Working on the front lines with children, therapists and the clinical team at Children's Hospital of Orange County, Dr. Heather Huszti shares what’s going on in the world of mental health as it relates to kids and the pandemic, and practical steps we can take to support them.
Kate Gosney-Hof...: Hello, and welcome to the Hope Happens Here podcast. I'm Kate Gosney-Hoffman, I'm so glad you're here. Today we are joined by Dr. Heather Huszti. She is a licensed psychologist and Chief Psychologist at CHOC Children's Hospital in Orange County. We're so glad to have her with us today, and she just had a wealth of information about what's going on in the world of mental health as it relates to children. She is on the front lines, working with kids in the hospital and supporting the therapists and the clinical team at CHOC, and so they've seen a rise in acuity with mental health cases in children of all ages.
And, not to lie, she gave some real staggering statistics about what's going on in mental health in kids, and it's sad. There's a lot going on, there's so much struggle happening with kids along the side, the worries of the pandemic itself. And yet, what was really good about talking with her, even though she was delivering all this really kind of sad information, and daunting information about kids and mental health, and mental illness, she also was really practical about, "Hey, here's what we can do,". She gave us some real good tid bits about how to talk with our kids about COVID, how to best support them emotionally and mentally, how to pay attention to general hygiene of health, sleep, exercise, nutrition, and how that all really matters. She provided so many good resources about how to support ourselves as parents and support our kids, as well as what to look for and signs and symptoms of mental illness, and struggling, and when we need to reach out for help.
So there was so much practical information that she offered and I'm so grateful. And her driving point in all of this is how important it is to pay attention to kid's mental health. Children... in mental health, it doesn't just start as adults most of the time. Usually there's a pattern since childhood, and so one does not exist without the other, most of the time. So, we will not solve mental illness in adults unless we pay attention to mental illness in children. So, really grateful to have her here and all the things and information she offered. So we're going to talk to Dr. Huszti on the phone today, so let's give her a call.
We're so happy to have you here today. Thank you for joining us.
Dr. Heather Hus...: My pleasure.
Kate Gosney-Hof...: There's just so much we could talk about, about what's going on right now in the world of mental health and children and families, with just COVID and everything going on. But before we jump into that, why don't you share with us a little bit about what you do and why you got into this work.
Dr. Heather Hus...: Okay. So, I am a pediatric psychologist by training. So that's actually a specialized area of child psychology, working with kids who have medical conditions as well as mental health conditions.
Kate Gosney-Hof...: I see.
Dr. Heather Hus...: And I've been at CHOC for many years, and what I do now, my role has morphed as CHOC entered into larger areas of children's mental health, my job grew and became overseeing the psychology piece and the mental health programming piece, as well as working with our social workers and LMFPs who do therapy with kids.
Kate Gosney-Hof...: Okay. So, that's a big job that you do.
Dr. Heather Hus...: Yes.
Kate Gosney-Hof...: How long have you been with CHOC?
Dr. Heather Hus...: So, I got to CHOC in 2002, so 18 years. Starting on my, I guess... yeah, I'm on my 19th year now. So I've been here quite awhile.
Kate Gosney-Hof...: Wow, wow. I remember when I was in graduate school, one of my, I think... boy it was a long time ago, but I'm remembering now as we're talking, during the career class we had to write a resume, a job application and a resume, for our dream job. And my dream job at the time was a therapist in the pediatric psychology unit of CHOC, specifically. And I was very passionate about that and to work with children. And so I just have the upmost respect for what you do. And-
Dr. Heather Hus...: Oh, thank you.
Kate Gosney-Hof...: Yeah, no. I mean, you are on the front lines of, in some ways, the most important work that's out there, dealing with the next generation of people. And I'm curious, for you, what... I mean, this is a big, big question, but what has it been like in the last eight or nine months for you? What is the landscape of mental health and children right now?
Dr. Heather Hus...: Yeah. I mean, it's been so hard. And I have to say my job really is supporting those folks who are on the front line right now. And I just couldn't be any more proud of our team and what all they're doing to address kid's mental health. The number of children needing services, parents worrying about kids is only continued to grow. I mean, our number of calls have increased by over 150% comparing year to year.
Kate Gosney-Hof...: Wow.
Dr. Heather Hus...: Yeah. And we've also seen a tremendous increase in acuity, so that kids are presenting with more severe problems, with things that are requiring more support. And so that's so hard for kids and families who are experiencing that, but also for the therapists, because I'm just seeing family after family in crisis is just hard. And we feel so much for the community, and want to be there and provide support and there's just a limited amount, there's only so many hours in the day, if you will. So it's really just...the landscape has changed dramatically.
We have found... We, starting in March, basically, as much as we could, switched over to doing work virtually through a secure platform. There are certain things that we continue to do in-person with kids who are at most risk. So, that would be in our mental health in-patient unit, that would be in our emergency department, as we screen kids for psychiatric concerns, and that would be in our consultation teams that deal with children who are hospitalized for medical concerns, and then have mental health concerns on top of that. And then, other than that, we're trying to do things virtually, just to keep our families safe, as well as our team. We're also doing neuro-psychological testing in person, as well.
Kate Gosney-Hof...: Okay.
Dr. Heather Hus...: So, we're all having to learn a whole new skill, because we went from doing less than one percent of our sessions online to almost 100%. So that's been a learning experience for our kids and our families, as well as our clinicians.
Kate Gosney-Hof...: That's a huge shift.
Dr. Heather Hus...: I just... Pardon?
Kate Gosney-Hof...: Sorry. That's just a huge shift, right, to do this kind of work virtually.
Dr. Heather Hus...: It is. And then just trying to figure out like, "Okay, wait. How do we make this work? And what is the same and what isn't? How do we adapt?" So, I think in some ways, there's been some really good things that have come from that, and in other ways it's like, ugh, we can't wait to being able to provide services in-person.
It's been quite the journey, I would say. When we started in March, I think we all were like, "Okay, well we're going to do this for a couple of weeks and then we'll be back." I don't think anyone expected this sort of journey. And I will say, in the beginning we really were like, "How is this going to affect kids?", we just didn't know. And I got a lot of questions of, "What do you think is going to happen to the mental health of kids?" So, being the scientist behind the therapist, I went back into the literature and looked at what did we know that happened with SARS or H1N1, which were two other sort of pandemic-like episodes around the world. And looked at those kids maybe who had to quarantine due to those illnesses, and the literature did not give us a lot of comfort, in that they were finding maybe around a third of kids were really struggling with mental health issues that were quite prolonged. It wasn't just, "Hey, as soon as I get out of quarantine, I'm better." There were lasting effects for years.
And so, in the beginning I would be saying to people, like, "I'm kind of scared, because look at this," and I think a lot of people are like, "Ah!", that was something else. And I think what we've come to find as the data's coming out now, for our kids, is it's worse than we thought. Because our isolation is longer, there's huge economic fallout, all the things we know that cause problems for children's mental health. For instance, for every five percent increase in unemployment rates, so every five percent we add to unemployment rates, we add about 30 to 50% more children's mental health problems.
Kate Gosney-Hof...: Wow.
Dr. Heather Hus...: So, as you think about our unemployment rate doubled to tripled, so think about that increase then in children's mental health issues, just from that, let alone everything else we're dealing with.
Kate Gosney-Hof...: Wow.
Dr. Heather Hus...: So, yeah. So, the literature, sadly, did start to guide us with like, "Oh my gosh, how are we going to try and mange some of this onslaught?" And, sadly, what the literature is telling us now is it may be three to five years before we get back to normal in terms of mental health issues for kids. So, we're really concerned. Not just where we are now, but where we're going to be in the coming years.
Kate Gosney-Hof...: Right. So this is a parallel epidemic in its own way?
Dr. Heather Hus...: Yeah. I think that's a good way of putting it.
Kate Gosney-Hof...: It's its own tidal wave of concern and... Yeah. I mean, it's very concerning because, what you just said, the scale of that is really unimaginable. 30 to 50% more mental health concerns in children. Wow. That takes me a minute to sort of digest that. That's a lot.
Dr. Heather Hus...: I know, I know. It is. [crosstalk 00:11:25]
Kate Gosney-Hof...: And you know you're not really hearing much about that either, I have to say. There's not... I haven't... I mean, I'm in the world of mental health and I have not heard those statistics, and I'm wondering why we're not hearing more about it. Maybe it's because it's so fresh and new, it's too scary. What do you think?
Dr. Heather Hus...: Yeah, I mean, I think... I've certainly seen more articles out there about, "Gosh, we're worried for our kids," but certainly not on the level that we've seen about adult mental health. And quite honestly, that's how it's gone for years, right?
Kate Gosney-Hof...: True
Dr. Heather Hus...: I think adult mental health issues... Adults can speak for themselves, they express symptoms differently. They're kind of in our face a bit more, right? And kid's mental health has always been a smaller portion of the mental health world. It's someone else who has to advocate for children, they can't just sort of go, "Excuse me, I'm having some trouble processing my feelings." Instead, they, right, they may misbehave. It may take time for people to start to go like, "Oh, maybe that's a mental health problem, and not a behavior problem", right?
Kate Gosney-Hof...: Mm-hmm (affirmative)
Dr. Heather Hus...: And I think where we miss an opportunity because of that and because of that lack of focus is, prior to the pandemic anyway, half of adults with chronic mental health issues first had symptoms before the age of 14. And 75% had symptoms by the age of 24. So the idea that we can treat the adult mental health concerns by focusing only on adults is a fiction. And we will never ever solve the adult mental health problem until we pay more attention to the children's mental health problem.
And I will say, sadly, as we look at data, Mental Health America actually ranks states in terms of their ability to provide mental healthcare. And they look at adults versus kids, and sadly, when we look at California ranks I think 21st for, out of 51 states, so lower is better. We ranked 21st for adult mental healthcare. Of course, we'd like to be much better than that, but we are 33rd out of 51 for children's mental health. And when it comes to something like the number of children who are diagnosed with Major Depressive Disorder who receive treatment for that disorder, we rank 45th out of 51.
Kate Gosney-Hof...: Oh my gosh.
Dr. Heather Hus...: Yeah.
Kate Gosney-Hof...: Ugh.
Dr. Heather Hus...: So, I think when people in Orange County are like, "I'm sorry, our children are on a burning platform here." That's why, right. And it is so much easier to shift that curve of disability that may come from chronic mental health problems when people are kids, because we can keep them in school, we can keep them out of jail, we can do all of these things. And the brain is plastic, so we can...which means it's more adaptable to change. So, we probably can work better with kids than we can with adults. So, for all of those reasons, we really want to have that attention on kids mental health as well. Not that adult mental health isn't important, it absolutely is, but we're not going to solve that problem without focusing on kids too.
Kate Gosney-Hof...: Right, I hear you. They're inherently connected, obviously. Right?
Dr. Heather Hus...: Yeah.
Kate Gosney-Hof...: It's, it's... You can't just focus on the adult experience of mental health, and just completely disregard their journey as children, and when these symptoms started showing up. So really, the earlier intervention is what you're saying is going to be the most important, or is the most important [crosstalk 00:15:38] possible.
Dr. Heather Hus...: Absolutely.
Kate Gosney-Hof...: Right.
Dr. Heather Hus...: Which is true of any chronic illness, right? [crosstalk 00:15:43]
Kate Gosney-Hof...: Right, exactly.
Dr. Heather Hus...: If you say, "Hey, I'm not going to treat my diabetes for 10 years," it's going to be much more difficult to have you lead a productive and pretty symptom-free life, than if I catch it right away and do something about it.
Kate Gosney-Hof...: Right. I just love that analogy so much, it just makes so much sense. Why wouldn't we treat this like any chronic illness and look at the history of it, instead of just what's happening in this now moment?
Dr. Heather Hus...: Right. Yeah.
Kate Gosney-Hof...: What do you think...and again, big question, but how could we be better at this?
Dr. Heather Hus...: Yeah, well, I do think one is to elevate children's mental health in any discussion of mental health, right? So I think for years people have been like, "Mental health. Adults." And so I think really being sure that we pay attention and don't just give lip service to "Oh, yeah, yeah, yeah. Mental health for kids, that's good too." We have to invest in that. We have to invest in the specialty, because when you look at children's mental health throughout the country, so this is the entire country, there are 8600 board-certified child and adolescent psychiatrists. For the country. There's one state where there's one for the entire state.
When you look at psychologists who specialize in children, it's somewhat better, but it's probably somewhere around 20,000-30,000, for the country. So for people who are explicitly trained to manage children's mental health. And it is a specialty area. You'll see therapists sometimes, they're like, "Oh, I'm comfortable working down," and it's like, "Yeah, kids don't express themselves like adults do." You can't sit a kid down and go, "So, what's going on with you?" The kid is going to be like, "Do we have a game to play or something?" Because they express their behavior through play, through behavior, because they have limited, given their brain development, they have some limited abilities to construct the sort of cognitive world that we expect for adult mental health. So it's important to have providers, and it's important to recognize that.
And sadly, when you look at the economics of mental health right now, what's happened is we have a great county system that has developed a lot of services, but unfortunately in the commercial side of things, what insurance pays as reimbursement rates are so low that most providers have been like, "Yeah, I'm not accepting insurance," so they've gone to a cash pay only system. And so, in some ways the underserved populations right now are people with commercial insurance, who will tell you, "I can't find a therapist who takes my insurance in the community." So I think we have to advocate for the fact that in order to expand our provider network, we have to look at what are we doing to manage cost, and I think we've... I'm doing air quotes here, we've managed cost so well that we've driven people out of the field, which means now California was 44th for kids being taken care of who have a diagnosis of a mental health disorder.
And I think people, when I say Major Depressive Disorder, I think a lot of times people go like, "Oh yeah, I've felt blue, how serious is that?" And what we forget is Major Depressive Disorder is a mental health disorder with a mortality, a death rate, associated with it, because most people who die from suicide have been depressed. That is a consequence of untreated depression. It's not something to kind of... And I know you as a mental health provider know this, but I think sometimes people forget that it's not just a, "Hey, I just feel a little down," it is a serious medical illness that needs treatment.
Kate Gosney-Hof...: That needs treatment, exactly. And, it's hard to say, well you're talking about the insurance issue, and it is so unfortunate because it is not quite... I'm curious about your opinion of this, it's a whole nother topic, but...It hasn't been, it's not treated... I'm blanking on the word, what that's called in the world of insurance and payers, but when something is the same as the other.
Dr. Heather Hus...: Oh, yeah. So, they talk a lot about that idea of parity, right.
Kate Gosney-Hof...: Parity, thank you.
Dr. Heather Hus...: [crosstalk 00:20:52] There are parity laws, exactly as you say, that mental health should be treated the same as physical health, but the variety of ways in which parity doesn't actually happen will curl your toes. I think on the plus side, California actually, the governor just signed a bill, which I believe will go into effect in January, to really strengthen the idea of parity, right? So that some of those most common things that happen will be covered now by law, so that in insurance commission can go like, "Guys, yeah, no, you can't do that." I know actually Congresswoman Katie Porter actually has introduced some legislation in the House at the national level to start to mandate tracking on parity, so that we can actually look and go, "Hey, here's where the problems are, now what are some keys we can put into that oversight and regulation." So, people are starting to pay attention and be advocates for this.
Kate Gosney-Hof...: That's good to hear.
Dr. Heather Hus...: So, hopefully we're getting there. And I have to say, for all the... I know I'm sounding like a Debbie Downer if you will [crosstalk 00:22:14] here, of like, "This is bad, this is bad."
Kate Gosney-Hof...: It's okay.
Dr. Heather Hus...: But I will also say, on the plus side is I think we're having a conversation like we've never had before, with people recognizing that mental health exists. And I have to say, my job would never be what my job is today 20 years ago, because no one was really tracking on mental health, right. And one of the things I think that's going to make a big difference, honestly, is children's hospitals are now going, "Oh, holy cow. We have to really pay attention to this." It is... And as we sort of say it at CHOC, hashtag help is help, right? You can't have one without the other. You can't have mental health without physical health, you can't have physical health without mental health.
Kate Gosney-Hof...: Exactly.
Dr. Heather Hus...: So, I think people are more and more going, "Oh, right. The brain is an organ, just like all the other organs."
Kate Gosney-Hof...: Oh, right. Yeah, yeah.
Dr. Heather Hus...: Right. Woops, we forgot. One of my favorite quotes is, "You can no more draw a line dividing the brain from the body than you can draw a line to divide two oceans."
Kate Gosney-Hof...: Wow. That's so good.
Dr. Heather Hus...: They're interlinked.
Kate Gosney-Hof...: Yeah.
Dr. Heather Hus...: But, as I tell my patients a lot, we were a little slow on the medical side to pick that up. But I do think people are now seeing that. And as we're trying to go to a more population-based way of providing health, and look at more preventative care-
Kate Gosney-Hof...: Prevention, right.
Dr. Heather Hus...: I think now mental health is going to start to be woven in a lot more thoughtfully, because now people are starting to go like, "Oh, that's a driver of cost. Oh, that's a driver of disability. Who knew? Okay, let's treat that."
Kate Gosney-Hof...: Right. Exactly. And let's talk about nutrition and how that affects the brain, right?
Dr. Heather Hus...: Absolutely.
Kate Gosney-Hof...: And what happens when we don't sleep, and when we have et cetera, et cetera, et cetera, this is all connected. And so...
Dr. Heather Hus...: It absolutely... We actually have on our website, and at the end I can give some links-
Kate Gosney-Hof...: Yeah, please.
Dr. Heather Hus...: But, we've created a handout called Mood Hygiene, if you will, that really goes through those kinds of things. How much sleep do kids actually need at different ages? What is good nutrition? What are coping strategies that you can use to build resilience in kids? What are things you can do to sort of either manage mental health concerns and make them as least bad as possible, and what are things you can do to prevent, perhaps, some mental health concerns emerging to begin with. And then also looking at things like screen time, looking at drugs and alcohol use, and looking at social media. So, we kind of go through all of those categories to be thoughtful about what does constitute good health?
Kate Gosney-Hof...: Right.
Dr. Heather Hus...: Oh, and exercise [crosstalk 00:25:15]
Kate Gosney-Hof...: Exercise, yeah. I mean, what a great resource. And yes, that is something I definitely want to have you share at the end, because, I mean, as a parent myself, I have a three year old and a one year old, and sleep has always been an issue for my three year old. And I know, I mean, I can just see it. I mean, I'm a mental health professional, and when it's in your own family and you see these things happening, it's just, I know that sleep just plays a role in so many things, and it's just such a concern. But it's not something that you really hear talked about that often, or historically, when it comes to mental health. And boy, it just is everything in a lot of ways. So anyway.
Dr. Heather Hus...: It really does. It does drive a lot of symptoms. And honestly, anytime we evaluate for ADHD type of symptoms in kids, we should be asking about sleep.nBecause lack of sleep can make you look like you have Attention Deficit Disorder or anxiety. Because it just drives those symptoms, and no one's sleeping very well during this pandemic, so I think that's just added to it.
Kate Gosney-Hof...: Well, and there's just so many directions we could go. I mean, I feel like I could talk to you all day about all these things. And guess I better return to what this conversation... what was intended to have a theme around what you're seeing right now in terms of COVID and how that's affecting children and their families. This is all relevant though, and connected, because like you said, the sleep is being effected. People have more anxiety, they're disconnected from peers. You brought up screen time in the mental health hygiene, and we know that that is obviously upped because of virtual school. I mean, the list goes on really. And it's just a lot.
Dr. Heather Hus...: It does. I think it's just... And it's overwhelming for everyone, I think.
Kate Gosney-Hof...: Sure.
Dr. Heather Hus...: And I think so many of the coping strategies we used previously just aren't really available or available safely, right? I know I was talking with my mom the other day and we both were kina like, "I just want to go to a store and wander around for an hour."
Kate Gosney-Hof...: I just want to get a coffee and wander around Home Goods, is that too much to ask?
Dr. Heather Hus...: Yes. Exactly. I know, right? And so I think the other thing we sometimes aren't thinking about but some studies are coming out now, is when you think about teenagers and kids, they're amount of physical activity has plummeted. And they're amount of sedentary time has increased dramatically. And when you think about, well, what's a good Mood Hygiene for kids? Get moving, and get active. And these kids, we've taken that away from them too, right?
Kate Gosney-Hof...: Yes.
Dr. Heather Hus...: So, it's... and it's just hard, "Gosh, I'm not in school," or "I'm back to a hybrid method," how much P.E. can we do safely? And what does that look like? And how do we make it engaging for kids? So, I think people are starting to look at all of these things and how does that all tie together to cause problems for kids?
And, we're all together in a household where there's probably times, even in the most loving of families, where we don't like each other very much, because we're in each other's face all day long. And then for other families that really struggle to cope already, there may be an increase in violence, or there may be an increase in conflict, and that's not good for kids either. So there's just a whole range of things that are probably driving some of the problems we're seeing with children's mental health.
Kate Gosney-Hof...: Yeah, yeah. It's a lot and I'm sure you have seen all different kinds, like you said, a range of all different experiences and effects of this.
Dr. Heather Hus...: Yeah.
Kate Gosney-Hof...: What has been the most common... What have been the most common things that you've seen right now, and concerns for kids?
Dr. Heather Hus...: Yeah. I mean, I think we've definitely seen an increase... You know, I was talking about acuity. We've definitely seen an increase in kids coming in with suicidal ideation. So, suicidal thoughts happening. We've seen an increase in kids who've made suicide attempts. On our in-patient psychiatric unit, we've actually seen an increase in very severe depression, but also in psychosis. And we're trying to sort of pull apart... So, psychosis being when your mind doesn't process reality correctly, right? So you might see things that aren't there, hear things that aren't there. And it's been a very hard to control psychosis. So, we're not sure exactly what's happening. But we've seen that pretty consistently throughout the pandemic.
Kate Gosney-Hof...: Interesting.
Dr. Heather Hus...: We've seen kids with pre-existing mental health disorders just are having a terrible time coping. And just, things getting harder. And then I think we've heard from a lot of parents of particularly school-aged and younger kids that the acting out behaviors, right, the getting into trouble, the defiance, the kind of, "You can't make me," has increased dramatically. And as parents, those are really hard behaviors to deal with and figure out, "What do I do?" And then, I think all of us have experienced this, but we're just on edge emotionally, right?
Kate Gosney-Hof...: Right.
Dr. Heather Hus...: I find there're times where, I mean, I know better, and there're times where I find myself responding irritably. And it's like "Wait, I'm not mad at this person. Why am I upset?", or, "Why is my tone so bad?" Because I just think we're all at our limits of how to manage.
So, I think one thing I definitely want to say to parents is give yourself some grace, right? Of course, we want to do the very best we can for our kids, and for our families. But also understand these are extraordinary times, and we're not going to perfect. We're not going to be perfect in the best of times, and we're really not going to be perfect now. So, really giving yourself some grace. And modeling that for your children, right, of like, "Hey, you know, I'm sorry. This has been really hard for me. I bet it's been hard for you too. Tell me what you're struggling with?" It can be a way of teaching kids coping skills, right?
Kate Gosney-Hof...: Right.
Dr. Heather Hus...: Teaching kids ways to express what's going on inside. Helping them name the emotions, right? Where, sometimes I'll talk to younger kids and they'll be like, "I just, I just...," and I'm like, "Inside you feel like 'Ahhh!'," and they're like, "Yes!" And so then you can kind of name that emotion, right. Like, "Well, when that happens and you go and kick things, makes me wonder if you're angry. What does anger feel like to you?" And then we can name it and talk about it, because it's very hard to manage it if I don't even, if I'm not able to name it, right? And I just think "I'm bad" versus "I'm angry", right?
Kate Gosney-Hof...: Right. Right, exactly. "I am bad" versus "I'm having a feeling of anger."
Dr. Heather Hus...: Right, right. Exactly.
Kate Gosney-Hof...: And one thing that comes to mind, too, about the parents, is I think so much of a source of anxiety for children, and I think it for all human beings, is when I feel something yet I'm being told something different, right? There's an incongruence and so, for children, I mean obviously things are different, we can't hide that. But if parents are trying really hard to not talk about it because they don't want to make it worse, or protect their kids emotionally from that, yet they are not okay, and the see their parents not being okay. And it's not getting talked about, that can add to the anxiety and the feelings that they're going through, the negative feelings, and so I appreciate your bringing up the dialogue piece of things, and talking modeling that, and admitting that, "Yeah, I'm not okay. How are you?" And so [crosstalk 00:33:49] Yeah, go ahead.
Dr. Heather Hus...: I think that's that delicate line between kids don't want to see their parents fall apart, of course [crosstalk 00:33:56] that's my world. But at the same time, kids don't need you to be superhuman either. Because that, in some ways is bad too. Because then it's like you said, either, "Okay, but what you're telling me isn't consistent with what I'm seeing," or "I feel like I'm terrible, because I'm not being super person, but you are. Why am I having these feelings?"
Kate Gosney-Hof...: Right.
Dr. Heather Hus...: So, I think being able to, at that sort of baseline level of, how do I help kids have control somewhere in their lives? And actually, kids don't need a lot of control to feel better. I mean it even is, what clothes do you want to wear? Do you put on a costume before we hop on that Zoom session? I mean, what does it matter, show up to school in a costume.
Kate Gosney-Hof...: Why the heck not?
Dr. Heather Hus...: Who cares, right?
Kate Gosney-Hof...: Yeah.
Dr. Heather Hus...: Let's do something that's fun. What do you want for dinner? What would be a special treat? What's a good movie you want to see? These are things where we can give kids control that don't matter that much, right?
Kate Gosney-Hof...: Right.
Dr. Heather Hus...: Kids start to learn, "Oh, I make a decision, something happens as a result of that decision. I grow more confident in that. I feel more in control." And then also letting kids know, what are we doing to protect you? Because that's the other scary thing, right, like, "Is something going to happen to my parents, is something going to happen to me? I hear all these scary stories out there." So, the other things is to kind of be like, "You know, our family, this is the way our family is managing this. Remember? We wear masks all the time. Masks are very effective. That's one of the things we're doing. And remember, we're not going out as much, but that's how we're protecting our family." So that kids sort of get the message of as parents, we have a plan, we're enacting the plan, and we're keeping you safe. And you don't have to worry, that's grown up stuff. Your job is do these things.
Kate Gosney-Hof...: We are keeping you safe, because there is so much fear out there, and I appreciate that gentle reminder that, "That's our job, that's what we're here for, to keep you safe. And sometimes we feel scared too, but don't...," exactly what you said, you said it way better than I could. But that's something that I hear all the time, I mean, in my own community, in my own life, and then just in talking with other parents about, "How do I talk to my children about this, without instilling fear in them?" And it's a tough, it's a tough one. It really is, because we're so scared of making their negative feelings worse, right?
Dr. Heather Hus...: Yeah, and where's the guidebook that comes with parenting in a pandemic, right?
Kate Gosney-Hof...: Right. Parenting in general, and then add a pandemic on top of it.
Dr. Heather Hus...: That's right [crosstalk 00:36:37] guidebook for parenting, and then let's put a pandemic on top of it.
Kate Gosney-Hof...: Super fun.
Dr. Heather Hus...: If I'd known it was going to go on this long, I would have tried to have written that in March and made a million dollars.
Kate Gosney-Hof...: Totally. Gosh, missed opportunity.
Dr. Heather Hus...: I know, seriously right?
Kate Gosney-Hof...: Well, yeah. So, that's important, to support our kids emotionally that way. And I think I love what you said about we don't have to be superhuman, we don't have to be a super parent. Because God knows parents are dealing with something, things that they've never dealt with before either. Working from home on top of the childcare, on top of being a teacher, and managing all of that, there's just no doubt that we're all our limits, like you said. And so, I think being-
Dr. Heather Hus...: Absolutely.
Kate Gosney-Hof...: No, go ahead.
Dr. Heather Hus...: I was just going to say, I have, even in my own field I'm like "Wow" around kids and I know sometimes parents are like, "Oh my gosh, you're hearing my child in the background," or they've wandered into the picture and you know, for me it really is just like, "That's great, I love seeing your kids!" Don't feel guilty. And then I can just see them like, "I'm so sorry, this is so terrible." And again, give yourself grace, right? It's life man, we're all experiencing it, so lets just give ourselves a little grace and say, "Here's my lovely child."
Kate Gosney-Hof...: This is my life.
Dr. Heather Hus...: And don't worry about it.
Kate Gosney-Hof...: Yeah, exactly. I mean, I think in a way... Do you think that in a way, because we've all been stretched to our limits that we don't really have a choice but to be real and authentic. [crosstalk 00:38:10] Just take off those masks that we wear, I mean not the masks you that we're wearing now, but you know what I mean.
Dr. Heather Hus...: Yes, I know what you mean. Our metaphorical masks.
Kate Gosney-Hof...: Metaphorical masks, yes. [crosstalk 00:38:22] Thank you. That all of a sudden got complicated, and it didn't use to be, using that metaphor. But we're all just having to be like, "All right, this is it. This is just our life and yeah, my kitchen's a mess, and it just, sorry, there it is." And just having to just really, like you said, give ourselves grace and have compassion for one another in all this.
Dr. Heather Hus...: Absolutely. And when you step back for a minute, you'll notice like, "Oh, you're a mess too, okay good," [crosstalk 00:38:52] in common now, right?
Kate Gosney-Hof...: Exactly. Exactly. Well, I mean one thing I'm really taking... Well, I'm taking a lot of things from this conversation, but one thing I really am appreciating is just the normalization of all of our experiences. And you are working in a hospital with some serious, serious cases, and seeing some very sad things every single day. And not only working with children who are struggling with mental health, but also holding space for the therapists and other clinicians that are working with those kids, and that's a lot. And I just want to acknowledge that.
Dr. Heather Hus...: Thank you.
Kate Gosney-Hof...: That's a lot, and I appreciate it, and I see that. And I'm grateful to you, so thank you.
Dr. Heather Hus...: Thank you, I appreciate that.
Kate Gosney-Hof...: Yeah, of course.
Dr. Heather Hus...: I've got an amazing team who cares so much about our kids and families in Orange County, so anything we can do to support them we definitely want to do.
Kate Gosney-Hof...: Well, that's awesome. And you have had to adjust in your own ways, like you said, with how you provide and manage care and it's all been such a year of transition in so many ways. And so, like you said, we're all just doing the best we can.
I see that we are about out of time, and so I'm kind of doing a hard shift here, but I want to just ask you, is there anything else that you want to mention to the parents listening? Anything you would like them to know? And then any other additional resources that you might want to let them know?
Dr. Heather Hus...: Sure. So, a couple of things. I do kind of want to say to people, because I do get asked this a lot, is "When do I worry?" So, what's normal, as a result of this, and when do I worry? I'll just say a couple of things. We worry certainly if kids express suicidal ideation. So they're thinking about hurting themselves. That's definitely something we don't want to wait on. I'm going to give you some resources on that in just a minute.
When kids behavior or their way of interacting with the world, particularly changes in sleep, eating, not enjoying things that they previously liked to do, so those kids who are like, "Yeah, video games just aren't fun anymore," and if that goes on for most every day, so more often than not, two weeks or longer. So, what we call persistent, right, it's not just today's a bad day, but weeks. And that if it occurs in multiple settings. So it's not just how I interact with mom, but I'm kind of doing that with my friends, or I'm seeing that at school, even if I'm doing school in the house, that those kinds of changes are helpful to get checked out. So we call that persistent and pervasive, right? And those would be the times that I would think about, as a parent to go, "Hm, I wonder if I should check this out a little further and see what's going on."
I will say, we have a couple of... Let me give you the crisis numbers first, and then I'll give you some additional background. Crisis numbers if you're really worried about your child being safe, the Orange County Behavioral Health has a crisis assessment team that you can call, the number being 1-866-830-6011. They can come to your house, or wherever you guys are, and make that evaluation. Or you can take your child to the nearest emergency department.
We also have a California... I'm going to give you actually the Suicide Prevention Lifeline. It's 1-800-273-8255. Which also spells out talk, those last four numbers. That's available 24 hours, seven days a week. So if it's just, "I just need to talk to someone, I need to get some support," adults or kids, that's a resource.
Let me give you a couple of resources that we've put together at CHOC, that if you're kind of like, "Well, I don't think my child's that much in crisis, but gosh, I'd like some more ideas of things to do," we've written about 20-30 blogs about different ways to help parents during this pandemic. Those are on our website. So, if you go to the www.//blog.chocchildrens.org. And there's a lot of different information on there, but you can search for mental health blog. We also have a mental health toolkit that has things like that, remember I mentioned we have that Mood Hygiene on there. We have resources for mental health providers, for pediatricians, for parents, and for schools. And it's called our Mental Health Toolkit. You can go to the CHOC website, which www.choc.org/mentalhealthtoolkit
And then we also have a couple of videos that demonstrate how to do deep breathing, how to teach kids guided imagery, and actually have some guided imagery, so ways to kind of, both for kids or even for yourself as parents or adults to kind of calm down, so some coping strategies. So that also is our main choc.org. So, www.choc.org/coping. And those are a couple of our psychologists who've put those together. So, I'll say, all of these resources have been created by our psychology and social work and marriage and family therapist team. Our child and adolescent psychiatrists have also contributed to the toolkit, and so you've got information form a wide variety of providers.
Kate Gosney-Hof...: Boy, that is just an amazing list of information and resources. I am so grateful that you've just spelled all that out. Thank you. And I'm going to look at some too, for my kids and my family.
Dr. Heather Hus...: [crosstalk 00:45:38]
Kate Gosney-Hof...: I am so happy that you told us about that, so thank you, and it sounds like a lot of work has been put into provide those resources.
Dr. Heather Hus...: Well thank you so much for including us. We always love to talk about children's mental health, so anything we can do to be helpful.
Kate Gosney-Hof...: Thank you.
Dr. Heather Hus...: Thank you.
Kate Gosney-Hof...: So much.
Dr. Heather Hus...: It was a pleasure talking with you [crosstalk 00:45:53].
Kate Gosney-Hof...: Same. Have a good weekend. Bye.
Dr. Heather Hus...: You too. Bye.