dr. Helen Egger · Becker’s Healthcare -- Pediatric Leadership Podcast

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  Thanks for listening. Now here's the episode.
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  This is Chris Sosa with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Helen Egger,
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  MD Co-founder and chief medical officer at Little Otter. Dr. Egger,
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  thank you so much for joining us today.
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  Thank you so much for having me.
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  Dr. Egger,
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  could you please introduce yourself and tell us a bit about your background?
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  Yes, so I co-founded Little Otter with my daughter,
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  which has been the most amazing experience to build this company
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  with my oldest child.
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  And really us together is what makes Little Otter special.
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  So I obviously have my background, uh,
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  in science and in medicine and in academic leadership.
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  But my daughter brought to the company hurt incredible
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  experience in computer science. She majored in computer science, um,
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  at UNC and then worked at a big data consulting company
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  called Palantir.
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  And then prior to Little Otter was the 20th employee at Chan
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  Zuckerberg Initiative where she built and ran their infectious disease
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  division.
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  So really I believe that we are gonna create innovation
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  in healthcare when we bring the expertise in healthcare
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  together with the new approaches in data science and technology
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  and in business development from the technology realm.
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  Dr, I gonna speak in broad strokes a little bit here.
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  What are the main challenges hospitals and health systems face,
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  including little Otter that is in meeting children's mental health needs?
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  Well,
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  we are in a child mental health crisis and we know that
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  the Covid exacerbated mental health challenges for children as well as
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  parents. Um, but we were in a crisis before covid.
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  So one in five children have an impairing mental health disorder,
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  and that's from children ages two to 18 years old.
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  But fewer than 50% of children get the mental
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  healthcare they need.
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  And many fewer children get actually evidence-based,
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  high quality mental health care. There are a number of reasons for this crisis.
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  One is that mental health has been carved out
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  in terms of many of the services provided to people,
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  and therefore the reimbursement rate is significantly lower.
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  And it can be difficult for families to be able to access care
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  overall or care that is covered by their insurance.
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  But there are other challenges. I mean,
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  I think one of the things about mental health is that their professionals from
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  many different disciplines who practice mental health, you know, psychiatrists,
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  psychologists, master's level social workers, um, MFTs,
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  et cetera.
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  And therefore I think that there is a real crisis in
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  consensus about what quality mental health care looks like
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  and how we are gonna deliver it to children and families.
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  As far as treating children's mental health is concerned. Dr. Eric,
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  could you please describe little Otter's philosophy and methodology?
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  Absolutely. So the reason that I left, uh,
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  academic medicine after 30 years and you know, left my endowed chair and tenure,
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  et cetera,
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  is that I've had the privilege as a researcher and a leader to see
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  the incredible advances that we have made in identifying mental health
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  challenges in children and providing effective
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  evidence-based treatment.
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  But what I was seeing is that what we are doing behind the walls of academia
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  is just not reaching people.
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  The other issue is that we have a problem with access because
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  there aren't enough, um,
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  mental health providers who have expertise in pediatrics and they're
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  bunched up in certain geographic areas.
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  So a sobering statistic is that 70%
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  of the counties in the entire US do not have one child psychiatrist.
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  So when we conceived of the idea for Little Otter,
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  it was clear that we had to have a way to be able to provide quality mental
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  healthcare. But number two,
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  that we had to embrace a fully digital approach because that is the
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  only way to be able to reach families across the country,
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  um, with the kind of specialized care that we do. Now,
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  little Otter is a digital early childhood mental health company. Uh,
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  we provide care to children from birth to age 14
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  and their parents. So my, uh,
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  research over the last 30 years is focused in the area of early childhood
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  mental health that is children zero to six years old.
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  So I know well from my work, um, and the work of my colleagues,
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  how it's even more difficult to get mental health care for your young children,
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  um, than it is to get help for teenagers.
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  And it's so important that we're addressing adolescent mental health.
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  But the fact is that mental health disorders start
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  early.
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  50% of adult mental health disorders start before the age of 14.
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  And so our philosophy at Little Otter, it's again bringing my, uh,
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  research work as well as clinical work to create an accessible,
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  effective,
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  inclusive platform that can do the early identification of
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  mental health problems in children and provide effective treatment.
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  The other thing that sets Little Otter apart in our philosophy,
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  really in many ways comes from my experience as a mom navigating
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  the health system.
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  We know that people do not live in isolation.
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  The child lives in a family and that we need to be thinking
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  holistically and inclusively about a family's mental health if we're gonna help
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  a child. So we provide a mental health care to children,
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  um, with therapy as well as medication management,
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  but we also provide mental health care to parents. We do parenting,
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  um, support as well as evidence-based interventions. We do couples counseling.
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  We do family therapy.
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  Our philosophy is centered in the idea that really mental
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  health has to do with one's internal experiences,
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  but also having strong supportive relationships with the people who you
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  love. And that's what we are, um,
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  focused on building this new model of care to bring, um,
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  this approach into the homes of families.
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  Dr. Er a couple things. I'm glad you mentioned. First,
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  the digital nature of mental health treatment. Uh,
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  could you describe some of the advantages and maybe disadvantages of how
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  telehealth has evolved in the mental health field?
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  Telehealth has had a big impact in the field of
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  psychiatry and mental health, particularly during the pandemic.
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  And I believe that the data show that the only way that we are going
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  to address the mental health crisis for children and for adults is
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  really embracing telehealth and digital health.
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  One of the key things to realize is there's a challenge of getting access to
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  mental health care,
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  but there's even a bigger challenge of getting access to the expertise
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  in the area that you're having problems with.
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  And so if we think about our area at Little Otter of early childhood mental
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  health, even if you wanted to get in-person care,
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  you are very unlikely to be able to access the level of expertise
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  that, um, we can deliver digitally. Now,
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  people can be very skeptical about the idea that you can do, uh,
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  tele psychiatry or telemental health with children, but again,
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  this is where you need to bring your expertise. We have developed, um,
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  and wonderful ways of using the zoom,
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  blackboard drawing together. We, you know,
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  the child can sit on the floor and the parent can put the computer on the floor
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  and we can play together so that it is very clear that
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  it is both effective and satisfying, uh,
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  to be able to deliver, uh, mental healthcare, uh, in this kind of way.
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  Now there's so many advantages for families.
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  We come to you and we are able to care for the child in
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  the place where he or she lives. So we get to see the child's room, their puppy.
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  We also get to see where, um, the family interactions are happening.
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  It's much more convenient for parents. We find that commonly with,
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  in-person care, it is only one parent who comes to the session,
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  which makes sense 'cause you have to leave work and drive, pick the kid up.
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  We now have really robust engagement of both parents in care
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  because even if one parent is at work, they can, um,
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  log onto the Zoom call and participate in the session.
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  So we really find that there are huge advantages.
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  There are some, um, things that we do not do that are not appropriate.
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  I think for, uh,
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  a telehealth approach that would be a child needing a higher level of care,
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  some kind of intensive outpatient care, or obviously inpatient care.
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  Number two, if you had a child with a new onset psychosis,
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  I think that you wanna have to do a medical workup,
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  but I would want that to be done in person and doing, um,
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  evaluations and, um, diagnosis of autism spectrum disorders.
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  So, and some families have preference, so when those,
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  any families in those situations come to us, then we, um,
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  we refer them out and work with them to be able to find the care they need.
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  Dr. River,
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  I'm also so glad that you mentioned how the mental health of the family unit is
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  so important.
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  What do you think are the greatest challenges and the goals of making this
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  approach more mainstream?
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  I think that the approach that we are taking to mental health is an approach
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  that should be used across the lifespan, right?
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  If you are a person who's experiencing a severe depression,
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  we shouldn't just be focusing on your care if it's, let's say a mother,
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  but we need to make sure that the children and the family are okay and that the
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  spouse is okay.
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  So the way that we approach this at Little Otter is to bring
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  measurement to every step of our process so that our care
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  is data driven and our outcomes are data driven.
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  So I created something called the Child and Family Mental Health Checkup.
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  And I think this is key to when a person first comes for care,
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  that we have to understand what's going on. So in the checkup,
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  we address the child's mental health and the impact of the child's mental health
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  on their functioning, on their parents' functioning and the family functioning.
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  I really think these kind of checkups should be standard in pediatric visits
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  as well as at schools. We check children for their height and weight,
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  but we don't have a way to check in about how their mental health is doing.
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  But in the, uh, checkup that I created,
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  we also screen the parents for anxiety and depression and
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  we assess the dynamics in the family.
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  So we assess conflict in the parent partner relationship in the
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  co-parenting relationship in the parent-child relationship,
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  and try to understand how much stress this family is
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  experiencing.
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  And the importance of this being integrated and done together is that then you
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  can make clinical treatment decisions about what are the most
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  urgent issues to address and how are you gonna do that.
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  And an example I give is,
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  if you have an anxious child who needs to do cognitive behavioral therapy,
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  you are not going to make a lot of progress with that child's anxiety.
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  If every night the parents are fighting and, um, you know,
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  there's a lot of conflict in the family,
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  we have to be able to address the environment that that child lives in as much
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  as the symptoms that they are experiencing.
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  Dr. Ger finally,
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  what steps do you think hospitals and health systems can take when treating
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  children for suicide ideation in particular?
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  This is, uh, a very important area. We have seen, uh,
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  an increase in children with suicidal ideation, um,
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  as well as er visits for suicidal ideation or attempts.
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  So let me first tell you what we do at Little Otter. So in our, uh,
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  first intake call with a master's level a provider,
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  we do a formal screening for suicidal ideation with the
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  child and with the parent.
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  And if we find that the child has suicidal ideation that doesn't need to,
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  you know, immediate hospitalization, but the child has these symptoms,
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  we then get them in within 24 hours to do an
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  assessment with one of our providers that assesses the child's mental health,
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  but also combines safety planning. Um, and, um,
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  some feedback on how to manage this with the child and the parent.
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  I think the way that health systems, um,
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  and hospitals should address this is first you need to ask,
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  you need to screen. So children who are in the hospital,
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  um,
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  it should be part of the assessment that is done when the child is admitted
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  and during the hospital stay, but also in, um,
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  general pediatric clinics,
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  but particularly in subspecialty clinics where we see very high rates of
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  depression in children who are facing cancer or diabetes or other chronic
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  health conditions. And then you need to be able to, um,
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  provide the child with the correct intensity evidence-based intervention
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  to help with the suicidal ideation. And there is a,
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  a evidence-based therapy called Dialectical Behavioral Therapy that
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  is, um, for adults,
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  but also actually now for children and adolescents.
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  And it has a very robust evidence-based for being effective.
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  So I would say that if you want to really help children
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  with suicidal ideation,
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  you have to have providers who are experienced in delivering
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  DBT.
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  Doctor,
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  I thank you for being so generous with your time today and all your insight on
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  these crucial topics.
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  We very much look forward to sharing your insights with our audience,
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  and I look forward to connecting with you again soon.
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  Great. Thank you so much.
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