The Mental Health Evolution

Rachel speaks with Joanne Frederick, founder and CEO of Government Market Strategies, about something most clinicians never see but feel every single day — the procurement decisions, ownership structures, and administrative design choices that determine who gets credentialed, who gets paid, and who gets left out.

Joanne has spent more than 30 years on the inside of the largest government healthcare programs in the country — Medicare, Medicaid, TRICARE, and Veterans Health — helping clients win contracts in excess of 25 billion dollars and watching the same patterns play out across every system she has worked in. Her perspective on the CAQH rebrand to DataSpring is not that of a worried clinician. It is that of someone who has seen this move before and knows exactly what it means when the entity governing a shared infrastructure becomes owned by the people who benefit most from controlling it.

The conversation covers the structural conflict of interest created by insurer ownership of the credentialing backbone, why credentialing delays are a revenue problem and a patient access problem as much as an administrative one, and what it would actually take to fix a system that Joanne argues was never designed to serve everyone equitably. She walks Rachel through the TRICARE reforms happening in 2026 and what they reveal about how large government healthcare programs modernize — and don't. And she ends with a call to action that is both practical and urgent: find the people with the courage to say this doesn't make sense anymore, and support them, because they are going to need all the help they can get.

This episode also includes a brief ad read for the Foundations of Trauma Therapy course at the Trauma Specialist Training Institute — an eight-week live remote training starting October 20th. Early bird pricing is available through October 6th. Group rates for teams of five or more are available by emailing [email protected] and mentioning the podcast.

Featured Training Foundations of Trauma Therapy — Trauma Specialist Training Institute https://www.traumaspecialiststraining.com/trainings/foundations-trauma-therapy

Resources Mentioned

Articles Referenced:

• CAQH Rebrands as DataSpring: Under Payer Ownership — Acuity News: https://acuity.news/regulation/caqh-rebrands-dataspring-payer-ownership-credentialing-2026/
• 5 Trends Shaping Payer Enrollment and Medical Credentialing in 2026 — Medallion: https://medallion.co/resources/blog/5-trends-shaping-payer-enrollment-and-medical-credentialing-in-2026
• These Changes to TRICARE Plans Are Taking Place in 2026 — Military.com: https://www.military.com/benefits/tricare/these-changes-tricare-plans-are-taking-place-2026.html
• 5 Things We Need To Do To Improve The US Healthcare System — Joanne Frederick, Authority Magazine: https://medium.com/authority-magazine/joanne-frederick-of-government-market-strategies-5-things-we-need-to-do-to-improve-the-us-0dc5ca52aa7a

Connect with Joanne Frederick:

• Government Market Strategies: https://marketstrategiesonline.com

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast
• Instagram: /thementalhealthevolution/
• LinkedIn: /the-mental-health-evolution
• Facebook: /TheMentalHealthEvolution

Music by Zach Harrison

Rachel speaks with Marcus Schmit, Executive Director of NAMI Minnesota, about what is actually happening on the ground as federal Medicaid funding cuts ripple through the mental health system — and why, despite everything, pessimism is not a strategy.

NAMI Minnesota has been a statewide leader in mental health advocacy, education, and peer support for decades. Marcus stepped into the Executive Director role as his state was navigating an extraordinary convergence of collective trauma — the pandemic, the murder of George Floyd, a school shooting, the assassination of a state legislator, and the sweeping immigration enforcement of Operation Metro Surge. The result was a 4,000 percent increase in NAMI Minnesota's social media engagement and helpline calls through the roof. What that moment revealed about the need for mental health information and community connection is now reshaping how NAMI Minnesota thinks about its work.

The conversation also digs into the policy crisis facing community mental health providers. The federal Medicaid funding freeze that stopped payments in their tracks is not a future threat — it is already affecting providers across Minnesota and the country. Marcus walks Rachel through what that means for the clinicians, crisis services, and peer support programs that depend on Medicaid reimbursement, and why peer support in particular — one of the most cost-effective tools in mental health care — is often the first thing cut when budgets tighten. He also shares what he believes the path forward looks like: a community-wide response to collective need, with employers, funders, sports teams, and neighbors stepping up together.

Resources Mentioned

Articles Referenced:

• Mental Health Providers Say Federal Medicaid Halt Will Lead to More Crisis — MPR News (February 2026): https://www.mprnews.org/episode/2026/02/26/mental-health-provider-federal-medicaid-halt-will-lead-to-more-crisis
• Medicaid Cuts Threaten Hundreds of Hospitals, New Report Finds — NBC News: https://www.nbcnews.com/health/health-news/medicaid-cuts-threaten-hundreds-hospitals-new-report-finds-rcna265789
• State Budget Fallout: Trump Health Funding Cuts — KFF Health News: https://kffhealthnews.org/news/article/state-budget-fallout-trump-health-funding-cuts-obbba/
• Medicaid and Social Services Under Pressure — KFF Health News: https://kffhealthnews.org/medicaid/medicaid-social-services-gavin-newsom-california-republican-criticism/

Connect with Marcus Schmit:

• NAMI Minnesota: https://namimn.org

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast
• Instagram: /thementalhealthevolution/
• LinkedIn: /the-mental-health-evolution
• Facebook: /TheMentalHealthEvolution

Music by Zach Harrison

This week's episode is something a little different. Recorded live at the 10-year anniversary celebration of Trauma Specialists of Maryland, this episode turns the tables on Rachel — instead of hosting, she is interviewed by two of her longtime friends and supporters from the Frederick community, Tom Lynch and Karlys Kline. Tom Lynch spent more than 45 years practicing law in Maryland, most recently with Miles and Stockbridge in Frederick, and has served as chair of the Community Foundation, Frederick Community College, and the Frederick Chamber of Commerce. By his own account, his most important role is supporting the work of his wife, Karlys. Karlys Kline is a community leader and philanthropist who founded the Women's Giving Circle and has served on the boards of more than 42 local nonprofits and businesses. Together they bring a community perspective to a conversation about what it means to build something meaningful in mental health care over ten years. The conversation covers how Trauma Specialists of Maryland grew from a single practice to seven locations, what Rachel has learned about building a team of clinicians who are genuinely committed to trauma work, and what the next chapter looks like. Tom also shares something personal about his own experience as a patient at Trauma Specialists — a candid and moving reflection on what seeking help looked like for him and what it made possible. It is one of the most powerful moments we have recorded on the podcast. Foundations of Trauma Therapy — Trauma Specialist Training Institute: Course starts: October 20, 2026 Format: Eight-week live remote training on Zoom Early bird pricing through: October 6, 2026 Group rates for teams of five or more: [email protected] More information: https://www.traumaspecialiststraining.com/trainings/foundations-trauma-therapy Connect with Trauma Specialists of Maryland: Website: https://www.traumaspecialiststraining.com Connect with The Mental Health Evolution: Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast Instagram: /thementalhealthevolution/ LinkedIn: /the-mental-health-evolution Facebook: /TheMentalHealthEvolution Music by Zach Harrison

Rachel speaks with Sara Bradley, Executive Director of York Day Early Learning in York, Pennsylvania, about a problem most people in the mental health field have never thought about — and that affects millions of the patients they see every day.

The American child care system was built around a standard workday. For the nearly 20 percent of workers who work nonstandard hours — overnight shift workers, first responders, healthcare workers, contract workers, and others — that system simply does not work. York Day is one of the very few organizations in the country trying to change that. Founded more than 90 years ago, York Day has spent the last six months piloting a 24-hour early learning program that meets families where they actually are rather than where the system assumed they would be.

Sara walks Rachel through what building that program has actually looked like — the surveys, the pivots, the assumptions that turned out to be wrong, and the ones that turned out to be right. What started as an attempt to run a clean second shift became a fully fluid 24-hour model because the community did not need a program with a clean start and stop — it needed one that could absorb the reality of shift work schedules. York Day is now 18 months into a pilot designed to produce a replicable blueprint that other organizations across the country can use.

The conversation also covers the behavioral health dimensions of child care access — the chronic stress, anxiety, and depression that parents experience when reliable care is unavailable, the six million children in the United States living with a parent with co-occurring substance use disorder and mental illness, and why for families in recovery, child care is not a peripheral issue but often a direct factor in whether a parent can sustain sobriety. For clinicians, the message is direct: the parents sitting across from you in your office are being shaped by forces that start well before they walk through your door.

Resources Mentioned

Articles Referenced:

• When Work Isn't 9-to-5, Child Care Can't Be Either — The 74 Million: https://www.the74million.org/zero2eight/when-work-isnt-9-to-5-child-care-cant-be-either/
• How Inaccessible Child Care Affects Families and Early Childhood Educators — University of Michigan School of Public Health: https://sph.umich.edu/pursuit/2025posts/how-inaccessible-childcare-affects-families-and-early-childhood-educators.html
• U.S. Children Living with a Parent with Substance Use Disorder — JAMA Pediatrics (2025): https://jamanetwork.com/journals/jamapediatrics/fullarticle/2833575

Connect with Sara Bradley:

• York Day Early Learning: https://www.yorkday.org

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast
• Instagram: /thementalhealthevolution/
• LinkedIn: /the-mental-health-evolution
• Facebook: /TheMentalHealthEvolution

Music by Zach Harrison

Rachel speaks with Shana Palmieri, Chief Clinical Officer and co-founder of XFERALL (pronounced Transfer-all) , a real-time patient transfer and care coordination platform that is replacing one of the most broken processes in behavioral health — the psychiatric placement referral. Shana spent years as the Director of Behavioral Health Services at George Washington University Hospital in Washington, D.C., where she watched something that would change the direction of her career. Patients in psychiatric crisis sitting in overwhelmed emergency departments for hours, sometimes days, while her team of highly trained clinical social workers spent the majority of their time making phone calls and sending faxes trying to find them a placement. She co-founded XFERALL to solve that problem directly. The platform works by replacing the fragmented, paper-based referral process with a real-time digital system. A clinician enters basic patient information, the platform geolocates available, clinically matched facilities across the continuum of care, and within seconds the clinician knows which facilities have a bed and can accept the patient. XFERALL's median response time across the platform is 15 seconds. One county in California cut its average psychiatric wait time from more than two hours to 17 minutes. The national average for psychiatric placement is seven to eight hours or more. The conversation also goes deep on AI — specifically where Shana believes it belongs in behavioral health and where it does not. She draws a clear line between using AI as an operational tool to reduce administrative burden, surface critical clinical information, and connect a fragmented system, versus using it to make clinical decisions or predict risk in ways that could strip patients of their rights. Her framework is one of the clearest articulations of responsible AI use in behavioral health we have heard on this show. Resources Mentioned: Articles Referenced: Children in a Mental Health Crisis Can Spend Days in the ER Waiting for Treatment — NPR (August 2025): https://www.npr.org/sections/shots-health-news/2025/08/15/nx-s1-5502689/pediatric-mental-health-er-boarding-jama-health-forum AI in the Mental Health Care Workforce Is Met with Fear, Pushback, and Enthusiasm — NPR (April 2026): https://www.npr.org/2026/04/07/nx-s1-5771707/mental-health-care-workforce-artificial-intelligence-ai XFERALL Expands Real-Time Patient Transfer Platform in Southern California — PR Newswire (February 2026): https://www.prnewswire.com/news-releases/xferall-officially-expands-real-time-patient-transfer-platform-in-southern-california-after-already-seeing-success-in-the-state-302689675.html Connect with Shana Palmieri: XFERALL: https://www.xferall.com Connect with The Mental Health Evolution: Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast Instagram: /thementalhealthevolution/ LinkedIn: /the-mental-health-evolution Facebook: /TheMentalHealthEvolution Music by Zach Harrison

Rachel speaks with Stephanie Slowly Little, Executive Director of NAMI Maryland, about the state of mental health care access in Maryland, the funding landscape facing nonprofit behavioral health organizations, and what it actually takes to keep showing up for communities when every turn is making it harder. NAMI Maryland represents over 60,000 advocates, people living with mental illness, and supporters across the state. Stephanie, a licensed clinical social worker and public health executive with more than 17 years of experience, stepped into the Executive Director role in October 2025 and immediately began navigating one of the most challenging funding and policy environments the behavioral health sector has seen in years. The conversation covers the urban and rural access divide in Maryland, why different reports tell different stories about how well the state is meeting mental health needs, and what telehealth can and cannot solve for communities where geography and provider shortages compound each other. The most striking part of the conversation is Stephanie's candid assessment of the funding landscape. Everybody is talking about mental health, she says, but nobody is funding it. Every facet of grant and fundraising is challenging right now — philanthropic, foundational, state, and federal. NAMI provides free programs to every person it serves, and yet the organization, like every affiliate across the country, is struggling. She also flags a federal Office of Management and Budget proposal that could give the federal government unilateral discretion to cancel nonprofit grants — a development every behavioral health organization needs to be watching. Despite all of it, Stephanie's message is clear: it is not in times of feast that we do our greatest work. Resources Mentioned: Articles Referenced: Mental Healthcare Gaps Persist in MD Rural, Urban Areas — NAMI Metro Baltimore: https://namibaltimore.org/mental-healthcare-gaps-persist-in-md-rural-urban-areas/ The Workforce Report: Bridging the Mental Health Care Gap — Maryland State Snapshot — Inseparable (March 2026): https://www.inseparable.us/wp-content/uploads/dlm_uploads/2026/03/Inseparable-2026WFDevReport-MD-1.pdf Barriers to Health Care for Rural Americans — Rural Minds: https://www.ruralminds.org/rural-minds-in-the-news/barriers-to-health-care-for-rural-americans Community Resources and Hazards Across the Rural-Urban Continuum — JAMA Network Open (April 2026): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847289 Additional Resource: OMB Proposed Changes to the Uniform Guidance (Federal Grant Rules) — National Council of Nonprofits: https://www.councilofnonprofits.org/trends-and-policy-issues/omb-uniform-guidance Connect with Stephanie Slowly Little: NAMI Maryland: https://namimd.org Connect with The Mental Health Evolution: Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast Instagram: /thementalhealthevolution/ LinkedIn: /the-mental-health-evolution Facebook: /TheMentalHealthEvolution Music by Zach Harrison

Rachel speaks with Dr. Nick Jacobson, associate professor of biomedical data science, psychiatry, and computer science at Dartmouth's Geisel School of Medicine and director of the AIM HIGH Laboratory, about the first clinical trial of a fully generative AI therapy chatbot — and what the results actually show.

The access crisis in mental health care is the starting point for understanding why Dr. Jacobson's team built Therabot. In the most well-resourced mental health settings in the United States, there are approximately 35 providers per 100,000 people. In any given year, roughly one in three people will experience a mental health disorder. That means 35 people trying to treat 33,000 — and that is the best case scenario. In low-resource settings and rural areas, the numbers are worse. The result is wait lists that stretch for months, people seeking care at 2am with nowhere to turn, and millions of people who simply go without.

Therabot was built over six years by a team of more than 100 people, involving over 100,000 hours of human effort, to deliver evidence-based therapy in a clinically rigorous way. The trial, published in NEJM AI, found significant reductions in symptoms of depression, anxiety, and eating disorders — with effect sizes that mirror what you would see in the best evidence-based trials of human-delivered psychotherapy. Participants also formed a genuine therapeutic alliance with the software, a finding that surprised even the research team. Dr. Jacobson walks Rachel through what that means clinically, how Therabot differs from general-purpose AI tools like ChatGPT, and how the team continuously stress-tests the system to identify and eliminate harmful responses before they reach users.

The conversation also covers the policy landscape — specifically a New Hampshire bill that Dr. Jacobson testified against, which he argues would regulate the wrong targets entirely. The bill would impose burdensome review requirements on clinically validated AI tools while leaving general-purpose chatbots — which have no crisis protocols, no outcome tracking, and no accountability — completely untouched. He and Rachel discuss what thoughtful AI regulation in mental health should actually look like, and what clinicians and practice owners should be thinking about as these tools become more widely available.

Resources Mentioned

Articles Referenced:

• Many People Now Trust AI with Their Feelings, and Therapists Want to Talk About It — WBUR (May 2026): https://www.wbur.org/news/2026/05/07/artificial-intelligence-therapy-mental-health-care
• Bill Doesn't Protect NH from AI Harm, It Assures It — Union Leader (January 2026): https://www.unionleader.com/opinion/op-eds/nicholas-c-jacobson-michael-v-heinz-bill-doesnt-protect-nh-from-ai-harm-it-assures/article_b2c5bdf4-aca7-413a-a218-35e6a09de06f.html
• First Therapy Chatbot Trial Yields Mental Health Benefits — Dartmouth News (March 2025): https://home.dartmouth.edu/news/2025/03/first-therapy-chatbot-trial-yields-mental-health-benefits

Connect with Dr. Nick Jacobson / Additional Resources:

• This Therapist Helped Clients Feel Better. It Was A.I. — New York Times (syndicated): https://onehealthsociety.com/this-therapist-helped-clients-feel-better-it-was-a-i/
• How to Build a Therapeutic Chatbot — Psychiatric News: https://psychiatryonline.org/doi/10.1176/appi.pn.2025.09.9.23
• AI, Neuroscience, and Data Are Fueling Personalized Mental Health Care — APA Monitor on Psychology: https://www.apa.org/monitor/2026/01-02/trends-personalized-mental-health-care
• Can 'AI Therapists' Help Save LGBTQ+ People? — Out Magazine: https://www.out.com/health/ai-therapy-for-queer-people
• AIM High Laboratory at Dartmouth: https://www.nicholasjacobson.com

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast
• Instagram: /thementalhealthevolution/
• LinkedIn: /the-mental-health-evolution
• Facebook: /TheMentalHealthEvolution

Music by Zach Harrison

Rachel speaks with Dr. Shairi Turner, Chief Health Officer at Crisis Text Line, a nonprofit that provides free, 24/7 text-based mental health support and crisis intervention through a community of trained volunteer counselors. In 2025, Crisis Text Line had more conversations than any year since its founding — over 1.5 million — and the data from those conversations tells a story that every clinician and practice owner needs to hear. Dr. Turner walks Rachel through how Crisis Text Line actually works: what happens from the moment someone texts HOME to 741741, how volunteer counselors are trained and supervised, and how the organization handles the rare cases — just one percent — where a conversation cannot be de-escalated. She also shares the founding story of Crisis Text Line, born from a moment when a young person reached out for help through a volunteer platform with nowhere else to turn. The conversation covers what the 2025 data reveals about who is reaching out — rural communities, young people, and boys under 14 reporting suicidal thoughts at striking rates — and ends with a direct call to action for clinicians: ask young men and boys how they are doing, and ask clearly. If you or someone you know needs support, text HOME to 741741 to connect with a live volunteer Crisis Counselor. Resources Mentioned: Articles Referenced: 988 Mental Health Help Lifeline Helps Five Million in First Year — NPR (July 2023): https://www.npr.org/sections/health-shots/2023/07/15/1187862144/988-mental-health-crisis-line-gets-5-million-calls-texts-and-chats-in-first-year Why Depression Goes Undetected in Teen Boys — NBC News (June 2024): https://www.nbcnews.com/health/health-news/depression-anxiety-teen-boys-diagnosis-undetected-rcna141649 Annual Trends 2025 — Crisis Text Line: https://www.crisistextline.org/annual-trends/ Additional resource - Crisis Text line Terms and Conditions: https://www.crisistextline.org/terms-of-service/ Connect with Dr. Shairi Turner: Crisis Text Line: https://www.crisistextline.org Text HOME to 741741 Connect with The Mental Health Evolution: Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast Instagram: /thementalhealthevolution/ LinkedIn: /the-mental-health-evolution Facebook: /TheMentalHealthEvolution Music by Zach Harrison

Rachel speaks with Dr. Elizabeth Carr, a clinical psychologist and the founder and CEO of Kentlands Psychotherapy in Gaithersburg, Maryland. Elizabeth leads a team of 20 doctoral and master's-level clinicians and has spent over two decades building a community-focused, financially sustainable practice through some of the most disruptive periods in the history of mental health care. A former Navy psychologist and sought-after speaker on practice management, she recently published a piece on strategic positioning during industry upheaval that is the centerpiece of this conversation.

The mental health practice landscape is shifting in ways that are affecting practices at every size — but not all in the same direction. Elizabeth describes what she calls the barbell effect: solo practitioners, particularly those operating fully virtual, are being squeezed out by venture capital-backed platforms with enormous marketing budgets and SEO dominance, while large practices that over-expanded during the COVID telehealth boom are now sitting on overhead they cannot fill. Mid-sized, community-rooted practices that stayed nimble are finding themselves in a stronger position — but only if their leaders are paying attention to what's actually happening in the market and willing to respond. Elizabeth and Rachel dig into what that looks like in practice: how to read referral data, when to pivot your service offerings, what AI can and cannot replace in clinical work, and why hyperlocal, in-person, relationship-based care may be the most durable competitive advantage a practice owner has right now.

Resources Mentioned

Articles Referenced:

• A Workforce Under Pressure: Preparing the Behavioral Health Workforce for Today and Tomorrow — National Council for Mental Wellbeing (2025): https://www.thenationalcouncil.org/behavioral-health-workforce-under-pressure-preparing-today-tomorrow/
• Telehealth and Hybrid Practice Are Here to Stay — APA Monitor on Psychology (2024): https://www.apa.org/monitor/2024/09/telehealth-hybrid-practice
• Strategic Positioning During Industry Upheaval — Dr. Elizabeth Carr, Kentlands Psychotherapy (January 2026): https://www.kentlandspsychotherapy.com/mental-health-professional/strategic-positioning-during-industry-upheaval/

Connect with Dr. Elizabeth Carr:

• Kentlands Psychotherapy: https://www.kentlandspsychotherapy.com

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast
• Instagram: /thementalhealthevolution/
• LinkedIn: /the-mental-health-evolution
• Facebook: /TheMentalHealthEvolution
• Music by Zach Harrison

Rachel speaks with Matthew Bergman, founding attorney of the Social Media Victims Law Center, about the landmark KGM verdict — the first social media addiction case in the United States to reach a jury. In March 2026, a Los Angeles jury found Meta and YouTube negligent in the design of their platforms and awarded $6 million in damages to a young woman whose mental health was seriously harmed by her use of Instagram and YouTube beginning at age six. Matthew has spent four years building the legal case that made this moment possible, and the theory at its center is straightforward: this was never about content. It was about a product engineered to be addictive — one that shows kids not what they want to see, but what they cannot look away from. The conversation covers Section 230 and how the product liability approach found a path around it, the eggshell plaintiff doctrine and why blaming the victim failed in court, and what the verdict actually changes for the thousands of similar cases still working through the courts. Matthew also speaks directly to clinicians: ask about social media. When you see anxiety, depression, eating disorders, or suicidality in young patients, social media needs to be part of the assessment. The youth mental health crisis started in 2012 — when content began being fed to kids algorithmically — and the research establishing a causal relationship has only grown stronger since. Resources Mentioned: Articles Referenced: Research Points to How Companies Could Make Social Media Less Addictive for Teens — NPR (March 2026): https://www.npr.org/2026/03/27/nx-s1-5763017/social-media-teens-addictive-design Jury Finds Meta and YouTube Negligent in Landmark Lawsuit on Social Media Safety — NBC News (March 2026): https://www.nbcnews.com/tech/tech-news/verdict-reached-landmark-social-media-addiction-trial-rcna263421 Social Media Addiction Lawsuit Update — Social Media Victims Law Center: https://socialmediavictims.org/social-media-lawsuits/ Connect with Matthew Bergman: Social Media Victims Law Center: https://socialmediavictims.org Connect with The Mental Health Evolution: Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast Instagram: /thementalhealthevolution/ LinkedIn: /the-mental-health-evolution Facebook: /TheMentalHealthEvolution Music by Zach Harrison