You can't just seek therapy and think that everything will be OK with talking.
And you also just can't take medication and think that will solve everything,
so you need a combination of both.
It's just a natural way of thinking about taking care of everyone 'cause we're all family.
There's a lot of times that patients will come in to see their primary care provider
and actually be having mental health related issues or
conditions that we can streamline them being seen by a mental health provider.
So we're trying to keep in mind that as they're managing a physical illness
that also trying to help them manage the mental health challenges
that can come up when managing diabetes is so important.
Picking up those tools, you know, that we've been gifted.
It's starting to come together, this integration of services,
this whole thought of looking at the whole child
that which leads to a healthy family.
You know, I guess it's groundbreaking on the outside but yeah,
our grandmothers did that forever you know.
We're just following their lead.
The rewards of integrated healthcare are positive patient outcomes;
you know, improvement of their mental health; improvement of their physical health;
improvement of their social surroundings.
You go to somebody. You come in.
You know, you're depressed. You're anxious.
You come out maybe months later. You're happy.
You're hoping for the best that you'll succeed in whatever you want to do
and that you've managed everything and that at the end of the day,
you know, you're hopeful.
You have hope.
>>Aaron Gilchrist: Good evening, everybody, my name is Aaron Gilchrist I'm the morning
news anchor for NBC4 here in Washington, D.C. we appreciate you all being here tonight.
On behalf of the Substance Abuse and Mental Health Services Administration SAMHSA,
thank you so much for being here tonight at the George Washington University here in
Washington, D.C. for the national children's mental healh Awareness Day 2017. Now,
we are obviously very excited about the packed house, the full room that we have here
this evening, but not only about the audience that we have in person but also
folks joining us all over the country tonight on our live feed through the SAMHSA website
, our NBC Washington website as well and the websites of 28 NBC and Telemundo stations
across the country, and of course, you don't really exist f you're not live on Facebook
and Twitter so we are live there tonight as well. And we appreciate folks there to
join us today. Now with all these options to choose from we hope everybody will join the
conversation we're having tonight, using the hashtag #HeroesOfHope. Now each year
SAMHSA hosts Awareness Day to help increase understanding The mental health needs
of children, youth and families, and the services and supports that are available to help
meet those needs. And speaking of support, I do want to make sure that everyone is aware
that psychologists and family and youth peer mentors are available in this auditorium
tonight should anyone need them during this event. Just find someone with a staff badge
and they'll be able to point you in the right direction while we're here tonight. Now,
for those out of watching the webcast with us this evening lie or on demand if
you would like to seek services, SAMHSA has a treatment locator right on its website,
and of course if you need immediate help please do call 911, or SAMHSA's Lifeline
the number for the Lifeline is on your screen right now. Now tonight's focus is on
partnering for help and home. We're going to talk about a big change in the way that
we're used to treating illnesses in children and in young adults. When a child needs
help we know that most parents or caregivers try to identify te problem, maybe, maybe
it's an ear ache or an upset stomach or some trouble sleeping, and then you identify what
type of provider to go to, to try to get some help. Do you call your primary care doctor
, maybe you call a behavioral health provider. What we're talking about tonight
is the advantages of treating a whole child. The child's whole health, if you will,
understanding that all the symptoms can actually fit together, and the symptoms that I
just described can be a sign of something that is a mental issue, or a physical problem,
or combination of the two. Sort of a big idea to kind of wrap or heads around,
but it is one that many communities now and programs across the country are really
exploring and seeing some pretty exciting results. Tonight we are showcasing
these examples and talking about how we can make this big idea really just a standard
practice across the country. So. To start our conversation tonight it's my pleasure to
introduce the Acting Deputy Assistant Secretary for Mental Health and Substance Use
, Kana Enomoto. (Applause.)
>>Kana Enomoto: Thank you, Aaron, and thank you everyone wo is here this evening. On
behalf of the Substance Abuse and Mental Health Services Administration, I'm so pleased
to welcome you to National Children's Mental Health Awareness Day 2017. Over the
12 years we've hosted Awareness Day we've continued to add dozens of collaborating
organizations to our list of supporters, including federal agencies, associations, and not
-for- profit organizations. Working together, we've identified opportunities, creatd
strategic partnerships, and addressed challenges to focus attention on the importance of
caring for every child's mental health. Moving forward, we know these partnerships
are the key to our success. They'll help us develop stronger messages and stronger
programs. They'll help us deliver an integrated approach. As you will see during
our Awareness Day event, integration is changing the way we serve children and families.
Our theme for this evening, Partnering for Help and Hope, really reflects our goal that
we all work together to ensure the health of our nation's children, youth and young adults
. We know that many of you here tonight are grappling with a difficult challenge; how to
ensure the care of children and youth in our country in a multi- dimensional way. How
to make certain all young people are viewed and treated as whole people, as individuals
who have both physical and behavioral health needs. This s what we call integrated care
. Why is meeting the challenge of fully integrating health care delivery so important?
It's important because children, youth and young adults don't experience health
conditions in silos. As health practitioners, policymakers and family members, we know
our best chance to address the complex and comprehensive needs of children and youth and
young adults is to look at their whole health. Data from SAMHSAs Center for Behavioral
Health Statistics and Quality released today makes the connection very clear. The
data demonstrates the link between depression and several chronic health conditions among
adolescents. For example, the adolescents with asthma were more likely to experience
depression than adolescents who did not have asthma. We see a similar trend
linking depression to diabetes and to bronchitis. To help prevent depression in
adolescents it's important to address the mental health needs of children when they're
young. Well child visits or other care touch points are a good place to start. And
we are taking steps to make it easy for primary care providers to determine where to start
. What to ask what to look for I'm pleased to announce this evening that SAMHSA
is releasing a new set of educational materials to address depression and 5 other common
mental health conditions nong adolescents and young adults t materials were created
in collaboration with the American Psychiatric Associatio, American psychological
association and American Academy of Child and Adolescent Psychiatry. The
Family Education Materials series provides a tool for primary care and behavioral health
providers to use with their patients 16 to 25 years of age and their caregivers. This
set of tools is just one example of how we can make progress at the federal level and
have an impact on an individual level. Speaking of impact, the 21st Century Cures Act is
a groundbreaking piece of legislation passed just last yer with the potential to move
our country much closer to our goal, integrating care, and delivering better outcomes for
everyone. Through the Cures Act, SAMHSA's primary care and behavioral health care
integration program has expanded to include services for children and young adults .
The new program will fund substance abuse services as well as mental health services
, understanding there is often an association between the two. Now I want to introduce
to you a federal partner who has just been named this week as administrator of the health
resources and services administration, or HRSA. Dr. George Sigounas most recently at
he's Carolina Brody school of medicine sin Dr. Sigounas has tremendous experience as a
professor of medicine a scientist researcher and much more, and I know he will enrich the
conversation around integrated care. HRSA's and SAMHSA's commitments to sharing data and
best practices should be the standard for what every child ad every family should expect
as they seek care wherever they live. I look forward to working with Dr. Sigounas
closely on integrated care for all the children and families that we serve in our great
nation. Please welcome Dr. George Sigounas (Applause.)
>>Dr. George Sigounas: Thank you, Kana. As Kana said, integration is key to everything
when it comes to health care. There is no separating the mind from the body. So let's
make sure we all understand what fully integrated care looks like. By definition,
integrated care is an approach in which primary care and behavioral health clinicians
work together with patients and families to address their whole health. This approach
uses systematic and cost-effective strategies to provide patient-centered care
that improves outcomes. Later in tonight's program you will have the opportunity to hear
from two health care deliver registers to learn more about health care community programs
. We also know that primary care settings have increasingly become a critical gateway to
better care for individuals, including children , with both behavioral health and primary
care needs. Nationally about half of all care for common mental
health conditions happens in primary care settings. People are often more comfortable
talking to their doctor rather than seeking out behavioral health providers. They
may also have cultural beliefs and attitudes about behavioral health that make it
uncomfortable or difficult to seek that care. For example, in our Health Center Program,
which provides affordable, accessible primary health care for almost 24 million people
nationwide, depression and anxiety disorders ranked fourth and 7th respectively among the
top 10 reasons that a patient visited a health center . To address these needs, more and
more primary care providers are integrating behavioral health care services into their
practice settings. Today more than 90 percent of health centes now provide mental
health treatment or counseling services on site or through contracted arrangements, and
in 2015 there were over 7 million mental health visits. n the last year alone, we have
seen nearly a 20 percent growth in the number of patients seen for a mental health concern
. We also know that the limited availability of mental health services is particularly
true in rural areas. That is why our agency is working with rural communities and
providers nationwide to expand the use of tele-psychiatry and tele- behavioral
health technology, bringing these services to where people are. But whatever the reason,
and wherever people are, children, adults and their families, need a system of care that
can meet their needs. The great news is that we know integrated care works. Providing
behavioral health care in a primary medical care setting reduces costs and leads
to improved patient out comes. That is especially true when it comes to opioid addiction
, which several of our families will be discussing later tonight. Overall, when we
work together, we provide the best chance for people to get better, no matter what kind
of health care challenge they face. Thank you for having me here tonight, and I'm
looking forward to our program.
>>Kana Enomoto: Thank you so much Dr. Sigounas I really look forward to working with him
in the future. Perhaps no one appreciates the need for a whole health approach
better than an Olympic athlete. They know a great performance, especially one
that produces an Olympic medal or maybe a few more, is only possible when the mind and
body are both in good shape and working together. It is my gret privilege to introduce
our honorary chairpersons who have not only made our nation so proud with outstanding and
historic performances in the pool but who have also inspired our children with their
commitment to promoting positive mental health messages. Please welcome Olympic
champions Allison Schmitt and Michael Phelps. (Applause.)
>>Michael Phelps: Good evening. Allison and I are so proud to be serving as honorary
chair persons for SAMHSA's national mental health Awareness Day this year. alS as last
year during the publicity surrounding the 2016 Olympic games we both started speaking n
our own depression and challenges. It felt right to talk about it , since it was pat of
our journey.
>>Michael Phelps: What we didn't realize is how many peope all over the country would
relate to our stories, and how positively people would respond to our message, that
it is okay to ask for help. We get it. A lot of people tonight like to ask for help;
we're supposed to be tough, Allison and I understand that as athletes. Being tough
is definitely part of the job description. But I'm so glad that we both found the
courage to ask for help. And as we travel the country talking to children and youth ,
we're finding that courage can be contagious.
>>Allison Schmitt: Talking about mental illness is the the path to making as pulling a
muscle or breaking a bone. We want all children and families o feel comfortable asking
questions, and ask for help when they need it. Michael and I wee lucky to have a
supportive circle of mentors, friends and families, who partnered with us to find
resources and help us with our mental health challenges, and learn with ways to cope.
>>Michael Phelps: We know for many families finding help can e intimidating, confusing
and time consuming. That's why we were so happy to be part of tonight's discussion about
how behavioral and physical health providers can collaborate to better serve children and
young adults. You'll hear a lot about integration and systems change during these
three conversations. That's division providing services as a team, with a coordinated
plan that helps to identify challenges and work towards solutions.
>>Allison Schmitt: We're looking forward to learning rigt along with you tonight.
I'm excited to introduce our first discussion. To start off, our conversation will focus
on what we mean by whole health, and how two programs are addressing the mind-body
connection. First, we look at the Lummi Nation in Washington State, where a canoe
journey helps youth get in touch with the very real connection between their physical and
emotional health. Then we take you to the Bronx New York where an exciting program from
zero to three called HealthySteps takes care of famiy needs right in the pediatricians
office.
>>The youth are able to learn now more about who they are and where they come from, and I
think that that is definitely a wonderful journey towards healing.
>>For me, my healing is trying to get inside of my head and its thinking about who I am
as a person, and it's also bringing in a part of me that never really connected with
before.
>>When you look at it holistically, you're treating that child, their mental or spiritual
as well as their medical. You have to use a combination of thm all together to help the
child heal from the inside, out.
>>Now I feel like I can be heard, and that my voice does matter. [music playing].
>>HealthySteps is behavioral and the physical support right from that visit.
>>I was so scared I was in a very unhealthy place, worrying every day something was going
to happen. And then a knock at the door came when I took him to his first appointment.
And it was Janelle from the hel they steps program and she said hey do you have a moment
. And I said I don't know who you are but you're an angel.
>>Best part was when someone came to the doctor for a flu sht or well child visit also
got an opportunity to talk about the things that are hard for them.
>>For awhile we're just watching his milestones because he was premature, we were just
constantly worried about that. And she held our hand every step of the way.
>>A thank you to Michael and Allison for being here tonight and I just want to jump into
our conversation building on the video we just saw our first panl is going to talk about
the importance of addressing the whole health of children and youth. So please welcome
this evening, first Dr. Wanda Filer chair of the board of American
Academy of Family Physicians, from the child welfare association. And Paolo del Vecchio
from mental health services, before we get started I do want to invite the audience to
submit any questions here, folks online we are asking you to submit questions as well,
for the audience we have cards at your seats so if you have a thought please jot that down
. For folks who are watching you can submit questions through the webcast portal,
Twitter and Facebook as well. So Paolo I'll start with you to sort of frame the
conversation if you will for us tonight. When it comes to healh care why should we
be talking about whole child health care approaches?
>>Paolo del Vecchio: Thank you, Aaron. And I think it was Aristotle who said that the
whole was greater than the sum of the parts. And that's what really whole health, whole
child health care, is about. It's that we need to bring together the mental health, the
health care, schools , families, peers, and architects together o focus on the holistic
needs of youth and young adults. You know, right now, Aaron, for most families and
children they may have to go to a dozen or more different agencies to try to get help,
and confusing and trying to navigate complex systems, too often they fall through the
cracks. And what we reallyny, what we really need is that coordinated care models
, comprehensive coordinated care models that bring together in a teamibased approach with
a centralized contact, that's individualized supports for thoe individuals. And Aaron,
why this is so important is again, children are our future. And with the right treatment
, the right supports, and the right opportunities , that there are no limits for children
with mental health problems. That they can become doctors, scientists, Olympic champions
, and tefen directors of mental health agencies. Because I was one of those children
myself. And getting the right treatment, getting the right supports, having those
opportunities, I'm now able to make a difference in my communities, and all children
deserve no less.
>>Aaron Gilchrist: Absolutely. Teressa you grew up in an indigenous community and this
notion of the whole child approach notum familiar to you grew up near the Arctic Circle
in Alaska can you shed a little light for folks on this idea of the relational world view
a beautiful thing I'm just learning about, can you talk a little about that, growing up
where you grew up and having that view that so many indigenos communities have?
>>Teressa Baldwin: First of all, hello, my name is, I'm originally from kataspel Alaska
which is about 30 miles from the Arctic Circle, so I was asked to talk more about a
relational world view, and this is something that is very important when it comes to well
being as a native person. We see the world from the way that we are related to the land,
and for generations to come we have to protect this land, and o protect this
land you have to be able to protect our people as a whole, because we don't see ourselves
as individuals, it's more of our people, we see ourselves as people, so to protect the
next generation is to talk about this relation with the world and so I know in the mental
health field, we really do push this idea, not just to like teah our children, but to
make sure that they understand that, you know, we are the generation that is carrying the
burden, and we need to be able to teach so that the next generation, that doesn't see the
things that we're seeing today. In indigenous communities.
>>Aaron Gilchrist: Dr. Filer as a family physician you're oftentimes the first stop for
families. Frantic parents come to you when a child is hurt or something is physically
wrong. How important is it or how much does it improve your ability to treat a young
person if you've got an understanding of what behavioral issues may be in place , too,
when they come to you for a physical ailment?
>>Dr. Wanda Filer: Well, Aaron, I'm a family physician and we're trained in what we call
the biopsychosocial model in other words that person in front of me is more than one
organ system. My colleagues do one out of five U.S. offices so we take care of this
country, and we take children, bebut we also take chair of them across generations it's
not unusual for me to take care of the child, the parents, the grandparents. I love
>>Teressa Baldwin: sta's comments that generational viewI had a conversation with a
mother as recently as last week and her 15-year-old daughter has been diagnosed with a
fairly severe case of obsessive exuls exusive disorder and she shared a story with me
that I hadn't heard, when she was 6, trying to get her out the door to go to school
when the shoelaces weren't even, trying to tie the shoelaces, and this child sobbing so
the mother now has a context for that. So helping this child not only feel healthy
normal healthy and loved, but also make sure mom and dad are intact I do work around
childhood experiences and many of the parents I see have their own experiences and being
able to see them what are their psychosocial issues is there employment issues, is there
food and constitutional right, fortunately most of our folks ae insured that's been
a god send for improving access for many of our patients.
>>Aaron Gilchrist: We saw an interesting model in the HealthySteps portion of the vido
we saw a few moments ago , asking -- a behavioral health specialist asking questions not
only about the child's growth and development but also about any challenges the parent
might be having in raising their children and caring for their children's health. How
does addressing the family help better care for an individual young person? wan wand
it's huge. It's not unusual when I see a newborn for a newborn visit we'll turn around
and ask mom or dad or whoever brought that child in how are things going how are things
going at home we may screen the mother for instance for depression, we may talk to
them about what are their circumstances, how is the adjustment going in the family.
A lot of times, especially if this is the first child, there are a lot of fears, a lot of
anxiety, a lot of questions. And I have a chance to ease some of that and to help
normalize some of their fears. But also, we have -- I work in a federally qualified
health center in Pennsylvania and we have a project called family nurse partnership
and we actually have the moms who enroll in this, the nurses, can go out with them during
that whole pregnancy, and then for a subsequent year. And the out comes for those parents
, the moms are really proud because they know they've really invested in the health of
this baby, and the baby, the data shows babies tend to have much better outcomes.
>>Paolo the HealthySteps program focused first 3 years identify low for children. I know
you have a tool cick kit you're making parents, making families aware of providing
support for mental health challenges. Tell us a little bt about that?
>>Paolo del Vecchio: Sure Aaron, you know we provide supports and treatment early on
that we can help mitigate future disability and future problems, and this new toolkit
that we're just releasing today on infant and early childhood mental health consultation
helps to support caregivers to support social and emotional development and school
readiness. We know that only one in five teachers in this nation receive training on
social and emotional development. And this particulr model can help reduce by 50
percent preschool expulsions. So this particular toolkit on again infant and early
childhood mental health consultation provides models, financing, workforce issues,
all the how-tos on developing these kinds of efforts, and it's available on SAMHSA's
website.
>>Aaron Gilchrist: Teressa works a lot with young persons the mental and substance abuse
disorders. From a perspective how aware do you think young people of this mind body
connection and are they open to an integrated approach?
>>Teressa Baldwin: That's a really good question. I think that we're very aware of our
culture and tradition and how important that is to our people. But when you are in a
cycle of historical trauma, you don't actually realize that, you know, you kind of see it
as something that's very temporary. And that it's only happening to you. But really,
like historical trauma depose across generations, and has compounded the youth today. So
I think in an aspect, using culture as a protective factor s very important, and is now
coming to mind more. And so yeah, I do think it's like starting to become more aware in
my generation at least.
>>Aaron Gilchrist: Do you think young people are open to this approach, where we're
considering your physical health, your mental health, your spiritual health all those
things together, your cultural knowledge base? Do you think young people are willing to
receive that sort of approach in treatment?
>>Teressa Baldwin: Yes, and I definitely see it, from my own perspective, in my
own community, that a lot of youth are creating with meeting with and want to have help.
>>Aaron Gilchrist: You worked a lot with suicide prevention in your community too. Why
do you think this approach that we're talking about today so integral to helping people
who are in crisis when you're dealing with folks who are havig suicidal thoughts?
>>Teressa Baldwin: Well, it's really important because, you know, when you're talking
about the crisis of suicide, it's really the end point in so many different things
that are happening with person's life. So to be able to address both the physical needs
and your mental health needs is something that will broo prolong your life and something
that's much much more meaningful than just addressing mental health alone, which is very
important as well, but being able to combine those is very important.
>>Aaron Gilchrist: Dr. Filer you're the board chair of the American
Academy of Family Physicians. Can you talk a little bit about how your members,
how doctors, view this approach of integrated health care? And are you seeing improved
patient outcomes as a result of using it?
>>Dr. Wanda Filer: Our members as I've gone around the country are very supportive of
integrated health care with I've seen a huge shift in the last fw years we have much
more availability in the practices, health practices sits there's still some problems
with access to child mental health and getting those resources but we now have tele
medicine visits we have behavioral health in our office, there's a lot more availability
, and people are excited. We like team based care. And the ability to -- I see
a patient and maybe I'm helping them with their multiple chronic diseases, but
at the same time I identify and it may take a visit or two to convince them to see
someone for behavioral health. But if I've got that person on site or I can hook them in
for telemedicine I want to have that patient do that, begin that visit, as soon as
they're receptive to it. And so we've made significant strides, there's still more work
to be done.
>>Aaron Gilchrist: There are people who will say that you knw the doctor visit is rushed
, I don't feel like there's enough time to really talk about my issues to the level of
depth that I might like to. Is that something that doctors are aware of, and are trying
to sort of tackle for patients who are coming in?
>>I hear a murmur in the crowd that is one one thing I here frm my members is we want
more face-to-face time with patients. And our data suggests right now that for every
hour we're spending with the patient, we spend two hours on what we call administer trivia
. And it's not value odd we need to get or medical nurse practitioner physician
assistants back to having face-to-face time with patients. And we're working on that
there's many ways to accomplishment that, but I have conversations with patients abot
their mental health all the time. I would say 75 percent of my visits in any given day,
we have these conversations. How are things going at home, yu know, how are you doing
on all of the different stressors, many of these patiens I take care of for 15 or 20
years, and so I've had a chance to really learn and know them ad know what their
challenges are.
>>Aaron Gilchrist: Paolo, how is SAMHSA working with your partners to try to integrate
this type of approach into everybody's care?
>>Paolo del Vecchio: I think Aaron we know in the message around whole health care is
you cannot do it alone. So the need for us to develop partnerships at the federal, state
, community levels, among families, to meet the whole health needs of kids, is critical.
SAMHSA is working in partnership across federal agencies, so to kind of mention that
we are do for instance with HRSA around our primary behavioral health care integration
program. We're also working with our colleagues at the national institute of mental
health to develop first episode psychosis programs. We know 100,000 youth each year
experience a first psychosis break, and again, providing team based supports early on can
help promote recovery and well being, with treatments and other types of supports. We're
also working with our colleagues at Medicaid, at the centers for Medicaid and Medicare
services, to develop certified community behavioral health clinics. Which we really
believe can be a dpaim changer in community mental health. To raise the quality and
financing of community mental health perhaps like we haven't seen in 50 years. And last
thing I'll mention, Aaron, is we're working right now to develop the first interagency
serious mental illness coordinating committee. And that's a long title, that we loe in
government, of course, but what this is about, this is going to bring together over 10
federal departments. Health and Human Services. Labor. Education. HUD and others.
Along with other public stakeholders. To put a focus on serious mental illness in this
country. And that's very exciting.
>>Aaron Gilchrist: I do want to turn now to the audience questions. If you're in the
audience and you have a question, you have a question card you filled out just sort of
hold it up we'll try to grab it and work your questions in here. We have a few already
and Paolo I'll start with you this question some child mental health treatments are
spoursed by science, but some are not. What do you think nees to be done to maximize
the chances that children receive treatment that works?
>>Paolo del Vecchio: I think what's critical first of all is individualized care. That
what may work for one child does not necessarily work for anothe. So you really have to
tailor the care around the child and the family. And you know, what may work, both
medications as well as other psychosocial supports. Family psychoeducation, providing
training to family members, so that they can better work with treatment providers,
so they have the knowledge about how to access care, is also a really critical part. And
we know that peer support, how the other youth have gone throuh these systems, can be
incredibly hopeful, provide those role models to other yout, and help people find, you
know, recovery is possible.
>>Aaron Gilchrist: Teressa, that question was from mich in our audience. This question
from Twitter from barisfor Wilson. Can this approach, this whole child health approach,
impact social wellness for positive outcols, and if so, ho.
>>Teressa Baldwin: Yes. It can. And I can give you an example. So when I was younger,
I mean I grew up in the Arctic Circle and indigenous communitis we have a very high
suicide rate. And in my own community our suicide rate was 4 times the national average
. And so once I got a little bit older and I lost one of my really good friends, I had
started a campaign to change the dialogue around suicide in the State of Alaska. And
when I first came to different villages around Alaska, the elders were kind of frightened
about me talking about suicide. Because they thought that if we talked about it, their
children would commit suicide more. Which is not really the case. If you talk about it
and we have an open dialogue, you're able to really understand both the physical and the
mental needs of these children, and they think that is a prime example of the question
that was asked.
>>Aaron Gilchrist: Dr. Filer, this is from Andrea here in the audience. For parents
whose children are struggling with mental health problems, how can we best inform them
what treatments are evidence-based? There's so much information on the internet, parents
don't know what information to trust.
>>Dr. Wanda Filer: One of the things that we know is that having a usual source of care
. Having a primary care physician, provider who knows you, that can be a resource. Go
to that individual and ask your questions. I always -- we see lots of patients who come
in, we find all sorts of health information on the internet andI always tell parents
write it down, bring it in and let's talk about it before you o down that way, spend any
dollars, buy any materials on the internet. Come and talk to us, because I know you, I
know your children, maybe there's another alternative. Ad then there's a lot of
resources that physicians can go to, to figure out where is the evidence.
And sometimes also, sometimes my job is also to tell people what not to do, and maybe
there are other ways we can manage it. Get people into behavioral therapy and talk,
and talk through the issues. Both the children and the parents. And can be very
beneficial. So therapy, it may not be something that you have o buy on the internet.
>>Aaron Gilchrist: So you can start with Dr. Google, but then go to a real doctor.
>>Dr. Wanda Filer: Exactly. Can I quote you?
>>Aaron can I add to that? Just another resource that I thing is really helpful.
There's an old saying, the best consumer is an informed consume, and Kana mentioned in
her remarks that we're just releasing a set of materials on various mental health
disorders for children that we've developed in conjunction with the
American Psychiatric Association, American associatin of child and adolescent psychiatry
, and others. Families, as well. That provide that kind of basic information. That
they can receive. So again, that they're knowledgeable and informed consumers. Again,
that's available on our website, I encourage people to check that out.
>>Aaron Gilchrist: Okay this last question for the audience s from Steve, he says how
can we fuse more research into mental health delivery, just to ensure what we do actually
works, and it will contribute to knowledge production, to inform innovations, in
treatment development. I think. So how can we infuse more research into mental health
delivery is the question.
>>That's a great question, and there's absolutely a need to translate research into
practice. And one of the projects I mentioned around firt episode psychosis is a prime
example of that. This evidence based practice, which is a team based integrated care
model, was developed through research NIMH, and within a shot period of time, like
five years, we're able now to expand that model into communities across the nation.
Within that short period of time we've stood up 200 programs in states that really help,
again, individuals who are experiencing the first break of psychosis. So we need to do
more of that. We need to get from the research into the practice much quicker.
>>Aaron Gilchrist: Okay. Last question and I'll just sort of open it up this is from
Barry in the audience here hospital the integrated model of care address the social
determinants of health.
>>That's a very big issue for me as a family physician. Sometims patients will
tell me things, and sometimes they'll tell my behavioral healh colleagues things.
Sometimes they'll tell my front desk people things. And so what we know is as a team
, anyone who sees something has information or hears something, can bring it back.
And for instance, you know, I have a baby that I've been carig for, and the front desk
noticed that the mother was reusing disposable diapers. And the financial constraints on
this young mom were intense. And we were able to leverage soe social work, we also got
her all sorts of assistance through our faith communities, but also through Medicaid and
so forth. So it's the team. It's that integration, and as al we hear information, we
put the patient in the center of that care and try to lift them n whatever their
challenges are .
>>Aaron Gilchrist: All right great thank you, a great opening conversation here, we
appreciate all of our panelists to kick this off this evening, thank you so much .
>>Thank you. (Applause.)
>>Aaron Gilchrist: And now we will turn it back to Allison Schmitt
>>Allison Schmitt: Thanks Aaron. I found that visualizig success is an important step
to realizing success. It's been true to me through my career and it's true for improving
systems. First we need to see that it's possible, that it can and does work. To see how
we can accomplish it ourselves. One mace that has visualized successful integration is
New Mexico, where they're combining physical and behaviorl health services to provide
hope and help. The key ingredient? Communication .
>>I began to see my doctor, and I was telling her I wasn't feeling good, like my emotions
were crazy I didn't know what to do and she let me know there was a counselor here and I
just told her let me meet her I'm ready.
>>They know that they can trust us by being able to see them asa whole person,
so knowing that they're being taken care of internally and externally, I don't know if
that makes sense, but being able to say you know, my provider trusted person, and I'm
able to see both of them under the same roof, the impact is awesome.
>>Integrated health care is positive patient outcomes, and n treatment of their mental
health, in treatment of their physical health, in treatment of their social health.
>>When you look at hope I think that's a strong component in terms of behavioral health.
Because many times the patients that we see lack that hope. And I feel that one of
our responsibilities is actually to initiate that hope .
>>It's gotten me through life where I need to be, and it's ben good. I feel really
better than before. [music playing].
>>Actually feel like telehealth has helped us in many ways , whn we were in situations
where the kid would not have been seen if we didn't have telehealth.
>>It can open up personal things that I really want to, in a verbal conversation, it's
more comfortable to do it that way, so they know.
>>In a rural area it's pretty far the therapist there found te student and said hey,
let's connect, and she, the therapist and the student and I met, but I was not on site.
So telemedicine is super great for adolescent because it meets their needs it also meets
the needs of the parents.
>>With the computer it's just kind of a friendly setting like you're just having a chat
with someone and it's not as intimidating I'm in a medical office I'm getting
a prescription it's just I'm talking to someone over a computer.
>>Aaron Gilchrist: Before we start our next conversation, don't forget to keep the
questions coming, keep the conversation going by sending your questions through
the webcast portal, Twitter and Facebook, the hashtag we're usig tonight is he rows of
hope. Now, we've heard about the advantages of integrating behavioral and physical
health care for children and young people. Now let's talk a little bit about the key
element of a fully integrated children's health program, and that is effective
communication. Please welcome our next panel here, Lisa Lambet is the executive
director of the Parent/Professional Advocacy League. Dr. Lisa Cullins is a child
psychiatrist from the American Academy of Adolescent and Child Psychiatry.
Dr. Nerissa Bauer is from the American Academy of Pediatrics. And Juan Velez Court from
youth moef, Motivating Others Through Voices of Experience. Lisa let's start with you
now that we've seen the advantages of that approach of whole child health care what
do you see ideal way to get into that approach.
>>I think the partners have to be a team I can't emphasize that enough. Because they're
the experts on the children and the family and that's an important ingredient to be able
to make it successful. Families pair a really high burden of cae and are really
relieved a lot of times when there's someone else to help thm coordinate care for their
child and for their family. We did a quick survey a few years ago and 86 percent of the
families said that they were doing it themselves and they wee really hopeful that this
new approach would really help take some of that off of them.
>>Aaron Gilchrist: Juan, I know that you've delta personally wih isolation and with
suicide attempts, what are some of the challenges that young people have in revealing a
behavioral health concern to a doctor, to a family member even?
>>Juan Velez Court: It's acceptance at different levels acceptance when it comes to
their feels, a lot of times families may be threatened depending on their culture,
their friends, they're going to lose their support system, maybe not necessarily
to behavioral health but just the close people they've grown o love and appreciate. So
being able to find different ways to accept that. And make t a normal way. A lot of
times the issues we see behavioral health as a negative thing, some people in the
community. But when the youth is able to see that as you're my best friend you're
my family you're somebody that I love, and I appreciate dearly ad you're able to
fully support me then the youth feels more comfortable in being able to share that
experience, share what they're going through. And that's whatI did and that's what
helped me when I was able to speak with my family I was able to speak with my brother, my
family, and I felt like I was ready to begin a new phase in my life.
>>Aaron Gilchrist: What about when it comes to a doctor talkig to a primary care
physician, you know, you go in for your flu shot and there's something else on your mind
on your heart even, how do you approach that with your doctor?
>>Juan Velez Court: Honesty is key. When we talk about things, something is wrong, when
I began as a child obviously I didn't know the terminology, but I knew that
there was something wrong, so that is how I expressed it. Ask me more details that I
could not answer but when you saw that I was curious about wht was going on, and when
they explained to me then we went in a back and forth conversation of I can tell you
exact terminology but I could tell you situations that led to something similar. Oh,
when I was with these friends, I felt something, and later I learned that was anxiety
. Which was one of my diagnoses. Well, the previous panel talked about shoelaces ad
OCD. Exactly what I wnt through growing up and when I spoke abot my shoelaces my doctor
is oh that's what this is called. Oh, excellent. So I became part of that support
system for myself.
>>Aaron Gilchrist: Just talk.
>>Exactly.
>>Aaron Gilchrist: Just talk. Dr. Bauer the video we saw highlighted the potential
for telehealth, which we addressed just quickly a bit earlier. To sort of unlock thee
difficult conversations. Several young people said that t was easier for them to talk
that way, to be able to have a conversation through a -- you know, a device, if you
l rather than actually having that conversation in American. What are some of the other
advantages that you might see from telehealth?
>>Dr. Nerissa Bauer: There are other advantages certainly . I think especially in this
day and age when there are a lack of behavioral health specialists in certain parts of
the country, especially in the rural areas. I know that it can ease some of the stress
around trying to get to a clinic, to a a specialty center, where a lot of the behavioral
health specialists are and reside. And so decreasing that travel time, just trying to
figure out how to get there, trying to be on time, is a big win for tele health. As a
new modality, to help ease the burden for those folks who need it.
>>Aaron Gilchrist: Dr. Cullins, in the video we also saw some folks talking about
this idea of co-location, meaning that providers for a child and a family might -- that a
child and familyly might need to talk with who are all in the sae place together
what are some of the way to improve communication with the members of the child's medical
team?
>>Well locations is essentially. The medical home is a a good setting for, I have
fond memories of my pediatrician it's really a place they feel comfortable, and the
clinician is there, the pediatrician they trust so havig colocated with the
health professionals actually is the ideal situation, where I think for pediatric
providers they're able to when they're doing a well child visit and something come
up clinically that pertains to mental health issues they're abe to actually just drag
their mental health colleague and say hey, let me curb side yu really quickly I have
a patient right now that's dealing with this, let's say the patient had ADHD I've already
started this medication but is it time for me to increase the dose, or would it be help
ful if we have some parent training. And so it's so helpfl to have all these
disciplines in one place. And I think for the child, the most important thing, there's
identification and intervention. And what we do know, that sadly, when a mental health
issue has been identified, there's a delay of eight to 10 years before it's actually
treated. So once again, going back to this type of service delivery model is so
imperative to actually save lives.
>>Aaron Gilchrist: Do you find that practitioners are aware of this, to the extent that
they are sort of clumping together grouping their offices together to be able to treat
that way when it comes to children, are pediatricians near psychiatrists psychologists
to be able to have those conversations more closely?
>>Dr. Lisa Cullins: Well I think we're trying, we're on tht move, you know,
we anticipate -- we estimate that we -- therapy and child psychiatry in the country, we
currently have 9,000 but we're not all clumped together, but we are trying to establish
more of these types of relationships, where we're colocated. We have multiple types
of programs that enhance communication. Phone programs where a pediatric provider can
call a team of mental health clinicians and actually get that type of consultation, right
then, when the child is even in her office. So there's many was to still enhance
communication outside of the child psychiatrist or mental health physician to be actually
in the pediatric office.
>>Aaron Gilchrist: Lisa as a family leader how of you and other family leaders be able
to help people with this integrated approach?
>>Lisa Lambert: As Juan said it's important for good communication going on in the team
. It's also good for communication to be strong among the different people who are
helping to design these things. Because it's not like we have integrated care and it
never needs improvement. One of the things I say a lot at different tables is that
parents are the Amazon reviewers they're the mystery diners the consumer reporters and
they can tell with their children and systems what's working, we also want to do more
of what's working well and less of what's not working well. SoI think parents serve a
lot of individual functions when they can tell on an individual bases hey this is a great
model this is how it's improving families including my own. And also on a bigger level
what we're doing that is really working providing feedback from lots of families.
>>Aaron Gilchrist: Dr. Bauer we've been talking about this idea of bringing
people closer together and the idea that the system or many systems need to change
for improvement. For pediatricians who might be watching this and this conversation,
what advice would you give about more effectively collaborating with young people,
families , with their behavioral health providers too?
>>Dr. Nerissa Bauer: One of the things I would say is to know wo is in your community
for one. I remember when I first relocated from Seattle to Indianapolis I had to get out
and meet the other people that I was going to be working with. I think especially if I'm
going to be early identifying behavioral health problems there's a limit to what I can do
in that office for that family, so it really helps to know who your partners are. As
well as to be able to explain to the family, you know, I really need you to consider
going to therapy. Specifically could have been behavioral therapy. I don't provide
that. However, I do know so-and-so, and this is what to expect. I think just knowing
who though reach out for and how the systems of care work, how te referral patterns work
, and then be able to coach families through what to expect is very helpful.
>>Aaron Gilchrist: As a parent or -- I just wonder if pediatricians and psychiatrists
for example ever have -- you pick up the phone and you want o get to know as
pediatricians and psychiatrists that you might refer a family t, to know what their
style is to know their approach to know they might work for one family or not work for
another. Is that something that happens, pediatricians need to e doing more thinking
that of
>>Dr. Nerissa Bauer: Absolutely I think part of what I do , I need to make sure that I
build upon the trust that I have with families, and I don't want to necessarily tell them
to just here's a list. I like to let them know who they're going to go see. Obviously
it takes time to build those relationships with people in the community. But I think
it's a necessary endeavor. Because that family will then look to you for a source of
trust, and if you send them to someone, that perhaps isn't the right fit, but I also
think part of the communication, saying to the family , I'm going to refer to you this
agency, however, you need to come back to me if you don't fel like it's the right person
. It's not that the expertise isn't there, it's just that the goodness of fit between
you and that other person, you need to seek out help, might not be what you thought
it would be. And that's okay, we just need to make sure that e find you the right
person that you feel comfortable.
>>Aaron Gilchrist: And Dr. Cullins I'll ask you the same question from the other
direction. What encouragement would you offer to psychiatrists or other health care
providers about how to interact, interface with family doctors, o be able to execute a
really great plan for someone that needs help?
>>Dr. Lisa Cullins: Yeah, well, I definitely agree with Dr. Bauer, it's very important
for us to establish our network of providers, and know them basically, I take
the approach that I refer to pediatrician whomever, my own children, so it's
very important that we establish this relationship. But what I would tell pediatric
providers, I mean, we can basically provide a brief communication that can really be
powerful within a five, 15, 20 minute well child visit. And so really sometimes
pediatricians know someone that they went to medical school wit, or -- that we encourage
you pick up that phone, do that group consult. You have to really consider having a
colocated integrated model, it can be very cost effective. And once again, it can really
save lives. So we encourage the pediatricians to do that as wel. But you know, as I
said before, this is a move that we're cultivating. And so unfortunately there haven't
been that many avenues where we're really able to foster that type of communication. But
we're here now and we're able to do it, so we encourage everyone to.
>>Aaron Gilchrist: Juan, what do you think health care providers can do, behavioral
health care providers in particular, can do to make young people feel more comfortable in
talking about their behavioral health needs , and what services might be available for
them?
>>Juan Velez Court: I think it goes a lot right back to what yu mentioned with the
pediatricians about that atmosphere. Whenever that yout, that child goes in there how
can you make it the most comfortable place that can take them in their culture we don't
know where that child has been, that community, how can you make it such a forum where
that child will feel like this is part of my benefit system ths is somebody that's going
to help me. Maybe sometimes overprofessionalizing something can lead people to become
very afraid of receiving services. A lot of people don't receive services they need as a
whole a lot of times unless they're in crisis at different levels. So we make it a
normal part of their lives. You're going to have children that feel like that. I work
for a system of care in pure to ri to as well one of the benefis we have we have
sports activities within systems of care we integrate what they have in their compbts
communities in our system and we adapt what they need and we include as a result all
the professionals. And even when they don't have an appointment with us it will stil
come to us because they feel that comfortable with the system because it is part of their
daily routine.
>>Aaron Gilchrist: Lisa I think we talked touched on a little earlier there's a lot of
information, a lot of different ways for people to learn about this approach and
need for communication. What's your advice for pairns and caregivers that are trying to
navigate all the services and services that are out there.
>>I think you start with your primary care doctor they've knon them from when they were
really small, they maybe can say, this is what's going on or may roll it off to
a specialist, but it's a complicated system and I would say families, find an
organization or community resources that can help you navigate the system. Because
people have done this before you, and they have good advice, they have good ideas about
shortcuts or what to set as a priority, talking to another Veterans parent can be a
lifesaver for a lot of families and it's a really important thig to consider to add into
what you're trying to accomplish for your child. Aaron arena I want to turn to some
questions from the audience now, this is for anyone on the panel how does child health
differ in urban communities compared to rural communities what risk factors to
these children face and how can integrated care help address these risk factors?
>>Dr. Lisa Cullins: I'll take that one. What I've learned in my profession is that
mental health crosses all socioeconomic barriers, and all classes, and all cultures and
all races. And so the simple answer to that is that it works the same. However, it is
very important to integrate who that child is, who that family is, and the culture from
which they originate. So and we all do experience different things. But at the end
of the day once again is that mental health transcends all of these things, and it looks
the same. And so it's really important that if something is going on,
if the pediatrician smells something hm maybe we can see a little bit more, that it's
addressed right then and there.
>>Aaron Gilchrist: Juan, this question from Ashland Kansas, which I'm thinking is a
place as opposed to a name , someone watching the webcast, te question is how do you
become a youth leader.
>>Juan Velez Court: You become a youth leader by identifying these things that led
to you where you are, and being able to identify that across other leaders as well
. And the power of delegation. At some point you know none of s get any younger, you
aspire a system that would be there for when somebody wasn't there for you. You make
sure at the very beginning socially isolated how do you develop a youth leader you bring
the youth that are just getting inside a system into different aspects, being able to
create an equal environment, where they see the professional, it's not just their
supporters, not just a clinicians, but as peers, where we all have one common goal we all
have one common interest, whether it's rural, community, r somebody from the
metropolitan area, we all aspire to have this child grow so how can this youth leader
identify skills where they can then delegate that to the child that they are serving.
And motivational tools as well. So you have to be aware of who you're going to impact,
and how can that youth leader directly impact them based on te skill sets and the
experience that youth has had
>>Aaron Gilchrist: I'm going to ask you a question Juan from Mac from the audience I
think it's a good one particularly when we think about youth of color. I think
these things don't get talked about to the extent they need b. What can I DOS do as a
youth leader teach a a child that this is a real thing.
>>Juan Velez Court: I asked that same question years ago, in comedy movies we laughed in
drama movies we cry. So it's easy to take some of these thins that are happening around
us and applying them. You look at your parent, you look at somebody, whoever is in the
audience right now, there's got to be something that that person that may not be
accepting your situation, you're just too afraid to come out and reveal it, there has
to be something that person is very passionate about. How can you relate those two things
. So the same thing when you cry about this try um have stor, about becoming you know
like an Olympic gold medalist and all of these thngs, I want o have those things as well
. But I have these emotional barriers that I'm too afraid to speak out about. I'm not
saying this is a problem, this is something I want you to be on this drive with me, so
when we solve it together not only do I feel better, you feel better and the community
as a whole feels so much better. So include everybody based on specific examples that
they can relate to.
>>Aaron Gilchrist: Can I also offer a thought on that I think that's a big thing,
this idea that a child is experiencing a mental health issue, and they feel like they
can't go to an adult. I know it's a a bit off of what we're talking about, but it's a
big issue. What do you think you can do to make parents realize that it's real?
>>Dr. Lisa Cullins: Well I'm going to say that it doesn't always we want our children to
come to us, but I encourage you know children adolescents to go to adult authorities that
they trust. Sometimes it might not be their parent they're not ready to have that
conversation. If it's a guidance counselor if it's a teacher if it's a coach, a tuto,
a mentor, a church leader that they have the courage to go spek to someone that they can
share what's going on with them. And when that adult, should help facilitate perhaps
that conversation with their parents, because certainly we want the parents to be on board
. And the bottom line is I encourage everyone, if a child adolescent is saying hey, you
know, I need some help or something is not right, you should listen. Because
most children adolescents don't say that. So when they are identifying something,
this is the time that we need to listen.
>>Aaron Gilchrist: Lisa, a question for you from the audience. How do you integrate
informal supports, and non traditional intenkss into practice, how helpful has this been?
>>We were involved as an organization with an integrated care practice a number of years
ago, and we started by just going into the in-services at their lunchtime and telling
them about us, and you know, generating sort of that relationship so they could say well
gee this question has couple, why don't you just go talk to this organization here, this
family organization here, so it began with a very simple thing, and where the needs were,
it expanded, so we started doing some work together, they began asking to us review their
booklets and their pamphlets to make them for family friendly, and one thing led to
another. But we started really small with something that was based on good communication
, and trying to figure out where the connections would be. And e didn't know when
we started how that would look. But it was pretty successful.
>>Aaron Gilchrist: This question from the audience again from Marisa for Dr. Cullins.
What if a loved one is experiencing a mental illness bt refuses to go to therapy or
acknowledge the extent of their illness, what advice do you suggest to urge them to seek
help?
>>Dr. Lisa Cullins: That's a a tough one. If it's a child it's a little bit easier, if
it's an adult it's a little bit more challenging. So probably they're thinking about an
adult so I'll start with the hard one. I think with that is having a conversation with
that person to really help them see what areas of their life is working, and what areas
of their life might not be optimal. And see if you can jon with them on that type of
level of that conversation, so that they can identify well like okay, well, I'm unemployed
, this and that, whatever it might be, and I'm struggling ina certain area. And then
that might open up that family member to be able to say well, from my perspective,
I'm thinking that you might be struggling a little bit with this, depression, or
you might be so overwhelmed. And it might really be helpful f you go in and talk
to someone. It doesn't mean you have to be on medications or anything like that, but
just talk to someone. And that mother can say this is my perspective but I think
it would be really helpful if you speak to a professional this is my perspective, but I
love you and I'm concerned about you, and it seems like we agree that this area of your
life could be a little bit better. And maybe if you had a little bit more support, you
know, it can improve.
>>Aaron Gilchrist: I listened to your voice as you answered that question and I think
it's important -- you know you want to go into something like that -- it's a conversation
, it's out of concern, not an attack, not an accusation, not you're falling apart and you
need this help sort of a conversation?
>>Dr. Lisa Cullins: Right. No, no, no. You have to be very empathic and allow them to
share what their experience is. Because I think that is one of the greatest barriers to
mental health treatment someone accessing it, because they feel that it's their fault.
Something is wrong with them. They want to pleas their loved ones, examine so
they're letting them down, they feel a sense of failure. So tht loved one is able to
open up the conversation, so that they -- they, begin to understand what their sister or
brother or mother is actually enduring. That can really allow that family member to say
yeah, this is what I've been going through. And I'm glad you're here to support me.
>>Aaron Gilchrist: I want to try to slip in one more we havea few seconds left from
Lisa in the audience here, for anyone what do you see is the largest barrier to fully
integrating mental health into primary care. For anyone.
>>I don't want to keep talking.
>>Well, I'll take a go at that. I think for instance, when we identify a mental health
condition, as pediatricians we want to try to identify them as early as possible so that
way we have the best chance to mitigate the sequelae and sometimes when we identify these
issues it's really difficult to refer to our colleagues because either there are a lack
of them, or long wait lines. And it's really discouraging for some families who are
really in crisis. And I feel like more needs to be done to help primary care physicians
, clinicians, who are on the ground , to feel like they have access to adequate strategies
, and evidence based practices that they can either adapt into primary care practice, if
they don't -- are not fortunate enough to have a colocated model a fully integrated
health system, but that's an ongoing discussion . I think that's -- that makes it
really challenging.
>>Aaron Gilchrist: Okay, a very robust conversation here. Thank you to our panelists
for helping us to understand the value of communication here. (Applause.)
>>Aaron Gilchrist: Increasing clear that building relationshis is just a critical part
of finding success in this integrated care approach. Want you to keep the
questions coming of course on social media we will get to as many of them as we can
through the program tonight and now we'll turn things back over to Michael Phelps.
(Applause.)
>>Michael Phelps: We have a question from the audience, and it's how did Bob bowman and
the other coaches help you approaching with strultion while maintaining a high level
of performance. For me I was extremely lucky to have a coach who acted almost as a parent
, really. So for me I it was so lucky just because it's like every little small thing
we paid attention to. And you know, we were in it for the long run, and we spent our
20 years together. I think he taught me so many things and so many things I still use in
my life today. And one of the things he always was pushing for me to go out and reach
for help, and supporting everything that I did. And you know, for me somebody who
has spent a long time with him, that was something I was extremely thankful for. And he
was on board, and he learned through the process as well. So I think it was cool,
you know, me looking back now, it was something that we both grew from. And we both
learned a lot from. So I think that for me, our relationship changed
tremendously over the years, and right now he is little boon's granddad. So -- he's been
so supportive of everything that I've done, and I could never, ever thank him enough.
Okay, so as we've heard tonight, we can't compartmentalize a person's health we can't
separate mental from the physical. Mental health needs o cooccur with physical
health conditions, and vice versa. Being healthy is an entire package, and should be
supported by a team of providers who work together with families to develop one treatment
plan. Children's National Medical Center in Washington, D.C. truly does understand this
. They're improving overall health by focusing on the needs of the whole child. Let's
take a look.
>>Diabetes isn't just, you know, something you check in and it goes away, it's everything
, it's your entire life, your entire life changes because of this disease? Kids with
diabetes are more at risk for things like anxiety and depression, since sometimes that
can be an issue and we'll help try -- manage that.
>>Our Psychologists don't just deal with the patient they deal with the family. With
me I don't see any other way of doing the best care without mental health or other
multidisciplinary support.
>>So there's a comprehensive team for management at various stages, depending
on the patient's needs.
>>We have to communicate effectively as a trym to know what a family needs thu trician
, psychology, a social worker.
>>Are you eating the correct amount of stuff are you eating the right types of food, I
feel like that whole some kind of integration of everything really is key to taking
control of diabetes, and diabetes management.
>>To go to a psychologist that can kind of help you through the process that you've gone
through, and the changes that you're going through, and to hae a realization or to
finally fulfill what you want to fulfill , in terms of diabetes management, is a really
big thing .
>>You cannot lose hope. Because when one loses hope then there's despair. And you can't
take care of your physical health without mental health support or without a firm mental
picture.
>>Aaron Gilchrist: And with that, let me introduce our panelists for our third panel
this evening, where we will talk about the special needs of children, youth and
young adults with chronic health concerns. We have Kim Erlich from the national
association of pediatric nurse practitioners, Dr. Maureen Monaghan who is with the
children's national health system. Dr. Adair Parr is joining us from the
American Psychiatric Association, and Nicole Pratt of family voices in New Jersey.
Thank you all for being here today.
>>Thank you.
>>Aaron Gilchrist: Dr. Mon Han I'll start with you play two roles as a psychologist and
health educator. Why is it so important that we look at diseases like diabetes and
asthma through a behavioral health lens?
>>Dr. Maureen Monaghan: I think what we've heard echoed here tonight through all the
panel is we can't really separate physical health and mental health we know in order o
feel your best physically you need to feel your best measurabe and vice versa I work
with our diabetes program that you just saw highlighted in the video and it's
really important not only that I understand our emotional needs f our patients
and families but I also understand what they do medicaly every day for diabetes
management. And so I can't do what I do without the health knowledge that goes
along with it.
>>Aaron Gilchrist: Kim as a a nurse pran practitioner I imagie you sea lot of kids who
come to you with chronic problems they're dealing with, e talked about diabetes
or obesity in some cases. Tell us about some of the behavioral health needs that you see
in patients you see.
>>Kim Erlich: Well I think the variety is really striking . If we think about
one patient's story that was very, very striking, so this patient was a 17-year-old
Tongan male who had grown up nice and healthy, was playing foodborne illness and began
to have some pain, and through a series of tests was diagnosed with a very rare
but benign bone cancer that led to many different growths in his lower legs, and he ended
up needing multiple surgeries and couldn't play foodborne illness anymore and began
to have cooccurring behavioral disorders related to the trauma of that, and the
adjustment that having a comorbid chronic condition causd in his life. And that's
one of the examples that I can think of. But just the range of disorders that people
have is very striking. Aaron airnl you used the term cooccurring, Nicole I know you'e
--- you've hade a mom too you had a deal with a child with asthma and cooccurring
health concerns as well. How did that unfold in your family.
>>Nicole Pratt: Well I am a mom, I have two children with different types of
special needs and my daughter and son both were born premature at 26 weeks. So when
my daughter was born there was not what's called the RSV shot, she got a virus,
which causes her to have severe asthma and bronchial conditions. And then she developed
a learning disability on top of it, and then later on in life when she was around 15, had
her first mental health crisis. Which was indirectly related to her medical conditions,
but more related to my having had been in a domestic violate marriage when she was younger
. So between her asthma and learning disability and the mental health crisis, but the
good thing was at the time when she had her crisis I was working in a system of care
in New Jersey . And so I had knowledge and information on my side to be able to get her
all the right services and supports that she needed. Even during a time when I did have
to take that trip to the psych ER and I particularly told the psychiatrist that I was not
hospitalizing my daughter. Which was not very popular. Wih the nurse manager there.
But I knew that was something that having my daughter at home getting her the in-home
behavioral health services, and supports from school, as well as my support and support
from others, was going to be -- be able to help her move through her life, which it has.
And my daughter has been crisis-free for with about three years and off medication for two
, but I've done a lot of work to get her there. It wasn't easy.
>>Aaron Gilchrist: That's wonderful. Kim how difficult is it to bring up behavioral
health concerns with families that are also dealing with chronic issues? Are there
strategies that people can use to sort of help build a bridge between those two things?
>>Kim Erlich: That's a great question. You know, for me it's very easy to bring up
those concerns with families. It's very natural. I feel likeI have a wonderful rapport
, easy rapport with teens and their parents, who I take care of. But it doesn't come
that easy to everyone. And so a big part of my role is training primary care providers,
the people I train are pediatricians and family practie physicians mostly. Training
them in -- to get more comfortable with bringing these things up. And there are a bunh
of strategies. Making it more of a conversation is a great strategy. Learning about
motivational interviewing is a great strategy. And there are a lot of resources
supported by some of the collaborative organizations that are here tonight, AA for one
American academy of pediatric has a wonderful opportunity for its members around
motivational interviewing and those types of strategies are really helpful in helping
people become more comfortable in bringing these things out. I think a lot of providers
didn't have this as part of their training, and they themselves, because
of the historical societal stigma et cetera, they may not themselves be very comfortable
with these issues to begin with. So then they find it even hard tor bring it up
with patients and families that they take care of. But you askd what are the strategies
, I think that's -- that's the key right there, for them to learn these strategies like
having a conversation, using motivational interviewing, makig the connection
for patients and families between the physical disorder ad the behavioral disorder.
A lot of times families don't realize that. Even though it might be occurring, you know,
in their child, they don't see the connection. And so once you make a connection for them
, a lot of people actually have a a sense of relief.
>>Aaron Gilchrist: Dr. Parr we've talked about patients who start with a chronic health
issue, but sometimes it doesn't happen in that order. How do yu address issues like
obesity with children and families who come looking for mental health care as opposed to
those physical issues ?
>>Dr. Adair Parr: Sure, that's a great question. I spend a lot of my time talking about
weight, with children. So but you do want to approach it in a sensitive manner, and --
but I approach it from sort of a whole health type of approach. So we want to
give families and children and teenagers particularly advice about thinking mindfully
about their habits and trying to be healthy, focusing particulary on things like
encouraging exercise, thinking about what they're doing, you know, on a day-to-day basis,
and being thoughtful about it. So it's always -- it's a sensitive topic,
and particularly in teenagers, you don't want to create another problem. So by being
sensitive, and also listening to the teenagers and seeing what, you know,
their strategies r and what their concerns are, is a large piece of that.
>>Aaron Gilchrist: I'll ask you too about medication, another challenge
for children dealing with chronic conditions is trying to balance medications. Can you
talk a little bit about what approach you might encourage for that, and how a team can
help with that issue?
>>Dr. Adair Parr: Sure. I've had the opportunity to work in a primary care pediatric
setting where I'm working in an integrated care model called collaborative care psychiatry
, and we've been able to through the nern psychiatric association I was trained
in collaborative care psychiatry which is evidence based integrated care program, and
it allows me to work in communication with the pediatrician, so I work with a a team, so
we've talked a lot about teams tonight, and the biopsychosocial aspect we look at with
these families and youth. So what I do is work with the pediatricians and a nurse
care manager, and we've been able to set up a program in whih we are able to treat --
help the pediatricians treat things like anxiety and depression, and then we also use
evidence based tools like screening tools, symptom forms, which allow us to
identify patients who are not doing well. And when those patients are aware of them, I'm
able to do a psychiatric consultation. So that those folks who are either more complx
or having problems are the ones that I end up seeing. So it's been a great way to also
provide access quickly to patients who may not otherwise have access to a
child psychiatrist.
>>Aaron Gilchrist: Nicole I would imagine some of this could become overwhelming
for families and parents and caregivers when you have childrn who may be dealing with
asthma and diabetes or other serious illnesses that you're suddenly having to navigate a
large maze of people who can provide you some help. How did you navigate some of
these issues, and finding what you needed to get the outcomes that were needed?
>>Nicole Pratt: I was aggressive and curious about information. When I started working
in this field I started working in an early intervention program as a family support
worker, and that gave me the opportunity to go out into the field and work with families
who had children with a variety of different medical conditions and such, and so I was
one that always took the lead and found out information, resources and supports for
these families. And in turn, as I was using some resources and supports I would always
share the information with the family and say hey, this is something that I used, it can
certainly help you as well. Where I'm working at now for the statewide parenting network
, with we have a family voices chapter, we do a lot of work in connecting families
to resources and information. I do a training on health advocac, thelt literacy,
helping families understand your health insurance. And the resources that are within
your health insurance, whether you have a private insurance or Medicaid based HMO,
if you have an HMO in your system. So what are those resources and supports in there.
And I help people navigate those systems, and what they are. Because they can be very
intricate systems, even from getting SSI Social Security, how do you navigate and get
that support and service and what could it offer you. So a lot of my own experiences
I've used to share with families to get their resources.
>>Aaron Gilchrist: What about the coordination piece, you've got all
these players involved and moms have to -- and moms do it really well but mom has to
figure out how to make sure that all these people are talking to each other and treating
one individual.
>>Nicole Pratt: I had a lot of family support, and family sourt is key in that.
And I'm not just talking about your blood family relatives. Sometimes having
that external family support, whether through your doctors office, a family support
organization, other family organizations, friends, all thoe people around you help you
to kind of pull it together and keep it together, and help you o say it's okay to cry
when you need to. That it's okay. And feel sad sometimes, that you're doing the best
that you can, and sometimes what you think is not working, will eventually work. But
really have that strong family support is key in a parent, in a family's life
. Especially if you are a single mom like I am, I relied n that very heavily as a lot
of family support from also people who work at my job, justa variety of different people
to really keep it together. Because it can be very overwhelming and stress ful. When
my daughter went into crisis even though I was working in the system, it was still very
overwhelming and stressful. I had to rely on my family suppors for that.
>>Aaron Gilchrist: Dr. Monaghan can you talk a little bit about the integrated care
of children, and do you see better outcomes as a result of that.
>>Sure. This integrated care model is not a new model for our add 11th
children's diabetes program at Washington national I think it's been around for awhile
where there are a number of services available for a multidisciplinary team for patients
and families. For our integrated care model we have or psychologist our social workers
our nutritionists our diabetes nurse educators, our physicians working side-by-side
really as part of the team. So it's not even colocated that we share an office, but we
really are collaborative in that we're constantly talking about patients and families
that we work with, and setting collaborative goals and providig consultation to each
other. In terms of outcomes, I think it is a very successful model of care for us.
We're starting to integrate even more, I know Dr. Parr mentioned using validated
screening tools, that's one way that we're really bringing our behavioral health services
, even more to the to the forefront to our patients and families by screening adolescens
for depress sanity disorders when they're coming in for a routine diabetes care visit to
help start that conversation. We also make sure that we as a behavioral health team
try to get to know patients and families that are there. So frm the time a child is
coming into our emergency department with dagis of diabetes, someone from the psychology
team will be there within the first 24 hours just 0 to say hi, that we're here, that
we're part of a team. So that way if resources are needed in the future, they already
are aware of the services we can provide.
>>Aaron Gilchrist: Well we have a big stack of questions coming from the audience, I
want to turn to these now. This is for anyone on the panel. Should mental
health screening be a part of routine clinical care for children with chronic health
conditions.
>>Yes.
>>Yes.
>>Yes absolutely. I'll go ahead and answer that. In fact , I think it's really a key
piece of this. One of the primary issues with this is access to care, once you identiy
a problem, in the setting I'm in we've been able to -- I'll give you an example
of something that happened recently with a child that came in, young man probably 17,
came in for a well child visit, and a screening was used with a PHQ 9 which identifies
depression in teenagers and he identified that he was -- had suicidal thoughts. And so
the pediatrician was able to come and grab me, and I was able to do a -- you know
a screening exam and questionnaire, and then he came into the office with me,
the following day, to have a consultation. So that was an example of how we used our
system right there to help a child who really needed some help.
>>Aaron Gilchrist: Nicole, this question is from Elisabeth watching the webcast, who
says it's hard being a caregiver to children with special physicl and mental health needs
. What advice do you have for caregivers to take care of themselves, what
message do you have for parents who are struggling to get help they need for their child
with mental and physical health problems.
>>Nicole Pratt: I chuckle because I am guilty of not havig had not always doing
self-care. And when I started working for the statewide parens network and the
people around me -- you know they would see me working and taking care of my children,
they would -- one of my -- would say you need to take care of yourself you need to slow
down and take care of yourself. And it still didn't kind of register I was like yeah I
think I need to. But what I found was that my body was beginning to say you need to tae
care of yourself and I would get a cold. More often than I shoud have. And so
I started recognizing the signs and started doing more things -- some of the more things
for myself. So it's really important to listen to your bod, because your body will tell
you when you need to slow down. And find that one person that yu can talk to. One
person that you can call and almost any given time that you can talk to and just vent
. Because most of the time as parents, when we're dealing with children with
different types of special needs, you need to vent and get it out. And I find that many
times when I have done that, it has really helped me to refocus myself. So I do a lot of
refocusing, and whatever it is, you know, going to the gym, taking a walk, going get
your nails done I mean these are the things that do I that really helps me with those
things. There was a part two of the question?
>>Aaron Gilchrist: I think you tackled it pretty much.
>>Okay. . I wanted to make sure I got everything.
>>Aaron Gilchrist: This question is for Kim from tym hee in the audience who says
tell us about the role that the pediatric nurse practitioners play in terms of integrated
care, the transition from parent being the primary manager of a a chronic health
condition to a teenager, youth, taking on that responsibility cn be very stressful
for the whole family. What advice do you have for families and youth going through that
change.
>>Kim Erlich: So I think that kind of as a two part question. The first parttic
the rolg of pediatric nurse practitioners in all of that. o there are a lot of
pediatric nurse practitioners who come into primary health cae practitioners, like myself
, and work in this larger area of field and people working in all aspects of the field,
so people are working in primary care offices, mostly in primary care, and and then
they're becoming the people in the primary care office that are really strong at
doing behavioral health so they take a lot of that, there are people who truly specialize
in behavioral health , and then there are those of us like me wo sat in both worlds and
really work in primary care behavioral health in like an integrated model such as the one
that I work in , which is a pilot. And then the second part of the question was about
transitioning from parents and providers sort of managing the care, to more having the
team assume more of the care over time on their own. And I think that's a sort of a
hot button issue for adolescents transitioning into youth as wel, and the same thing
could be said for behavioral conditions as for other chronic health, you know,
physical conditions. The more that youth are involved from the beginning in their care,
the better off they'll be. I know for me, I'm in California where we have the California
minor mental health consent law, which says that tenancy 12 and over can get their own
mental health care. So that really has facilitated teens assuming more of a role, and
being stronger at sort of learning about and managing ther own care in time, and
that's something that we certainly encourage from the beginning, from the screening phase
.
>>Aaron Gilchrist: Okay, Dr. Parr, this is from Jane here in the audience. Mental
health issues such as ADHD are commonly misdiagnosed among youg children how do you
avoid the misdiagnosis and differentiate between dipical development versus a
true diagnosis.
>>Dr. Adair Parr: Great question that's my job as a chid psychiatrist I've been trained
to look at the medical piece as well as the psychological piece and social determinants
and put that all in a development trajectory of the child adolescent even in the context
of the whole family. ADHD is a primary example of something tht you don't want to
misdiagnose, and seems like everybody knows what the symptos are. So it's
really important also to gather information from other people. So whether it's teachers,
parents, to look also at different settings, and dpa they are that information, to put
that all together. So I think though as a child mental psychiatrist I'm uniquely
qualified to look at that all together and to make that assessment. That's what I do
every day.
>>Aaron Gilchrist: Okay, Dr. Mon Han this question from Sam watching the webcast --
that's a long one -- how do you help children youth manage the anxiety that comes from
living with a life-threatening chronic health condition. How have you seen depression
impact diabetes management r there any warning signs of mentl health issues that show up
in the management of the disease. If I refer to a family remember who has a child facing
a dual diagnosis what do you suggest I can do to help them find the best resources for
their needs. We're short on time if you want to tackle a one or two parts of that.
>>Dr. Maureen Monaghan: Sure one of the things I think they talked about is anxiety
about having a chronic illness, every day when you talk to families with diabetes we're
con stanl giving the message, one of our people always says perfection is a dirty word
in diabetes so we try to tailor the message to the patient and family and we're
always trying to meet the patient and family where they are. You're not going to be
perfect but let's look at everything you're doing day-to-day to manage diabetes let's
really celebrate that and then let's see where we want to make some changes, so trying to
take a strength based approach from that. And the other questions were about depression
and if you have a dual diagnosis we work with that again commonly could have been
behavioral therapy wags mentioned before, going to someone who is knowledgeable
about diabetes, and mental health conditions , if possible. Going back to
endocrinologist talking with your team to get recommendations and they're the best people
to point you in the direction if you don't have someone that's available within your
clinic.
>>Aaron Gilchrist: Some great advice there. Ladies thank you so much for being part of
our last panel today. Some great questions, thank you agai. (Applause.)
>>So I think if we get ready to wrap up this evening we've had a lot of food for thought
. A lot of information that's come and a lot of process. This conversation you
just watched will be available for awhile now on the internet for you to be able to
kind of go back and re process some things and ask some more questions. Right now though
we'll turn the program back over to Secretary Enomoto.
>>Kana Enomoto: Thank you, Aaron a. Tonight it is my great pleasure and honor to
introduce my new boss, Dr. Thomas E. Price, Secretary of te Department of Health and
human services. We're so fortunate to have his support as we partner to improve health
outcomes and deliver hope for American youth and their families. Dr. Price's experiene
caring for patients and his deep and really personal understandig of how public
policy affects those who deliver and receive care inspired him to pursue a career in
public service. First, in the Georgia State Senate and later n the United States
Congress. Since being sworn in as secretary of the Department f Health and human
services in February he's expressed the department's ongoing commitment to high quality
evidence based treatment for mental health issues. The principles
of the patient centered health care system he envisions -- affordability, accessibility,
quality, choices, innovation , and responsiveness, inform his leadership of the
department and drive his decisions involving children's health needs. Secretary price's
understanding of the connection between mental and physical health concerns, such
as childhood obesity and depression, makes him a true champion of our work. As Secretary
, Dr. Price aims to cultivate partnerships with organizations and individuals, including
many of you here tonight, who are committed to giving youth ad families the support
they deserve. Please join me in welcoming Secretary Price. (Applause.)
>>Dr. Thomas Price: Thank you. Thank you so much Kana for that kind introduction. My
goodness, she has done such a great, great job, will you pleae join me in giving Kana a
round of applause that for the work that she does. (Applause.) Thanks to all of you for
being here tonight for this remarkably important event, to help shine the nation
's spotlight on children's mental health. And thank you fr all that you do, day in and
day out, each and every one of you, to help our fellow Americas who are struggling with
mental illness or depression or drug addiction. It really is an honor for me to be here
with you this evening. But I have to tell you that it's alsoa little bit intimidating.
Part of my job tonight is to give an award to Michael Phelps and Allison Schmitt two
of the most decorated athletes in all of human history. Now, when a person who
has earned his or her way to one of the most prestigious award ceremonies in the world
, that would be the Olympics, it would be easy to think that any other award
ceremony pails in comparison. It's kind of like having a Nobel prize winning physicist
get first place at a high school science fair. But even though tonight's award isn't
gold or isn't bronze or isn't silver, I think that Michael and Allison will find it to be
just as valuable. Because what they understand and appreciate s the vital importance of
mental health in our country and in our communities today. Now, you heard a lot this
evening about the insep rability of physical health and mental health. And
this is more than just a framework to help us think clearly about health and wellness.
It really is an undeniable fact of the human condition that applies to all of us, even
those like Michael and Allison, who have super-human abilities. We tend to think
of Olympic athletes in terms of their physical attributes, of te God-given anatomical
gifts that every limpian has honed with super ( 0 Olympian hs honed with super
strength activity from a very young age, the quickness of the sprinter the raw power
of the wres already the grace of the gymnast and the incredible speed of the swimmer.
But the success of the athlete is truly determined less by the strength of her body than
by the resilience of her mind and the tenacity of her spirit. Even for the most gifted
athletes, the health of the body depends on the health of the mind. And you all know that
, that's why you're here. There's no way to separate the two. Now, Michael and Allison
are living proof of this fact. Both were born with athletic abilities that 99.9 percent
of humanity can only dream of possessing. And combined with a lifetime of training and
their boundless will to succeed these natural physical gifts helped them become two
of the greatest swimmers on the planet. But at the very same moment, the very same time
that the world was mambleing at their extraordinary athletic feats, Michael and Allison
were privately battling depression. An illness that jeopardized not just their
performance on the water but their ability to live healthy ad flourishing lives. Now
everyone knows how this story ends in 2016 Michael and Allison led team USA to an a
incredible porches in Rio and a grand total of 33 medals, their tryum have last summer
were just more than the natural steps of two incredible careers. They're a testament
to the truth that what makes an athlete, what makes all of us, s our mental health.
Before tonight I had never met Michael or Allison, we just hada great conversation back
stage and I said go dogs to Allison, and go blue to Michael. But I know and you know
about their battles with depression because they had the courage and the confidence to
tell their stories to the world. And this is why we're honoring them tonight. Michael
and Allison's stories are so important to hear because they prove that mental
illness impacts people of all backgrounds, and from all walks of life. Even those who
appear to have it all. A supportive friend group, a lovig family, and professional
success. But they can struggle, and to see the value the purpose in their lives. Even
the national heroes can field isolateed and alone. This is a message that America needs
to hear. Today approximately 60 percent of adults and 50 percent of adolescents with
mental illness fail to get the treatment and the services that they need. It's a number
that we ought not be proud of. This is a tragedy that none of s should be willing to
tolerate. No American should suffer in silence or in shame. They need to know that
they are not alone, and that seeking help is not a a sign of weakness, it's a sign of
strength . So thanks to the efforts of Michael and Allison and everyone in this
room tonight, and everyone listening, we're beginning to make progress in this fight.
But there is so much more, so much more to do. Especially for our young people, who have
seen an increased rate of major depressive episodes in recent years. New data from SAMHSA
's national survey on drug use and health released just today tells us that
adolescents who have diabetes or asthma, as well as those who are overweight or obese,
are much more like looly than their peers to experience a majr depressive episode. And
this underscores the need to make sure that we're all providing health care to all
of our children that takes into account both their physical and their mental health needs.
Three of the top priorities that we defined as -- for the Department of Health and
human services in my role as Secretary are serious mental illness, childhood obesity, and
combating the scourge of drug addiction and substance abuse. These three interrelated
problems are some of the most pressing challenges that we have facing our nation today.
And we can solve them. We can solve them, but it's going to require public and private
collaboration, fresh thinking, bold ideas and action, and a commitment to prioritizing
evidence based solutions. Now, much of this effort is already underway as you all well
know within the government and many of the organizations that are represented here tonight
. And we have also seen a renewed commitment in the executive branch from
President Trump who has assembled a Presidential commission to look at what the federal
government can do to better tackle the opioid crisis, a scourge across our lan.
President Trump has also begun the process of appointing a new assistant Secretary of
mental health a brand new position within HHS that will help elevate and make
more prominent the importance of mental health and substance abue from our government
's position. But overcoming these challenges can't be done y just one person or by one
government agency alone. We've got to work together, and we've got to have the courage,
like Michael and Allison, to speak out about mental illness. In both our personal and
our professional lives, we can't wait for our colleagues or our neighbors or loved ones
who are quietly struggling with mental illness or substance abue to come to us. They may
, but we can't wait for them to do so. We must never be afraid to go to them and ask the
simple question: How are you doing? Are you all right? Sometimes that's all it takes
to save a life. So I commit to doing my part as Secretary of Health and Human Services
as a physician, as a member of the community, to meet this challenge, and I invite and
challenge each one of us to join us at the Department of And at SAMHSA, in your
own neighborhoods, in your own communities across this great land. I know that if we do
that we will make a huge dent and move in the right direction of solving the challenge of
mental illness, depression, and substance abuse, and making certain that we tie for the
American people together the importance of mental health and physical health.
Thank you so much for what you're doing. God bless you. (Applause.) And now I have
the wonderful honor of asking Michael Phelps and Allison Schmitt to join me on the stage
to present the 2017 SAMHSA special recognitions award to Olympic and mental health
champions, Michael Phelps and Allison Schmitt. (Applause.) .
>>Give a big round of applause. (Applause.)
>>Allison Schmitt: Thank you Secretary Price and thank you SAMHSA. Out of all
the awards I've received in my life, I'm most honored to receie this award. When I
chose to speak out about my own mental health struggles, my only goal was to save one life
. No person should have to endure internal struggles in pan alone, nor should any
family have to mourn the loss of a child they didn't know was struggling. Throughout my
journey I've realized how prevalent mental illness is in the world we live in. Ignoring
signs, sweeping issues under the rug or feeling ashamed of your feelings, Michael and I
encourage each of you to speak out, in the care for every child's mental health. As I've
just finished my first semester towards my masters in social work, counseling I look fard
to continuing to de stig my advertise the negativity mental health. Being accepted to
mental health has been the most challenging yet the greatest key to excel in this game of
life. I do fully understand it's not easy. But together, we can make a change. For me,
I'm forever grateful for the support. For Michael, his wife Nicole, my parents,
my siblings, my teammates, my coaches, my aunt Amy and uncle Tim who loss a child to
suicide in 2015, as well as the rest of my family and friends wo sit by my side during
the toughest times in my life so far. Thank you, Michael, for being that lending hand
for hope and help. Without my support system, I wouldn't be standing here today. So
please, I beg you to be that hand for that struggling child. Thank you. (Applause.)
(Laughter)
>>Michael Phelps: Whoops. Thank you SAMHSA, and Secretary Price for spreting the
message that we should all care for every child's mental health. The struggles that I've
had weren't easy, and they weren't fun. But they're a part of my journey.
For the longest time I was really good at compartmentalizig things and just pushing
deeper and deeper, so I never had to deal with them. That brought me to a point in my
life where I found myself at an all-time low. It was then thatI finally decided that
I needed help, and that I could not do this alone. Life is tough. And it's tough for
everyone. As I look back at my journey, I'm so thankful for the support that I've had.
For my wife, my family, and my real friends. For me, I can't thank them enough for being
there. And being willing to take the time to help me. I truly encourage everybody to
ask for help, or to reach out to somebody you trust, just to tal. And to be there
for others in a time of need. Communication is so big, and its sometimes that we make
it a lot harder than it truly is. I hope my story, my messag, will help others get out
in front of this. This is something that we all have the power to change, and we can
make a difference. Thank you . (Applause.)
>>Aaron Gilchrist: And with that Awareness Day 2017 comes to a a close. I'd like to
thank our discussion participants, and of course the tremendous audience for all the
questions that kept coming through the evening. Let's keep talking about integrated care
and how we can ensure that our children, youth and young adults have every opportunity
to thrive. I want to let you know that an on-demand version f tonight's webcast
will be available in the next several days at SAMHSA.gov/children. I'm going to get
ready for my broadcast tomorrow morning by sleeping right now. In the car on the way home
. Thank you all for being here. Have a good night. (Applause.)
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