Taking Healthcare by Storm: Industry Insights with Dr. Robert Oliver

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Robert Oliver, Ed.D., Co-Founder and Senior Master Trainer of Education and Treatment Alternatives, Inc.

Dr. Oliver describes how his upbringing in poverty and supportive relationships led to a career in youth mental health and to co-founding Education and Treatment Alternatives to expand Aggression Replacement Training. He outlines when families should seek help, why Gen Z mental health challenges are rising, and the need for evidence-based, measurable, well-implemented mental health services in schools.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-032726-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality Insights. Today's guest is Dr. Robert Oliver, an educator, psychotherapist, author, and nationally recognized leader in youth mental health. With more than 40 years of experience working with children, adolescents, and families, Dr.

Oliver has dedicated his career to helping young people build the skills they need to manage emotions, resolve conflict, and thrive in school and in life. And we know with all the recent occurrences in the world that these skills are so very important right now. He is a principal and co-founder of Education and Treatment Alternatives, an organization that has trained thousands of practitioners across the country and internationally in evidence-based approaches, including aggression replacement training, his work bridges, education.

Mental health and family systems and is grounded in a deeply held belief that there are no throwaway children, only young people who need the right support at the right time. Today we'll be exploring why youth mental health challenges are so prevalent right now. And I'm gonna say not just youth, uh, adults, older adults, all of us, how the pandemic continues to affect adolescents and.

 what truly works in supporting kids and families. And then we're gonna be finishing on what bold changes could transform mental healthcare in the United States. As I said, it is so very needed right now. Dr. Oliver. Bob, thank you so very much for joining us today. Thanks for having me. So we're gonna just jump in.

You've had more than four decades of youth mental health and education experience. What moments or experiences most shaped your decision to dedicate your career to working with children and families? I was most influenced by my own experience of growing up in extreme poverty and all the adverse childhood experiences associated with that.

And more profoundly, I think I was influenced by the relationships that helped me navigate all the craziness of my youth.   And. How helpful people were throughout my childhood and adolescence that really built the resilience I needed to overcome some of the adverse experiences. Yeah, resilience is a really important thing that I think a lot of individuals kind of overlook as being important.

So for listeners who may not be familiar, what is education and treatment alternatives and what problem were you try trying to solve when it was created or when you became involved in it? Well, ETA was formed in 2002 with Mark Amandola, my business partner. Um, mark was the executive director of Percy's House at that time, and I was, in the Erie School District running the student assistance programs and was principal of alternative education and what we were looking for.

Something that would help us with these highly aggressive kids that we are working with.  And we happened to see an in-service in Pittsburgh with Dr. Arnold Goldstein from Syracuse University, who had created aggression replacement training as a cognitive behavioral approach for intervention with high risk ing.

After that, both of us implemented it in the programs we were running and started seeing some real success with it. We also then started a really in-depth relationship with Arne Goldstein, um, who kind of liked what we were doing and, and signed us on to help him with his trainings at that time.

And then in 2001, Arne got. Brain cancer. And in 2002, a week before, um, he actually died, he called us to Syracuse and asked us to carry on his work. And since then, mark and I have continued to train in a RT and constantly update the program based on current research and practice. Yeah. And I think it is.

So like I said, so very important in having organizations like yours. So I know that many parents struggle. Including myself, I have three teenage daughters. Many parents struggle with knowing when behavior crosses from normal growing pains into something that needs professional support. And I think that this question is gonna be very, very useful to a lot of individuals out there.

So what are the signs that tell you it's time for parents? Adolescents to reach out for help. I would say there's three things that the key difference between normal behavior and potential mental health issues is the duration of the problem, the severity of the behavior, and how is that behavior interfering with daily functioning.

So by duration we mean is a problem. Behavior lasting for more than two weeks. By severity we mean as a problem, behavior causing significant distress for your child or your family. And then finally, we are looking at interference with daily functioning across different environments.  Is the behavior starting to have impact at home school or with friends?

Then there are, there are some key indicators that we would look for. You're looking at and remember these things lasting for more than a two weeks. So we're looking at emotional and mood changes. So is your child's persistently sad or irritable? Are they experiencing severe mood swings? Are they starting to have excessive worry or fear?

And a real key one is, are they expressing any hopelessness or worth lessness? And then. Do you start to see any repetitive behaviors that were not in existing before based on their fear or anxiety. And then you'll probably also see some physical changes over the course of a couple weeks where maybe their sleeping habits change, their eating habits change.

They start creating unexplained physical ailments and then certainly look for changes in appearance and hygiene. Those are very concrete signs that I think a lot of parents will appreciate, and you know, making sure that they trust, you know, themselves in seeing those signs so they can get help for their children.

 So from your perspective, why are mental health challenges so prevalent among children and adolescents today compared to early generations? I know, I mean, I was born in 1975 and, and I feel like it was very rare to have anyone talk about anxiety, depression.  But it seems like it is. It is very prevalent currently, and I, I'm really interested in hearing your perspective of why you think that's happening.

 If you were born in 1975, that was the first year that I was out of college. So in Interesting. but there are, there's actually a lot of evidence  that's supports what you're saying. That there are numerous studies and data that indicate that mental health issues are more prevalent in the current younger generation, specifically in Gen Z, those born between roughly 1997 and 2012.

And it's the rise is supported by both self, um, reported data and objective measures such as emergency room visits and hospitalizations.  An example of a data piece is a 2021 study found that 42% of Gen Z High School students reported persistent feelings of sadness. Or hopelessness. And that was 50% higher than reports of millennial high school students in the early two thousands.

So we have actual self-reported data pieces that show that there absolutely is a higher level of mental health issues today than, than there used to be. and I think there's. Several reasons why they are so exacerbated. And one would be the external stressors and world events. You know, if you think of the stress we all went through with the pandemic think of some, some huge issues, especially ones that Gen Z are really clued into, like climate change.

Gen Z is experiencing a lot of economic instability. And then just think of. Watching the news today and being blasted with mass shootings and social injustice and all the issues that we see on a daily basis that, um, you might not have seen in the sixties and seventies. And then they also are feeling a lot of academic and financial pressure  academic pressure coming from how far behind every almost every student is coming out of the pandemic.

Some of the things like math scores, they're projecting we won't recover the deficits until halfway through this century. So their long-term impacts on academic performance. And then even though youth do have. Access to treatment  and they are starting to use telehealth options a lot.

 There's still a significant barrier, uh, because of cost.  There's a shortage of mental health professionals and then there's also a lack of culturally responsive care.  Um, there's lots of things that are creating this. Perfect storm. I guess I would say   the other thing that I would add is the increased use of social media and AI has had profound impact on  adolescents and children  and it's really fascinating when you look at during the pandemic, the use of.

Technology, the use of social media was up to eight hours a day because kids were going to school on technology. But it's interesting that girls tend to use social media significantly more than boys.  they average adolescents average about 5.3 hours. Boy, adolescents average about 4.4 hours.

So, and, and that doesn't, that's just using social media.  you, include gaming, educational use and the watching of videos. It comes up to about eight hours of, uh, media use per day. So that's having profound impacts on it in interesting. There is some evidence it's that the use of social media and gaming in particular actually makes kids more intelligent.

Oh wow. I mean there's, I guess there's some upsides, right? There is some upside. I think those of us that aren't using social media as much struggle to find the upsides. Yeah. Yeah. So you've touched briefly on the COVID pandemic and you know, we hear it's over, you know, move on. But how do you continue to see the pandemic's effects showing up emotionally, socially, or behaviorally in adolescence?

We certainly have, have identified that in schools, the behavioral issues due to under socialization coming out of the pandemic, especially among younger children is really really pronounced.  I just read a study not that long ago that kindergartners, because they were not playing with other children during the pandemic and going out to playgrounds and things as much have like this profound fear of climbing.

So you didn't, when kids came back to school after the pandemic, you did not see them taking the risk of climbing up on the bars, you know, the monkey bars and playgrounds and things, which I found, Kind of interesting.  The other thing we've seen in schools especially is elevated anxiety and depression.

There's been a really heightened increase in suicidal ideations. And I, I think that is contributed to by their hindered social development during the pandemic. And then again. There's just a lot of evidence that increased screen time is, is really  contributing to, the mental health problems of children and adolescents.

 The other big thing that's contributing is the educational gaps in learning loss that they experienced during the pandemic. We're focused on those and trying to overcome those, but it is really a slow, slow process. Yeah, that's super interesting about the monkey bars. Yeah, that's something I had never, never thought of.

But I guess, you know not being able to play with other children and see what they were doing and mimicking what they're doing, which is  a lot of what kids do when they play it's just fascinating. I. Yeah. So based on evidence-based approaches like aggression, replacement training, what do you believe truly works when it comes to supporting youth mental health and what on the other, the other side of the coin, what well-intended strategies Miss the mark here.

obviously I think aggression replacement training, which is an evidence-based program, has a profound impact on behavior, and we've seen the evidence of that over 30 years. And, and there's multiple studies that say that, but mark Lipsey from Vanderbilt University. Did a meta-analysis of what works.

So he took every existing evidence-based practice, every study of every evidence-based practice, and said which one had, which ones had the highest effect size and which were the least expensive to implement. And he listed  five out of his research, which was. It's kind of the gold standard of research and evidence-based practices.

He had aggression, replacement training, functional family therapy, multi-systemic therapy, big brothers, big sisters you know, the, that mentoring programs. And then I would add, now he didn't have this in his original study, but there's a lot of evidence that dialectical behavioral therapy should be added to the list too.

Interesting in his research, aggression replacements training had the highest effect size of any of the evidence-based practices and was the least expensive to implement. And then. One of the things when you look at what, determining what interventions have the least impact, that's a complex issue.

Cause I believe that effectiveness depends on specific conditions. It's the severity of what you're trying to impact and then the individual patients need. And, and one thing that we have. Found, I think in modern medicine and modern mental health treatment is the more prescriptive we can be to an individual, the higher the impact we're going to have.

 And each individual needs so many diversely, different things. So we also know. We, we've had a lot of low intensity interventions such as general psychoeducation about mental health literacy programs that are delivered to the general population to teach about mental health don't typically have  large effects on, on specific outcomes.

I still would say it's important to do those and get information out, but they do not have high impact on  specific outcomes. What is your vision for the future of education and treatment alternatives, and how do you see its work evolving to meet emerging needs in schools and communities? This is the issue that Mark and I are focused on most intensely right now.

We're both. Deeper into the fourth quarter than we would prefer to be. And we're looking at how will we carry on Arne Goldstein's work and our work? So we have been looking at different partners and there's a couple things we're looking for is somebody with the resources that we believe that.

Like we have developed a training site, a virtual training site that delivers aggression replacement training, but schools and agencies need so much more than that. So we, we are thinking of partnering with someone that has resources to allow us to develop a comprehensive mental health, behavioral health.

 In-service training, virtual site, and you know, looking at things like trauma-informed school, trauma-informed care  other evidence-based practices, but even for classroom teachers. if I have a student that's bipolar in my class and somebody's diagnosed that and has told me that this student is bipolar, I don't think I ever had training on how to handle a bipolar person in my classroom.

So we need to have specific. In services on different diagnoses that I, if I'm a classroom teacher, I can go in, I can look and get practical tips on what you should do and how you should approach this individual  in an academic setting. So, you know, we're, we're thinking of a much more comprehensive.

Site than we currently have. So that's our, now one thing also, we have a, a school curriculum that is, that research press being edited right now. It's a K three curriculum and a four to six curriculum that takes the components of aggression replacement training and makes them applicable for classroom teachers to be able to teach it.

 What the title is, is the prepared student using the components of aggression replacement training. Because most schools will not be able to implement aggression replacement training with fidelity. They're not gonna run three small groups per week, but they could teach their social skills, they could teach the self-regulation skills in the classroom.

So that's should be coming out by fall.  we just had a, a second printing of our anger control, which is a self-regulation curriculum. Those sound very helpful.  I hope all the teachers out there understand how helpful that is going to be in, um, you know, meeting students where they are.

Last question, and I ask almost all of my guests this question because I'm very curious. If you were placed in charge of mental health care in the United States, what are the first one or two changes you would make to better serve children in adolescence? The first thing I would want is, the funding that we currently have for mental health, which has significantly grown the last few years, especially here in Pennsylvania.

Is it being targeted to the right populations and are we collecting measured outcomes that say that what we're spending our money on is the right thing to be spending our money on. An example of that would be in Pennsylvania. There's a hundred million dollars a year going out through Pennsylvania Commission on Crime and Delinquency to schools for mental health personnel.

And one of the things I've observed in evaluating some of the mental health programs in schools is true therapy going on is true mental health intervention going on? You know, are they being prescriptive with kids? And what I find in schools is that a mental health professional who should be doing therapy is a fireman.

They're they're sitting with the kid that just went off and had a huge problem, deescalating 'em and getting 'em back to class, , but not doing ongoing treatment. And I worry about that, that, you know, to change the behavior. Are you giving that, that students are working with the skills to be able to change their behavior?

 And are you doing true therapy? The other thing that I worry about with. Mental health personnel in schools is, the whole HIPAA thing is mental health professionals in schools have an office. Kids walk by that office. If I'm walking into that office as a student, everybody knows that I'm going to see the mental health person, But on the other hand I know from, uh, working in the Erie City School district, that when referrals were made to outpatient counseling, that a lot of the students that we had could not access. That  they didn't have transportation. They didn't, their parents might be working two jobs and couldn't take them.

You know, there were all kinds of barriers for them to access mental health. So. Having it right there in school  is to me, is a good thing. So I guess I would like to see a well-defined implementation process for mental health in schools, and I'm, I'm not sure that we have that right now.

Yeah. I, I will say, I think, you know, reducing the stigma around students accessing care would maybe go a long way, yeah. And that, and that is something that we're seeing with Gen Z is, is that they are much more able to embrace mental health and there doesn't seem to be as much stigma, attached to it as with previous generations.

So that's a good thing. Yeah, I agree. So, if people wanna find out more about education and treatment alternatives than you, how can they do that? Our website is uscar.org. U-S-C-A-R t.org stands for the United States Center for Aggression Replacement Training. And if you go there, you'll see all of our access information, including phone numbers and how to contact either Mark.

Our wonderful. I encourage everyone to who's interested to, to check out the website. And Dr. Robert Oliver, I enjoyed the conversation. Thank you so much for joining us today. Thank you very much.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.