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This is the Becker's Healthcare Podcast,

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created by the team of
Becker's Healthcare,

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a multimedia company devoted to
the people who power us healthcare.

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Four new 15 minute episodes are released
daily containing industry news analysis

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and thought leadership.

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From powerful healthcare decision makers
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Thanks for listening.
Now here's the episode.

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This is Chris Sosa with the
Becker's Healthcare Podcast.

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I'm thrilled today to be
joined by Helen Egger,

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MD Co-founder and chief medical
officer at Little Otter. Dr. Egger,

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thank you so much for joining us today.

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Thank you so much for having me.

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Dr. Egger,

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could you please introduce yourself and
tell us a bit about your background?

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Yes, so I co-founded Little
Otter with my daughter,

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which has been the most amazing
experience to build this company

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with my oldest child.

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And really us together is what
makes Little Otter special.

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So I obviously have my background, uh,

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in science and in medicine
and in academic leadership.

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But my daughter brought to
the company hurt incredible

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experience in computer science. She
majored in computer science, um,

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at UNC and then worked at a
big data consulting company

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called Palantir.

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And then prior to Little Otter
was the 20th employee at Chan

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Zuckerberg Initiative where she built
and ran their infectious disease

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division.

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So really I believe that we
are gonna create innovation

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in healthcare when we bring
the expertise in healthcare

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together with the new approaches
in data science and technology

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and in business development
from the technology realm.

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Dr, I gonna speak in broad
strokes a little bit here.

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What are the main challenges
hospitals and health systems face,

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including little Otter that is in
meeting children's mental health needs?

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Well,

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we are in a child mental
health crisis and we know that

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the Covid exacerbated mental health
challenges for children as well as

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parents. Um, but we were
in a crisis before covid.

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So one in five children have an
impairing mental health disorder,

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and that's from children
ages two to 18 years old.

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But fewer than 50% of
children get the mental

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healthcare they need.

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And many fewer children get
actually evidence-based,

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high quality mental health care. There
are a number of reasons for this crisis.

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One is that mental health
has been carved out

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in terms of many of the
services provided to people,

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and therefore the reimbursement
rate is significantly lower.

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And it can be difficult for
families to be able to access care

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overall or care that is
covered by their insurance.

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But there are other challenges. I mean,

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I think one of the things about mental
health is that their professionals from

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many different disciplines who practice
mental health, you know, psychiatrists,

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psychologists, master's level
social workers, um, MFTs,

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et cetera.

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And therefore I think that
there is a real crisis in

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consensus about what quality
mental health care looks like

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and how we are gonna deliver
it to children and families.

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As far as treating children's mental
health is concerned. Dr. Eric,

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could you please describe little
Otter's philosophy and methodology?

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Absolutely. So the reason that I left, uh,

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academic medicine after 30 years and you
know, left my endowed chair and tenure,

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et cetera,

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is that I've had the privilege as
a researcher and a leader to see

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the incredible advances that we have
made in identifying mental health

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challenges in children
and providing effective

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evidence-based treatment.

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But what I was seeing is that what we
are doing behind the walls of academia

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is just not reaching people.

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The other issue is that we have
a problem with access because

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there aren't enough, um,

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mental health providers who have
expertise in pediatrics and they're

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bunched up in certain geographic areas.

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So a sobering statistic is that 70%

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of the counties in the entire US
do not have one child psychiatrist.

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So when we conceived of
the idea for Little Otter,

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it was clear that we had to have a way
to be able to provide quality mental

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healthcare. But number two,

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that we had to embrace a fully
digital approach because that is the

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only way to be able to reach
families across the country,

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um, with the kind of specialized
care that we do. Now,

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little Otter is a digital early
childhood mental health company. Uh,

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we provide care to children
from birth to age 14

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and their parents. So my, uh,

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research over the last 30 years is
focused in the area of early childhood

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mental health that is children
zero to six years old.

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So I know well from my work, um,
and the work of my colleagues,

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how it's even more difficult to get mental
health care for your young children,

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um, than it is to get help for teenagers.

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And it's so important that we're
addressing adolescent mental health.

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But the fact is that mental
health disorders start

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early.

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50% of adult mental health disorders
start before the age of 14.

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And so our philosophy at Little
Otter, it's again bringing my, uh,

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research work as well as clinical
work to create an accessible,

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effective,

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inclusive platform that can
do the early identification of

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mental health problems in children
and provide effective treatment.

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The other thing that sets Little
Otter apart in our philosophy,

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really in many ways comes from
my experience as a mom navigating

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the health system.

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We know that people do
not live in isolation.

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The child lives in a family
and that we need to be thinking

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holistically and inclusively about a
family's mental health if we're gonna help

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a child. So we provide a
mental health care to children,

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um, with therapy as well
as medication management,

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but we also provide mental health
care to parents. We do parenting,

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um, support as well as evidence-based
interventions. We do couples counseling.

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We do family therapy.

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Our philosophy is centered in
the idea that really mental

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health has to do with
one's internal experiences,

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but also having strong supportive
relationships with the people who you

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love. And that's what we are, um,

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focused on building this new
model of care to bring, um,

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this approach into the homes of families.

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Dr. Er a couple things. I'm
glad you mentioned. First,

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the digital nature of
mental health treatment. Uh,

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could you describe some of the
advantages and maybe disadvantages of how

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telehealth has evolved in
the mental health field?

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Telehealth has had a big
impact in the field of

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psychiatry and mental health,
particularly during the pandemic.

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And I believe that the data show
that the only way that we are going

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to address the mental health crisis
for children and for adults is

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really embracing telehealth
and digital health.

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One of the key things to realize is
there's a challenge of getting access to

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mental health care,

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but there's even a bigger challenge
of getting access to the expertise

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in the area that you're
having problems with.

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And so if we think about our area at
Little Otter of early childhood mental

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health, even if you wanted
to get in-person care,

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you are very unlikely to be able
to access the level of expertise

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that, um, we can deliver digitally. Now,

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people can be very skeptical about
the idea that you can do, uh,

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tele psychiatry or telemental
health with children, but again,

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this is where you need to bring your
expertise. We have developed, um,

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and wonderful ways of using the zoom,

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blackboard drawing together. We, you know,

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the child can sit on the floor and the
parent can put the computer on the floor

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and we can play together so
that it is very clear that

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it is both effective and satisfying, uh,

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to be able to deliver, uh, mental
healthcare, uh, in this kind of way.

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Now there's so many
advantages for families.

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We come to you and we are
able to care for the child in

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the place where he or she lives. So we
get to see the child's room, their puppy.

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We also get to see where, um, the
family interactions are happening.

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It's much more convenient for
parents. We find that commonly with,

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in-person care, it is only one
parent who comes to the session,

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which makes sense 'cause you have to
leave work and drive, pick the kid up.

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We now have really robust
engagement of both parents in care

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because even if one parent
is at work, they can, um,

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log onto the Zoom call and
participate in the session.

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So we really find that
there are huge advantages.

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There are some, um, things that we
do not do that are not appropriate.

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I think for, uh,

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a telehealth approach that would be a
child needing a higher level of care,

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some kind of intensive outpatient
care, or obviously inpatient care.

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Number two, if you had a child
with a new onset psychosis,

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I think that you wanna have
to do a medical workup,

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but I would want that to be
done in person and doing, um,

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evaluations and, um, diagnosis
of autism spectrum disorders.

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So, and some families have
preference, so when those,

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any families in those situations
come to us, then we, um,

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we refer them out and work with them
to be able to find the care they need.

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Dr. River,

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I'm also so glad that you mentioned how
the mental health of the family unit is

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so important.

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What do you think are the greatest
challenges and the goals of making this

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approach more mainstream?

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I think that the approach that we are
taking to mental health is an approach

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that should be used across
the lifespan, right?

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If you are a person who's
experiencing a severe depression,

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we shouldn't just be focusing on your
care if it's, let's say a mother,

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but we need to make sure that the children
and the family are okay and that the

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spouse is okay.

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So the way that we approach
this at Little Otter is to bring

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measurement to every step of
our process so that our care

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is data driven and our
outcomes are data driven.

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So I created something called the
Child and Family Mental Health Checkup.

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And I think this is key to when
a person first comes for care,

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that we have to understand what's
going on. So in the checkup,

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we address the child's mental health and
the impact of the child's mental health

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on their functioning, on their parents'
functioning and the family functioning.

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I really think these kind of checkups
should be standard in pediatric visits

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as well as at schools. We check
children for their height and weight,

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but we don't have a way to check in
about how their mental health is doing.

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But in the, uh, checkup that I created,

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we also screen the parents
for anxiety and depression and

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we assess the dynamics in the family.

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So we assess conflict in the
parent partner relationship in the

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co-parenting relationship in
the parent-child relationship,

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and try to understand how
much stress this family is

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experiencing.

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And the importance of this
being integrated and done
together is that then you

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can make clinical treatment
decisions about what are the most

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urgent issues to address and
how are you gonna do that.

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And an example I give is,

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if you have an anxious child who needs
to do cognitive behavioral therapy,

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you are not going to make a lot of
progress with that child's anxiety.

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If every night the parents are
fighting and, um, you know,

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there's a lot of conflict in the family,

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we have to be able to address
the environment that that
child lives in as much

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as the symptoms that
they are experiencing.

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Dr. Ger finally,

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what steps do you think hospitals and
health systems can take when treating

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children for suicide
ideation in particular?

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This is, uh, a very important
area. We have seen, uh,

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an increase in children
with suicidal ideation, um,

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as well as er visits for
suicidal ideation or attempts.

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So let me first tell you what we
do at Little Otter. So in our, uh,

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first intake call with a
master's level a provider,

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we do a formal screening for
suicidal ideation with the

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child and with the parent.

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And if we find that the child has
suicidal ideation that doesn't need to,

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you know, immediate hospitalization,
but the child has these symptoms,

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we then get them in
within 24 hours to do an

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assessment with one of our providers
that assesses the child's mental health,

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but also combines safety
planning. Um, and, um,

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some feedback on how to manage
this with the child and the parent.

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I think the way that health systems, um,

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and hospitals should address
this is first you need to ask,

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you need to screen. So children
who are in the hospital,

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um,

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it should be part of the assessment
that is done when the child is admitted

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and during the hospital
stay, but also in, um,

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general pediatric clinics,

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but particularly in subspecialty
clinics where we see very high rates of

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depression in children who are facing
cancer or diabetes or other chronic

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health conditions. And then
you need to be able to, um,

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provide the child with the correct
intensity evidence-based intervention

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to help with the suicidal
ideation. And there is a,

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a evidence-based therapy called
Dialectical Behavioral Therapy that

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is, um, for adults,

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but also actually now for
children and adolescents.

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And it has a very robust
evidence-based for being effective.

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So I would say that if you
want to really help children

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with suicidal ideation,

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you have to have providers who
are experienced in delivering

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DBT.

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Doctor,

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I thank you for being so generous with
your time today and all your insight on

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these crucial topics.

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We very much look forward to sharing
your insights with our audience,

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and I look forward to
connecting with you again soon.

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00:16:10,725 --> 00:16:12,035
Great. Thank you so much.

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00:16:14,505 --> 00:16:17,755
It's so important for leaders at the
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00:16:17,865 --> 00:16:19,475
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00:16:19,905 --> 00:16:23,035
help our audience better do this
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and meaningful way. Becker's
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00:16:27,665 --> 00:16:30,675
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00:16:33,625 --> 00:16:38,435
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