Mental Health for Growing Minds and How Parents Can Help

The mental health crisis in adolescents is a growing problem. Three years after the COVID pandemic uprooted life as we knew it, kids are still dealing with many issues causing a number of mental health conditions.

 Dr. Laine Taylor,  Medical Director at The Village for Families and Children in Hartford, joins me to discuss mental health in children in this episode.

Prior to working at The Village for Families and Children, Dr. Taylor was an assistant Professor at the Yale Child Study Center and worked in child psychiatric inpatient service for seven years.  Dr. Taylor completed general psychiatry residency at the University of Arizona and completed a Child and Adolescent Fellowship at The Yale Child Study Center in New Haven.  

A recent report stated that 40 percent of US parents are “extremely” or “very” worried that their children struggle with anxiety or depression. The Pew Research Center report concluded that mental health is the greatest healthcare concern among parents. 

We discussed the health disparity in mental health for Black and Latino children, and the barriers o treatment that exist. 

To learn more aboutThe Village for Families and Children, visit www.thevillage.org

For more information on CT Paid Leave or to apply for benefits, visit www.ctpaidleave.org

https://ctpaidleave.org/s/?language=en_US



https://www.facebook.com/CTPaidLeave



https://www.instagram.com/ctpaidleave/



https://twitter.com/CTPaidLeave



https://www.youtube.com/results?search_query=ct+paid+leave

Transcript

Nancy Barrow: 0:01

Hello Connecticut, and welcome to The Paid Leave Podcast. The title basically says it all. I'm Nancy Barrow, and I will be delving into this new state program and how it can help you and your family. This podcast will give you information you should know about Connecticut Paid Leave and maybe just a little bit more. Connecticut Paid Leave brings peace of mind to your home, family and workplace. Welcome to The Paid Leave Podcast. This episode is about mental health in adolescents, tweens, teens and young adults. Globally, it's estimated that one in 710, to 19 year olds experience mental health conditions, yet these remain largely unrecognized and untreated. 10s of 1000s of adolescents in Connecticut still don't have access to effective mental health care. Poor access can lead to not getting a correct diagnosis or a misdiagnosis of mental illness in kids and adolescents, and an increase in use of emergency rooms for psychiatric issues and is a risk factor for severe mental illness, substance abuse, failure in school and entering the juvenile justice system. National studies show that one in five kids, children and teens, have mental illness, but only one quarter of them get services that leaves about 125,000 children without mental health care right here in Connecticut. This is where Connecticut Paid Leave can help. Many people may not realize that mental health issues can be a serious health condition and can allow up to 12 weeks of income replacement under Connecticut Paid Leave if you or your child needs treatment for mental health issues, it must include incapacitation and treatment from a mental health professional. And you can take the leave all at once, like in a block or intermittently, if you have to drive your child to the healthcare provider and you have to take time off from work, or you can do reduced schedule, like if family therapy is needed, so you may have to take afternoons off so you can all get together. Either way, there's a lot of flexibility with Connecticut Paid Leave. Joining me today is Dr Laine Taylor. She is the Medical Director at The Village of Families and Children in Hartford, and prior to working to The Village, she was assistant professor at the Yale Child Study Center and worked on the child psychiatric inpatient service for seven years. And did you get your MBA in business health care when you were in med school?

Laine Taylor: 2:30

Yeah, at the same time.

Nancy Barrow: 2:31

Ok, over-achiever right there! And not only that, but you completed general psychiatry residency at the University of Arizona, and you did an child adolescent fellowship at the Yale Child Study Center in New Haven. You certainly come to this podcast with a lot of knowledge and experience. So thanks for being here!

Laine Taylor: 2:52

Oh, it's a pleasure. Thank you so much for having me.

Nancy Barrow: 2:54

Well, can you tell me exactly what a medical director does at the village?

Laine Taylor: 2:58

Yeah, you know it's, it's a combination of clinical work as well as administrative work, but at the village, there's a unique opportunity to additionally do advocacy for policy that's related to mental health care, mental health care for adults, for children. And so have the opportunity to be in some rooms to really talk to people who if you are a danger to yourself, meaning that make the laws that help with creating Connecticut Paid Leave and those kinds of amazing things that are transformative for our families. you have actually, like harmed yourself in a grievous manner that could cause injury, or you are a danger to others in which you identify a target or someone that you want to harm or potentially kill? No, go straight to the hospital, right? Everything else can be pretty gray, and so sometimes you can have a family walk in the door and you can say, yes, you're appropriate for regular weekly therapy, outpatient care. But there are many levels, and we're really fortunate in the state of Connecticut to have a multitude of levels of care between hospital and outpatient that can really provide support to families and kids. So it's really sometimes you can know, yes, in fact, this kid is struggling so much that they indeed need more intensive services, or they definitely need outpatient but usually it takes a little time to get to know. Family and the children to discern that more specifically.

Nancy Barrow: 5:03

Because it is sort of a systemic situation with the family.

Laine Taylor: 5:08

Oh, yeah, and that's the thing that I again, is very cool, but also challenging with working with kids is that so many systems touch kids, right? We're talking not only about families, we're talking about social peer groups. We're talking about school, we're talking about their community. All of those different pieces play a role into like, into how you consider and think about working with kids and families.

Nancy Barrow: 5:28

Interesting that you, you know, said that it can be more gray with kids. Are they treated differently for mental health issues than than adults are?

Laine Taylor: 5:36

Yeah, definitely. You are always considering multiple systems with kids, sometimes with adults. You can be just dealing with that individual and talk about what other areas touch them, like work or family, but not necessarily have to engage said individuals with kids. You're automatically thinking about interacting with talking with the school, thinking about interacting with family, maybe even talking about how to engage their their friends, but it's so much more like village like approach to the work that we do with kids, which, to me, is very filling, yeah, and that's why I like working with them.

Nancy Barrow: 6:18

Yeah, it's, it's, I bet it's very rewarding, because you probably see the results and it, you know, can alter how a family works together, you know, because when there's dysfunction in the family, do you treat the family all together as well? Do you do a lot of group therapy or family therapy with them?

Laine Taylor: 6:36

Yeah, that's actually highly recommended. I will say that the way that our healthcare system is set up, it doesn't really lean toward allowing for more intensive family work. I think, you know, I've been able to, I've had the fortune of being going abroad and and studying some abroad and mental health. And other countries can kind of make provisions to allow for families to be more engaged. But here in the US, typically, and again, not to plug too much, but Connecticut Paid Family Leave has made a major difference in this, and families are still learning about it. But so many times before this existed, families would have to caregivers would have to say, I either have to work and pay the bills or I hike and show up for therapy, for treatment, for my kids, and now you don't have to make that kind of like black and white choice. You have opportunities to allow you to be able to do both and really show up. And that's how you can make a difference in families, is when they show up, when you can engage them more directly, because we have those systems in place. It's just how can you get through the barriers that make it difficult to attend?

Nancy Barrow: 7:41

Yeah, and paid, you know, Connecticut Paid Leave really is a barrier breaker, so it really will alleviate a lot of stress on the caregiver, who can take some time off from work and drive their kid to therapy and not have to worry about not getting paid. Exactly No, it's, it's a it is. It is a beautiful thing that we have this in Connecticut. How did you see covid affect kids and young adults in the past three years? Because it's almost three years ago that that it all shut down.

Laine Taylor: 8:14

You hear a lot about the impact of the pandemic on worsening rates of anxiety and depression in kids, and I think that is very true and very real. But I think another piece that really needs to be highlighted is the developmental trajectory of those kids, right? So kids that you know, when you're a school age kid, or even high school, you are learning how to figure out your independence. You're learning to figure out, like, how peer groups work versus your family works, and how do you navigate without, you know, adult guidance, sort of social strata. And that was all interrupted, because the only way that kids had connection was through computers, right through social media. And so that that three dimensional experience of being present with peers, and three dimensional experience of being in school that was really cut short by the pandemic, that's at the best situation. What also happened, very seriously, here in Connecticut is we had 70,000 kids who the school system just lost, like they didn't know where they went. They weren't registering for school, they weren't showing up for the classes, they were just gone. And so you have all of those kids, and these are kids in our more urban cities, Bridgeport, New Haven, Hartford, Stanford, that.

Nancy Barrow: 9:40

Didn't have access to computers or?

Laine Taylor: 9:42

No, the computers were put out there. It's just that you had to engage. You can't just give a computer to a kid and say, go to school, right, right, right, even the most motivated kids going to struggle with sitting in front of a computer for, you know, six hours a day. But you then think about the kids who are already on that disengaged level. People already at that high risk for not completing school, and then they were gone, literally gone and and so we're just now starting to be able to pull those kids back in, and those school systems are working really hard to do it. But that's as you pointed out, three years and when you like when you're 43, like me, three years is nothing, right? But when you're 16, when you're 12, when you're 10, nine, that's a lot of time for your development. And so that's, it's, it's a huge, huge change and a shift. The cool thing is, kids can make it up. Kids are so resilient and they can get they can make up, like lags and development. We've seen that time and time again, but it does take investment by adults who really are there and will consistently be there, even when they're struggling with their anxiety, even when they're struggling with severe depression, even when they're struggling with aggression and anger, because kids are angry too, and that's something that is anecdotally noted by all a lot of my colleagues, not only here in Connecticut, but across the nation. Kids are just angry.

Nancy Barrow: 11:08

Since Covid? this brought out a lot of anger.

Laine Taylor: 11:11

Oh yeah.

Nancy Barrow: 11:12

Tell me why. Like, tell me what they were dealing with and why it's it's manifesting itself as anger?

Laine Taylor: 11:19

I had to be honest, I don't think we have a really good handle on why it is, yeah, but I do think that there's something around the social isolation. I think there's something around sort of while, while we think of the internet as this global access, it's a very narrow place to be. So you can funnel yourself into very narrow thinking, into very narrow sort of exposure, especially through social media, right? Because it has those algorithms that sort of pin you in a particular direction, right? And so and so that's probably a part of what has happened. And they have, like, nothing else to do, yeah, right? They didn't have anything else to pull them away from that, going to school during the day, those kinds of things. And so that's a that's a complete hypothesis. It's there's no we still don't fully get it, but it is definitely something that is being observed.

Nancy Barrow: 12:09

So I read somewhere that black and Hispanic adolescents are often diagnosed with behavioral aggressive issues like ADHD rather than mood disorders, and with those two types get different treatments, and is that kind of indicative of racial disparity in mental health?

Laine Taylor: 12:27

Yeah,so yeah, it's, it's, it's, it's such a profound question that you're asking, because even before the pandemic, there is a real issue within medicine and psychiatry, in which there is a bias in training that I think is only now starting to get some light shed on it, where programs are actively talking about these issues when, where you could call into question use of words like violent when You're talking about a child's behavior, right? But there are, there are racially laden undertones when we use certain words, and so there's efforts toward training fellows and residents and med students and across the paraprofessional, yeah, brown, how do we how do we use more descriptive language, rather than sort of pan-descriptive terms, right, right?

Nancy Barrow: 13:24

That like that. It's like a behavioral aggressive issue?

Laine Taylor: 13:29

Correct, and it is, it is, in fact, true that that there is a bias toward thinking about black and brown children being more aggressive, having more aggressive tendencies, and that being the focus, as opposed to really thinking about what underlies the behaviors that are being seen there is, I mean, systems have taught us time and time again, when, when a black or a brown person demonstrates anger there, that they are suddenly more dangerous, right, right? And so then that can lead kids to have more interventions in schools where with police engagement, that kind of thing, where people are feeling more threatened as a result of an expression of their anger. That's very true within the system. Within child psychiatry, it does tend to funnel black and brown kids more toward behavioral interventions, as opposed to, like, thinking about trauma treatment, right, or anxiety or depression. And if you look at the diagnostic criteria for depression, specifically, when you're thinking about kids, irritability is a part of it. Yeah, not for adults, but for kids, irritability is a part of it. And kids don't demonstrate that sad. I'm sad all day long, every day, kind of thing, they can have happy days but still be quite depressed. And when they get really down, they may not just sort of internalize and feel sad and cry. They may lash out and externalize, is what we call it. And so if you're trying to just treat aggression, it's going to lean toward kids being on heavier. Duty medications like antipsychotics instead of depression, which would lead to antidepressant medications. So it's really about making sure that the whole spectrum of of the picture of the kid is being considered. And I think that bias is something that that pervades every system that touches a kid. And if you're if you're a parent, if you're a school staff member, a teacher, and you start to see that that's the language, don't don't hesitate to step up and say, Hey, this is what I understand about this kid, in order to change perspective, because that can make a huge difference for how people encounter and engage with kids. It also can make a huge difference on how they're treated within mental health environments.

Nancy Barrow: 15:48

When you have mental health professionals that look like them, I feel like that will also normalize for them, that it's okay.

Laine Taylor: 15:58

Yeah, just that. That, in and of itself, is a huge barrier, though, too. To be able to bring in individuals of color into the mental health fields is a huge difficulty because, because systems can be set up to make it more difficult. There are, there is some legislation out there that is, is aimed at addressing how some of the testing has bias that has been proven, and how the testing that is required is same, the same testing with bias that actually has demonstrated a lower passing rate for black and brown individuals who have the same education and so, so there's just, if you kind of hear you won't be able to make it. It makes it much harder to even seek going into social work or counseling or medicine. And so there are a lot of efforts to really address the systems that have been proven as barriers. And so hopefully, in the coming generations, we'll have more and more black and brown folks who will show up in the psychiatric fields,

Nancy Barrow: 17:01

Are more boys affected by mental health issues?

Laine Taylor: 17:05

So, you know, what's interesting kind of along those same lines, is we tend to have boys who present more because of behavioral issues, or anger, right? Anger, aggression, that kind of thing they don't have the tools to express, right? So you see more externalizing type of behaviors, or they rise to sort of the awareness of school, or, you know, mental health professionals or their parents because of behavioral management issues, and that, again, is just a marker for something else that's going on with them. But we within our culture have said that that is a more appropriate way for boys to express themselves than other means. And for girls, sometimes they actually don't show up for treatment because they're so internalizing that until it gets really bad, it's not no one knows. And to be fair, even in that, even kids struggle to know that they're struggling until it gets really bad. But if, oftentimes when I talk to kids, I ask them to kind of walk me through their experiences, they can say this was the time when I feel like things got really bad, but things had already been bad, and things don't just switch like that. So when you kind of have them walk it through more incrementally, they realize it's been going on for a long time, and I get a lot of parents who will come to me and they will say, I just didn't know this was happening with my kid. I had no clue. And I really want them to feel reassured that, yes, that's typical, because oftentimes the kids don't really know until it gets really bad too. And so for boys, they might present earlier, more more frequently, because they just demonstrate it with their behavior, and it's so disruptive sometimes. But you also have boys that internalize too, and they're less likely to get picked up, right, because it's sort of like, oh well, they're just going through a phase.

Nancy Barrow: 18:57

So what usually happens when someone comes to see you. Is there like an event that happens? Or how is it, if it's so hard to see and it's hard to figure out, if your child is struggling, because they do internalize it so much, is there like some kind of event that happens that they usually come to you?

Laine Taylor: 19:17

Really, there's some sort of like, either series of events or changes that are noticed by a caregiver, school or someone in their life, or there is a big thing that was sort of like the Hallmark moment that will then lead them. But it is really important to not only focus on that situation or even that series of events, and really understand more broadly what's gone on with the family, with the child, with the school, et cetera.

Nancy Barrow: 19:45

So what kind of therapies do you use for kids? Is it like cognitive behavioral therapy? Do you ever use like biofeedback? I know that my brother used that when he was at University of Boulder. He went from a really small school to a really huge school and got overwhelmed. So what kind of techniques do you use that help kids?

Laine Taylor: 20:05

Yeah, well, specifically within The Village, we have a wide array of services. So we have from outpatient weekly therapy to a residential so where kids will live on campus and get intensive treatments for four to six months. We also have in between extended day treatment, which is, you kids go after school for three hours, five days a week for six months, and that's primarily group. There is some individual and family as well. And then you also have in home levels of care. So there's, there are many different kinds. I think the most popular here in Connecticut is called ICAPs. It's called intensive in home child and adolescent psychiatric services. That's why we call it ICAPs. And that's the most common is actually an in home intervention that was developed out of the Yale Child Study Center and is just widely available and used in the state. The cool thing about that, and that's a six month long treatment where the clinicians go to the home and two to three times per week for an hour to two hours each time, and work with the family and work with the kid. And it has very it's very much based on understanding family systems and generational dynamics. So it's not just like, what's the current family, but what did the parents go through, and how that feeds into what's going on? There are barriers, right? I mean, some families just don't want you up in their house all the time, right? So, yeah, so that sometimes that's not a real preferred method, but, but it is a very common level of care and and it's more effective, or I think so. Yeah, I think for certain populations. I don't ever like to say that one particular intervention is great for everybody, but it has. It can be transformative for many families to be able to sort of see and have light shed on areas that they they were really blinded to, and understanding how that has an impact, how parents can be able to recognize how they may be feeding into a pattern of behavior with their kids that perpetuates the things that are concerning, and the kid being able to have a space of like that's comfortable, to be able to talk about what's really going on with them. And they don't just go to the home, they might go to the school with the kid. They may go to the park. They they engage with them in the community as well. And again, that's like, there's a lot of different there's a lot of different letters for all the in home programs, but there are quite a few here in the state of Connecticut.

Nancy Barrow: 22:37

It's really nice to know that. I think it's it's a great thing that we have in Connecticut. One of the things I didn't realize is that suicide is the second leading cause of death among people aged 15 to 24 according to the Center for Disease Control. That's really alarming to me.

Laine Taylor: 22:53

i think that it is definitely increasing. And the depth of despair and sadness that kids are experiencing, I think is definitely increasing. I think the pandemic, again, because of the isolation, exacerbated a lot of that and and so that's where our fantastic inpatient hospitals play a role and a really good coordination of care, leaving from the hospital into the community. Programs, the in home programs actually are particularly useful for kids who are struggling in this way, because they actually have crisis 24/7, crisis support so that they don't have to go to the emergency department if they struggle for a night they can talk to their clinician oftentimes, oh, you know, in the middle of the night, if they need to, in order to get some support. And the idea is to prevent hospitalization, because hospitalizations like the ICU for mental health, right, right? No one goes to the ICU is like, Okay, I'm cured. I'm better now that I've left the ICU, you always have a step down from the ICU. And so the idea of these community programs and sometimes residentials are meant to be a step down based on this level of severity that the of illness of the kids contending with. But these other programs are meant to try to prevent them from getting so ill that they go, have to go back to the ICU, right? But just like in the ICU, you know, risk of worsening illness and death is still high for those kids who need to go to that level of care, so you just have to really pay attention and really provide wraparound support services for those kids.

Nancy Barrow: 24:35

Alcohol or substance abuse can be part of the bigger mental health picture for kids. Do you treat these conditions, or do you have community partners that you use?

Laine Taylor: 24:45

We do? I sigh, because in Connecticut, we don't do great for kids around this and the need is expanding. I will try so hard to not go on a soapbox about this, but

Nancy Barrow: 24:59

Go ahead if you need to!

Laine Taylor: 25:00

The rates of marijuana use, alcohol and tobacco use amongst youth is really rising really rapidly and and the there is a direct correlation between parents actively using marijuana and their kids using marijuana. There's also a sort of belief that it's like a safe, natural sort of alternative. And you know, harm reduction strategies are fantastic, but I think it's also really important to understand that the impact for kids on their developing brains versus adults are very, very different. So in Connecticut, we need to do better. We need to be able to develop more, more treatments. Honestly, if you are under 13 at this point and you have any substance use issues, which you think, how could you I have in this last year, had 211 year olds who struggled with active marijuana abuse, like regular, active marijuana abuse and so and can't get them into any treatment outside of outpatient, right? So they're still in the environment in which they're they're using to be able to combat that and give them some period of ability to get away from the use is a huge and very important piece of it, and it's very difficult to do. It's not difficult to do because their environment continues to have it in their presence. Gotcha. And so it's, it's, it's easy. It's very easy for kids to access and not to mention, you know, the rates of fentanyl that these things are laced with that's in the community. It's, you know, kids are getting access to things that are really, really dangerous for them. Again, age makes a big difference. So if you're an adult, especially in the state of Connecticut, and you have Husky Medicaid or even uninsured, you have access to detox treatment, you have access to intensive outpatient programs, things like that. There are some of these programs for youth, but again, if you're under 13, it's really, really hard, and also you can't utilize the same strategies that work for adults with kids, because it has to be much more family based. So you're requiring of the family to be engaged, and especially for our youth, who are on the lower socioeconomic status, their families are taxed with a lot of things that they have to take care of. So then to engage the families is is just, you have so many more barriers, right? So there's just, there are a lot. We have so much, so much more room to grow. And I'm hoping that in the you know, coming years, some legislation will come out, as well, as you know, there will be real efforts to create appropriate interventions. We do have mdft in the state of Connecticut, which is in an in home specifically for youth who have substance use or are at risk for adjudication incarceration, and they that is a really phenomenal in home program. And then at The Village, we have that as outpatient but so there's, there's something.

Nancy Barrow: 28:00

There was a CNN report that said 40% of us parents are extremely, or very worried that their children will struggle with anxiety or depression. And they said that mental health was the greatest concern among parents, followed by bullying, which worries parents about 35% of the time. The concerns Trump fears of kidnapping, dangers of drugs and alcohol, teen pregnancy and getting into trouble with the police. Are you surprised by the fact that parents are so worried about their children's mental health?

Laine Taylor: 28:35

I'm not. I do think that it has become a greater focus, and that's a good thing. I think that people are more aware of what's going on with their kid, and more vigilant about their kid struggling with anxiety or depression or any other mental health issue. And I think it's really present in in a way in homes, in a way that it hadn't been before. It makes sense to me. I think again, we talked about the pandemic effects and that that worsening presentation for kids and how they manage their moods and so. So, you know, hopefully, with the number of services and the opportunities to really provide care that kids don't have to kind of swallow it and figure it out, that they can actually get support and help.

Nancy Barrow: 29:18

Yeah, that would really help. And I know that you're a big supporter of Connecticut Paid Leave, but do you think that the word is getting out to the parents and the caregivers and and even the social workers who are who are dealing with them or other mental health professionals? Do you think that they're getting aware of Connecticut Paid lLave and they realize the benefits of it?

Laine Taylor: 29:38

Little by little? And I think, I think that that the torch needs to be carried by the providers as well, right? I think that, you know, employers will talk about it, but I think it's important for providers to suggest and think about that. When they're experiencing parents having difficulty with with transportation, or worrying about their job, one of the first things they should do is say, hey. Have you thought about Connecticut Paid Leave, even on an intermittent basis, in order to provide support so you can, you can meet the needs of your kid in this moment?

Nancy Barrow: 30:07

Doctor do you see the stigma of mental health going away or waning?

Laine Taylor: 30:13

Waning. I mean, I think everybody's always, there's always going to be somebody or some cohort of folks who are going to struggle with the idea of thinking that our mind is as valuable as our body, but, but I do think that it's waning, and I think I mean the as I say body, it brings to mind also understanding sort of whole person health, right? So we have so so for so long, siloed our mind and our body, but they're intimately connected. And so being able to think about our healthy bodies actually makes a difference for our healthy mind, and vice versa. So if we are in a state of extreme stress, our body isn't isn't caring for itself. Cortisol levels are high. We're often in taking things that are bad or toxic for our bodies, which only then feeds back to our mind to make things more difficult, right? So, so, so I think that, I think the other approach so dealing with the stigma of mental health, I do think with the amount of conversation and discourse that's out there about mental health, I think things will get better and people will be more amenable to getting treatment and seeking treatment. But I think the next step is also thinking about how to the do those two things work together so that we can have overall good health?

Nancy Barrow: 31:25

How can they get a hold of you at The Village?

Laine Taylor: 31:29

So you can walk up! 331, Wethersfield Avenue in Hartford, 1680, Albany Avenue in Hartford, and then you can also give us a call at 860-236-4511,

Nancy Barrow: 31:44

Dr Laine Taylor, Medical Director at The Village of Families and Children. Thank you so much for being on the podcast. It was such a pleasure to have you here and have this discussion.

Laine Taylor: 31:53

It was a great pleasure for me as well. Thank you.

Nancy Barrow: 31:55

For information about The Village, please go to the village.org. For information about Connecticut Paid Leave or to apply for benefits, please go to ctpaidleave.org This has been another edition of The Paid Leave Podcast. Please like and subscribe so you'll be notified about new podcasts that become available. Connecticut Paid Leave is a public act with a personal purpose. I'm Nancy Barrow, and thanks for listening.