Dr. Dani Milliken serves as the Director of Mental Health at CHOC, Children’s Hospital of Orange County. Liz Hawkins is a long-time volunteer at CHOC and mental health advocate. In this episode, they discuss what mental health treatment for children and teens actually looks like and help to demystify that process. They also share insights that may be helpful to caretakers seeking mental health treatment for their children.
Kate Gosney-Hoffman:
Hello and welcome to the Hope Happens Here podcast. I'm Kate Gosney-Hoffman. So glad you're here with us today. Today I have the pleasure of speaking with Dr. Dani Milliken, director of mental health from CHOC, Children's Hospital of Orange County. As well as Liz Hawkins, a long time volunteer and mental health advocate that is also an imperative part of the team at CHOC. Today we're here to discuss mental health treatment for adolescents and children, and hopefully demystify some of the treatment around that have Liz and Dani share their insight surrounding caretakers seeking mental health for their children. Welcome you two.
Dani Milliken:
Thank you.
Liz Hawkins:
Thank you.
Dani Milliken:
So excited.
Kate Gosney-Hoffman:
I wish you could see this dynamic duo in front me. They are wearing the cutest matching shirts and have the brightest smiles and just I can tell, already, about how passionate they are about their work, about how you are so passionate about what you do. I want to just talk a little bit about you each personally, a little bit about your bio, your background, and what you do. And then, we can jump into talking about adolescents and mental health. Who would like to go first?
Liz Hawkins:
Sounds good. I'll go first.
Dani Milliken:
All right.
Kate Gosney-Hoffman:
Liz, so Liz Hawkins.
Liz Hawkins:
Yes. Well, thank you so much for having us here.
Kate Gosney-Hoffman:
Absolutely.
Liz Hawkins:
Anytime we get to talk about pediatric mental health, that's really what's important to me as an advocate, but it's important, too, to Dani and I both. I actually started at CHOC as a volunteer in a radio station, as out Seacrest Studios, before it was Seacrest Studios it used to be something called Radio Lollipop. 10 years ago, I started in the studio, and that transitioned to being a NICU cuddler, so I get to hold our NICU babies, and give our parents a break when they need to go get a Starbucks or go take a shower or just have a private conversation.
Kate Gosney-Hoffman:
That is just the best job description in the world. "What do you do?" "I cuddle babies." That sounds like Disneyland to me.
Liz Hawkins:
Yes, it is a really cool job.
Kate Gosney-Hoffman:
I mean, obviously, hard, because you see some things I'm sure, little babies in the NICU, but at the same time, how important is that for them to have that interaction.
Liz Hawkins:
Yeah. We try to think about those jobs in the hospital as the same I would think about it on Dani's unit. Eventually, I transitioned to Child Life, our incredible Child Life program at CHOC. And then, I got to go over to our mental health inpatient center. We call it our MHIC, and that's like an ICU for mental health patients. And I got to go over there, and we kind of think about it in the same way that we do as a cuddler, right? You're there for just a finite amount of time, and your job isn't to cure anybody, to treat anyone, your job is just to make their day a little bit better while you're there. And I think that's really how you have to think about it, that's really how I've been able to be at CHOC for 10 years, through patient loss, through really difficult times with parents that are grieving. You see people on their worst day, quite honestly. You see kids on their worst day, and parents, as well.
Liz Hawkins:
And I think if you can just be there and just be there in the moment, it really, my goodness, nothing trains you for being in the moment more than being at CHOC. It really doesn't matter what else is happening in your life, if you're able to leave that in the parking lot, and when you get into your role, into whatever unit you volunteer in, whether it's Dani's unit or in the NICU, being able to be there for that child and just making it better, whether it's holding a NICU baby or playing Uno or soccer outside with our mental health patients, it's really a pretty cool job. That's the best part about what I get to do.
Kate Gosney-Hoffman:
Awesome, awesome. So you're volunteering there, you're still a volunteer?
Liz Hawkins:
That's correct.
Kate Gosney-Hoffman:
And you're a loyal volunteer, it sounds like.
Liz Hawkins:
That's right. Yeah, so-
Kate Gosney-Hoffman:
Part of the family.
Liz Hawkins:
Part of the family. And during COVID, unfortunately, and understandably so, we did have to stop the volunteer program at CHOC. So in-person volunteering really was not a thing, understandably so, but I was able to do a lot from home. And so, I actually am also a proud member of our mental health advocacy committee at CHOC. It's really one of the few groups at CHOC that has their own advocacy group. We have parent and family committees. But we don't have anything else like the mental health advocacy group. It's a group of powerful and passionate donors and volunteers who do outreach in the community, whether it's schools or faith communities, for me, a lot of times I'm writing a lot of things that it's either going out to local or state politicians. I just finished with another group of volunteers planning our mental health awareness month in May, and we're doing something super cool called a check-in challenge. That's really what I get to do with those volunteers, and it keeps me pretty busy, actually.
Kate Gosney-Hoffman:
Wow. Yeah, I bet.
Liz Hawkins:
But I'll be fortunate enough to go back into Dani's unit next week.
Kate Gosney-Hoffman:
Oh, yay!
Liz Hawkins:
So I'll get to see all my friends-
Dani Milliken:
So exciting.
Liz Hawkins:
... and all my new friends, too.
Kate Gosney-Hoffman:
I bet you've been missed, for sure.
Liz Hawkins:
Oh, thank you. It's been awesome to get that feeling of like, "Okay, I'm going to go back in and get to see our kids."
Kate Gosney-Hoffman:
There's a light at the end of the tunnel here. Awesome.
Dani Milliken:
Man, I always get so excited when I hear Liz talk, because I think what's so special about Liz is that she doesn't get paid by CHOC. This is a community member that's really stood up and said, "Hey, mental health is really important, and I want to come in and help in any way that I can," both on the advocacy side and the committee, but then also just really frontline, hands-on, helping kids, interacting with them. I mean, that doesn't happen everywhere. That's really special.
Kate Gosney-Hoffman:
Yeah, for sure.
Dani Milliken:
Yeah, it's really exciting.
Liz Hawkins:
Yeah. Thank you for that.
Dani Milliken:
You're amazing.
Liz Hawkins:
Thank you.
Kate Gosney-Hoffman:
And how about you, Dani? Tell us a little bit about you. Dr. Dani.
Dani Milliken:
Yeah, that's right. Dr. Dani. I've wanted to be a psychiatric nurse literally my whole life. I had distant family member, who had the diagnosis of schizophrenia, and at a young age I had an experience when he was in crisis, when I was in the car with him and really just seeing how hard it was for the family to find resources for him to get high-quality care and treatment. And I remember telling my mom, "Hey, when I grow up, I want to take care of people like that, and I want to help them."
Kate Gosney-Hoffman:
Wow.
Dani Milliken:
And that never left me. So I never wanted to be an astronaut or a teacher. Always wanted to be a nurse, always wanted to help mental health patients. And so, I went right into nursing school, I got out, and went into a state-owned and operated adult care mental health system. And in those systems, you really see just textbook mental illness, and you get to really experience how hard it is, how broken of a system it is, you see a lot of people that are really struggling inside of a system. And so, I realized really quickly, "Man, we could be doing things so much better." And so, I started making small changes, and those small changes got noticed, and so quickly got into leadership and went over to Children's Hospital in Ohio, and opened a brand new unit for them. What I thought would be a once in a lifetime opportunity to really change the way that care gets provided.
Kate Gosney-Hoffman:
She says that so nonchalantly. Opened up a brand new unit.
Dani Milliken:
Yes, that's right.
Kate Gosney-Hoffman:
That was just no big thing. It was tacos for lunch.
Dani Milliken:
It's interesting, because people think these places just exist. And in Ohio, at the time, it didn't. There was nowhere for these kids to go. And so, in my lifetime, which hasn't been very long, there's lots of places opening pediatric mental health units right now. And so, when California called I was kind of like, "Ooh, I'll go on vacation to California and check it out." And when I came out here, what I really truly fell in love with was the community support and involvement around mental health is really unique and special. And I think, if you've grown up here your whole life, maybe everybody's used to it, but coming into it, from the outside, it was really just moving, and it really helped me think, "Wow, we could create a system of care here that doesn't exist." And not just recreating a system of care, but really doing something different.
Dani Milliken:
And my boss Melanie Patterson at CHOC, I mean, just really believes... and our CEO Kim Cripe, everybody was just really behind this notion of, "We don't want to just open a unit, we really want to change the way that care gets provided across the nation." And so, we did it. We opened an 18 bed inpatient mental health unit. We take kids from three all the way up to 17.
Kate Gosney-Hoffman:
Three?
Dani Milliken:
Yeah, three. That's everybody's reaction. It's always like, "Oh, three."
Kate Gosney-Hoffman:
Well, I have a three-year-old, and so I think... that just hits my heart real hard hearing that.
Dani Milliken:
It does, it does. And it's real. Typically, our three and four-year-olds, they're living really hard lives at home, and there's a lot of trauma that happens. And so, they come in and they kind of help sort that out, get them on a different trajectory. But when you start at five, is where we really start diagnosing major depressive disorder, and we actually start seeing kids attempt to take their life. And so, when you can imagine that a five-year-old feels that hopeless, it's really striking and it happens more frequently than people, I think, realize.
Kate Gosney-Hoffman:
That's true.
Dani Milliken:
And so, that's why we need to have units like this, and we need to have programs, outpatient and inpatient, that people can really interact with and engage with and get high-quality care. And so, that's what we do at CHOC.
Kate Gosney-Hoffman:
I mean, my immediate feeling is, "Thank god. Thank god that you guys were here, that you came to do this and open it up." Because we were talking a little bit before we started recording that we live in an area where there's so much awareness of mental health and there are so many resources for mental health treatment, and you would think that it would be easier to connect people to care. I mean, this is why Be Well exists, obviously, for us to have a continuum of care and connection and networking and lessen that burden, but especially for children. I mean, I know personally, when I was trying to find resources for children, we didn't know where to send them, and it was so hard. And even the places that we did know exist were maybe to acute or there wasn't enough beds. The resources are limited, and you would think that they wouldn't be. It's just so needed.
Kate Gosney-Hoffman:
And also, even my reaction, I'm a mental health professional, to hear little babies having this as young as three and five-year-olds going through this. Being able to actually say that out loud and for you guys to acknowledge it and say, "This is real and we need to have a resource for it," instead of us just all pretending that's-
Dani Milliken:
It's not happening.
Kate Gosney-Hoffman:
... not happening. Am I making sense?
Dani Milliken:
You are.
Kate Gosney-Hoffman:
I just feel like there is a collective denial-
Dani Milliken:
Oh, definitely.
Kate Gosney-Hoffman:
... about how early this happens or how early it affects children. So I think because we don't want to see it, we don't want to look at it. It's sad.
Liz Hawkins:
I think, as an advocate, that's one of the biggest points that we're always trying to make, especially to local law makers, local and state officials, it's reminding them how important pediatric mental health is, because I think a lot of people focus on what they see, right? What they can see, either in homelessness, in problems in our community, and they're not really focusing on our second graders, the kids that are really experiencing trauma so young, and they carry that through their life. What encouraged my husband and I to get involved as donors and advocates, to transition really just from being a volunteer who comes to CHOC a couple times a week, to somebody who says, "Hey, wait a minute. I want to do something about this. I want to put my money where my mouth is," is by this idea that CHOC was in the paper, in the register, gosh, I think five or six years ago talking about pediatric mental health.
Liz Hawkins:
And prior to that, it's always been an interest of mine, and I had never heard of a health care system in Orange County talking about it. Prior to us opening, there were no beds for kids under 12. Kids under 12 had to go and get treatment elsewhere in LA, San Diego, and when you think about that, you're a mom and you have other kids, and you can imagine trying to split your time being a part of someone's care plan and, "Okay, I got to go from work to the hospital." It's very hard. When we opened up, it was the first time that I had ever heard of a hospital saying, "Hey, we're going to talk about this problem, and we're going to address it."
Liz Hawkins:
And it's something that we do as advocates is constantly have to remind local law makers, "Hey, don't forget about kids." Because if you want to treat all those other things that happen down the line, you got to start now, in first grade and second grade. And we need to have those resources and education available to our educators, to everybody who's around kids, to let them know, "Yeah, it does happen." I mean, Dani, you can attest, our first patient was five years old?
Dani Milliken:
Yeah, one of our first patients, five years old, wanted to die. Didn't want to be alive anymore and, I think, we were able to bring him in to care. We luckily happened to open the same week that he was in our emergency room. Had we not opened, he wouldn't have gotten care, and that's staggering, right? Because you're thinking-
Liz Hawkins:
Gives me chills.
Dani Milliken:
... if you break an arm and you take your kid to the emergency room, the arm gets fixed and you get connected with outpatient support that's going to take the cast off, physical therapy that's going to help.
Kate Gosney-Hoffman:
That literally just happened to my one-year-old at CHOC.
Liz Hawkins:
Oh wow.
Kate Gosney-Hoffman:
We literally just took her cast off at CHOC.
Dani Milliken:
Yeah, perfect.
Kate Gosney-Hoffman:
And you're right, that that continuum of care, it's natural, you don't think about it. Of course that's there, that's built in.
Dani Milliken:
And if you were to show up with that same child who doesn't want to be alive anymore, that has no hope in life, and you show up to the emergency room, you might not get care. And that should outrage all of us, right?
Liz Hawkins:
Great point.
Dani Milliken:
That should make everybody stand up and be like, "Wait a second-
Liz Hawkins:
Great point.
Dani Milliken:
... here's a kid just the same as this kid with a broken arm, and that needs just as much, if not even more support around them, but there is not a ton of support that exists." And so, when we brought this kid up, it was really cool. His family came up and we had all these... being one of our first patients, they got a lot of care, everybody was real excited to really get in there and help out. And so-
Kate Gosney-Hoffman:
That's amazing.
Dani Milliken:
Yeah. And so, at the end, we were playing cards with him, because we're talking about a five-year-old. And I think when he was like, "Hey, you know what? I think I want to be here. I want to stay. I want to stay here." And we realized he's not talking about staying on the unit, he's talking about staying on this planet. He wanted to stay alive and he wanted to keep fighting. And, for us, it's like, "Yes. We saved a life today." And so, that's really cool.
Liz Hawkins:
Yeah. I think, when I'm on our unit, I always admire our staff so much, because that's what they're doing. They're doing important life saving work every day. And it looks like playing Uno and it looks like playing soccer until you're really exhausted, and it looks like having a Popsicle with a kid, but that's what they're doing. Sometimes we have to remind them. I mean, Dani does an amazing job as a leader, as you might imagine, with her enthusiasm and her energy, she's reminding them, she always says, "You guys are changing the world," and I think sometimes they kind of, they're like, "Oh," because they do it every day, right? And I think sometimes they're reminded by stories like that or by other kiddos that we help out that will write them a really nice card or draw them a picture, and it really does draw them into that focus every day of like, "Wow, this is real life saving work."
Kate Gosney-Hoffman:
Yeah, absolutely. So you, I mean, we touched a little bit on maybe the stigma, the denial of this kind of treatment with children, and what's your take on that? Why do you think that exists? Is it just because we don't want to look at it? What do you think it is? Why does this feel so hard compared to adult treatment? It just feels hard to access or accept or acknowledge or talk about, it just feels harder.
Dani Milliken:
Mm-hmm (affirmative). Yeah. We oftentimes talk about stigma and just how it impacts our kids, and I think it's really important that people understand, it is so real and it is so present in everything that kids are doing. These kids are living really hard lives. They have a lot of trauma experiences, and sometimes it's important to have somebody validate that. And a lot of times, instead, what happens is like, "It's a phase. Get up. I went through something similar and you can do this just fine." And I think-
Kate Gosney-Hoffman:
Yeah, minimization of it.
Dani Milliken:
Yeah, and not validating the way that they feel. And I think, too, the other piece of it that's really scary is that society views inpatient mental healthcare, for example, in a very particular way, right? When you think about, "What do I know about an inpatient mental health unit?" You kind of start thinking about horror movies.
Kate Gosney-Hoffman:
Clockwork Orange.
Dani Milliken:
Yeah. [crosstalk 00:18:31] Or One Flew Over the Cuckoo's Nest, and things like that. And just recently there's a whole series put out about psychiatric nursing that really leans towards being a horror film and talking about restraining people and using shock therapy and all of these really scary, tangibly horrible things. And people think that's what we do. And so, it's really important for us to demystify and destigmatize what happens when you seek treatment? And what happens is, is you're greeted by really wonderful people who are there to help you, it's not scary and it doesn't have to be. But when you come into an emergency room, and people say, "Hey, we think that you need to go to the inpatient mental health unit." I've had kids show up to our unit and say, "Is this going to be what it looks like on TikTok? Is this scary?"
Kate Gosney-Hoffman:
What does it look like on TikTok?
Dani Milliken:
I don't know. I think that's a valid question, but it's things that people have talked about, things that people are seeing. And then like, "Hey, on this streaming service, is that what this is?"
Kate Gosney-Hoffman:
Wow.
Dani Milliken:
And so, we have to constantly educate the kids when they come up like, "No. You're in a healing environment, with a bunch of professionals that really care for you."
Kate Gosney-Hoffman:
You're safe.
Dani Milliken:
Uh-huh (affirmative). And you're safe. And so, that's why allow people like Liz and volunteers to come on our unit, because I will say, that doesn't happen everywhere. Volunteers and community members and tours on inpatient mental health units don't happen in other organizations. And the reason we do it, is so that we have the ability to change people's mind, so that we have the ability to show them, be transparent with them, decrease their anxiety. Like, "Hey, you can come on." We've had lawmakers, we had Lil Nas X came onto the unit and-
Liz Hawkins:
Sheriff Barnes.
Dani Milliken:
Yeah, the sheriff. We've had so many people, Katie Porter and different mayors and celebrities and teams, and what that does is it allows us to break down the stigma for the person coming on, but then it also allows us to say to the kids, "We're not hiding you. We want you to be seen, too. Your childhood is not on pause. We want you to be able to be a kid here, too."
Kate Gosney-Hoffman:
Love that.
Dani Milliken:
And so, it kind of helps break down some of that stigma.
Liz Hawkins:
Definitely. And I think having been in the hospital for so long as a volunteer through child life and, as I mentioned, through the NICU, our kids, they've come through CHOC in some way. They might've broken their arm. They have had a virus or something that has needed treatment, and they're not dumb, they know that at CHOC we're the Disneyland of hospitals, we always have fun guests and activities and things to do and there's always a volunteer to give you a high five or a sticker in the elevator. And when I first met Dani, long before Dani came over, actually, I talked with our chief psychologist and I had said, "What are the chances that we could have volunteers in the unit?" And she said, "Well, I'm not going to tell you no, but that's really going to be up to the person that we hire. It's not a thing."
Liz Hawkins:
And I said, "Okay," and when Dani came on board I greeted her and said, "What are the chances that we could volunteer in the unit?" And she said, "Oh wow. I really want to tell you no, but I'm going to work backwards to yes." And that stayed with me for so long, and I thought, "Wow." That became really her motto is, "Okay, I want to say no, but I have to figure out how I can work backwards to yes. How can we make this happen?" Because she knew that I was right, that we were talking about normalizing the hospital experience for them. If we're going to say that we provide pediatric mental health care in a different way, then this is one of the many ways that we can be distinctive.
Liz Hawkins:
We can be distinctive by having a volunteer who is just here to hang out with you. I'm not here to do therapy, I don't do anything more than... if I get you your favorite juice or make you some mac and cheese, maybe we'll go play some soccer, any combination of those things. And when kids find that out, actually, it really blew me away, because the kids will say, "Wait, you're just here to hang out." And I'll say, "Yeah." And they'll say, "Well, you mean you don't get paid to do this." "No."
Kate Gosney-Hoffman:
It blows their mind, I'm sure.
Liz Hawkins:
Sometimes they'll ask, "Why do you want to be here?" "Well, because you guys are my favorite patients." And they'll say, "Why are we your favorite?" And I say, "Because you guys are the most sensitive," they're incredibly sensitive to each other and to just themselves and the world around them. And a lot of times when people experience really difficult things in their lives, I think that's one of the, I guess, benefits of that is that it makes you sensitive to other people. When one of the other patients is hurting or upset or they have a really tough meeting with a parent, those kids rally around each other and they support each other. They might be all be going through different things, but they are all experiencing the same experience in a mental health, inpatient unit, and that's pretty unique.
Kate Gosney-Hoffman:
It's powerful.
Liz Hawkins:
Yes, very powerful.
Dani Milliken:
Very powerful.
Liz Hawkins:
And a lot of times, when they leave, they're exchanging phone numbers or email addresses or whatever, and they have that connection or, "Hey, that person sees me." But when an adult sees you and validates what your experience is, it's not only powerful from our staff, but also to hear from a community member, "Hey, I'm really sorry that you're experiencing that. I'm just really grateful that you're here, and I'm really glad you're safe." And exactly what you said is what I say all the time, right? "I'm just really glad you're here." And we've tried to repeat that as much as possible, and eventually these kids believe it, because it's true, we're really glad they're here. And our job is just to, my job, is to keep them entertained and engaged and just try to make their day a little bit better, and Dani and her team have the tougher job. But they get it done, and that's why they're called the MHIC dream team, because they really are incredible.
Kate Gosney-Hoffman:
I think that the concept of having somebody to just hang out and just be with them is really important, especially for adolescents and children, because there's a power differential, it's there when you're working with a clinician, with a doctor, with a psychiatrist, whatever. It's there. They know that they're a patient and the roles are very clear. But when there's somebody there that's just authentically just there to just chill out with them and just bear witness and acknowledge their experience and be like, "Hey, I'm here with you. I see you, with no strings attached," not that it's better or worse than the clinician working with them, it's just a nice complement to the work that's being done, because I know that kids are just real sensitive to that power.
Dani Milliken:
Yeah, and they're really receptive.
Kate Gosney-Hoffman:
Authority.
Dani Milliken:
Yeah, and they get it. And I think what we really strive for on my unit, that the bit thing, right? People view inpatient mental health as this really restrictive care environment where there is this power and control struggle between staff and patients. And for us, we try to take that away, because really, all of adolescence is about wanting to make your own choices-
Kate Gosney-Hoffman:
Totally.
Dani Milliken:
... and be a part of everything, so when you can give the patient the choice, and you can recognize you're angry and that's normal. Emotions are okay. And we don't need to physically regain control of the situation just because you're angry. When you're angry, you can use these coping strategies, and let's help work through that. That's the skill of psychiatric nursing, is working through a crisis. And unfortunately, what society sees is the skill of psychiatric nursing is using those high-level interventions of restraints and seclusion and medications, but those teach nothing to kids. And so, we try never to use those, and we haven't used restraints on our unit for a year now, and that's unheard of.
Kate Gosney-Hoffman:
That's amazing.
Dani Milliken:
Across the nation, you see 30 to 40% of kids going into restraints on inpatient mental health units, and on ours it's less than a half a percent. And so, it's not enough. We need zero all of the time, but I think it just goes to show you, when you take away the power and control struggles and say, "Hey, you're a human being, and I'm a human being, and I'm here to connect with you, and to help you learn different, more adaptive ways to engage with your emotions," kids really respond to that.
Kate Gosney-Hoffman:
Yes. And how refreshing for them to hear that, because my assumption is that they have not ever had their emotions validated or maybe rarely had their emotions validated in the past, so that self-regulation doesn't exist, because they haven't been allowed to work through it, like you talk about. And so, to just have that human connection, which I talk about all the time, about how that is just everything. It's everything. It's healing in itself and it's like the seed being planted is just the beginning of a journey that is healing when you are seen by somebody else and recognized and validated.
Dani Milliken:
It only takes one person-
Kate Gosney-Hoffman:
Totally.
Dani Milliken:
... to save a kid's life. They need one person to help them heal from the trauma that they've experienced. And I think one of the best stories that I have, that I'll share really quickly-
Kate Gosney-Hoffman:
Oh, please.
Dani Milliken:
... is we had a patient that we had cared for a few years earlier than when we got the letter, but she sent a letter in, and it was a picture of her in her graduation outfit, and in the letter she's like, "Hey, you know what? I never wanted to graduate. I didn't think I would graduate, because I thought I'd be dead, because I thought I would end my life. And that stayed with me for many years before I got treatment with you. I was just like, 'Yeah, graduation's not a thing for me.' And then, when I came to the unit and I interacted with the staff and I learned some things, that started changing the way that I was thinking about my life, and here I am, on my graduation day, and I'm alive." And she's like, "You know, I'm going to go on and be a nurse and help people, because this is something that I can give back, since you guys gave so much to me."
Dani Milliken:
And it's not to say, "Oh, good job us." But what it is to say is that sometimes, when you think about our job, our job is instilling hope into kids. Yeah, there's a big treatment mechanism that we go through, but in the end, when you strip everything away, when a kid comes on our unit, we just want to instill hope into them, so that they know, "Hey, you're worth being alive." And sometimes, we're the only people in their lives that say that. And so, I think anybody that's listening, when you're thinking about, "How can I help this? How can I help end the stigma?," check in on people. Check in on the kid, ask them if they're okay. No kid's ever like, "Ugh, I wish you wouldn't have asked me."
Kate Gosney-Hoffman:
That's right.
Liz Hawkins:
They may not answer you, but I don't think they're going to say, "Don't talk to me." Yeah.
Dani Milliken:
Yeah. And if they don't answer, you keep showing up. You keep showing up and you keep asking.
Liz Hawkins:
Yes. And I would also say to check in on parents that you know that are experiencing some difficulties with kids in their lives, because it's a really lonely place. We've talked about stigma and what that does, and stigma isolates and bad things happen in isolation. And I think we have a great friend at the CHOC Foundation who is a huge supporter of mental health, both personally and professionally. And her name is Madeline Hall, and Madeline always says, "Mental illness is the no casserole illness," right? No one's bringing you a lasagna when your kid goes into an inpatient unit.
Dani Milliken:
It's true.
Liz Hawkins:
Because people don't want to talk about that. And I have to say, right before I started on the unit, I was so pleasantly surprised. Here I am, for a couple years before our unit was built, out there in the community with my husband talking about mental illness being the no casserole illness, and Dani had told me, "Hey, you know what? We just had a soccer team. We had eight kids on a soccer team get permission from their parents to come and visit their other teammate who was in our unit. And I thought, "Wow. Okay, the tide is changing." Right? This is really cool. Those parents could have easily said, "Oh no, I don't what happens there. I don't want you to go there." But instead those parents said, "Yeah, your teammate is hurting. Your teammate needs a buddy. You go and see them, just like you would if-
Kate Gosney-Hoffman:
If they had a broken arm or something.
Liz Hawkins:
Yes. In pre-COVID times, we would go and see anybody in the hospital and make them feel better, give them a little bit of hope, right? And that was such a cool thing. I thought, "Wow, I really am coming to a different place." It's such a reassuring-
Kate Gosney-Hoffman:
It gave you hope.
Liz Hawkins:
Yeah, it gave me hope, for sure, as an advocate, because you constantly, sometimes, beating your head against a wall, sometimes. And you think, "Gosh, I wonder if things are really changing out there," and it's really cool to see that it is. But I think, on the stigma side of things, I want to say that one of the statistics that made me really jump in as an advocate is hearing it takes a parent an average of seven years to get help for a child in a mental health crisis.
Kate Gosney-Hoffman:
Seven years.
Liz Hawkins:
Seven years. Think about that. That is a child, right? That is the life-
Kate Gosney-Hoffman:
I was just going to say that.
Liz Hawkins:
... of a child.
Kate Gosney-Hoffman:
That is a child right there, yeah.
Liz Hawkins:
Because just like what Dani was saying, you can dismiss a lot of things as, "Oh well, it's a phase or it's this time of their life," or "It's COVID," or it's all of these things. But I think what we know and what we talk about all the time is if something is persistent and pervasive and affecting your daily life, that's really when you know either as a parent or caregiver, an auntie, I'm a very proud auntie, to a lot of kids, many of whom I'm not related to, but don't tell them that. But that is something that we're always reminding those parents, "Hey, if this goes beyond two weeks, that's when we really when we need to start looking at this as, we're going to need to talk to somebody and get help," and we can make that not scary by saying, "If it was any other illness, right? It wouldn't be this super scary thing."
Kate Gosney-Hoffman:
We wouldn't be waffling back and forth on whether or not we need help.
Liz Hawkins:
Need help. Yeah, you would just do it.
Dani Milliken:
And you weren't like, "Oh, I wonder if other kids break their arms," before you took them. Like, "Ooh, is it okay to go the hospital?"
Kate Gosney-Hoffman:
Great point.
Dani Milliken:
It's like, hey, one in five kids are struggling with this in our country-
Kate Gosney-Hoffman:
Or am I bad enough to go to the hospital? I mean, I know that a lot of parents will just be like, "Let's not..." Like earlier, you said kind of minimizing it, "It's not that bad. I mean, this kid over here, I heard, was going through X, Y, and Z-
Dani Milliken:
Exactly.
Kate Gosney-Hoffman:
... and my kid is just a little sad, sometimes." Do you think that's because, this could be a real long conversation, but the denial of or sort of the stigma, especially around pediatrics, do you think a lot of the time it's because of the parents, not all because of the parents, but because parents don't want to admit, because of how it may reflect on them? Or what do you think about that? Is that a barrier that you're seeing? Do you work with the parents, as well, when you're working with the kids?
Dani Milliken:
Yeah. I think there's a ton of barriers, right?
Kate Gosney-Hoffman:
Exactly, yeah.
Dani Milliken:
And I think the biggest barrier is really, and kind of what you're talking about is not parents not wanting to admit or not really understanding it, but really dealing with their own trauma, as well. And so, the trauma that's impacted a child, also is impacting the adults in the family. And so, when you've experienced a trauma, it's hard to put that information out there. It's hard to trust people, because you're scared that I'm going to get judged if I bring this up. It's not necessarily that I don't want to. It's more so like, "What are people going to say about me as a parent?," and that's shameful.
Kate Gosney-Hoffman:
That's right.
Dani Milliken:
Healthcare organizations need to wrap our arms around families and say, "It's okay. We're so glad you're here." And unfortunately, in many organizations across the country, that isn't what happens, and it does turn into, "Oh, if only you would've done this, your kid would be okay."
Kate Gosney-Hoffman:
[crosstalk 00:34:50] It has the opposite effect, right?
Liz Hawkins:
Doesn't do any good.
Kate Gosney-Hoffman:
It doesn't do any good, and because what you're looking at a lot of the time is generational trauma, right? And if we could just reframe it and be like, "Actually, by you bringing this above board, you're breaking these cycles." You are saving your kids and their generation after that.
Dani Milliken:
And it didn't matter why your child broke their arm, it was good on you, parent, for coming to the hospital and getting her care. You would never have never been made felt bad about that. And so, it needs to be the same thing.
Kate Gosney-Hoffman:
Good point.
Dani Milliken:
And just because you come to the hospital doesn't mean you need to be on an inpatient unit. There's lots of other levels of care-
Kate Gosney-Hoffman:
Good point.
Dani Milliken:
... that we can get you connected with. It doesn't have to be this life altering situation. If you're concerned, you go in. If your kid has-
Kate Gosney-Hoffman:
Bottom line.
Dani Milliken:
... slight fever and you're concerned, you go in. It's the same concept.
Liz Hawkins:
Yeah, and I think when you start treating it that way, you really see... I'm going to lose my train of thought, actually. But I think when you start looking at it that way, and you normalize it, it certainly makes it something that, I think, we all hear. Like, "Yes, of course, why not." Right? But for so many parents, I think that there is just that fear of, "What are other people going to think?" And that is what patient and family centered care is. That is what we try to do at CHOC and what other hospitals all over the country really say that they're doing. But what ends up happening is parents do get stigmatized, right?
Liz Hawkins:
And at CHOC, I think we do a really, particularly, a very good job of really involving and engaging those parents in that care plan, because this person is still a child, right? And we can't change all the dynamics in their life, but we can engage these people that are closest to them, to let them know, "Hey, this is how we can make this better." And, I think the other really incredible benefit is, if you intervene at an early age in mental health, you can help prevent it from being a lifelong illness.
Kate Gosney-Hoffman:
Totally.
Liz Hawkins:
And that's something I think a lot of people don't really understand or they think that it's only through medication or it's only through certain avenues. And so, I think it's really just about that early intervention, right? What happens if you wait too long to set the broken arm? And so, I think that's what this is and getting parents and caregivers out there, not just parents, but teachers are often the people that spot this first-
Kate Gosney-Hoffman:
Of course, yeah.
Liz Hawkins:
... or the people that'll say something about it, and send us kids to our emergency room, because they see it, and they already know that, for them, there's no shame or stigma, it's a part of their job, it's part of what life is like as a teacher these days, having to see it and say something, because you could save a kid's life.
Kate Gosney-Hoffman:
Absolutely, absolutely. Let's talk about actual therapy with kids, what it looks like, what the differences are between that and adult treatment. What kinds of things are incorporated?
Dani Milliken:
Yeah. Our unit looks a lot different than what you would see on an adult unit, and mainly because these are kids and childhood doesn't stop, right? That's out thing at CHOC. Your childhood doesn't stop when you're in the hospital, and so a lot of it is really fun, and a lot of it is, like Liz said, making connections with kids over playing games or being outside and things like that. We have this really structured day. It's kind of cool, it's like a school day almost, and they go from group to group, those groups are facilitated by child life specialists. We have a teacher, we have an art therapist, and a music therapist. We have regular therapists, we have nurses and psychologists, and psychiatrists, and everybody really wraps our hands around the family and is like, "Hey, how can we help?"
Dani Milliken:
And so, we come at it from a lot of different angles. We do family meetings, we do individual therapy sessions. We do group therapy sessions, and then we do a lot of psychosocial, just kind of like, "How do you sit in a classroom and make it through class?" And so, we mimic that on the unit, or if a kid has a particularly hard time eating or has an eating disorder, we sit in a dining room altogether and we try to normalize eating as much as we can. And so, every kid gets really specific individualized care, under this bigger umbrella of trauma-informed care, which is essentially really being empathetic and meeting kids where they're at, and knowing that our length of stay on our unit it very short, right? So we're not going to do this really long-term work, but we're going to stabilize the crisis, and then we're going to hand you off to an outpatient team that really does that full, long-term work, if that's what you need.
Dani Milliken:
And so, yeah, it's a really cool environment. We've got a 3,600 square foot outdoor play area, and kids can go out there. We play soccer and all kinds of really cool outside stuff, and it allows them to soak up the southern California sun. We try to realize normalize being on the unit, and engage. We also just partnered with an organization to provide horticultural therapy-
Kate Gosney-Hoffman:
Oh, right on.
Dani Milliken:
... where they're playing with plants and doing these cool things with flowers. On many pediatric units, what you'll see is the kid will come in, you'll maybe make some med changes, provide some therapy, and then the kid will leave. And on our unit, what a disservice to the family, so we really want to bring the family in. That's why we have therapists who offer those family therapy sessions and individual therapy sessions and things like that, because we really want to provide that higher level of quality.
Liz Hawkins:
The other thing that makes our unit unique is parents can visit anytime, anytime of day, and they can stay, and that's not something that's common elsewhere. It's usually you have visiting hours, and I really can't imagine having a five-year-old and-
Kate Gosney-Hoffman:
No way.
Dani Milliken:
Dropping them off.
Liz Hawkins:
... just visiting them from 5:00 to 6:00 every day.
Kate Gosney-Hoffman:
Nope, wouldn't do it.
Liz Hawkins:
And hoping that your job and everything else in your life is going to be okay with that. So we have that for parents and a lot of times what we see is parents are using this as their own respite time, and so they do come and visit, but they are not, even though they could be there all day, every day, they are using this as time for themselves, and to figure things out at home or have private conversations and things like that, so that is something that makes us extra unique.
Kate Gosney-Hoffman:
What I'm gathering from you, and appreciating hearing so much is we started talking, in the beginning, about this demystifying what pediatric psychiatric care looks like, and I appreciate so much that you were saying that it has this misinterpretation of it's like this constrained, hidden, this jail-like unit. But instead, actually, there's this beautiful... I mean, you guys have rainbows on your shirts right now.
Dani Milliken:
Literally.
Kate Gosney-Hoffman:
Literally rainbows on your shirts that says, "Check in on your friend," I think is what it says? And I think that says a lot about what mental health treatment for kids can look like and does look like at CHOC, and hopefully other places, as well. That it is colorful and beautiful and actually it's centered around support, and the word that comes to my mind is love, and that is so refreshing to hear. And I think refreshing for listeners to hear, too, that it's not as scary as it sounds. And also, there's certain things that you're talking about that can be tools, just knowing for our own mental health, and our kids' mental health. You're talking about horticulture, you're talking about music, you're talking about-
Dani Milliken:
Art.
Kate Gosney-Hoffman:
... art, social support, being outside. Those are all things that we can do at home. I'm not saying that it's the same as being treated in a hospital, but those are tools that are used in a clinical setting, and so they are powerful. And so-
Dani Milliken:
That's exactly what we're trying to do. We're trying to give them coping strategies that they can use, right? They come in and sometimes have these maladaptive ways of dealing with emotions, and we're here to say, "Hey, we know you're going to experience these emotions, so let's prepare you to handle them in a more adaptive way, and understand that, yeah, it could be literally as easy as planting a seed or doing an art project or things like that." And the parents sometimes are like, "Oh man, would that work?" And it's like, "We don't know, but we won't know until we try."
Kate Gosney-Hoffman:
Absolutely.
Dani Milliken:
And so, you just got to keep trying until you find the shoe that fits, and it's really exciting when you do, because then kids start to blossom.
Liz Hawkins:
Yeah. Sometimes on our unit, I've come in and one day I've left and the person has one color hair, and then the next day, come in and the person has a new color hair, right? Because that might be something that they want to express themselves and they were thinking, "Hey, what if I dyed my hair purple?" And we get the parent permission and a parent will allow that, and you start to see that child start to bloom, like what Dani's saying, because they're allowed to be who they really are. They're allowed to express themselves, certainly, in a much healthier way than maybe they were doing so before. Sometimes it is small things like that. I mean, what's a hair color? You can rinse it out if you don't like it. We can change your hair anytime, it grows back, all of those things. But I think that's what's really cool.
Liz Hawkins:
Or sometimes painting nails, doing makeup. Makeup, we've learned, is an incredible coping strategy for so many girls and boys, for anyone really. But just this idea of something touching your skin, making yourself look good, so you feel good. I mean, that's certainly why I wear makeup, and I'm not surprised to see our young girls on our unit, sometimes they will do... I mean, it's almost like watching a YouTube tutorial. I mean, they know more about makeup than any of us.
Dani Milliken:
Yeah, they give me lots of tips. All of the time.
Liz Hawkins:
Yes. I mean, there's a lot of places that wouldn't allow that, and you're in the hospital and it seems like in other places, it's like you have to feel sick, right? You have to almost look like how you feel. And in our unit, we want to encourage people to feel good and that can look like a lot of different things, and if that means you paint every single one of your nails a different color, so you have 10 digits with different colors on it, then great. Okay. And if it means that we play Uno for two hours straight, then I guess that's what we're doing, because these are kids in crisis, right? And so, this is how we would interact.
Dani Milliken:
Meeting them where they're at.
Liz Hawkins:
Right.
Kate Gosney-Hoffman:
Mm-hmm (affirmative), absolutely.
Liz Hawkins:
Exactly.
Kate Gosney-Hoffman:
When you're talking about dying your hair or any of these little actions towards self-expression and whatnot, I think, "Well, there is a part of them that wants to be seen," or "There's a part of them that wants to be here, or else they wouldn't care what they hair color looked like."
Liz Hawkins:
Exactly.
Kate Gosney-Hoffman:
So to not allow that to happen, would be such a detriment, because that's actually a way of this developing brain trying to find some kind of belonging or self-expression, whatever it may be. So to celebrate that, I think, is a really beautiful thing, even though it may seem trivial to somebody else.
Dani Milliken:
Yeah, and to be clear, I don't think organizations set out with this malintent of, "We're not going to let this happen."
Kate Gosney-Hoffman:
Oh no.
Dani Milliken:
But I think mental healthcare is, unfortunately, very antiquated, right? Our laws are written in the '60s and '70s, haven't really been updated very much. Definitely weren't written for children, and then you get into this mindset, because of regulatory issues and everything like that, that everything has to be safe. And it's like, "Oh, they could take the nail polish bottle and hurt themself with it, so we can't do it." And I think what we try to do is, "Yes, we want to provide a safe environment, but we also want to make every decision grounded in empathy, dignity, respect, the most basic of principles, and not use safety as a crutch." And I think that's kind of where people get hung up and not being able to do all these really cool things.
Liz Hawkins:
Yes.
Kate Gosney-Hoffman:
What a great point.
Liz Hawkins:
In fact, when Dani and talked about being a volunteer, of course, that's something that comes to a lot of people's minds is safety, and they're always thinking about safety for the volunteer or the person on the unit, but what about safety for our kids, right? We want to make sure that I certainly don't want to retraumatize or further traumatize anyone, and that means that I have to get a lot of training, in order to be able to do that. And that also means that I'm not alone with a child, I'm not one on one with a child. So there's a lot of different protective factors for them, not just for me as the individual that's coming on. And I think, to Dani's testament, I came on as the only volunteer, for now, and eventually we'd love to be able to take this and grow that program. I know there's people out there right now that want to volunteer at CHOC, in this program, and we're getting there.
Dani Milliken:
We are. We'll get there, I promise.
Liz Hawkins:
And it's taken some time, obviously, to do something that they don't do anywhere else. But the other cool thing is that, Dani mentioned the horticulture program, we were able to actually bring on Ocean Institute and they would come in person and do one class a month, and we would learn about the ocean. You learn about ecology and it was just such a cool program to be able to have these three amazing educators coming in with their passion and enthusiasm. And a lot of people said, "Oh, I don't know that you could do that." Man, our kids loved it, it was something different, completely different in their day. Sometimes they'd bring in a turtle-
Dani Milliken:
Starfish.
Liz Hawkins:
... yeah, sea stars-
Kate Gosney-Hoffman:
Wow.
Liz Hawkins:
... a turtle that lives on their rocks in front of the Ocean Institute named Jetty. So the turtle would come in, and for some of our kids, they've never been to the beach. And for some of our kids, they have been there, and it's a reminder of, "Ah, a place that made me feel really great." And so, I think these things really open up... I love the idea that Dani and her team are all about bringing the world to these kids, instead of, like she said, shutting them out.
Dani Milliken:
Shutting them out.
Liz Hawkins:
Right.
Kate Gosney-Hoffman:
Mm-hmm (affirmative). And that is such a reframe of mental health treatment, in general. And like you said earlier, you felt the tide changing, and I hope that that continues to change in all settings of mental health, that it's not this shut away, shameful thing, and that's what we're trying to do here, and this is why you're here talking to me right now, and talking to our listeners. I appreciate it so much, because you are good examples of doing that work, so I thank you very much for that.
Dani Milliken:
Well, thank you.
Liz Hawkins:
Thank you.
Dani Milliken:
Because, I'm telling you, you're going to save a lot of lives by airing this, and just letting people know, "Hey, the curtains are back, you can talk with us about unit and things like that." Even if it's just one kid or one family thinks, "Oh, maybe I could go to the hospital to get care, instead of taking my life." That's a huge win, so thank you so much.
Kate Gosney-Hoffman:
Wow.
Dani Milliken:
For giving us the platform.
Kate Gosney-Hoffman:
Oh my gosh, and you save lives every day, and I am so grateful. On that note, is there anything you'd like to say to or a direction you'd like to point or any kind of words of encouragement for, maybe, caretakers that are listening to this right now. Anything that you would like to share, just as we wrap up?
Liz Hawkins:
I think I'd say, you're not alone. That's one of the biggest things that our kids, when they are discharged, I think it's actually one of the most beautiful things that happens, is that we're not solving everybody's problems in seven days, right? But when they leave, they know that they are not alone. The patients are not alone. When those patients parents are walking them out, those parents also know, they've seen these other parents in the lobby or have been able to talk with them. And, for them, that's got to be a relief to know there are other parents out there dealing with the same things I'm experiencing, maybe even in worse situations. So I think that's really the biggest thing, and I think how we remind people that they're not alone is by checking in on them.
Liz Hawkins:
And I think that's certainly something that CHOC's put a lot of muscle behind this spring, after living through this pandemic for over a year, it's really easy for people to live in isolation, and to feel like, "Oh god, I'm really alone in this." And when you're dealing with mental health, in isolation, again, that's a bad place to be. So I think reminding everybody who feels so alone, whether you're personally experiencing the one in crisis or you are a parent of somebody who's really going through a rough time, I'd say believe your kids when they tell you, and just know that you're not alone.
Kate Gosney-Hoffman:
Love that. Thank you.
Dani Milliken:
Yeah. I think, for me, it's pretty similar. It's just we're here to help you and that there is help that exists, and when you reach out for help, it doesn't have to be bad or scary or shameful or make you feel guilty, it's just you're taking care of yourself, and so you should be really proud like, "Wow, look at me. I'm taking care of myself and I'm coming to get help." And I think the big thing that I want people to hear is that it only takes one person to instill hope into a kid to keep them alive.
Dani Milliken:
And so, we had a kid on the unit one time who was really struggling and really suicidal, and I said to her, "Hey, you're worth being alive. You're worth being here." And she looked up at me and she said, "I am?," as though this was this huge moment. Like, "Nobody's ever said that to me. I am worth being alive?" And so, I just think to myself, all it takes is a coach, a teacher, a guidance counselor, a cousin, a friend, anybody, the cool aunt, just somebody looking at kids and saying, "You're worth being alive. You are such a good human and the world is a better place, because you're here." That's what really saves lives.
Kate Gosney-Hoffman:
So don't underestimate the power you have-
Dani Milliken:
Exactly.
Kate Gosney-Hoffman:
... with another person.
Liz Hawkins:
Absolutely.
Kate Gosney-Hoffman:
Dr. Dani Milliken. Liz Hawkins. Thank you so much for being here, and for all that do.
Dani Milliken:
Thank you.
Kate Gosney-Hoffman:
May is Mental Health Awareness Month.
Dani Milliken:
That's right.
Liz Hawkins:
[crosstalk 00:53:51] That's right.
Kate Gosney-Hoffman:
And so, this couldn't be more appropriate right now. Thank you so much for everything.
Liz Hawkins:
Thank you, Kate.
Dani Milliken:
Absolutely. Thank you.
Liz Hawkins:
Appreciate it.
Kate Gosney-Hoffman:
Okay.