Pediatric Meltdown

https://302.buzz/PM-WhatAreYourThoughts

"You have been assigned this mountain so you can show others how it can be moved" Mel Robbins. In this podcast, Dr. Lia Gaggino discusses her experience with children's mental health and emotional wellbeing. She shares the reason why she has been so interested in this field, and that childhood experiences can shape who you become as an adult. She also discusses the importance of seeking help and how therapy can be a gift. Dr. Lia explains why there should be no shame in seeking medication if it is necessary to help improve a child's mental health. Pay close attention since she will be sharing interesting ways to cultivate self-help. Listen and enjoy!

Key Highlights:

[00:01 - 03:34] Opening Segment

Why Lia became interested in the children's mental health field

The importance of children's mental health and emotional wellbeing

The benefits of therapy and medication for those who need it.

[03:35 - 09:23] Why Kid's Mental Health Means So Much to Me

How medication can be a game changer for those with mental health issues

Ways to connect with others and cultivate self-help

Lia recommends books, podcasts, movies and music

Seven things Bessel van der Kolk shares in The Body Keeps The Score

[09:24 - 13:06] Closing Segment

How to best take care of yourself

Resources Mentioned:

Podcast: Happier by Gretchen Rubin, Unlocking Us by Brene Brown

Books: Theophilus North by Thornton Wilder, The Language of Flowers by Vanessa Diffenbaugh. Anything by Alice Hoffman and Brene Brown.

Film: Lars and The Real Girl - WATCH THIS ONE

Music: Fleetwood Mac Rumors, Moonlight Sonata, pop music, Maroon 5, Pachabel's Canon

Key Quotes:

"Childhood shapes you and you rise above or you struggle." - Lia Gaggino

"Mental illness does not limit you, but it is important to seek help." - Lia Gaggino

"We're really good at meeting other people's expectations, but not always our own." - Lia Gaggino

THANK YOU FOR YOUR SUPPORT!

Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.

If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter or email me at [email protected] or [email protected]. To learn more about me visit https://www.medicalbhs.com/

LOVE WHAT YOU...

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Even though the situation that we are facing with the youth mental health crisis right now is daunting, there is such an opportunity for creativity and innovation and with the kind of clinicians that we interview today, there is such an opportunity to really write a new plan. Dr. Lois Lee and Dr. Ben Biermann discuss how primary care settings are seeing an increase in children coming in with suicidal thoughts or attempts. They emphasize the importance of partnerships between providers and discuss ways to advocate for funding for expanded mental health care. They also talk about early intervention services, community-based mental health programs, and school-based mental health services.

Dr. Lois Lee’s work focuses on pediatric emergency medicine, health disparities, injuries, and health policy. This is grounded in her clinical work as a pediatric emergency medicine physician at Boston Children’s Hospital and Associate Professor of Pediatrics and Emergency Medicine at Harvard Medical School. At Boston Children’s Hospital, she is the Associate Program Director for Public Policy at the new Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.

Dr. Biermann is a child and adolescent psychiatrist on faculty at the University of Michigan Medical School.  His clinical work focuses mainly on hospital-based care:  psychiatric emergency services, psychiatric inpatient, consultation/liaison, and ECT treatments. Dr. Biermann’s clinical and scholarly focus has been on adolescents with mood disorders and disruptive behaviors, treatment-resistant depression, and youth in crisis.  He also has an interest in substance use disorders and dual diagnosis. 

Key Highlights: 

[00:01 - 08:41] Open Segment

Dr. Lois and Dr. Ben share their background and work

The increase in the boarding of mental health patients

Mental health crises are not a COVID induced problem

[08:41 - 18:22]  Risk Assessments And Safety Planning With The Child First

Pediatrician's perspective on the current state of emergency rooms and children who are seeking care

How child psychiatry can be helpful to know if a  child should be admitted or not to the hospital

Social work helps to ensure that mental health is a part of the patient's care

[18:23 - 28:24] How We Can Better Serve Our Kids

Why emergency room doctors should assess a child's risk for suicide

Doctors should consider if kids need to be medically cleared before admitting them

How to provide more equitable care for all children

[28:25 - 38:02] Ensure Patients Receive The Best Possible Care

The potential of telehealth in psychiatry

The importance of investing in psychiatry workforce development

There is a need for more mental health professionals due to the increasing population

Engaging patients in a standardized way can help connect them to treatment

 [38:03 - 51:50] Mental Health Is A National Crisis

Why the integrated behavioral health care can be helpful 

More collaboration and coordination are needed to address the youth mental health crisis

What can help improve access to care and funding for mental health initiatives

[51:51 - 1:00:24] Final Takeaways

• Our kids are not doing well emotionally
• Access to mental health care is in short supply
• Suicide remains the second leading cause of death in youth
• The emergency rooms are overrun with kids waiting, boarding for help
• The pandemic magnified the mental health crisis
• For underserved minoritized and poor youth, the access to services is even more...

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ADHD is a label, it's a name of a category of behaviors that we want to look at and potentially see how can we change the environment to make a kid the most successful as possible. In today’s episode, our guest is Colleen Cullinan, Ph.D., a pediatric psychologist at Nemours/Alfred I. DuPont Hospital for Children in Wilmington Delaware. She specializes in integrated primary care within the Division of Behavioral Health. Dr. Cullinan completed her Ph.D. in Clinical Psychology at Western Michigan University in 2015. Dr. Cullinan supervises psychology externs and interns, and she directs medical education efforts for Nemours’ residency training programs. Her presentation and publication records center around integrated care, family-based interventions, and experiential cultural humility training. 

If you want to gain a deeper understanding of the strategies for boosting executive function, this episode is for you!

Key Highlights:

 [00:01 - 11:13] Open Segment

An overview of ADHA management

Having conversations with families about the types of ADHA

The executive functioning in kids and adults

Why setting families expectations is a critical part of ADHD management

[11:14 - 22:42]  The Journey of Starting to Manage A Chronic Neuro-Biological Condition

Dr. Colleen’s outlook on children having trouble at school

Why the Vanderbilt can be helpful

You need the time to do a good job to gather information

[22:43 - 33:47] Kids with ADHD Need a Lot of Practice

What happens when the medication therapies are not working

How executive function coaching looks like

Why internal speech is important and complex

Kids need more training in nonverbal cues

[33:48 - 45:49] Executive Functions That Are Underdeveloped

Incentive systems do work, but sometimes we are trying to incentivize the wrong thing

Talk about hindsight, foresight, and insight

How the sense of time is perceived by kids vs adults

[45:50 - 57:07] Working Memory vs Multitasking

The executive function of working memory

Dr. Colleen's insights about multitasking being a fantasy

Always think about the kid and their family

[57:08 - 1:11:44] Final Takeaways

• Start with conceptualizing the diagnosis when talking to parents
• Take a good history, a really good history
• Throw away the label and really look at the executive function
• Start with psycho-education for families and patients
• Lay out the deficits of ADHD
• For kids with ADHD, the impact of those executive functional skills deficits may set them back two to three years
• Lay out building the parent's skills of expectation, setting realistic goals
• Let's talk about some of the specific deficits
• Internal speech
• Hindsight, foresight, and insight
• Cents of time
• Working memory 
• Explain to families that ADHD is highly genetic and that there are often ADHD families
• Future teaching and predicting setting expectations and what that can look like
• Set the tone with the families
• Lay out that intervention and management will be an experiment

Resources Mentioned:

• Driven To Distraction - Ned Hallowell

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Apraxia is a disorder that affects language development. It is most commonly seen in children between two and seven years old, but it can also occur at any point during development. In this episode, Dr. Sheryl Rosin, Ph.D. discloses the symptoms of apraxia speech and the importance of visiting a specialist for an evaluation if you believe that your child may have it. During the evaluation, your child's receptive and expressive language skills will be assessed to determine if there is a problem with that area of development. If there is a problem, therapies may be recommended to help your child improve their speech. Let’s dig into the childhood apraxia!

Dr. Sheryl Rosin is a speech-language pathologist, professor, and certified autism specialist with 25 years of experience in the field. She has presented around the world and has been published in research journals on best practices in assessment and intervention for individuals with ASD. She is the owner and director of Palm Beach Speech-Language Specialists in south Florida and the Founder and Consulting Director of The St. Kitts Spectrum Services Centre in St. Kitts, the first autism clinic in the Caribbean. Dr. Rosin was the recipient of the 2017 Louis M. DiCarlo Award for Clinical Achievement from the American Speech-Language-Hearing Association.

Key Highlights:

 [00:01 - 09:27] Open Segment

An overview of apraxia speech

The difference between apraxia in adults and children

A referral to a professional for further evaluation is always beneficial in determining if apraxia is present

[09:28 - 22:46]  Referring A Child  For An Assessment

Have an honest and open conversation with parents when referring the child for an assessment

Things pediatricians might see when referring a child for an assessment of a speech or language disorder

Different ways apraxia can be diagnosed 

[22:47 - 32:53] Therapy Involves Building Up Vocabulary and Fluency

Speech therapy for children with apraxia and dislocates

It is more typical for individuals to have typical disfluency than stuttering

Why singing can be a great way for disfluent individuals to improve their communication skills

[32:54 - 44:17] It's Always Okay to Check Out A Child's Development 

The difference between stuttering and apraxia

When pediatricians should refer children for speech and language evaluation

Pediatricians shouldn’t wait too long to refer a child for evaluation to offer hope to parents

The importance of following up on any concerns or suspicions that may arise after a good visit

[44:18 - 50:53] Final Takeaways

• When children are not meeting developmental milestones for receptive or expressive language, check it out.
• Childhood apraxia is a speech disorder of motor coordination and planning
• Apraxia may look like groping or searching to get sound out
• Because this is a motor coordination and planning disorder, there may be associated fine motor and gross motor delays as well
• The differential includes brain trauma and injury
• Refer for an evaluation when you're concerned, there is no time to waste
• It helps the speech therapist for us to set the state of what some of these possibilities might be
• The evaluation with the therapist, especially with these young kids is to play really smart play
• Therapy for apraxia looks like learning a sport and building motor memory
• Moving on to stuttering and stutter like
• Stuttering can be a lifelong disorder
• Trust your expertise to know what feels like a typical development
• When in doubt, check it...

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Domestic violence is a pattern of abusive behavior in which one partner repeatedly uses physical force or threats of violence against the other partner. It can take many forms, including physical, sexual, emotional, and economic abuse. Domestic violence affects everyone, no matter what age or size, and it is an important topic we should cover, however, it might be triggering for some people. If you're worried that someone you know may be experiencing domestic violence, it's important to talk to them about it.  In today’s episode, our guest Dr. Claudia B. Fenderson, EdD shares with us relevant information about the resources available to help victims get out of abusive relationships and discloses why professionals like pediatricians can play an important role in identifying and providing resources to children and families affected by domestic violence. 

Dr. Claudia B. Fenderson has served as the Director/Chair of the Doctor of Physical Therapy Program at Marist College until her retirement this past year. She has a BS in Physical Therapy from Columbia University; an MS in Physical Therapy from Long Island University and an EdD in Child and Youth Studies from Nova Southeastern University. Her career spans more than 45 years and the majority of her experience has been in the areas of education and neurologic rehabilitation, primarily in infants and preschoolers with developmental delays and disabilities. 

Key Highlights: 

[00:01 - 09:31] Open Segment 

How Dr. Claudia got interested in domestic violence

Violence can be classified into four types: physical, sexual, psychological, and economic

Domestic violence can involve any type of abuse, from physical to emotional to financial, and can happen to anyone

[09:32 - 20:07] Have Conversations About Healthy Relationships with All of Your Patients

There are warning signs that should be observed in order to identify domestic violence

It is important for professionals to ask about domestic violence when they are concerned for a child's wellbeing

How to identify a controlling relationship, and offer resources to teens who are in a difficult relationship

[20:08 - 33:28] Provide Resources and Support to Victims

During Covid was difficult to identify people who were experiencing domestic violence

Health care professionals should be aware of risks and be prepared to help victims in difficult situations

Domestic violence is a problem that affects both men and women, but it is especially an issue for women

Healthcare providers should be aware of the signs and symptoms of domestic violence

[33:29 - 41:45] Help Patients Feel Less Alone 

By asking questions, clinicians can help prevent harm to patients and children

Offering resources and help to adult victims of domestic violence is essential

Adults need to know that they are not alone and that they can come to talk to us if they need help

[41:46 - 44:38] Final Takeaways

• All professionals who care for kids have an opportunity to ask about domestic violence and safety
• Domestic violence and intimate partner violence is all about control
• We often consider physical abuse, but we need to think about emotional abuse
• Domestic violence is common with estimates that one-third of men and women have been in a domestic violence situation and that 15% of children may have witnessed domestic violence
• Domestic violence is a public health concern
• Teens who have witnessed domestic violence may believe that violence is an acceptable way to deal with conflict
• Ask universally about domestic violence and intimate...

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We know that change is hard and it takes a lot of hard work, but we want to remind you that it's okay to take small steps in the right direction. If you're feeling stuck or frustrated with your current path, remember that it's okay to be patient and to start small! In this episode, Dr. Jutte shares his journey as a pediatrician, and why he has focused on community-based interventions to address social determinants of health. He also discusses the importance of poverty and how it impacts health disparities in our population. Pay close attention since we have a deep conversation on how pediatricians can raise awareness and connect with their patients to make a difference. His mission is to increase thoughtful investments into low-income communities in order to revitalize them and support the well-being and health of these neighborhoods.  We need your help. We need your voice. We need you to get involved. Let’s dig into Neighborhood Transformation: Changing the Zipcode Impact!

Douglas Jutte, MD, MPH is Executive Director of the Build Healthy Places Network, a national organization with the mission to transform the way organizations work together across the health, community development, and finance sectors to more effectively reduce poverty, advance racial equity, and improve health in neighborhoods across the United States.

Key Highlights:

 [00:01 - 10:52] Open Segment

Dr. Jutte shares his background and work experience

The reason why pediatrics is one of his favorite specialties

How Dr. Jutte went from a primary care pediatrician to the executive director of Build Healthy Places Network

How pediatricians can work with other professionals to improve the health of their patients

[10:53 - 19:41] The Importance of Community Engagement

The importance of revitalizing low-income communities

Why having community engagement is key to addressing health disparities

What the social determinants of health are and why they need to be interconnected to improve individual health

The key components of thriving communities

[19:42 - 28:33] The Community Development Sector

How the Obama administration helped revitalize neighborhoods that may be experiencing gentrification

There is a lot of money available for various purposes, but it is not legislated or part of the regular budget

[28:34 - 38:44] Pediatricians and Healthcare Providers Are Essential Players

How for-profit affordable housing developers use federal affordable housing tax credits to make projects more affordable for low-income families

Methods community development centers use to help low-income residents

The role of Community Development Corporations (CDCs) in affordable housing

Why the government can’t just give money to non-profits directly

[38:45 - 48:48] We Underestimate The Power of our Doctor Title

Pediatricians need to be aware of and engaged with the issues surrounding community development

Pediatricians have a lot of power to advocate for their community and can help develop policies that support health

Why work as a pediatrician has the potential to have long-term impacts on children's health

[48:49 - 58:32] Final Takeaways

• The path to your passion is not linear
• Zipcode has more implications on health outcomes for children than genetic code
• Lifting out of poverty is not just about lifting an individual or their family, but about lifting the neighborhood
• When looking at heat maps for poverty and obesity, there is a perfect overlap with poor neighborhoods
• The mission of Build Healthy Places Network is to transform...

https://302.buzz/PM-WhatAreYourThoughts

Trigger warning: suicide

Dr. Lois Lee’s work focuses on pediatric emergency medicine, health disparities, injuries, and health policy. This is grounded in her clinical work as a pediatric emergency medicine physician at Boston Children’s Hospital and Associate Professor of Pediatrics and Emergency Medicine at Harvard Medical School. At Boston Children’s Hospital, she is the Associate Program Director for Public Policy at the new Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.

Eric Fleegler, MD MPH is a pediatric emergency physician and health services researcher at Boston Children’s Hospital and Assistant Professor of Pediatrics and Emergency Medicine at Harvard Medical School. He was a political science major at Brown University, received his MD from the University of Pennsylvania School of Medicine and his MPH from the Harvard School of Public Health. His clinical work includes attending to the emergency department as well as director of the sedation service at Boston Children’s.

[00:01] Opening Segment

• Eric and Lois share their to the pediatrics space
• Why they are focused on injury prevention?

[08:25] A Pediatrician’s Role in Firearm Injury Prevention

• How enormous is the firearm injury problem in the United States?
• Eric shares some important stats
• The importance of limiting gun access to kids
• The role of pediatricians and other healthcare professionals in preventing firearm injuries
• Lois explains

[18:01] Safe Storage of Firearms

• Lois talks about an interesting study about gun access among kids
• How pediatricians should talk to families about storing firearms in the home
• Listen to Eric and Lois
• Where firearms can be stored if there is a child with a mental health issue in the home

[28:24] The Right Approach to Talk About Firearms With Families

• Conversations about firearms are different from other common patient conversations
• Here’s why
• Storytelling is a great approach to forwarding advocacies on firearm injury prevention
• Legislations and regulations around the country are varied regarding firearm injury  prevention
• Eric tells us how this is affecting children’s safety from firearms

[39:24] Institutional Changes to Prevent Firearm Injuries and Death

• Connecting with government officials about firearm injury prevention
• Gun manufacturers cannot be sued for any injury or death
• Here’s what we can do
• Institutional changes are key to firearm injury prevention
• Lois explains

[48:10] How to Start Your Advocacy on Firearm Injury Prevention

• The severity of firearm-related deaths according to Lois
• Lois and Eric have messages for their younger selves
• Listen to their messages too!
• The role of the local chapters of the American Academy of Pediatrics

[55:54] Final Takeaways

• Conversations about firearm injury prevention are painful and frustrating
• Stats to consider in relation to firearm-related injuries and deaths
• Children of color are at a higher risk of injuries and death from firearms
• Suicide and firearm-related injuries and death
• Access to firearms among children in the home
• The parents keeping their children safe and the children’s curiosity about firearms
• The role of pediatricians in preventing injuries and death from firearms
• Mental health and access to firearms among children
• Alternatives to keep the children safe...

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Dr. Sanjeev Arora is the founder and executive director of Project ECHO. He is also a distinguished professor of medicine with tenure at the University of New Mexico’s Health Sciences Center. 

Previously, he served as executive vice chair and acting chair of the Department of Internal Medicine and president of the medical staff. He also served on the UNM Health Sciences Center board for five years. Dr. Arora has also served as president of the University Physicians Association.

Born in Nangal, India, Dr. Arora was raised in a household of physicians which gave him a strong sense of responsibility to give back to his community from an early age. In 1980, he moved to New York and, later, Boston to study medicine and become a gastroenterologist.

In 2003, he founded Project ECHO to ensure more people had access to best-practice care for hepatitis C. Today, the ECHO model is being used in nearly every country to solve the world’s greatest challenges in health care, education, and journalism, and more.

[00:01] Opening Segment

• Dr. Sanjeev Arora shares his journey that started in his home country of India
• He talks about the origins of Project ECHO

[07:36] The Four Key Principles of Project ECHO

• The four key principles of the ECHO model
• What does Sanjeev mean by “democratizing knowledge?”
• Child psychiatry is one of the most underserved spaces in healthcare
• How can this be solved?

[17:57] How to Scale the ECHO Model 

• Sanjeev talks about what should be the foundation of offering service
• He shares some strategies to scale Project ECHO to other diseases
• This is the way that Sanjeev and his team measure the outcomes of the ECHO model

[27:53] The Future of Project ECHO

• Sanjeev gives his outlook for the future of the ECHO model
• He shares an inspiring thought on the reality about happiness
• Disease prevention and healthcare education are only two of their priorities
• Here’s why they’re promoting these advocacies

[36:50] Final takeaways

• A simple idea can move mountains
• What it takes to take healthcare to the next level
• The four key components of the ECHO model
• Project ECHO has been participated by millions around the world
• The strategy used by the Project ECHO
• Learning by doing
• The benefits of the ECHO model
• Love and compassion as embodied in the ECHO model
• The American Academy of Pediatrics serves as a learning hub for the ECHO model
• The only way people can be happy

Key Quotes:

“If an expert, a specialist in a university, just shares their knowledge with primary care doctors [and] in rural areas, good things will happen.” - Dr. Sanjeev Arora

“The only way a human being can be really happy is by living a life of service.” - Dr. Sanjeev Arora

Email Sanjeev at [email protected] and visit https://hsc.unm.edu/echo/ to know more about Project ECHO.

THANK YOU FOR YOUR SUPPORT!

Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.  

If you’d like to connect with me, you can find me on LinkedIn, Facebook,

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Dr. Lisa Lowery is a native of Grand Rapids and a graduate of Ottawa Hills High School.  She attended Michigan State University receiving her Bachelor of Science Degree in Microbiology, with Honors. Her research during her fellowship concentrated on sexually transmitted diseases and reproductive health.  While at the Johns Hopkins, she obtained a Master of Public Health in the Department of Population and Family Health Sciences with a Certificate of Concentration in Maternal and Child Health.

Currently, Dr. Lowery is an Adolescent Medicine specialist at Helen DeVos Children’s Hospital-Spectrum Health Medical Group.   She has been on faculty since July 2004.  Dr. Lowery also serves as Adolescent Medicine Section Chief and an Associate Program Director for the Combined Internal Medicine/Pediatrics Residency Program Michigan State University/Grand Rapids Campus. 

She is the president of West Michigan Medical Society/National Medical Association and serves on the Grand Rapids Urban League Board of Directors and the Michigan Eating Disorders Alliance Board.  In the summer of 2018, started serving on the Cherry Health Foundation Board and the Kent County Community Health Advisory Committee.

[00:01] Opening Segment

• What’s been happening in Dr. Lisa Lowery’s career?
• She gives an update
• Lisa talks about their monthly series on diversity, equity, and inclusion

[07:01] Breaking Down Structural Racism

• The next generation of physicians should have these qualities
• Listen to Lisa
• The impacts of the pandemic to the healthcare sector according to Lisa
• Lisa talks about structural racism and why it matters in the healthcare sector

[17:48] Dealing With Oppression and Discrimination

• Oppression and discrimination look different among teenagers
• Lisa explains
• The importance of making appointment-setting easy for teenage patients
• What does being an “emotional container” mean?

[27:58] Being Vulnerable With Patients

• Lisa shares a humbling moment she experienced as a medical practitioner
• It is all right for physicians to be vulnerable with their patients
• Lisa tells us why
• The right way to communicate with a patient according to Lisa

[37:24] Learning About Bystander Interventions

• Lisa reveals a secret about how she talks with her patients
• The benefits of conducting Bystander Intervention Workshops
• Recognizing privilege that people of color don’t have

[47:57] Making a Difference in the Healthcare Sector

• How physicians can lend their voices to promote diversity, equity, and inclusion
• Lisa’s reminder for physicians who want to make a difference in their workspaces
• Here’s Lisa’s message for her younger self that you don’t want to miss

 [56:29] Closing Segment  

• Final takeaways
• Everyone has racial biases
• Start with recognizing your own biases
• The uncomfortable feeling of being curious
• Addressing teenagers who are people of color and LGBTQIA+
• The importance of empathy
• Safety among children of our BIPOC brothers and sisters
• Questions that physicians should ask their young patients
• Why allyship is important
• When to intervene as a bystander
• Small changes can lead to radical shifts
• Fixing racism is not a minority’s responsibility
• Let’s all be lifelong learners

Key Quotes:

“...medicine is still a