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Introduction: Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham,

Cailtin Whyte: I'm Calitlin Whyte, and today we're discussing mental health awareness in children and teens with Amy Brown, a Certified Art Therapist who also serves as the Milieu Coordinator on the Inpatient Behavioral Health Unit at Children's of Alabama. So Amy, what are some warning signs parents can look for in children who might be struggling with mental health issues?

Amy Brown: That's a great question. Thank you for having me on today. So some warning signs for parents to look for are really anything that's out of the ordinary for their child. They know their child the best. And so if they see anything that is just different and they kind of, it gives them pause, it gives them heartburn to say what's going on. So it might be if your child is generally very outgoing and a very social child, and then all of a sudden they're very quiet or withdrawn, that would be something to kind of go, Oh, okay, timeout. What's going on? Let's have a conversation with the child, or maybe vice versa. If your child is very quiet or introspective or tends to be very even withdrawn, or maybe they just like to play video games all the time. And now all of a sudden they're very social and very active. That might be again, just a sign to say, okay, let's have a conversation and see if we need to take this farther.

Host: Now talking about mental health is a difficult issue even with adults. How do you start the conversation with children and teens?

Amy Brown: I think you just open the door and let them guide that conversation. So just being honest and saying, you know, I noticed something's different. You don't have to put words in their mouth or assume things, but just give them the opportunity with your observations to say, this is what I've noticed. Is this something that you want to talk about? Is this a conversation that we can have? Is there somebody else that you feel comfortable talking to, maybe the child or the teen doesn't feel comfortable talking to their parents, but let's find somebody else that you do trust that you can talk to. Maybe it's a teacher, maybe it's a therapist or a counselor at school. Maybe it's a Pastor or a Rabbi. Maybe it's a neighbor, family friend, but let's find somebody that you can trust that we can talk to so that we can begin to help that child or that teen feel safe and more willing and able to open up about what's going on.

Host: Now, how would this early intervention, you know, talking with young people about mental health issues, help as our children grow into adults?

Amy Brown: So I think that's the biggest key is that if our kids become more aware of what's going on, more aware of how they're feeling, and even further how they're coping with those feelings, then they can find healthier ways to cope. Cause we all have feelings and they can become very intense at different points in our lives, but we all hopefully have different ways to cope with them. And on any given day, our coping skills that we might generally use might not work. They might not be as effective as we had hoped or they were last week. And so if our kids become more comfortable talking about that and more comfortable, beginning to be aware of different types of coping skills and ways to cope, then they can explore different options. So maybe one day being with your friends is really helpful, but maybe the next day going for a bike ride or reading a book is more helpful than being with your friends.

 

But if we only have one way to cope and that way isn't working, it can get anyone in trouble, a child, a teen, or an adult. We frequently use the metaphor of tools as we use coping skills and coping tools. So often to say, you know, that's great that you have a bunch of tools, but if you only use the hammer, it's not always the best tool. Sometimes you really need a screwdriver. And so if we use a variety of different tools and coping skills, we can find the best fit for that situation, for that feeling, for that intensity level, even. But if we only continue to go back to our primary coping skills or that hammer metaphorically, then it's not always going to be the best fit.

Host: I like that metaphor a lot. That kind of really gives you a clear picture. Like obviously, yeah, you can't use a hammer to install a picture frame or something like that.

Amy Brown: Right. Exactly. And if we have different ways to cope with anger or sadness, then we have, you know, we can find the best thing to do. It's not always going to be that crying for instance is the best option. Sometimes it's very cathartic to cry, but sometimes we really need to be outside and get our hands dirty and maybe plant in the garden. You know, maybe a kid needs to go swing on a swing and maybe that's the most helpful thing. Maybe they need to go swim. You know, it's different for every kid for every situation. But if we don't have different options, then we can get into trouble, emotionally get into trouble.

Host: And that kind of leads me into my next question. You know, mental health stigma, there is so much of mental health discussion has been in the shadows and it's, we're working to get it, you know, more out. So people are talking, how do we work to end that stigma with young people when it comes to, you know, their friends being in school, things like that.

Amy Brown: I think it begins by just talking about it at whatever comfort level anyone has be it, an adult talking with their peers, be it a child, talking with their peers. When we talk about it, it begins to break that stigma down. So that's a big part of what mental health awareness month is, is just at whatever comfort level you have saying, this is where we are. This is where I am even specifically, and this is what I can do to help. This is what you can do to help. So a child maybe talking to their friends about, you know, what, I'm really not having a good, it would really help me if today we could chill and watch a movie. It would really help me if we could go outside and play on the playground today in the midst of COVID right now, everything is a little bit different. But if we begin to have those conversations, that's a great way to break down that stigma. Another big piece of that is education.

And so really informing ourselves as adults and then hopefully informing our kids so that they can teach themselves and others about mental health. What are the warning signs? What are the things to look for and how it can be better? It doesn't have to be, you know, this kind of black cloud that hangs over people, the rest of your life. We can have different times of stress. We can have different times of struggle or challenge, but we can also have different times of joy and excitement and living the life that we want to live. So at Children's one of the ways that we do that is that we have Cares classes that we teach our family members, our caregivers, about mental health, how to keep things safe in the home, what to expect so that when they go home, when they have their child that comes back from the hospital, they have a better idea of what to expect. They have some more education about mental health, about behavioral health and behavioral issues.

Likewise, we teach the kids while they're inpatient and in our outpatient setting, we work to teach the kids about what's going on, some education of what to look for. How do you know if you're having a really bad day or it's starting to get bad? Because hopefully, if we can touch it a little earlier, things are easier to treat, easier for that kid to manage or that family to manage with maybe some behavioral changes, some different types of therapy. We do lots of different types of therapy at Children's. We do PCIT and CBT and DBT, which are just big fancy terms for different psychological theories and ways of treatment. But I say that to say, we have lots of different options because different things work for different people. And if we're teaching people and educating them, hopefully that is a big part of breaking the stigma.

Host: Amy, if I'm a parent listening who might be concerned about their child, I mean, where do I start? And when might I start thinking about bringing in a medical professional?

Amy Brown: So I think a good opportunity is if you kind of have heartburn about it, then that's a great time to go, okay, I need to get somebody else involved. And it might be that everything is fine, but it's better to engage in that conversation and start that earlier rather than later. So a great place to start is with your primary care physician for your child, your pediatrician, another great option at Children's is that we have the Perk. And so that is a wonderful resource that anyone can call parent child grandparent, anybody, neighbor can call and say, I'm worried about my son or my daughter, and this is the situation. And they can help match you with resources for your child, for your area and for their specific situation. It's a free service that Children's provides and they can help you determine over the phone to say, Oh, this is the time to come to the ER, or this is the time to say, I need to call the pediatrician and get a sick child visit.

Maybe they say, this is time for a therapist. We need not just a pediatrician, but we need a psychiatrist or we need a psychologist, or we need a master's level therapist. And they're really good to help determine what is the best fit for that child in that situation and that area, because it might be that we have a great resource, but if it's three hours away, it's not really feasible. And so what's available and that child area. So that's a great resource. We also have our Pass program, which is a telemedicine program, which if you are in a more rural area, but you really need a resource, they've done a great job of pairing with pediatrician, excuse me, they've done a great job of pairing with pediatricians to help through telemedicine, get that child the services that they need. So you would go to your local pediatrician's office and they could help connect you via telemedicine to our Pass program and connect you there. So that even if you are three hours away, we can still get you services.

If we have a service that best fits you. We have just opened 10 new beds and our inpatient behavioral health unit. And so we now have 44 beds. We serve all spectrum of behavioral health issues. So anything from a patient or a child who is suicidal or depressed or a child who's anxious, or has an eating disorder or a child who has autism or developmental delays, we see all types of patients and we are prepared and ready for anyone with our 10 new beds. We have lots of state of the art technology that we can use to help patients with lots of different abilities and disabilities that they might be challenged with. We also have just doubled the size of our outpatient practice. So we have moved now to Patriot Park, which is in Homewood. And we now have an outpatient service in Homewood that is twice the size. And we have an outpatient practice here at our main campus downtown.

Host: Well, we appreciate your expertise and your time to focus on this delicate issue Amy. That was Amy Brown. She is a certified art therapist and serves as the Mileau coordinator on the inpatient behavioral health unit at Children's of Alabama. I'm Caitlin Whyte. Thanks for joining us.

Conclusion: Thanks for listening to Inside Pediatrics, more podcasts like this one can be found at childrensal.org/insidepediatrics.