Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Amy Wimpey Knight, President of the Children’s Hospital Association

Transcript

Amy Wimpey Knight, President of the Children’s Hospital Association · Becker’s Healthcare -- Pediatric Leadership Podcast

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  This is Chris with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Amy Wimpy Knight,
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  president of the Children's Hospital Association. Amy,
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  thank you so much for joining us today.
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  It's great to be here with you all. Thank you for having me.
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  Wonderful. In the meantime,
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  could you first give us a little bit about yourself and your background?
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  Sure. Um, I'm the president of the Children's Hospital Association,
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  so we represent over 200 hospitals, children's hospitals nationwide,
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  um, and the families and children that they serve.
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  So we have a focus on advocacy and policy,
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  on care delivery and on just improving the lives of children and,
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  and their families.
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  Amy,
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  what would you say are the most pressing concerns for youth mental health today?
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  I, I think, um, when you talk about children's mental health, it's,
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  it's a big topic and so if we had to focus on two things,
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  I think we've all seen it in the news lately.
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  Certainly it's all touched us in our personal lives, but I would,
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  I would focus on two things. First of all, it's the kids themselves.
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  So when we talk about youth, we're not only talking about adolescents,
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  but we're also talking about children and just how it's impacting them
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  and their own experiences should be of concern for all of us,
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  and that's one of the reasons we are all talking about it.
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  So if you look at the incidents of mental health crisis,
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  quite honestly in children, it's really grown over the past decade plus.
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  So we're dealing with a number of children who are along that continuum from
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  starting to experience some emotional distress to children that have actually
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  been in crisis and in our cases have shown up in children's hospitals,
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  emergency rooms, um, in our ambulatory areas, and even in our inpatient areas,
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  seeking, seeking care. So that's the tip of the iceberg.
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  If we're seeing it at that level and a number of children that we're seeing
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  today, which is two and three times what we've seen previously,
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  we know that children more broadly are in need.
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  So those in our schools and in our communities,
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  the second concern I think goes without saying is,
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  do we have the providers to meet that need? And by providers,
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  we both mean people and programs.
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  So at a time in our country where we know we have fewer mental healthcare
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  professionals overall, um, to serve our country's needs,
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  we actually have a disproportionate, fewer only 4%, for example,
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  of clinical psychiatrists are trained to take care of children.
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  And so we have an extreme shortage, not only of of licensed professionals,
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  but also of training in our communities and our schools and in our families to
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  be able to identify and cope with the early onset of potentially, um,
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  emotional challenges and then more long-term, severe mental illness.
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  Uh, you took over as the C HHA president in 2020.
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  Certainly that was a difficult time for everyone's mental health,
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  not only children,
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  but how do you think children's mental health has changed since the pandemic and
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  its onset?
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  Um, it's changed a lot,
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  and I think it's important to realize that even before the pandemic,
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  really the decade prior to that, we saw children's health, the need for, um,
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  children's health, mental health care increase quite a lot.
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  So demand was growing. Um,
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  really from the late early two thousands to 2019,
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  we saw a double in a tripling and that time of suicide ideation and children
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  attempting suicide. Um,
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  what happened really during the pandemic was an exacerbation of that.
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  So we saw it increased that same level in a very short period of time.
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  So children, um, faced all kinds of crises during the pandemic,
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  I think we all did if we're frank with ourselves. And so, um,
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  they're hit differently than adults are.
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  So issues of illness and financial strain, um,
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  being away from school,
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  being away from peer groups had a disproportionate impact on, on,
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  on our children.
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  And so what we saw during that time in particular was nearly a tripling of
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  suicide ideation and suicide attempts in our children's hospital emergency
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  rooms, um, which was quite concerning. We certainly saw, um,
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  more than a hundred percent increase really in, um, eating disorders, um,
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  particularly in young women and that situation. And then just children overall.
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  We saw it start to impact kids at a younger age.
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  So why typically you didn't see mental health issues come to the forefront maybe
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  until the early teens, we started seeing children ages six to 12, um,
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  show up with mental health conditions or early mental health conditions that
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  required an intervention as well. So, um,
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  it's a situation that has grown and unfortunately hasn't been subsiding. Um,
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  it's probably the biggest symptom of that from a children's hospital
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  perspective, again, is what happens in our emergency rooms.
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  And then unfortunately,
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  what happens when we're unable to get children immediate care. Um,
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  some children's hospitals have very intensive ambulatory programs, um,
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  outpatient programs and, um, inpatient care, but the,
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  the bed capacity to be able to treat these children today, um, is,
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  is far lower than what we need overall, um,
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  in most states and in most communities and certainly across the country.
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  And thank you for laying out those challenges and concerns that not only
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  children but hospitals and health systems are facing.
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  What would you say right now are the steps that are being taken to support
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  mental health in communities and what can hospitals and health systems do to
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  further that effort?
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  There's, there's a lot of energy around this right now, and I,
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  I think if we pause to look at, um, you know what,
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  one of the other things that's changed really since the pandemic is we've seen
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  more of a destigmatization of it.
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  So certainly we're having this conversation today,
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  and these conversations are happening in communities overall.
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  So we can think about the role of the health system, which is one piece of this,
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  the healthcare system, whether it's a children's hospital or,
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  or other hospitals within our communities.
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  But we also need to look at the community at large in many cases.
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  So just like any other, um, chronic disease, it happens early.
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  You may notice the signs of a child having, um, asthma,
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  for example, when they're younger.
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  The same thing happens with behavioral and mental health as well.
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  So you can start to see signs that maybe something's wrong,
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  maybe it's tossed out as though they're just upset or it's just a behavior. But,
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  um, that early intervention is gonna be really key.
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  So the healthcare system can be part of that solution,
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  but partnering in particular with our communities and our schools,
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  early childhood education and most of all our families to be able to, um,
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  to impact that.
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  The other thing that the healthcare system overall is doing right now is really
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  leaning in the health system and advocating for more training
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  for providers and for better reimbursement. Um, both from our,
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  um, publicly sponsored insurance programs like Medicaid and our commercially
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  sponsored programs as well.
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  So we just don't pay these providers enough to keep them to stay in their
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  profession, but also to continue to grow that workforce,
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  which we talked about earlier, is so incredibly important. Um,
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  health systems and hospitals across the country are leaning in and,
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  and training primary care physicians,
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  pediatricians to be more involved in this space as well.
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  So it's really building that village around our kids, um,
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  to be able to identify maybe a problem in school,
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  something that we can treat early, and so it doesn't become, um,
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  become a bigger issue as as they get older.
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  I'm glad you mentioned how important it's to see the signs early. Uh,
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  speaking of which, what trends do you think are going to develop on the horizon?
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  You know, it's really hard to predict the future, but I think we're,
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  we're living it a little bit right now,
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  and particularly in the mental health space. You know, I think, um,
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  one of the things that we talk about a lot,
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  and it's really hard to get your arms around is that about 50% of,
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  of mental illness begins before the age of 14.
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  So we just talked about early intervention, um,
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  and importantly it's over 10 years.
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  So just about 11 years between maybe the first signs of an emotional condition
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  or a mental health condition,
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  the shown nearly 11 years before someone gets treatment for that.
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  So if we stay on a current trajectory that we're on and we look at really the
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  past five years and what we've experienced as a nation,
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  and more importantly what each child has experienced in their own lives,
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  we're on probably a trajectory to see more mental health conditions than even we
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  have today.
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  The good news is everything else we just talked about is we have ability to
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  change that. So, um,
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  moving upstream and working with families and working with schools and working
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  with providers and building that workforce, um,
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  to build that support system for kids to teach them very early on coping skills
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  and recognizing how they can, um, one, soothe themselves, treat themselves,
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  and then ultimately to, um, be support systems for their families and, um,
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  for their friends in that same capacity. So l left to our own devices and,
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  and not enter, not, um, implementing some of these changes,
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  we're probably going to need more of a system going forward.
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  We know we don't have enough today, um, so we will need more of that,
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  but we certainly have an opportunity to invest in our kids and in our healthcare
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  system and in our other systems to be able to, to head that off if we so choose.
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  Here's something that's exactly what happens. Amy,
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  are there any other issues do you think that need a brighter spotlight right
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  now?
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  Yeah, I think, um, obviously mental health is a concern nationwide,
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  and that's both for adults and for kids. And so, um, probably we certainly,
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  obviously we're talking about kids today and would definitely focus our
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  spotlight there if at all possible. Our country has many needs and it's hard.
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  We have, we don't have unlimited resources, um,
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  but we would really kind of posit as,
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  as a community of children's hospitals and chi child health providers,
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  we can invest in our kids today to have a healthier future.
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  So oftentimes kids are the last one to receive care,
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  thank goodness most children are generally healthy, um,
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  and don't have some of the illnesses that that other adults and including some
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  of us have as well. Um,
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  but investing in that prevention early on will make them productive citizens,
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  productive military members, um,
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  and productive next generation of all of the talents that we have in our country
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  today.
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  So we would just really focus our efforts on kids and ensure
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  that when we're talking about legislation or when we're talking in a community
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  about resources, that we certainly, um,
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  carve out some of those specifically for our children.
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  Amy, thank you so much for sharing your insights today.
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  It was very much a pleasure speaking with you,
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  and we look forward to connecting with you soon.
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  All right.
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  Thank you very much for spending time on this incredibly important issue.