Safety First Episode 1

Resources from the Episode

• "Breaking Free of Child Anxiety and OCD" by Eli Lebowitz
• "Loving Someone with Borderline Personality Disorder" by Shari Manning
• "Cognitive Behavioral Treatment of Borderline Personality Disorder" by Marsha Linehan
• "What Happened to You?" by Bruce Perry

Hillside Youth Behavioral Health Resources

The views and opinions expressed in this episode are those of the guest alone and do not necessarily reflect the views of the host, the Safety First team or any affiliated organizations.

Transcript of Safety First Episode 1

[Intro Music Plays]

Amanda Giordano: You're listening to "Safety First: Tackling Tough Topics with Teens." Our goal is to provide useful information about issues that affect today's teenagers to help support parents and professionals who work with youth.

Hi, everyone, and thank you for joining us today on the "Safety First" podcast. I'm very excited to introduce our guest, Amy René. Amy is a licensed clinical social worker with over 30 years of clinical social work experience. She's worked at Hillside for over 20 years and is the vice president of community operations and clinical services. After serving in multiple roles, she's responsible for the administration and oversight of all outpatient-level programs, including the intensive in-home therapy, the virtual intensive outpatient program and the partial hospitalization program.

She was intensively trained in dialectical behavior therapy, which, Amy, I hope you'll tell us more about in this interview. And she's participated in and conducted trainings locally and nationally in areas like family preservation, foster care and much more.

So, Amy, thank you so much for joining us today.

Amy W. René: Thank you for having me.

Giordano: Yeah. Well, just to get us started, will you tell us a little bit about your work and your professional journey?

René: Sure. So I got my bachelor's degree of social work from the University of Georgia back in 1993. And when you get a bachelor's degree in social work, you're a generalist. And so I knew I wanted to work with children and families. And so I did several interviews, but I landed at the Division of Family and Children Services, and I am really, really glad that I did because I would not know what I know about children and families if I had not worked for 11 years actually at DFCS.

So while I was there, where I served in foster care, adoption and in resource development, which is building foster homes and adoptive homes for children. And so I learned a good bit about families and about families in particular that have children with mental health issues.

So a lot of children in foster care do have and struggle with behavioral health challenges.

So then I knew that Hillside had a community-based program.

So Hillside is widely known to be a residential treatment facility. We have been providing that service since the 1980s. We actually have been open for 135 years, over 135 years as a nonprofit in Atlanta. But we have been doing residential treatment since the 80s.

Well, in the 90s, we got savvy that children need to be with their families. And so we actually opened our community-based services at that time. And I knew Hillside to be one of the most quality providers that I had seen in the community. And so I actually had placed a child here and knew about the services that were provided to that child and decided, I want to go do that.

So I had a caseload of families and children that I worked with for a while before I got promoted into leadership and worked in their homes, helping them to parent their youth with mental health challenges.

Giordano: Wow. Such great experiences. And I'm really excited to hear about what you have seen, what you've learned and what you can share with parents or professionals who work with youth, who might be listening.

So in your opinion, how common are mental health concerns among adolescents?

René: So hugely common right now, unfortunately. And it's interesting, I ask my 14-year-old daughter that question this morning, and I said, how prevalent do you think that this is? And she said, "Like one out of every two."

And I said, "Elsa, it's not that bad." It's 20% and kind of going statistic is lately. And we have seen an increase. But to hear that from my baby's mouth, it's pretty significant to say that I do think we have more than 20% of youth struggling mainly with anxiety and depression. And we can talk some more about that.

Giordano: Yeah. Yeah. So about 20%. And that kind of leads into the next one of what are the mental health concerns that you're seeing and that you're working with at Hillside?

René: Yeah. So here at Hillside, we're no different than the community as far as the struggles. So the types of issues we're dealing with are a lot of anxiety and depression.

Here at Hillside, we do have the highest level of care. So I will speak about levels of care. In the mental health world for children, adolescents or adults we have levels of care and those levels of care are pretty much the same for either population.

Children and adolescents usually start out by having some outpatient services, just like an adult does. So they go to talk therapy once a week and usually don't start out on medication, usually start out in talk therapy. And then medication can be added and then they go up the levels of care as the needs increase.

So here at Hillside, it's no different that the behaviors are just more severe and more life-threatening issues, more suicide attempts, suicide ideation, etc.

But the base of why they're doing that is because of anxiety and depression.

Giordano: Yeah. Okay. So a lot of anxiety.

What are some of the risk factors that increase an adolescent's vulnerability to mental health concerns like anxiety and depression?

René: Yeah. So I will say genetics and stress are probably really high. There's also if the child is struggling with their sexual orientation. LGBTQ youth are — there's a representation of them that have mental health challenges.

We also have seen a huge and high level number of kids with trauma. And so unfortunately, all of us experienced the global pandemic, which was a traumatic incident. And so that happened, you know, 2020. It's very recent. And so we're still seeing the outcome of that and the social delays that occurred from that and that trauma and how that impacted our families and children.

So I would say more than anything, I want to get across to you that, and working with children and adolescents who are struggling with mental health, I can also say that the family has to also be talked about. The parents who are dealing with kids with these challenges really need as much treatment as the children that are getting the treatment, the children or teens. When I say children, I mean teenagers as well.

Because of my training, my background, my knowledge, that is what I've learned overall is you can't isolate a kid and pull them out and give them treatment and think that they're going to be okay. This systems approach has to be looked at because usually that child's anxiety is coming from a place of being in a system where there is some anxiety and so they go together.

And so when I'm working with my interns, we have interns here at Hillside. We have about six or seven clinical interns at a time. We do a good bit of work and letting them know you're not just working with teenagers, you're working with an entire family. So you also have to do adult care.

Giordano: Yeah.

René: And a lot of caregivers are now struggling with their own anxiety and depression.

Giordano: Yeah. And I think for a lot of people in the community, this idea of getting treatment or getting professional services is a little bit abstract and may be unclear.

So if a family is aware that they have an adolescent who's struggling with depression or struggling with anxiety, what could that road to treatment look like?

René: Yeah, I would say first and foremost, you can do a Google search, of course, and find a therapist that's very close. You want accessibility. So you do want a therapist that you can get to physically.

In Georgia, we have made it easy. The 988 number, I'm sure a lot of you have heard about 988. 988 is where you call if you're suicidal. But it is also a link to the Georgia Crisis and Access line in our state.

So if you are looking for a mental health professional that has your insurance, you can call that line and they should be able to connect you to a provider. Another recommendation I give to families is if you're trying to use your commercial insurance, and that is a huge issue — a lot of families want to use their insurance — then you go straight to your insurance first to find the providers that take your insurance, and then you want to look at how close they are to your home or your child's school or your workplace or whatever so that you can get the child there.

I will offer that Hillside's admissions department, if your child is already in treatment and is not having an easy time of treatment and it's not going well and they need something more, that is when you can reach out to our organization.

And so all the services that we provide here at Hillside, we have four different programs. They are all covered by insurance and Medicaid, and they are accessible and more intense than just sitting in an office and having a therapy session, so I can break down those services if you want me to.

Giordano: That'd be great. Yeah.

René: So one of my favorite programs, the one that I came to Hillside to work in, is the in-home program.

So we go out to a family's house and provide the therapy services in the home in the natural setting. We support kids and their schools, their community and with their families. If they're struggling with their sibling, we'll do a sibling session. So we really meet the family where they're at in that program and provide a lot of parent support.

So again, I can't overemphasize that to you. That's the message I want to leave, is that this is not a treatment that you can just give the child but it has to be the whole family. And so we do family work as well and moving up in levels of care.

The next one is an intensive outpatient program, and we have that virtually. So it's after school, 3 to 6 p.m. We do an individual therapy session, a family therapy session, and we have a psychiatrist that will treat the child and do an evaluation and then use medication if needed.

And then we have our partial program, which is our day treatment. It's called Experience DBT. And we love that program because the kids get a huge amount of treatment, experimental treatment and also therapy so that kids are here all daylong, 8:30 a.m. to 4 p.m., and so they're getting their therapy services and able to do a little bit of their schoolwork during the day as well. Although the emphasis is on their mental health while they're with us, that's about an eight-week program.

And then there's the residential program, which is 24 hours a day, seven days a week. The child comes and is here for about 100 days. Our average length of stay in the residential treatment program is 100 days. And so they will receive individual therapy, family therapy, that services are clinical all daylong.

So they're in groups. We use horticulture therapy, art therapy. So again, it's a lot of hands on work and building skills to be able to tolerate your emotion, emotional distress and distress tolerance. And so those are the big emphasis here for kids who are struggling with anxiety and depression. That's critical.

Giordano: Yeah, for the partial hospitalization program and the residential. How are parents involved in that?

René: Yes, thank you for that. Since I have said I'm going to emphasize that you mentioned DBT in the beginning, so dialectical behavior therapy is heavy skills.

We break down and do different modules.We work on mindfulness, we work on distress tolerance, emotion regulation, interpersonal effectiveness skills. The same skills that the youth are getting.

We have a parent group and so the parent caregiver group is on Tuesdays at lunch time right now we change the time based on what's the need. And then so we meet with them and they're able to also follow along to use those same skills in family therapy with their child and adolescent.

And so they learn how to regulate their emotions. You can't help your child regulate their emotions if you don't know how to regulate your own, and so that’s critical and important.

Also, we have a psycho-ed group which is a little bit different, and that meets every other Friday. In that group we work with the parents as well for an hour. It's more things like, here's the psychopharmacology that we use here at Hillside most frequently. Let's talk about how they work. So it's more of a knowledge base, not a skill-based group.

Giordano: Great. So at every level of care there's that systems approach.

The family is involved as the teen or the child gets these skills and this knowledge, the whole family is as well. Okay.

René: And now that we have telehealth, those groups are actually available to the families in all four programs. So even the intensive in-home and the virtual IOP those families can participate in those two groups.

So it's all done on Zoom. We do it at lunch time, so we make it pretty easy for a working parent to attend.

Giordano: Fantastic. So my next question, if you think about the adolescent years, there's a lot of ups and downs, a lot of maybe trauma and emotions.

So how can a parent distinguish between just kind of typical adolescent development or some warning signs that their child might really be struggling with a mental health concern?

René: Yes, that's a great question. So the things I most often say are change in diet, change in sleep, change in desire to be motivated to attend to their daily life.

We are seeing more and more school avoidance. And school avoidance can start out looking very much like they're just not wanting to go to school that day. When it turns into a pattern of behavior, you might be struggling with some anxiety.

And so the main thing is to really talk to your child, to find out what is going on. But those are some of the behaviors that you'll see.

Boys tend to be more externalizing. So you may see opposition, you maybe see attention problems, not able to focus. Some of that is normal.

But again, when it happens pervasively and it's happening alongside lack of sleep, lack of eating or overeating, these are things that you're going to start to see that perhaps they're having some thoughts that you want to attend to depression, anxiety.

Giordano: And so if a parent is trying to have that conversation with their child, with their teen, what are some of your suggestions of what that conversation could look like or how the parent approaches that?

René: So I would say not in a direct fashion. Amanda, like you and I are having a very open conversation. Teenagers have a really hard time with that.

And so my advice would be to in the car on the ride to somewhere that's not stressful, like not at the beginning of their school day, but maybe at the end of the school day. “Hey, have you been having some, you know, thoughts of, you know, like what's going on with the you?” And so just trying to find out.

I think being more open ended with your questions is better than leading them. “Are you are you thinking of hurting yourself?” would not be where I would start. That would be where I end.

So, "Hey, I noticed you've been having a hard time, and you're up late at night. Is, you know, what's going on?"

Are you having some thoughts, maybe using your own experience as well? Again, mental health, usually there's some genetic predisposition, so the parent who's asking their child about this, already has experienced this themselves and so that's when you know what it feels like.

So you can use your own experience to be able to question and ask.

Giordano: Yeah, and have a lot of empathy for what might be going on.

René: Yeah.

Giordano: So what are some ways that you think we as a society or individual families can promote mental health among adolescents?

You know, it's a big question.

René: Well, I know it's, it is a huge question, right.

I think the biggest thing is talk to your child, find ways to engage with them, be a part of their life, be motivated and active in their school and their activities. You know, don't be the silent parent.

It's normal for teenagers to want to pull away from their families. But there's subtle ways of being involved and how you can show interest.

And so I think that it's critical to be there and be as engaged as they'll let you.

I would also highly, highly recommend another thing I can't overemphasize is healthy sleep. And so if there aren't any mental health issues and you've got a teenager, they're probably not sleeping enough. You and I are probably not sleeping enough and so there's more and more research that showing the importance of sleep as especially when it comes to mental health issues, that if you're not getting the basics: healthy diet, healthy sleep, then you're going to struggle if you have a mental health condition.

And so if you can promote healthy sleep just on a whole has a family that goes a long way. So to a child being able to regulate their emotions.

Giordano: Yeah. Yeah. And those are things I think are very practical and things that families can do to kind of assess their sleep patterns and assess their communication.

Is there anything else that you feel like might be detrimental to adolescents mental health that parents and families could be aware of?

René: Yeah, we haven't touched on socials. We could do a whole podcast right on social media, right?

And so I think being aware of a child's use and pattern of behavior. We here at Hillside do not tell parents you cannot have your child on social media because that is unrealistic. And so being able to figure out the boundaries and how often and what platforms, all of that.

I think families need a plan. Again, I think in dealing with mental health at this stage of my career, after 30 years of working with people and family, it's all about supporting the parents.

So helping the kiddo with learning some skills, this is a lot easier than getting into, “Okay caretaker, how can we help you to figure out how to support this child that is starting to struggle?” because that's where the issues begin.

And so a lot of times it is a little more challenging with parents because they have trauma as well. They have their own needs. You may be doing referrals and trying to help them get connected to services that they may never have had and actually need. And that's okay.

But we here at Hillside know you can't just treat the child. You've got to approach the system that the child is living in. Our families are very complicated and complex now. It's no longer two parents and two kids. It's a grandmother, you know, a child and their teenage daughter living together in a home.

And that's, those are the families that we are seeing and seeing the issues that come up with multigenerational parenting. So it's quite complicated now.

There is a book I wanted to recommend, “Breaking Free of Anxiety and OCD” is really helpful. Dr. Lebowitz. So if you are dealing with anxiety in your teenager, particularly this is a great one, especially if they're around 10, 11, 12. I think every parent should read it because it does talk about how the anxiety in the family system can worsen without meaning. And so it's not that parents mean to, that as you protect your child from this world that we're living in, it can increase your anxiety. And so it's all about accommodation and what that looks like. So I highly recommend that book to a lot of the families that we work with.

Giordano: Fantastic. And just in closing, is there any encouragement or anything you'd like to leave our listeners who are working with adolescents?

René: Yeah, I think, you know, here at Hillside we're dealing with kids with really severe issues and they're not new to the system. So if I could talk to those families, you know, a few years ago when they started to have issues, don't be scared to get help for yourself and your child.

The stigma around mental health is lessening because we have podcasts like this, because we have radio shows, because we talk about it more, that is all a really good thing. And it's okay to get that support that you would need.

Giordano: Yeah, yeah. Fantastic.

Thank you so much, Amy, for being here and all of this knowledge and wisdom that you shared with us.

And for listeners, thank you so much for joining us on the "Safety First" podcast, where we tackle tough topics affecting today's teens. I'm your host, Amanda Giordano, and we hope you'll join us for our next episode.