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This is Chris with the
Becker's Healthcare Podcast.

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I'm thrilled today to be
joined by Amy Wimpy Knight,

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president of the Children's
Hospital Association. Amy,

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thank you so much for joining us today.

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It's great to be here with you
all. Thank you for having me.

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Wonderful. In the meantime,

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could you first give us a little bit
about yourself and your background?

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Sure. Um, I'm the president of the
Children's Hospital Association,

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so we represent over 200 hospitals,
children's hospitals nationwide,

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um, and the families and
children that they serve.

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So we have a focus on advocacy and policy,

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on care delivery and on just
improving the lives of children and,

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and their families.

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Amy,

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what would you say are the most pressing
concerns for youth mental health today?

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I, I think, um, when you talk about
children's mental health, it's,

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it's a big topic and so if we
had to focus on two things,

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I think we've all seen
it in the news lately.

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Certainly it's all touched us in
our personal lives, but I would,

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I would focus on two things. First
of all, it's the kids themselves.

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So when we talk about youth, we're
not only talking about adolescents,

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but we're also talking about children
and just how it's impacting them

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and their own experiences should
be of concern for all of us,

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and that's one of the reasons
we are all talking about it.

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So if you look at the incidents
of mental health crisis,

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quite honestly in children, it's
really grown over the past decade plus.

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So we're dealing with a number of
children who are along that continuum from

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starting to experience some emotional
distress to children that have actually

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been in crisis and in our cases have
shown up in children's hospitals,

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emergency rooms, um, in our ambulatory
areas, and even in our inpatient areas,

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seeking, seeking care. So
that's the tip of the iceberg.

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If we're seeing it at that level and
a number of children that we're seeing

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today, which is two and three
times what we've seen previously,

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we know that children
more broadly are in need.

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So those in our schools
and in our communities,

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the second concern I think
goes without saying is,

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do we have the providers to meet
that need? And by providers,

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we both mean people and programs.

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So at a time in our country where we
know we have fewer mental healthcare

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professionals overall, um,
to serve our country's needs,

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we actually have a disproportionate,
fewer only 4%, for example,

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of clinical psychiatrists are
trained to take care of children.

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And so we have an extreme shortage,
not only of of licensed professionals,

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but also of training in our communities
and our schools and in our families to

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be able to identify and cope with
the early onset of potentially, um,

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emotional challenges and then more
long-term, severe mental illness.

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Uh, you took over as the
C HHA president in 2020.

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Certainly that was a difficult
time for everyone's mental health,

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not only children,

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but how do you think children's mental
health has changed since the pandemic and

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its onset?

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Um, it's changed a lot,

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and I think it's important to realize
that even before the pandemic,

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really the decade prior to that, we saw
children's health, the need for, um,

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children's health, mental health
care increase quite a lot.

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So demand was growing. Um,

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really from the late early
two thousands to 2019,

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we saw a double in a tripling and that
time of suicide ideation and children

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attempting suicide. Um,

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what happened really during the
pandemic was an exacerbation of that.

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So we saw it increased that same
level in a very short period of time.

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So children, um, faced all kinds
of crises during the pandemic,

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I think we all did if we're
frank with ourselves. And so, um,

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they're hit differently than adults are.

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So issues of illness and
financial strain, um,

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being away from school,

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being away from peer groups had
a disproportionate impact on, on,

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on our children.

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And so what we saw during that time
in particular was nearly a tripling of

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suicide ideation and suicide attempts
in our children's hospital emergency

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rooms, um, which was quite
concerning. We certainly saw, um,

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more than a hundred percent increase
really in, um, eating disorders, um,

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particularly in young women and that
situation. And then just children overall.

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We saw it start to impact
kids at a younger age.

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So why typically you didn't see mental
health issues come to the forefront maybe

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until the early teens, we started
seeing children ages six to 12, um,

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show up with mental health conditions
or early mental health conditions that

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required an intervention as well. So, um,

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it's a situation that has grown and
unfortunately hasn't been subsiding. Um,

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it's probably the biggest symptom
of that from a children's hospital

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perspective, again, is what
happens in our emergency rooms.

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And then unfortunately,

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what happens when we're unable to
get children immediate care. Um,

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some children's hospitals have very
intensive ambulatory programs, um,

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outpatient programs and,
um, inpatient care, but the,

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the bed capacity to be able to
treat these children today, um, is,

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is far lower than what
we need overall, um,

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in most states and in most communities
and certainly across the country.

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And thank you for laying out those
challenges and concerns that not only

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children but hospitals and
health systems are facing.

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What would you say right now are the
steps that are being taken to support

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mental health in communities and what
can hospitals and health systems do to

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further that effort?

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There's, there's a lot of energy
around this right now, and I,

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I think if we pause to
look at, um, you know what,

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one of the other things that's changed
really since the pandemic is we've seen

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more of a destigmatization of it.

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So certainly we're having
this conversation today,

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and these conversations are
happening in communities overall.

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So we can think about the role of the
health system, which is one piece of this,

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the healthcare system, whether
it's a children's hospital or,

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or other hospitals within our communities.

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But we also need to look at the
community at large in many cases.

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So just like any other, um,
chronic disease, it happens early.

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You may notice the signs of
a child having, um, asthma,

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for example, when they're younger.

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The same thing happens with
behavioral and mental health as well.

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So you can start to see signs
that maybe something's wrong,

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maybe it's tossed out as though they're
just upset or it's just a behavior. But,

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um, that early intervention
is gonna be really key.

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So the healthcare system can
be part of that solution,

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but partnering in particular with
our communities and our schools,

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early childhood education and most of
all our families to be able to, um,

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to impact that.

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The other thing that the healthcare system
overall is doing right now is really

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leaning in the health system
and advocating for more training

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for providers and for better
reimbursement. Um, both from our,

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um, publicly sponsored insurance programs
like Medicaid and our commercially

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sponsored programs as well.

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So we just don't pay these providers
enough to keep them to stay in their

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profession, but also to
continue to grow that workforce,

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which we talked about earlier,
is so incredibly important. Um,

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health systems and hospitals across
the country are leaning in and,

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and training primary care physicians,

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pediatricians to be more
involved in this space as well.

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So it's really building that
village around our kids, um,

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to be able to identify
maybe a problem in school,

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something that we can treat early,
and so it doesn't become, um,

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become a bigger issue
as as they get older.

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I'm glad you mentioned how important
it's to see the signs early. Uh,

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speaking of which, what trends do you
think are going to develop on the horizon?

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You know, it's really hard to predict
the future, but I think we're,

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we're living it a little bit right now,

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and particularly in the mental
health space. You know, I think, um,

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one of the things that
we talk about a lot,

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and it's really hard to get your
arms around is that about 50% of,

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of mental illness begins
before the age of 14.

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So we just talked about
early intervention, um,

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and importantly it's over 10 years.

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So just about 11 years between maybe the
first signs of an emotional condition

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or a mental health condition,

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the shown nearly 11 years before
someone gets treatment for that.

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So if we stay on a current trajectory
that we're on and we look at really the

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past five years and what
we've experienced as a nation,

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and more importantly what each child
has experienced in their own lives,

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we're on probably a trajectory to see
more mental health conditions than even we

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have today.

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The good news is everything else we
just talked about is we have ability to

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change that. So, um,

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moving upstream and working with families
and working with schools and working

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with providers and building
that workforce, um,

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to build that support system for kids to
teach them very early on coping skills

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and recognizing how they can, um, one,
soothe themselves, treat themselves,

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and then ultimately to, um, be support
systems for their families and, um,

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for their friends in that same capacity.
So l left to our own devices and,

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and not enter, not, um,
implementing some of these changes,

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we're probably going to need
more of a system going forward.

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We know we don't have enough today,
um, so we will need more of that,

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but we certainly have an opportunity to
invest in our kids and in our healthcare

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system and in our other systems to be
able to, to head that off if we so choose.

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Here's something that's
exactly what happens. Amy,

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are there any other issues do you think
that need a brighter spotlight right

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now?

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Yeah, I think, um, obviously mental
health is a concern nationwide,

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and that's both for adults and for
kids. And so, um, probably we certainly,

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obviously we're talking about kids
today and would definitely focus our

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spotlight there if at all possible. Our
country has many needs and it's hard.

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We have, we don't have
unlimited resources, um,

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but we would really kind of posit as,

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as a community of children's hospitals
and chi child health providers,

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we can invest in our kids today
to have a healthier future.

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So oftentimes kids are the
last one to receive care,

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thank goodness most children
are generally healthy, um,

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and don't have some of the illnesses
that that other adults and including some

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of us have as well. Um,

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but investing in that prevention early
on will make them productive citizens,

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productive military members, um,

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and productive next generation of all of
the talents that we have in our country

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today.

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So we would just really focus
our efforts on kids and ensure

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that when we're talking about legislation
or when we're talking in a community

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about resources, that we certainly, um,

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carve out some of those
specifically for our children.

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Amy, thank you so much for
sharing your insights today.

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It was very much a
pleasure speaking with you,

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and we look forward to
connecting with you soon.

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All right.

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Thank you very much for spending time
on this incredibly important issue.