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Duologue with Leslie Heaney
[REVISIT] Mental Health Matters - feat. Corinne Catarozoli, Ph.D.
00:49:34
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- [00:05]
Leslie Heaney
Well, May is Mental Health Awareness Month, and in honor of that, I'm focusing today's episode on children's mental health and speaking with Dr. Corrine Cataruzzoli. Dr. Cataruzzoli is the co Director of Behavioral health Integration and Innovation at Weill Cornell Medicine, where she works across inpatient and outpatient medical settings to embed evidence based mental health services into the continuum.
- [00:29]
Dr. Corrine Cataruzzoli
Of care for children.
- [00:31]
Leslie Heaney
She earned her BA from Wake Forest University, her MA from New York University, and a PhD in clinical psychology from Fairleigh Dickinson. Dr. Cataruzzoli completed her internship at Montefiore Medical center, where she received specialized training in the application of behavioral health interventions for children and adolescents coping with acute and chronic mental illness. She's been on the faculty at weill Cornell since 2017. In today's episode, Dr. Cataruzzoli and I talk about the three most common types of mental illness affecting children and adolescents. What we as parents can do to help identify these mental health issues, the best treatments that are currently available for these three most common conditions, and where we can go to find mental health providers for our children. So this episode is super informative and practical. Get ready to get out your pens and paper and take notes. I learned a ton from Dr. Cataruzole and I know that you will, too.
- [01:34]
Dr. Corrine Cataruzzoli
Dr. Cataruzoli, it is so nice to see you. Thank you so much for joining today.
- [01:40]
Thank you so much for having me. I'm excited to be here.
- [01:43]
Well, it is Mental Health Awareness Month, and there's a mental health crisis among our youth. And so I thought that might be of greatest interest. And this is an area of expertise for you. So I'm so thrilled to have you on to talk to us about this. Tell me, what is the landscape like today?
- [02:06]
Yeah, the big headlines, of course, are the youth mental health crisis, which is still ongoing. So back in 2021, the US Surgeon General issued an advisory on youth mental health, and around the same time, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital association jointly declared a national state of emergency in children's mental health. And these were unprecedented statements at the time. And they all warned about this urgent need to address escalating rates of mental health issues facing our kids. So now, a few years later, we're starting to see some of the data from these pandemic years being published, and it is quite startling.
- [03:00]
So the I wanted to ask you, how did they measure that at the time to say we're experiencing a mental health crisis? Was it the volume of kids that were looking for care and it wasn't available, or was it, I hate to even say it, but a child suicide rate, what were the numbers they were looking at to make that determination?
- [03:20]
Right. They look at all sorts of metrics. So they look at rates of anxiety and depression, which all increase. They look at ER visits for reasons like suicidality, which were up over 50% at the time. And then the CDC does a big survey of high school students and they published a report on this in 2023. And some of those statistics showed really alarming trends. 42% of high school students said they felt persistently sad or hopeless, and one in five had said that they seriously considered attempting suicide. So these are really alarming numbers. Teenage girls in particular were shown to be particularly vulnerable. They fared worse on basically all the measures that the CDC administered. So we're continuing to see this trend that started during the pandemic of worsening rate and then coupled with that is a really high demand for care.
- [04:21]
Even though these rates skyrocketed during the pandemic, this has been an ongoing. We've seen the mental health of children and adolescents decline over the past few decades. Right. And I don't know if that's attributed to more screen time, isolation, social media or what, but it's been a. And the trend has been going upward. And of course the pandemic just, you know, seemed to magnify or intensify some of these already existing issues.
- [04:50]
Right. It's been probably a multifactorial reason that these trends have been going on for a while. And then they really sharply increased during the pandemic because of things like isolation and disruption to social, um, functioning, disruption to school, obviously a lot of anxiety about illness. And, and at the same time that was layered on top of a long standing shortage of child mental health specialists, child psychiatrists and child psychologists dating back for quite a while. There's been a workforce shortage. So when you combine this workforce shortage with a steep increase in need, it just makes it impossible for everybody who needs care to get it for sure.
- [05:40]
So what, so what are sort of, are there kind of the most, the most prevalent or the most common mental illnesses that, that you and your colleagues see now, and that were probably of most concern kind of during the, the pandemic period. And coming out of that.
- [05:56]
Yeah. Among kids, anxiety is far and wide the most common class of mental health problems. So currently the rate is about 1:3. Adolescents who are affected typically starts in childhood. And then we see a lot of in adolescence as well. Depression is another class of mental health diagnoses that we see quite a lot. And since the pandemic, these rates have risen quite a bit, along with related problems like suicidality. And then another group that we see are behavioral issues in typically in younger children. So these may be related to diagnoses like ADHD or they can also occur independently.
- [06:46]
And so let's, let's break those down then one by one. And I'd love to hear from you for people who are listening, sort of what are the indicators for each of these things? What should parents look for? What are some of the causes? You know, for example, anxiety and depression. I understand that some of it may be genetic, so there's a piece of the puzzle there. And then, then we'll talk about what people can. Once we scare everyone, we can talk about what they can do sort of to address it if they do have concerns about their own child or children with some of these prevalent illnesses. So anxiety, what do we look for?
- [07:28]
Sure. So anxiety, I should say to start, there are normative childhood fears and anxieties that are completely common and not pathological at all to have. So children are often afraid of things like the dark or monsters or teenagers, stress about college applications. And that's really normal normative. And those tend to be somewhat transient. So what we want parents to look for and when we become more concerned is when anxiety really persists. It really is disruptive to a child's functioning. It makes it hard for them to do things like go to school, participate in their activities, or it's causing a great deal of distress to the child or the family, family unit. Things parents can look out for are avoidance. That's a big sign. Not wanting to go to things like birthday parties or social events or school, other activities like soccer practice those. Avoidance can be a big red flag that they're the situation is anxiety provoking to the child. Lots of reassurance seeking, so asking excessive amounts of questions about what will happen or will they be okay or what's going to happen next. That can be a sign that a child is really struggling to manage anxiety themselves, are going to soothe themselves and is reliant on a parent to do so. And then other disruptions to things like sleep, appetite, those can also be indicative of anxiety too.
- [09:08]
So I guess if anyone is thinking that they're not quite sure if their child fits into what you would describe as kind of the normative category or one where they might want to seek some, some assistance, your recommendation probably would be if you're questioning whether there might be an issue, just maybe go find out. Right? Go see someone.
- [09:32]
Definitely benefit to early intervention. So early intervention is almost always associated with better prognosis because the earlier we can catch things, the earlier we can treat them and the more we prevent them from worsening or escalating. So we definitely recommend that. And we like, we like stepped care models where we can start with some brief intervention. And sometimes children just need a couple of sessions to learn some strategies to manage anxiety when it falls into that mild range. And that can still be really helpful. And then obviously we recommend more intensive services as symptoms worsen. But we do have really good. The good news is, after we've scared everybody, is that we do have really good treatments for anxiety. We have pharmacological treatments and non pharmacological treatments. So cognitive behavioral therapy is an evidence based treatment that has really robust scientific support for pediatric anxiety. And this is a short term skills based treatment that teaches children really concrete strategies that they can use to manage anxiety symptoms. And then medications too, in particular SSRIs can also be helpful. So we can either use CBT and medication separately or sometimes we combine them. And there is some evidence to suggest that when they're used together in a combined fashion, there's an additive effect, particularly for that more moderate to severe range.
- [11:10]
So with cognitive behavioral therapy, that is something that a psychologist needs to be specially trained in doing. Right. So we're going to talk later about where people can go to find providers. And that would be something that if you think your child might have anxiety or maybe once they've been diagnosed with that, that might be something that you want to pursue. But can you give examples about what cognitive behavioral therapy is? The thing I think is so terrific about it is that you're giving a child or an adult tools that they can use, they can pull out of their toolbox whenever they need them. Right. It's not sort of talk therapy or thinking it through about why you might be anxious. It's like, okay, you're anxious, you're worried about this thing, let's kind of walk you through it to help address some of that anxiety.
- [11:57]
Exactly. It's a really based in the here and now approach. It's really pragmatic. So we do cognitive interventions where we help children identify anxious patterns of thinking that might not be 100% rational or based in facts and reason. And we do little exercises and teach them skills to identify these thoughts, challenge them, look for evidence, and then change them or reframe them. Around to be more factual and accurate. So that's one big bucket of intervention.
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If you had a, have you had a client or a patient that you, you give us sort of an example of what they're coming in, they're saying, sure, I'm terrified of dogs, the dog's.
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Gonna bite me, it's gonna really hurt me, and I better stay away from it in order to stay safe. So we would have them look at the facts, look at the evidence, what's happened in the past, what has happened to people they know, how likely is it really that that dog is actually going to harm them. And then we'd have them kind of do the math, do the mental math differently when they see the facts. Some of these are just cognitive errors that we make. And even as grownups, we're prone to these. But, you know, if a child is thinking, I'm scared to go to the birthday party, no one's going to talk to me, we would say, huh, what happened last time you went to somebody who's going to be there? Did you talk to them last time actually?
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What if a child said yes? The last time I went to the birthday party, nobody talked to me.
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Then we might do some searching on how they can, you know, use some social skills to break in, start conversations. We do a lot of behavioral, or rehearsal is what we call it, or exposure. So that where they. We actually practice doing these things because the more practice we have, the less scarier they are. So we work with kids to build a fear hierarchy where they can gradually approach anxiety provoking situations. So if they were scared to go to a birthday party, we might first have them go accompanied by a parent and just stay half the time. And then we might have them go, and the parent kind of hangs to the back and they participate. And then we gradually increase the difficulty level as they grow more and more comfortable and they gain this evidence that, oh, it actually was okay, that none of these horrible outcomes that I was scared about happened. They spell some of the myths that they had in their head about what it was going to be like. And it helps them see the likelihood of next time how things will probably be different than they expected it to be.
- [14:36]
I would think that part of this, I guess the dog example, which was my example, maybe think about this as another potential type of therapy to address some of this anxiety. Is exposure therapy part of CBT or is that on its own? Or how does that, how does that work exactly?
- [14:54]
Exposure is part of the B in cbt. It's one of the Behavioral approaches that we do. So. Absolutely. Exposure is a really potent intervention that we use to extinguish fears, whether it's fear of a dog or a social situation or going to school or making a mistake. But we come up with these graded exposures as a way to gradually get a child comfortable with doing these things. So absolutely. That's a really important one.
- [15:23]
I have a friend whose child was really very anxious about getting bad grades. And the person they were working with, they were doing cbt and the recommendation was maybe we just need to get a C or a B and just see what happens if we on a.
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Quiz something get a question wrong on purpose. Right.
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Exactly.
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Unacceptable at first. But we kids learn the world doesn't end if I get one wrong in my spelling test. Right. It's a really important lesson because the be and the behaviors, the exposures are connected to the cognition. And that's how we changed one of them because of this bidirectional nature.
- [16:07]
Right. So you're afraid to go to the party. We want to have you keep going to the party. Hopefully someone talks to you as you go to more of these parties. It works. But I just think it's such a terrific way. I think as a parent, you knowing that you have tools to help support your child and then your child having some of their own agency. Right. Being able to address some of these issues themselves is terrific. Right.
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We want to equip them with skills to manage it themselves. I tell kids I want them to become their own CBT therapists so then they don't need to come to therapy anymore. And that's why this is a short term treatment. So they, they have these at their disposal.
- [16:47]
And then you mentioned SSRIs. That would be for people who are not, you know, as familiar with what that term means.
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Selective serotonin reuptake inhibitors. These are medications you've probably heard of like Prozac or Lexapro that are used to treat both anxiety and depression and can be very effective too. Sometimes they're helpful to kind of turn down the volume or the severity of symptoms. So then kids can engage in cbt. If they're so anxious and paralyzed that they, they can't really engage, then that becomes a barrier. So that's a really nice kind of complement to use those two together. They do take a little while to start working. So sometimes folks like to use CBT in the meantime to start gaining some skills while they wait for the medications to start working. But families can consider them. Some of it is family preference to what's accessible to them. CBT isn't always widely available. So these are all the different considerations that I think of in the decision tree on whether where to start and what type of treatment recommend.
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And of course, someone would have to go to either a psychologist that would refer them to somebody to be able to prescribe that or go to a psychiatrist.
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Right. So psychiatrists will prescribe medications, although these days, sometimes even pediatricians are starting to do that more, which we can talk about that shift to make it more widely available.
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Okay, so depression, you said, is sort of the second most common. Right. Mental illness among children. How do we spot it? What do we look for? Because teenagers, for those listeners who don't have them yet, I have two. And they do like to kind of come home and go to their room, talk to their friends. You know, it's really sometimes you have like a window and what's going on. Then other times you pick someone up from school and it's like they're grunting sitting beside you in the front seat of the car. So I, you know, it's a hard, I think, as a parent of teenagers to totally know what's going on. I think, I mean, I only play a psychologist on TV shirt, but I, I think that's sort of normative. That's normal, too, right? 100% kind of wanting to sort of keep their own counsel. So when should we get concerned or what should we look for?
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Yeah, 100%, some moodiness or mood swings or, you know, days of feeling kind of down inside are completely normative in the context of adolescence. An increased desire for privacy and independence, all developmentally appropriate. So what we want parents to be looking out for are, again, persistent, persistently low mood every single day for weeks on end, or significant patterns of withdrawal, not just from wanting to play board games with your family, but not wanting to do activities that they used to love, not wanting to go to soccer practice or hang out with their friends, difficulty getting out of bed, hard time getting to school. Any, of course, statements about death or suicide should be taken very seriously. We try.
- [20:09]
Not.
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We, we encourage parents not to just write that off as though they're just being dramatic or. So those are the kinds of patterns that we want to look towards in terms of where we become more concerned that it might be more of a depressive episode than just normative. Teenage.
- [20:29]
So I like teen aging as a, as a, as a verb there. Doctor, because it is, it is a very active process, as I'm sure you know, too, from working with so Many teenagers. But is depression something that we should be concerned about in kind of the tween years or is it correlated? I mean would you see it more as they start to go through puberty? Can it present even in younger school age children?
- [20:54]
It. It typically has a later age of onset than anxiety, which anxiety often starts in more of the early childhood years. And we start to see depression more in the tween to adolescent years which is more of a common time of onset. It also kind of look like a lot of irritability which is often difficult to tease out from the normal teenage mo so but age is definitely a factor. It tends to be more towards those high school years where we really see it start more strongly.
- [21:33]
So treatment is. It's a similar. Similar to what you be how you would be approaching anxiety?
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Exactly. Very similar. CBT and medication also SSRIs and others can similarly be used together or separately to treat depression. We also have a treatment called dialectical Behavior therapy or dbt, another acronym that is also an evidence based treatment for teens with depression, suicidality or self harm. So that's another great option. It's a very comprehensive program that involves a range of different therapies and interventions. Sort of a cousin or a relative of cbt. So that's a great option too.
- [22:20]
How. What does that look like? Can you give an example of what a dbt?
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Sure. So it typically involves sort of a constellation of therapy. So usually individual therapy and then talk.
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Talk therapy.
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Yeah, right. And then group therapy which is actually family based where families parents right alongside their adolescents come in weekly and learn, go attend a skills group where they would learn things like distress tolerance skills, communication strategies for interpersonal effectiveness. So the nice thing about this is that parents are right there alongside their teen learning the same strategies. And I think the teenagers appreciate that, that the parents are not let off the hook here. But it really does recognizes that there's dynamics that play into these symptoms and it's not just all on the teen to kind of fix this. So and then there's also a phone coaching component where for crisis management where if teens are feeling unsafe they can page their therapist to get 247 on the spot phone coaching to manage suicidal thoughts or self harm urges. So it's very comprehensive in that sense.
- [23:37]
Oh, that is great. I want to talk to you more about that. When we talk about access, how do they. What would pe would parents be looking for someone who's trained as a DBT therapist? Would that be part of their profile, you know, on their CV when You're looking at different providers.
- [23:55]
Yes, exactly. You would want somebody who has expertise in this program, who. There are even programs that are certified in dbt, although there are many providers who offer and can teach DBT skills and strategies independently of a full comprehensive program. But yeah, like any of, like any provider you're looking for, you want to see that they have expertise and experience in one of these evidence based treatments.
- [24:25]
Okay, so the third, third most common you said is behavioral issues, which is a big catch. All right, like that's like none of the above, right? That's the thing. Or all, all of the above, maybe. I don't know.
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And any parent of a young child will probably feel like they qualify for that because as you can see, the trend is there is a normative level of behavioral or oppositionality that comes with just being a kid and that's normal. And, um, we don't want to pathologize that. So what I'm referring to is when behaviors become so unmanageable that they're disruptive and disruptive in multiple settings. So at home, at school, at sports practice, in their clubs, or if they're really interfering with the child's ability to learn in the school environment, that's when we might intervene. So we're not talking about the occasional refusal to clean your room or refusal to put your shoes on and get out the door in the morning. I think those are just universal, difficult parenting experiences. But these are the more either explosive behaviors, oppositional behaviors, really refusal to follow directions. Like I said, sometimes it can be related to ADHD if kids are inattentive and, um, having a difficult time with sequencing of tasks that they need to complete. Um, but not always. Sometimes these occur independently too. And, and that's sort of a diagnostic differential that we would look at.
- [26:01]
If your child is being sort of repeatedly uncooperative. Seems too, too light of a term. Defiant.
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Maybe science is a good word.
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And that's happening at home and it's happening at school and it's happening at camp. That might be the time where you say, okay, we need to bring somebody in to help us learn the tools to figure out what's happening. Now is that related to anxiety and depression? Like is. Are the behavioral issues just a symptom of an underlying mental health issue? Right.
- [26:35]
It can be. Certainly even, you know, anxious kids, when they're being prompted to do something that feels very scary to them, can actually look very defiant because they refuse to go or they really don't want to do it. But it can also Be unrelated. And that's where a good evaluation helps to suss out, you know, diagnostic impressions. But the good news again is that we have good evidence based treatments for these kind of behavioral issues. And they typically all really involve heavily involve parents. Because the aim is to modify the child's environment, to change the reinforcement patterns, to change how these behaviors are being responded to. So this is not a drop your child off at the therapist office and pick them up after 45 minutes. It really and involves the parent in the sessions and giving them tools and strategies on how to manage these behaviors. Because parents are often a big mechanism of change in these kind of settings. So these are things like parent management training or parent child interaction therapy.
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Parent management training. Maybe I need this. I mean, I mean, I, I definitely, you know, could you, you know, we, I feel like anyone who's listening, I mean, we can all use all the help we can get. But what, what is that? And is that something that therapists are trained in, that people could also look for in a provider?
- [28:05]
Absolutely. So parent management training, or pmt, you may hear it called, are parent directed interventions in order to change or modify child symptoms, child behaviors. So these are things like teaching parents how to positively reinforce behaviors that they want to see how to do planned ignoring for behaviors they don't want to see.
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Planned ignoring. That's interesting. I like, I like that active ignoring.
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As I like really not responding to behavior that you're trying to extinguish because you don't want to even overly reinforce them with attention. It involves things like setting up reward systems, giving effective commands, helping kids with transition, de escalation, redirection. So all of these, it's really giving parents a toolbox of strategies that they can use to equip them to manage some of these problematic behaviors.
- [29:04]
Well, you mentioned adhd and I thought it was interesting about kids because part of what could be construed as being defiant or uncooperative might actually be a child having difficulty sequencing the steps right to be able to execute on whatever they're being asked to do. Like if a teacher said, you know, get your shoes out of your cubby and then we're going out to the playground. I mean, I remember in gym class, the gym teacher would tell us what the, how we're playing the game, and I would absolutely zone out. I'd have to wait to watch what, you know, was happening. And my maiden name is Bath Gate. I remember the coach would be like, bath Gate, what? Why are you staring at your shoes? I'm like, I just want to wait and see what the. Because I couldn't. I couldn't follow any kind of, you know, sort of extensive direction. So I wonder if, you know, that could also be a part of it for some kids, right? Just having difficulty because of their attention deficit disorder, having. Having that be a real factor in them or their behavior being perceived as being uncooperative. So tell me about that. And I. I want to do a whole episode on adhd because I think there's a lot of people who are. I mean, there's a lot of adults now talking about whether they have it and how we should diagnose ourselves clearly. I mean, maybe my. My example with me in gym class means that I. That's my. I should go get evaluated. But. But tell us about that. Are you seeing that with behavioral issues? And if you have a question about that, what are parents kind of first steps there?
- [30:39]
Absolutely. Yeah. So what you said is spot on there. It's often the case that behaviors we might see that look kind of oppositional are actually due to inattention. A child is distracted and not able to attend or sustain their attention for a long period of time. So if it's a parent, you gave them the directions, go put your shoes on, get your backpack, get your jacket, and meet me at the front door. Maybe they heard that first step, but then their attention waned. And it looks like they're not complying or doing what they're being asked, but really they've just gotten distracted by something going on or have lost their focus. So that can definitely happen. And then the hyperactivity side, too, for sure. These are kids who are restless, who have a hard time sitting still, who are fidgety, who are driven by a look like they're being driven by a motor. So those kids are often the ones in school who might be getting in trouble because they're being disruptive to the learning environment. And it's not that they're intentionally being oppositional, but they just have that excess energy and hyperactivity in their body, so it presents that way. So, absolutely, we have. In terms of treatment for adhd, we have a couple of options, too. First line is typically medication, specifically stimulants. Except for, if we're talking about preschool kids, there's a recommendation to trial behavior therapy first before considering medications. So that's important to know that those are our most effective treatments. But behavior therapy can also be helpful in terms of support with executive functioning and organization and prioritization. All those, you know, prefrontal cortex Functions that we need to develop that can be really useful for. And then school based accommodations are really crucial too. Schools can implement changes to help minimize distractions by giving kids preferential seating or other things just to help with their attention and focus in the classroom setting. So working with the school becomes really imperative to get those put into place.
- [33:00]
Okay, let's talk about. So people are listening. They're thinking maybe their child might have one or all of the, the different conditions that we've described. What's the next step? I think one of the greatest challenges is accessibility. You mentioned it when the CDC and the American Academy of Pediatrics said, oh gosh, there's a crisis here. And part of that was based on demand and having a lack of supply. Where do people go? What's their first step?
- [33:29]
Yeah, it has been a really hard time for finding a mental health provider, particularly over the past few years because of this long standing workforce shortage. Compounded.
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You mean workforce shortage like a shortage.
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Of psychologists, like child and adolescents, psychiatrists and psychologists? Yes. And you can go online and see there is a map of where these shortages are and the rates of them. Not surprisingly, in rural areas, the shortages are more extreme. But even here in New York City, there are shortages in order to meet the need. And then if we're talking about providers that actually take insurance that's, you know, that even makes it more inaccessible. So it's really tough right. Right now. But what I advise families is to start with your pediatrician. That's always a great option. Sometimes pediatricians have relationships with providers or places that they refer. And then similarly, school counselors too are great resources. So they often have clinics or relationships to different centers where they know providers and can help match a child up with somebody that would be a good fit. And then you can of course also get a list from your insurance company of covered providers who are in network with your insurance.
- [34:53]
That's good to know. I did not realize that. Okay, it makes sense.
- [34:56]
You should be able to give them your zip code and they kind of give you a list of folks in your zip code. That doesn't mean though that when you call all those people that somebody will say they have an opening and are available and all of that. So still tricky. But a nice tool that I like is the association for Cognitive and Behavioral Therapies or abct. They have a wonderful website with a great search tool where you can put in your zip code and find a provider. And that's a great way to ensure the person you're finding specializes in cbt because like we said earlier, we really want to make sure our kids are getting evidence based treatments. So that's a really good resource to know too.
- [35:42]
Looking at your insurance list will give you the names of providers. But this app, it's called the Maya app. Is it part of New York Presbyterian? Says New York Presbyterian.
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Yeah. The Maya app was developed by New York Presbyterian and Weill Cornell and it is a CBT based skills. So you can download it, it's available in the app Store and it's a way that people can access CBT skills, promote wellness. So that's a great option to learn about CBT too and actually see some of these skills in action.
- [36:16]
Would that provide list of providers in.
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New York that's more of a CBT skills based app, so you can learn about cognitive restructuring or learn about exposure. And it kind of walks you through in a really interactive way how to apply them. It's more of a. A wellness tool.
- [36:38]
Oh, that's great. Now can you. Is that for parents only or can kids also use that?
- [36:42]
It's more targeted for adults or young adults. Okay. But it would be great if we could develop kid version too.
- [36:49]
I was just thinking that maybe this. Corinne, this could. Because I think if kids were having. Kids are so used to doing quizlets and all these practice things that if they can practice different scenarios like birthday party, the dog thing, or whatever they are. There's a monster under my bed. That might not be such a bad idea. But the option or the, the resource that you mentioned where you put in.
- [37:14]
Your zip code, that's the association for Behavioral and Cognitive Therapies, or A T National or Organization of CBT providers. So there's a directory where you can, you know, put in your zip code and see who specializes in CBT in your area. And that.
- [37:34]
Oh, that is excellent. Okay. And I, I have read that there is. And I know that this is something, or I think this is something that you do a lot of work in and specialize in, but something called integrated care is becoming more popular and more accessible for patients. Will you talk a little bit about that?
- [37:53]
Sure. Yes. Given all of this difficulty that we're talking about in accessing mental health care and the workforce shortages at Weill Cornell, we've realized we need to. In order to meet the needs of this new mental health crisis. So our Behavioral Health Integration and Innovation program is working to embed mental health specialists into all settings where kids come for care. So that's the pediatrician's office, the subspecialist office, like The GI doctor or the neurologist, even our inpatient medical units. So wherever a child is coming in, we have a mental health specialist integrated right into that setting to provide some of these behavioral health support right alongside.
- [38:41]
Their medical care and also probably with diagnosis. Right. Like let's say you're going in to see it, you have a stomachache, right? Persistent stomachache. I mean that could be something where that stomach ache could be an anxiety symptom. Right? That, so you're, and, and, and how does it work? So I know New York Presbyterian has this program. Other hospitals or larger healthcare networks may have them too. Is it that you then go in, the doctor will say, you know what, we think there, there might be more here in addition to just a, a physical health issue. Can you take a look? And then you would go in and kind of do a assessment.
- [39:19]
Exactly. That's exactly how it works. The, the GI doctor might say, you know, we've done some initial workup and it's unremarkable, but you're having this pain. It also seems like you're, you know, dealing with some anxiety. We have a psychologist who is, you know, right down the hall or right next door. I'm going to bring them in and they're going to ask you some more questions and give you some strategies or some tools that you can use. So sometimes we're able to see kids right in their exact medical appointment, right alongside the GI doctor in this One Stop shop. Sometimes they're referred to us and they see us for a separate visit, but still in that same location where they're used to seeing their medical doctor. So it's comfortable, it's familiar. And then we have a lot of close collaboration with the physicians so we can give them feedback on diagnostic impressions and recommendations for treatment plan. And so it's very collaborative, very integrated and families really like it because they don't have to go somewhere else to get that. It's right there where they're being seen. It's efficient, it's immediate, they can get access right away. They don't have to get sent somewhere where there's a six month wait list which no longer becomes helpful.
- [40:34]
There's one that's oftentimes parents just have one question, right? It might just be one or two questions or child wants to ask something and as you said, instead of waiting six months to have a mental health assessment, to have that, that available right then and there. And in some cases you might even be able to give some very straightforward tools in one session or if it Requires follow up. You're already in that system and not having to wait and do those additional follow ups and assessments.
- [41:05]
Right? Exactly. When we can see kids early and quickly, we catch things sooner. It prevents them from escalating and then you're right, maybe they only need two, three visits instead of down the line, a whole evaluation and more intensive psychiatric treatment. So it's, in some ways it's actually a preventative model, but we can kind of identify these problems right away. And like I said, kids feel comfortable there. Parents feel comfortable in their pediatrician's office. These are probably places where they've been going since their children were babies. It's not foreign, unfamiliar. GARY PLAYS they trust their pediatricians or they trust their specialists. So they really, there's a lot of buy in when their medical doctor is saying, hey, this is something that would be helpful. And I think overall, more conceptually, it really puts the mental health priority right alongside the medical health or physical health. So that's always our goal, is to make mental health and physical health on par. And when we have mental health specialists working alongside our physicians, we have this kind of united team.
- [42:26]
Well, that's what I was going to say. There's, that's really, well where healthcare is headed. It seems there's so much more awareness around mental health and people understand the importance and the scientific reality of the mind, body connection. Right. So if the integrated health approach is really taking that head on. Right. And providing healthcare that way by let's, let's treat the physical part or the physical, physical health and at the same time, let's look and see if we need to treat some aspects of your mental health. Because it all sort of, sort of goes together. Right.
- [43:00]
It goes hand in hand. And we're also helping the physicians to start feeling comfortable assessing for these things. So, for example, in our endocrinology clinic, our endocrinologists now screen for depression in all of their adolescents with diabetes, because we know there's a huge risk of depression in that group. So part of us being there is shifting the culture and having them become more and more comfortable of doing some of this on their own and changing their practices, which is a really exciting thing to see too.
- [43:31]
And I think too, there'd be some economic benefits probably for people, right. Having this care, you know, accessible simultaneously with their other care. Right. You know, it would be cutting back on the number of visits.
- [43:45]
Absolutely, yeah. It's ultimately a cost savings approach for medical systems because we can divert a lot of the costly, expensive things that can happen, like ER visits, those are very expensive for the system and not to mention unpleasant for families. So if we have a mental health provider there in that visit, that can help make sure a child is safe, safe, they can avoid having to go to the er. There's also really compelling evidence and research that shows that psychology services for children with a whole range of medical conditions, like diabetes, for example, actually improves their physical health outcomes. So by having mental health services or, you know, psychological services embedded into their care, their diabetes actually gets better or their adherence to their epilepsy medication improves. So there's a lot of interesting downstream effects, too, that we're paying attention to.
- [44:50]
Oh, that is really interesting. You know, I. I interviewed Dr. Sally Prar, who's the head of. Of pediatrics at Kamansky at Cornell, and one of the questions I asked her is sort of, you know, how often should parents be taking their children to see specialists like, you know, the eye doctor, the ear doctor? And we did talk about the mental health provider. Whether it's separate or ideally, with what you're describing, whether it's integrated, just to have that, that check in is so important because you're treating the whole. You're really then treating the whole child. Okay. So for parents who've heard about anxiety, depression, we talked about adhd, some behavioral issues, and they want to learn more or read up on some of these things and just to see if they want to take a next step or see about other ways they can support their. Their children. Books, websites. You mentioned this ABCT search tool.
- [45:45]
Yep. And the ABCT website has a lot of. A lot of great information on cognitive behavioral therapy and its applications to a variety of different psychiatric concerns. So I would definitely direct families there to learn more about cbt.
- [46:01]
You can just Google abct.
- [46:03]
Yep. And it'll come right up. The association for Behavioral and Cognitive Therapies.
- [46:07]
Okay, what else? What else? Any books? Any other websites? I love this. This Maya app.
- [46:13]
Definitely go download the Maya app. And the New York Presbyterian center for Youth Mental Health website also has a plethora of information that's a great place to go that lays out more around this discussion of when should I seek a provider? How do I find a therapist who's a good fit? What does that process look like? How do I talk to my child about that process? So that's a fantastic resource as well. And then in terms of books, too, that I often recommend are Dr. Ann Marie Albano's book called you and your Anxious Child. And in terms of kind of more the ADHD side There's a book called Taking Charge of ADHD by Russell Barkley. And these are both guides for parents, written in very understandable terms, but they're from evidence based information. So I think that is so important and so key that parents are getting good info. So those are two that I recommend. And then I also love children's books too, to start infusing this into how we're talking to even young children about wellbeing and emotion. There's a really cute book called In My Heart that talks about all the whole range of emotions. A picture book. So that's a nice one too, to even start thinking about it at that age.
- [47:33]
Well, I think just having that open communication with your kids about the importance of talking about how you feel and what's happening with you to the extent that a teenager will, will talk to you, I think is, you know, just, it's great. As you said, let's start early and keep those lines of communication so that your child does come to you if they're really worried about something or they're really sad about something. And then you can, you know, look up all these great resources and tools that you told us about or go visit, you know, New York Presbyterian or another medical provider or network that has the integrated approach because that's, that's such a great way to address a whole host of concerns.
- [48:17]
Yeah, we're really excited about this initiative and really see it as an innovative way to address this youth mental health crisis that is ongoing. And we, I know all parents are so concerned about their youth. So it's really a priority for our institute to find a way to meet this need.
- [48:40]
Dr. Cataruzzoli, thank you so much for joining. I love. This is my first zoom. I've done some Riverside ones, but first zoom. And I think our conversation was great. I hope our sound is great.
- [48:51]
We'll thank you so much. This was so lovely to speak about this topic.
- [48:57]
Well, thank you so much for taking the time for being on. I really appreciate it. It was great. Thank you so much.
- [49:05]
Leslie Heaney
That brings us to the end of this episode of the interview. A huge thank you again to Dr. Cataruzzoli for joining us. And as always, thank you again for listening. If you enjoy the show, please rate and review us on Apple Podcasts and follow us on Instagram at the interview with Leslie Heaney. A new podcast is released every Wednesday, and until then, this is Leslie. And don't forget to join the interview.