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This is Chris Sosa with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Helen Egger,
MD Co-founder and chief medical officer at Little Otter. Dr. Egger,
thank you so much for joining us today.
Thank you so much for having me.
Dr. Egger,
could you please introduce yourself and tell us a bit about your background?
Yes, so I co-founded Little Otter with my daughter,
which has been the most amazing experience to build this company
with my oldest child.
And really us together is what makes Little Otter special.
So I obviously have my background, uh,
in science and in medicine and in academic leadership.
But my daughter brought to the company hurt incredible
experience in computer science. She majored in computer science, um,
at UNC and then worked at a big data consulting company
called Palantir.
And then prior to Little Otter was the 20th employee at Chan
Zuckerberg Initiative where she built and ran their infectious disease
division.
So really I believe that we are gonna create innovation
in healthcare when we bring the expertise in healthcare
together with the new approaches in data science and technology
and in business development from the technology realm.
Dr, I gonna speak in broad strokes a little bit here.
What are the main challenges hospitals and health systems face,
including little Otter that is in meeting children's mental health needs?
Well,
we are in a child mental health crisis and we know that
the Covid exacerbated mental health challenges for children as well as
parents. Um, but we were in a crisis before covid.
So one in five children have an impairing mental health disorder,
and that's from children ages two to 18 years old.
But fewer than 50% of children get the mental
healthcare they need.
And many fewer children get actually evidence-based,
high quality mental health care. There are a number of reasons for this crisis.
One is that mental health has been carved out
in terms of many of the services provided to people,
and therefore the reimbursement rate is significantly lower.
And it can be difficult for families to be able to access care
overall or care that is covered by their insurance.
But there are other challenges. I mean,
I think one of the things about mental health is that their professionals from
many different disciplines who practice mental health, you know, psychiatrists,
psychologists, master's level social workers, um, MFTs,
et cetera.
And therefore I think that there is a real crisis in
consensus about what quality mental health care looks like
and how we are gonna deliver it to children and families.
As far as treating children's mental health is concerned. Dr. Eric,
could you please describe little Otter's philosophy and methodology?
Absolutely. So the reason that I left, uh,
academic medicine after 30 years and you know, left my endowed chair and tenure,
et cetera,
is that I've had the privilege as a researcher and a leader to see
the incredible advances that we have made in identifying mental health
challenges in children and providing effective
evidence-based treatment.
But what I was seeing is that what we are doing behind the walls of academia
is just not reaching people.
The other issue is that we have a problem with access because
there aren't enough, um,
mental health providers who have expertise in pediatrics and they're
bunched up in certain geographic areas.
So a sobering statistic is that 70%
of the counties in the entire US do not have one child psychiatrist.
So when we conceived of the idea for Little Otter,
it was clear that we had to have a way to be able to provide quality mental
healthcare. But number two,
that we had to embrace a fully digital approach because that is the
only way to be able to reach families across the country,
um, with the kind of specialized care that we do. Now,
little Otter is a digital early childhood mental health company. Uh,
we provide care to children from birth to age 14
and their parents. So my, uh,
research over the last 30 years is focused in the area of early childhood
mental health that is children zero to six years old.
So I know well from my work, um, and the work of my colleagues,
how it's even more difficult to get mental health care for your young children,
um, than it is to get help for teenagers.
And it's so important that we're addressing adolescent mental health.
But the fact is that mental health disorders start
early.
50% of adult mental health disorders start before the age of 14.
And so our philosophy at Little Otter, it's again bringing my, uh,
research work as well as clinical work to create an accessible,
effective,
inclusive platform that can do the early identification of
mental health problems in children and provide effective treatment.
The other thing that sets Little Otter apart in our philosophy,
really in many ways comes from my experience as a mom navigating
the health system.
We know that people do not live in isolation.
The child lives in a family and that we need to be thinking
holistically and inclusively about a family's mental health if we're gonna help
a child. So we provide a mental health care to children,
um, with therapy as well as medication management,
but we also provide mental health care to parents. We do parenting,
um, support as well as evidence-based interventions. We do couples counseling.
We do family therapy.
Our philosophy is centered in the idea that really mental
health has to do with one's internal experiences,
but also having strong supportive relationships with the people who you
love. And that's what we are, um,
focused on building this new model of care to bring, um,
this approach into the homes of families.
Dr. Er a couple things. I'm glad you mentioned. First,
the digital nature of mental health treatment. Uh,
could you describe some of the advantages and maybe disadvantages of how
telehealth has evolved in the mental health field?
Telehealth has had a big impact in the field of
psychiatry and mental health, particularly during the pandemic.
And I believe that the data show that the only way that we are going
to address the mental health crisis for children and for adults is
really embracing telehealth and digital health.
One of the key things to realize is there's a challenge of getting access to
mental health care,
but there's even a bigger challenge of getting access to the expertise
in the area that you're having problems with.
And so if we think about our area at Little Otter of early childhood mental
health, even if you wanted to get in-person care,
you are very unlikely to be able to access the level of expertise
that, um, we can deliver digitally. Now,
people can be very skeptical about the idea that you can do, uh,
tele psychiatry or telemental health with children, but again,
this is where you need to bring your expertise. We have developed, um,
and wonderful ways of using the zoom,
blackboard drawing together. We, you know,
the child can sit on the floor and the parent can put the computer on the floor
and we can play together so that it is very clear that
it is both effective and satisfying, uh,
to be able to deliver, uh, mental healthcare, uh, in this kind of way.
Now there's so many advantages for families.
We come to you and we are able to care for the child in
the place where he or she lives. So we get to see the child's room, their puppy.
We also get to see where, um, the family interactions are happening.
It's much more convenient for parents. We find that commonly with,
in-person care, it is only one parent who comes to the session,
which makes sense 'cause you have to leave work and drive, pick the kid up.
We now have really robust engagement of both parents in care
because even if one parent is at work, they can, um,
log onto the Zoom call and participate in the session.
So we really find that there are huge advantages.
There are some, um, things that we do not do that are not appropriate.
I think for, uh,
a telehealth approach that would be a child needing a higher level of care,
some kind of intensive outpatient care, or obviously inpatient care.
Number two, if you had a child with a new onset psychosis,
I think that you wanna have to do a medical workup,
but I would want that to be done in person and doing, um,
evaluations and, um, diagnosis of autism spectrum disorders.
So, and some families have preference, so when those,
any families in those situations come to us, then we, um,
we refer them out and work with them to be able to find the care they need.
Dr. River,
I'm also so glad that you mentioned how the mental health of the family unit is
so important.
What do you think are the greatest challenges and the goals of making this
approach more mainstream?
I think that the approach that we are taking to mental health is an approach
that should be used across the lifespan, right?
If you are a person who's experiencing a severe depression,
we shouldn't just be focusing on your care if it's, let's say a mother,
but we need to make sure that the children and the family are okay and that the
spouse is okay.
So the way that we approach this at Little Otter is to bring
measurement to every step of our process so that our care
is data driven and our outcomes are data driven.
So I created something called the Child and Family Mental Health Checkup.
And I think this is key to when a person first comes for care,
that we have to understand what's going on. So in the checkup,
we address the child's mental health and the impact of the child's mental health
on their functioning, on their parents' functioning and the family functioning.
I really think these kind of checkups should be standard in pediatric visits
as well as at schools. We check children for their height and weight,
but we don't have a way to check in about how their mental health is doing.
But in the, uh, checkup that I created,
we also screen the parents for anxiety and depression and
we assess the dynamics in the family.
So we assess conflict in the parent partner relationship in the
co-parenting relationship in the parent-child relationship,
and try to understand how much stress this family is
experiencing.
And the importance of this being integrated and done together is that then you
can make clinical treatment decisions about what are the most
urgent issues to address and how are you gonna do that.
And an example I give is,
if you have an anxious child who needs to do cognitive behavioral therapy,
you are not going to make a lot of progress with that child's anxiety.
If every night the parents are fighting and, um, you know,
there's a lot of conflict in the family,
we have to be able to address the environment that that child lives in as much
as the symptoms that they are experiencing.
Dr. Ger finally,
what steps do you think hospitals and health systems can take when treating
children for suicide ideation in particular?
This is, uh, a very important area. We have seen, uh,
an increase in children with suicidal ideation, um,
as well as er visits for suicidal ideation or attempts.
So let me first tell you what we do at Little Otter. So in our, uh,
first intake call with a master's level a provider,
we do a formal screening for suicidal ideation with the
child and with the parent.
And if we find that the child has suicidal ideation that doesn't need to,
you know, immediate hospitalization, but the child has these symptoms,
we then get them in within 24 hours to do an
assessment with one of our providers that assesses the child's mental health,
but also combines safety planning. Um, and, um,
some feedback on how to manage this with the child and the parent.
I think the way that health systems, um,
and hospitals should address this is first you need to ask,
you need to screen. So children who are in the hospital,
um,
it should be part of the assessment that is done when the child is admitted
and during the hospital stay, but also in, um,
general pediatric clinics,
but particularly in subspecialty clinics where we see very high rates of
depression in children who are facing cancer or diabetes or other chronic
health conditions. And then you need to be able to, um,
provide the child with the correct intensity evidence-based intervention
to help with the suicidal ideation. And there is a,
a evidence-based therapy called Dialectical Behavioral Therapy that
is, um, for adults,
but also actually now for children and adolescents.
And it has a very robust evidence-based for being effective.
So I would say that if you want to really help children
with suicidal ideation,
you have to have providers who are experienced in delivering
DBT.
Doctor,
I thank you for being so generous with your time today and all your insight on
these crucial topics.
We very much look forward to sharing your insights with our audience,
and I look forward to connecting with you again soon.
Great. Thank you so much.
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