Mental Health & COVID: Adolescents part 1 of 3

Health Law Talk Presented by Chehardy Sherman Williams

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Rory Bellina (00:15):
Hello everyone and welcome to Health Law Talk, presented by Chehardy Sherman Williams. Before we get started, please be sure to subscribe to our podcast and follow us on Facebook, Twitter, LinkedIn, and YouTube – links in the description below. We hope you enjoy this episode.

Conrad Meyer (00:35):
All right. Good afternoon everyone. Welcome to another episode of Health Law Talk here with Chehadry Sherman Williams, and we have the Rory Bellina Health lawyer here, Conrad Meyer on the other side of the mic. And very special, I guess, Rory, what’d you call it? Multiple part series here,

Rory Bellina (00:50):
Three part series we’re planning on. It’s an excellent topic, very timely, and we’ve got some really exciting guests today.

Conrad Meyer (00:56):
Absolutely. We’re gonna be doing a three part series on C and mental health. And, and this is going to be something that we’re gonna start off. We’re gonna break it out in in three parts. The first part will be about covid and mental health issues dealing with adolescents, and then we’re gonna be doing covid and mental health with families and how families are coping with, with mental issues with covid. And then finally, the covid and mental health with elderly patients. Right. So elderly. And so today we’re gonna do it with covid and mental health and, and adolescents. Is that right?

Rory Bellina (01:24):
That’s today’s topic.

Conrad Meyer (01:26):
And we have two experts with us on the phone. Two experts. I’d like to introduce everyone to Tanya Stuart. Tanya is a licensed clinical social worker who is the owner of Genesis Behavioral Health in Baton Rouge. she is has extensive outpatient experience with and, and comes to a more holistic approach with treating adolescents and mental health. Is that right, Tanya? Did I get that right?

Tanya Stuart (01:48):
Yes, that’s right. That’s correct.

Rory Bellina (01:50):
Welcome Tanya. Thank you for coming

Conrad Meyer (01:51):
On. And then we have the, the Esteem, Brandy Klingman. Ms. Klingman is another LCS w and she is the owner of St. Christopher’s Addiction Wellness Center. and she has again, extensive experience in, in treating adolescents and mental health issues, dealing with adolescents. So we, we brought Brandy and Tanya on the show today to really talk to us about covid mental health issues with adolescents. Brandy, how are you doing?

Brandy Klingman (02:18):
Doing good. Thanks for having me. I’m excited to talk to you

Rory Bellina (02:20):
Guys. Thank you for joining.

Conrad Meyer (02:22):
So, I guess the, the, the first question is, is do you both, are you seeing this in your pr? Is this an important topic?

Tanya Stuart (02:30):
Absolutely. I think right now, more than anything, our adolescents are really suffering especially with this, the situation with the C and trying to adjust to not only the mandates based on school, but just their environment and home changing. Parents are struggling themselves. Kids are trying to find ways to, to not only keep their academics up, but to stay connected socially. So it’s been, it’s definitely been a struggle and we’ve seen major increase in acuity in addition to adolescents and families reaching out for help.

Rory Bellina (03:03):
And I have, I have a question before we, we jump right into this. I think you’d give our listeners some good background information. Can you tell us a little bit about your practice and what you were seeing pre covid? And then talk a little bit about what happened when Covid hit. And I know that’s a loaded question, but when Covid hit, we’d love to hear about how you shifted to a, a virtual practice or a telemedicine practice, and then really what, what changed with the patients you were seeing? Great question. Great question.

Tanya Stuart (03:32):
Okay. Well, I have an intensive outpatient program, so it’s right before the kids have to go into a higher level of care of residential where they disconnect from the family and sometimes even inpatient, where they have suicidal, homicidal, or greatly disabled symptoms. So we try to do a lot of comprehensive treatment. We work with the families are required to participate in group therapy in addition to the kids do about six hours of group therapy in our program. So in, just to give you an example, in 2020, we serviced probably about 55 adolescent families. And then so far this year in 2021, we have assessed 120 families and have served already 82 families. Wait,

Rory Bellina (04:21):
So we’re halfway done the year, and you’ve already doubled for this year, correct?

Tanya Stuart (04:26):
Correct. Mm-hmm.

Rory Bellina (04:27):
, that’s, that’s incredible. I’d love, Yeah, I’d love to hear about that. Can you, and obviously going back to my question, tell us about what, what have you seen and caused this kind of doubling and what do you attribute it to?

Tanya Stuart (04:38):
I think it’s a delayed response from Covid. I think when it first hit, it was a lot of unknown things and kids were kind of enjoying being home. But over time, I think the families were seeing a lot of stress with work. And also if they had their own mental health or substance abuse issues, those were exacerbated. And I think it just trickles down to the kids. And so what we see is a lot of isolation with the kids. And during adolescent years, connection is very important. And so they were kind of disconnected from maybe their role models at school or their peers activities that may have helped them to kind of just deal with, with being an adolescent in general. And so I think now what we’re seeing is we’re seeing a lot of more self harm. And when I talk about self harm kids cutting themselves, hitting themselves you like burning themselves. Wow. We’ve seen, yeah, lots of overdose pills attempts running away with substance use. Wow. So our program, a lot of kids, usually they fail at an outpatient level of care with their provider, and then they bump ’em up to our intensive program. We have kids just coming straight into the intensive program because outpatient one-on-one counseling wouldn’t be enough for

Rory Bellina (05:59):
Him. So Brandy, let’s go back in time to March, 2020. I’d love to hear about your practice and how your practice probably was forced to, you know, shift almost overnight or over a a week period time when we all had that stay at home order. And, and kind of what did you see in the mental health world when you had to switch from what was traditionally probably a face-to-face therapy to a virtual or a telemedicine therapy?

Brandy Klingman (06:24):
Right. No, that’s exactly it. That we were, I can go back to March in my mind immediately in just a panic because my outpatient clinic, we were servicing thousands of patients and around the Louisiana area, in person, traditional outpatient therapy coming in to get your meds managed by a physician or see your counselor. And I think it was around March 14th or so that we knew this was coming, and we had to decide how are we gonna go forward? Well, the government hadn’t made a real clear decision as to how we’re gonna do telehealth. So we were just kind of ready to batten down the hatches at the office. We were prepared to, Are we gonna be giving out medication for months at a time? Are we going to be giving endless refills? How long will this last? And we had a meeting with my providers to decide, you know, it’s not the patient’s best interest to give them some of these medications, these mental health meds for months in advance.

That’s just not the best interest they need to be checked on. So we had already decided internally, no matter what happened with the government or the, the country, that we were gonna keep tabs on our patients somehow. And we had decided FaceTime or calls that way would’ve been the way to go. And then thankfully, you know, they came in and made the, the rules just kind of wiped off the board, basically, that we could do telehealth openly. And there really weren’t that many structures or limitations around it. So we just decided that that was what we were gonna do to make sure that we could keep eyes on our patients.

Rory Bellina (07:46):
So you had already decided that you were gonna jump into, like you mentioned, the facetimer of the calls before. You know, what Conrad and I recognized and kind of all the, the rules that you mentioned, like you said, were thrown out the window when, you know, prior to Covid, there were very strict restrictions on how you could have a telemedicine visit, how you could bill for it. certain software you had to be set up where you had to be located. There were a lot of these rules in place. And like you said, best, they were kind of just thrown out the window. So your practice already decided, Look, we care about our patients. We’re not worried about the billing part right now, Let’s get this correct and get them treated. So moving forward, moving forward in our timeline, Tanya or, or Brandi, either of you could jump in here moving forward, when you heard that those restrictions were lifted and you could use FaceTime or Zoom or Skype for a visit with your patient, was that, was, were you ready for that or did you have to get some things set up and, and, and kind of, were you excited about that?

I’ve heard from a lot of providers that they were excited that finally things that they thought would help pr their practice were being allowed. But then some of them weren’t set up, some practices didn’t have enough devices or didn’t have strong enough wifi or different things like that. So talk about how you, you pivoted on such a short notice and, and moved over and how it made you felt.

Tanya Stuart (09:04):
Well, well, I’ll be honest with you. I remember standing in my copy room and John, one of my clinical director told me, we need to start looking at platforms. I was in denial. I said, What, what? We’re not gonna have to do that. Oh, it’s gonna be fine. It’s gonna be fine. And thank goodness I had some young people working for me because they were able to understand this technology and get us on pretty quickly. It took us probably about a good two weeks to transition. But when you’re doing telemedicine with adolescents, it’s even more complicated because of the safety issue. You know, they, it, the parents had to be at home while you were doing the meeting because if an emergency happened, we had to contact the parents so that they can get to the adolescent cuz we were offsite. So there were a lot of things that we had to learn about telemedicine.

we had, I didn’t really want to do it. I didn’t enjoy doing, it was something that I never thought I would do in my practice until Covid hit. I think I remember talking to you around that time and kind of thinking the same thing. Like we were stressed out trying to figure out how things would go, but I was excited about the opportunity to, to utilize any methods to connect with our patients. Cause I remember I was so nervous about just losing contact with our patients and our families because that would’ve been devastating to me. So I was prepared. I think I’m kind of like a soldier in that way. Like when, like, really when the shit hits the fan, I’m ready to roll. And I, I do well at that point now figure like at the end, we’ll figure out what are we supposed to do to stay in line, but we gotta survive this battle.

And so I was really ready. And then since I’ve loved it, like I’m, I love the idea that we can utilize this to reach patients all over the country. They don’t have to miss a half a day of work to come see their doctor. They can c call in in their car on their lunch break or in the counselor’s office at their school, rather than miss something to kind of connect with us. Now I’m in an outpatient setting where you’re, you know, at more intensive outpatient, they’re gonna need more connection. But the outpatient setting, we got to immediately triple our caseloads. We got to see so many kids and in ways that we wouldn’t normally see ’em sitting in their PJs while they’re eating breakfast. Mom or big sisters walking in the background. You hear the parents yelling, you can hear what’s going on in the house. It was just totally different world. Like we were really excited

Rory Bellina (11:19):
For it. And brand, You hit on some great points that I want to ask you or tie to elaborate on. So walk us through, obviously we don’t need any details or would expect that, but how did these visits go? I mean, did you see things that you weren’t seeing in the clinic setting, or did you, what were they? That might be a loaded question. Right, Right. , did you, did you you know, tell us the pros and cons of it because I think, you know, I think everyone had to like, like Tonya, you said you weren’t really looking forward to it or ready for it. And, and, but Brandy, you were, you were Tonya, you were forced to do it. So it kind of forced in certain providers to do this teletherapy. And, and I’d love to hear some of the, the things that you loved about it that you want to stick around. And then also some of the things that you felt were really burdens where you felt that you weren’t given the best treatment and and you wanted that patient in the room with you.

Conrad Meyer (12:08):
What made it easy? Pros and cons. Yep.

Brandy Klingman (12:10):
Yeah, yeah. No, we ha I can say some, some pros were obviously were able to reach out and see people we weren’t able to see before and in more environment that we had never seen their home environment. The cons were eventually, this is, I’ll just say this, My office had to put up a disclaimer at the beginning of our calls that said, you have to have one closed. You have to be sitting in an appropriate place. You have, your camera has to be turned on. It has to be light. Because we were seeing all kinds of things that

Rory Bellina (12:37):
We really sure

Brandy Klingman (12:38):
Would never have expected, you know, so I answer call with no clothes on or sitting in the bathtub. I’m like, No, this is not, this is not okay.

Rory Bellina (12:47):
So some parameters need to be put in place for administrative purposes. That, that’s fair. Yeah.

Conrad Meyer (12:53):
Yeah. So, so let me ask you this. So we’ve got the, the new technology out, right? We cut through the regulation. You’re in Covid Brandy, you’re seeing more patients and reaching out to areas that you probably haven’t before. You know, Tonya, you’re, you’re adapting your practice model to, to meet the, to meet the new, I guess the new parameters of where we are in in covid. This is more of a question about the, about the kids that you’re seeing. What, what would you say would be some of the top issues that both of you are seeing now with C and, and these and the children with these mask mandates, the school mass mandates, now even some of the school required vaccination rates, online classes. What are some of the, the top things that you’re seeing coming into the practice?

Rory Bellina (13:44):
And I’d like to throw in another one. What did you see right when everything started? Because I’m sure it’s, it’s it’s evolved. It’s evolved throughout. So if you could walk us through from March, 2020 to now, kind of as regulations and vaccines and masking mandates have all been out. Kind of walk us through what’s been going on with these kids. Yeah.

Brandy Klingman (14:04):
Well, what I find with the, with the adolescence is that with this year, this school year, just getting started, also, many of the kids and parents have chose to continue the online schooling. The schooling has adapted to do like a little hybrid, which we’ve also done in our program, always offering either a telehealth option or an in person. So some of the schools have opted to do the same. And what we’re finding is because of the, the, the new pandemic and how it’s spreading so rapidly, parents and kids feel more comfortable staying home. So that’s a majority of what our kids are doing is, is not reconnecting back physically back into school. So the masks have not been an issue so far, but what has been an issue is trying to engage, I can’t imagine them trying to engage in a school lesson, because when we’re trying to do group or individual with them, these kids are diagnosed with adhd.

They are not regulated on their meds as much as they would be if the teachers were involved telling the parents, make sure that the, the, the kids are taking their medications appropriately. So the lack of focus and engagement via telehealth has been a struggle for us with some adolescents. Mm-hmm. . And then they also know how to split screens and play their games while they’re, you know, Right. Thinking you’re paying attention to ’em. But, but they’re really not. So I have, I have reluctantly conformed to the new today. And so, but that is not how I prefer to do practice. But we do offer the hybrid model at my agency

Conrad Meyer (15:45):
And brand. What about you?

Brandy Klingman (15:47):
Yeah, we’re offering a hybrid. We prefer them to come in if they’re local and it’s available to them. But again, ours is outpatient. So it’s, we find it’s equal, easy to see them outpatient via telehealth. We’re able to do that. But something that I do think shifted since the beginning of Covid to now is the level of concern and their fixation. You know, I think in the very beginning we were all very scared. Nobody really knew a whole lot about the disease or the illness, and everybody was just kind of in it together. Whereas now it seems like there’s something different every week for them to come in upset about, you know? So some of, sometimes they’re coming in and they’re upset that they have to wear a mask, and then sometimes someone’s coming in upset that someone else is not wearing a mask, you know?

So it’s, we’re getting both sides of that. And there’s so much heat on us as providers. They want us to take a stand for them or to write them a note or to say that they’re, they’re medically exempt from this mask, or that they have to be around only people with masks. Everybody wants some kind of letter to document whatever point of view they’re going on. Mm-hmm. . And it’s just a lot of pressure on us. Mm-hmm. , and they came out, my husband’s a teacher in our town, and so I see both sides, you know, the teacher’s sides who are trying to do both the virtual and in person, and then also the healthcare. They came out in our area saying, Okay, well you have to have this mask on, or you have to have a note signed by any doctor. So then they’re flooding my office, asking for us to sign these notes, you know, so that they could be exempt from the mask. And it’s just so stressful for them as a person going through life trying to figure out what to do and then putting it on us to say, Okay, well this is what we’re gonna decide as medical professionals. Mm-hmm. . So it’s just a different type of game that we’re playing now of just how do we take care of them? How do we meet their need and keep them safe, but also from this virus too, you know, and keep the public Well.

Conrad Meyer (17:34):
So, so one of the things that that that, that we are hearing, and, and I mean just as a parent myself is, and I wanna see if you’re both seeing this, you know, boots on the ground and the trenches with your, with these to the children, is the fact that the virtual class itself, like the kids aren’t in school, so they’re not interacting with other children. There’s no social play, there’s no there’s no talking. And when you talk because they’re wearing a mask, they can’t see others’ expressions. So there’s then, now does that handicap children’s, you know, you know, mental health growth, is that something that y’all are seeing too? Or is, what do y’all think about that?

Brandy Klingman (18:10):
Yeah, ab absolutely. I think that kids already use a lot of screen time, is what I call it. And that’s gaming, computer, cell phone, social media. And then you add on the, the isolation of not having in-person contact and then the mass not being able to read body language. So a lot of these skills kids already suffer with social skills and adjusting and communication. And so now that they, they are withdrawn from that, I feel like that’s kind of what we’re seeing is an exacerbation of their mental health issues. The isolation which causing the depression, which causing the anxiety. And some of these kids who maybe have thought about self-harm are actually now doing it and they have less supervision also. Yeah. I couldn’t hear you more. I think like we’ve seen kids mm-hmm. , if you think about the stage of development, they are their peers at this age, they lot, not even separate.

Like I remember whatever my friends liked, I liked whatever they drank, I drank, we all ate the same thing at lunch together, you know? And right now they’re completely isolated at home most of the time in this hybrid version or this like online schooling, and they have nothing but what they’re looking for online. And you can find anything online that’s, you know, healthy or unhealthy. They can find ways to self harm or groups that are engaging in eating disorder behavior. And so you’re seeing some of the worst come out in these kids when they’re left to their own devices, you know?

Rory Bellina (19:32):
Mm-hmm. . So Brandy and Tanya, going back to my timeline, if y’all haven’t picked it up, I know I’m a very linear thinker, so I think of things in, in timelines straight. so let, so I’d like to analyze this a little bit more going on along my timeline. So let’s go back to when the mask mandate came out in Louisiana and obviously nationwide for most of the states. How did you see that affect children? Because I’ve got three children of my own. Connor has two, and I know the fact, the effect that it had on them, You know, from little things of we need to have masks in both of our cars and in their backpacks, and remembering them to, you know, they can’t see their friends’ faces, or it was hard for them to understand in the classroom because they’re trying to read the teacher’s lips or, or follow expressions. So talk a little bit about the mask mandate itself and where, I mean, we know the, the health reasons behind it, but where do you think it, it’s kind of hurt or it’s caused issues with some of your patient population?

Brandy Klingman (20:31):
I can, I can speak to the outpatient groups that we’re seeing and just also my experience as a parent with kids, young kids. I had a baby during Covid during that time. So, you know, I’m very aware of like mass culture around kids. And what I know is like, if there’s an underlying anxiety in a child around illness or safety, the mask just exacerbates that. They’re a little bitner more nervous, they’re worried they’re gonna catch something if they don’t wear the mask, right? Or if they see someone without a mask, they’re p tugging on your shirt saying, Mama, mama or Ms. Brandy, why is this person not having to whip mask on what’s gonna happen? So there’s that little underlying anxiety can be blown up. But then also, if they’re just in an environment that’s stressed and anxious, then they’re gonna even be more stressed and anxious.

So really it depends on how the mama and daddy are handling the mask thing. You know, the baby that I had during Covid, he was born during a time where you had to wear a mask on, wear a mask during delivery. And I wear a mask after, you know, visiting him in the nicu. That’s all he knows. And I’m not anxious about it. He’s not anxious about it. He can see a mask and not be upset. And I think that’s kind of the tone. If the family around and the community around the child is calm and responsible, and even then the person is more likely to respond to the mask in a calm way. Whereas if you’re anxious and you’re fighting and you’re scared, then that’s, that’s gonna be picked up by the kid, you know? Yeah. And I agree with Brandy. A lot of the kids’ attitudes and about wearing masks is definitely a direct reflection of how their parents are handling it. Sometimes I’ll have conversations with the adolescent, it sounds like I’m having it with their parents. Yeah. So that they’re really listening to what their parents say they’re taking on their attitudes and their point of views. So I, I encourage parents to be mindful about what they’re saying in front of their kids and just be age appropriate because we do not want to exacerbate their anxiety about things that, especially that they can’t control.

Conrad Meyer (22:27):
Well, I think, let me ask you this. So I, and, and I think those are all great points, and, and I think when we hear from, from both of you about your patients and, and what you’re seeing in the trenches one thing that I think gets left behind and, and to Tonya’s point parents who maybe who, who, who don’t think their kids have any problems. So what advice would you give parents in this, in this pandemic world and mask mandates and online learning and, and things like that? Parents who, who’s, who maybe they thought their children never had any anxiety or any problems. What would you advise parents to do to, to be on the lookout for so that maybe they could head off at the past? Right. Maybe some problems that, that maybe haven’t manifested, but are sort of, you know, fostering with the children.

Tanya Stuart (23:14):
Yeah. Well, I think one of the things why, why we see such an increase this year is because parents kind of waited. They, they felt as if this was something that was gonna pass. some of the symptoms they were seeing with the kids, they normalized it as adolescent or childlike behavior. And it’s not until this year where the, the symptoms got out of control. So I would encourage parents not to wait. The first thing that they definitely need to do is if they have any kind of concern about their adolescent, they need to start, I would start with the school. I would start with the school counselor and let them know what they’re observing and compare it to what they see in school. And if there is some concerning behavior or they’re not at their baseline like they used to be at school, then reach out to a professional. and it doesn’t mean anything. Like they, they’re gonna need medications. I think that’s a big thing. Parents don’t feel like well, they feel like if I get help, they’re gonna put my kids on meds. It’s just a an assessment period. It’s just finding out, you know, is this something that it’s just an adjustment or is this the onset of something more severe?

Conrad Meyer (24:25):
So, so to follow, well, to follow up on that, I’m sorry, I’m jumping in a little bit like head first. Right. how would that manifest? So in other words, I, I hear what you’re saying, but the, to the parents who, who like, like I said, maybe have never had an issue before, what manifestations would, would, would, would show that they might say, Okay, wait a minute, that’s not right. Or, Wow, am I really looking, you know, should I have some concern? What, what would be some manifestations

Rory Bellina (24:51):
Things to look

Conrad Meyer (24:52):
For? Right.

Tanya Stuart (24:54):
Anything off of their baseline functioning. So I describe baseline functioning as their normal adolescent behavior prior to Covid. and it could be that the kids adolescents, they like to be in their room. They don’t talk much, they just answer your questions. you know, that’s kind of your normal adolescent behavior. But if your adolescent used to come down for dinner and doesn’t come down anymore, spends more time on screen times is more agitated, you’re hearing more verbal aggression or seeing some physical aggression, some isolation. Those things out of the ordinary need to be assessed by either a school counselor or someone in the community. And like I said, it could just be something that’s out of the ordinary from what they’re used to functioning as. What happens is parents kind of write that off as adolescent behavior, or they’ll, they may have their own issues that they don’t have time to focus on what the adolescent is going through. It’s not until it’s too late. And when I say it’s too late, the, the cutting behavior has started, the substance use started so harder for the providers, harder for the families, and harder for the adolescents to kind of get out of that. So just to be more proactive than reactive to the symptoms.

Rory Bellina (26:12):
So I think we’ve, we’ve covered the, the, the mask part, and you’ve given some really, really good insightful information on what you saw during the, the, the mask mandate and its, you you’ve seen. So I’d like to also jump now over to the vaccine side. So as of today’s recording, the vaccine’s only approved for, I believe, 16 and older. the, the major vaccines, it hasn’t been approved for anyone younger for that. which I assume includes some of your population, but even forward thinking, have you had parents you know, approach you for advice on should they get their kids vaccinated or, you know, what are you hearing regarding the vaccine for this lower population? From what Conrad and I are hearing and reading, is that within possibly like, you know, the end of October, it might be approved for that six to 11 year old range, or six to 16. So what do you, what’s your opinion on the, on the vaccine and how you think it could affect

Conrad Meyer (27:09):

Rory Bellina (27:09):
Mental health, the mental health of kids?

Tanya Stuart (27:12):
Well, I think for my parents, they, they are very encouraged and want to have their adolescents vaccinated, especially going back into school and doing group therapy. So most of the, all of the parents have been on board or have a strong opinion about do they want the vaccination or not. They’re definitely not asking my opinion, but they do wanna know, am I vaccinated? and so we are all vaccinated in our office and, and we don’t mind telling them that, but we make it a point not to ask them if they are. We just ask them if they have any, any symptoms, fill out a questionnaire, take their temp, and they have to wear the mask and socially distance. So we wanna respect everybody’s privacy with this. We don’t want them to feel shamed or embarrassed because some of these adolescents, it’s not their choice.

They may want the vaccination, but the parents don’t. So we try not to make that big of an issue. We just try to give do the precautions as necessary. I’m surprised you have all your parents are on board for it. Cuz I’ve had like both sides, you know, in the office mm-hmm. where some of them are coming in and they’re, you know, they’re saying things that I, I don’t think are true. I mean, I’m not a physician in that way, but I don’t think it’s true that they’re playing microt, tripps and these kind of things. Mm-hmm. But they’re coming in and they’re saying that in session and it’s, it’s really not my place to correct them. It’s not our physician’s place to correct them mm-hmm. On every small belief they have. But it is something that’s very much there and they’re, they’re just spitting it out, you know, And, and I think that they’re anxious and upset and they feel unsafe. That’s the bottom line of it. But they’re coming up with all these words that they’re, they’re researching online for themselves. So we do have people who are vaccinated and who are being sound about what they’re doing, but even on that side, we’ll have them where they’ll say, Well, we’re not coming in here unless we know every single person that’s in here is vaccinated. And I’m like, but I, I can’t tell you if every person in the building’s vaccinated or not. You know? Mm-hmm. . So it’s like, I, I’m kind of getting the both extremes.

Conrad Meyer (29:10):
So, so brand to your point, and I think I’m gonna, I’m gonna sort of, you know, pigtail off of aro here. to, to, I guess the question I would have is, is, is, is that the anxiety that you mentioned from the parents? Do you see this anxiety transference or transferring to the children? So in other words, so in other words, now are the children emulating mom and dad? Yeah. You know, and, and, and are you both now, now let’s just hypothetically, let’s say we get down to where it’s now, now mandated for 12 and older, right? Do you believe this is gonna, you know, is it usually an emulation from the parents? So in other words, let’s say you have two parents who are pro-vaccine or the, are you finding the kids who are like, Oh, I’m great, that’s great. I can, I can get my vaccine too. You know, Or if the parents are anti-vaxxers, right? They don’t wanna get the vaccine, are the kids, is there an anxiety, there? Is the transference of anxiety from, from parents to children, or are emanating within children themselves?

Brandy Klingman (30:09):
Yeah, I mean, I kind of, I mean, we know that kids are their relationships. That’s kind of how their brain works at that point. They’re not separate from who they’re around necessarily. So they are emulating who they’re around. If they’re around and absorbing their parental influence and they’re around and absorbing their peer influence. And they kind of emerge as a mixture between the two, you know, is what I see. Like, I, like you said, you saw them talking, saying things that it sounded like they were parents, that they were just kind of quoting what their parents were saying, but they say it as if it’s their truth. And I see that too constantly. You know, and that’s just the natural setting. I mean, aside from Covid, kids take on their parents’ opinion about religion, about Yeah. Politics, politics, sports. Yeah. Sports, racism, whatever it may be, what they’re hearing in the home. That’s all they know. And you know, some of it’s good and some of it’s not.

Rory Bellina (31:03):
So Brandy or Tanya, where do you see things? And before we get back to a couple of just generic questions I have on your practice and how telemedicine has helped or, you know, not been in your favor, where do you see things going now? Like, like I mentioned, we’re in late August, this vaccine hasn’t been approved yet for kids, but all indications are that it will be in Louisiana it looks like we’re coming down off of a, a fourth wave. So where do you see things going, or if you could look in the magic crystal wall, where do you see things going for your patient population going forward with either getting back in school fully or, you know, getting vaccinated, the mask mandate, pop, possibly being rescinded? Where do you see things going with just kind of the general state of, of your, of your, of your patient population?

Tanya Stuart (31:55):
I think what I’m gonna see is probably another increase in numbers of families that need treatment. Mm-hmm. . I’m seeing, I’ve been in the field for a little over 20 years and I can tell you I haven’t seen anything like it. and not only do I see an exacerbation of symptoms, but I see a deficit of providers. we are in a major crisis with trying to get these individuals help. Everybody is not taking new clients waiting list two months out. you know, to find an, a good adolescent counselor, one that includes family, it’s very difficult. And so our agency is just busting out. We’re trying to do the best that we can with servicing these adolescents, but the, we have a lack of providers that are able to see these clients. So the longer they’re, they’re not being seen, the worse the symptoms are getting.

Yeah, I, I totally agree. I think we’re gonna be just seeing more and more of this. I, I know like last year, suicide surpassed homicide as a second leading cause of death amongst adolescents. and that age of 15 to 24. And then the first is accidents. And that’s largely made up of substance use, induced accidents, alcohol or drugs. And so the first two leading causes of death related to mental health issues, it’s a big issue, you know, for these kids. And I don’t see it going backwards. I, I do see the hybrid staying this telehealth option Yeah. Staying in place. I don’t think that’s, I don’t think that’s going back in the box. You know, I think that’s out and we know the benefits of it, of course we’re gonna have to refine it and get better, but I think that’ll stay. But I hope to see more people getting help because I know that there’s suffering. We know that cuz there, there are so much increase in suicide and overdose. So we just need to make sure that they’re getting access to the right care.

Conrad Meyer (33:44):
Right. So let’s talk about access, because I mean that that’s a very good point. I would’ve thought, and I mean, and, and Rory and I are looking at each other, we would’ve thought that, that that telemedicine would’ve increased access at least double or triple, just to your point, Brandi earlier. And so I guess the, even with that increase right, in the efficiency and the numerosity of patients, you’re able to see are you both still bursting at the seams and you, and, and and you’re telling me that, so there’s still not enough access for parents and children?

Brandy Klingman (34:16):
Absolutely. Yeah. Oh yeah, absolutely. How was trying to get a girl in the other day, and I, she’s not bad enough for Tanya, but just needs a counselor and it’s a waiting list of over a month.

Conrad Meyer (34:27):
Oh wow. Gee, wow.

Brandy Klingman (34:28):
And that’s with me asking, like that’s like, you know, if I’m trying that and I’m on a wait list for a month, a regular family is gonna be on a wait list for several months. Yeah. I mean, I can’t pull any more favors in the community. It’s and if I can’t take ’em, I’ll, they’ll say, Can you recommend someone? And I’ll tell ’em honestly everybody I recommend, they’re six to two months. I mean six weeks to, to four weeks out, I mean eight weeks out. So I would just start calling from your insurance list and get the first available. That’s not very comforting for me. No, because I don’t, I, That’s

Conrad Meyer (35:02):
Scary. I can’t even imagine what a, a family would feel if they were, they were told that. I mean, so wait, let me ask this to clarify. when you say there’s lack of providers, let me, I wanna make sure that our listeners understand. So, so can you clarify, is it a lack of inpatient beds on an inpatient system? Is it a lack of outpatient spots? Is it a lack of just we don’t have enough counselors, providers, mental health professionals to even adequately serve the needs of the population? Right now?

Tanya Stuart (35:28):
It’s all of the above.

Conrad Meyer (35:30):
All the above. Wow.

Tanya Stuart (35:31):
Okay. And with adolescent treatment, you know, we, the maples is my residential, it’s a psychiatric residential treatment facility that I paired with a hospital, Beacon Behavioral Health mm-hmm. to do. We are the first P RTF in the state of Louisiana treating this population. For what? For girls? Only for girls. Like that’s gonna be, the issue with that is you can’t get girls in anywhere in the country. If you wanna send your girl to just a, a female only residential place for adolescents. This is it in Louisiana, you know? And so the, as soon as she and she just opened up, you know, so soon as you’re full, is it, there’s, that’s it for beds. Yeah. So, you know, and outpatient is the same. Like, I couldn’t get in with someone for outpatient therapy. I’m actually hiring another person to just out therapy at Legacy.

Conrad Meyer (36:18):
So a follow up question to that, let me ask you this. So we’re, we’re at, we’re bursting at the seams, it sounds like, and, and from hearing from both of you. but, but has, I mean, overall though, would you both agree that telemedicine has increased the number of access you do have? For sure. Yeah. Okay. So that’s, that’s a definite,

Tanya Stuart (36:36):

Conrad Meyer (36:37):
Yeah. Yeah. And so you would agree then that that telemedicine and the way they cut the regulations here across the board, cuz it came from the governor’s order and from the federal mandate at OCR for HIPAA and, and and things like that. So, and we’re not gonna get into that now, but, but I guess you would agree that that, that the cutting of those regulations and the ease of use of, of using a Skype or FaceTime has, has really made a difference in your, in both your practices.

Tanya Stuart (37:02):
Yeah. Yeah. I mean time is time. So whether they’re seeing in person or via telehealth, it’s still the same time that’s taken up these providers and we just, they just don’t have enough. And they are also trying to balance their own home life with this covid and their kids. And so Right. It’s, it’s a struggle. It is.

Rory Bellina (37:24):
Yeah. So you mentioned it, we talked, we went back to talk about telemedicine. And I just had a question for you because I know that, that Tonya, you said you weren’t a fan of it in the beginning and, and Brandi, you kind of were, So have you enjoyed the relaxed regulations? I mean, do you hope that they stay, Do you hope that there’s some refinement or some changes or are there some things that you haven’t enjoyed with it? How it’s so kind of loose and relaxed right now where you can use these you know, different, different types of software? Kind of tell me about where you’d like to see things go from a regulatory standpoint on telemedicine or teletherapy.

Tanya Stuart (38:01):
Yeah, I think that I, I like the flexibility. I mean, again, most of my programs that I do are in person because I’m residential, so, so I, I actually live with the girls. But one of the things that I, I hope that insurance does is continue to support telehealth with reimbursement. because it, they haven’t made it easy. Yeah. And they’re making it very complex and with, you know, addendums and codes. They, they need to streamline this for providers because many of them have even gotten off of insurance companies panels because they can. And the demand is so great that now they can private charge clients they don’t want to, but the insurance companies definitely don’t make it easy for them to er reimbursement. Right now we’re seeing the same thing, the reimbursement thing. I’m hoping that they continue to make it easier as time goes on and remove some of the barriers, like the need for authorization beforehand.

I know that they relaxed some of that in the beginning and now they’re putting some regulations back in. I’d like to see national reciprocity across states. I I think it’s silly that we’re licensed in this state and if my patient goes to Texas or is evacuated, I can’t see them in Texas if I don’t necessarily go through all the hoops. if I live on the border between here in Mississippi that I should be able to see my patients, that kind of thing. I, you know, some of those small little things, I think we can fine tune as time goes by, but I do think they need to be, you know, looked at.

Conrad Meyer (39:35):
So let me ask you that, to that point Brandy, on, on the, on the telemedicine, the licensure. So like for example, I know with physicians, right, we have, we have the state board of medical examiners with, with social work, you have your own board of social work and I’m sure that’s with each state. Is that correct?

Brandy Klingman (39:50):

Conrad Meyer (39:50):
Yeah. Yeah. And so, and so, like for example, in Louisiana, you know, when we’re talking about origination site, distance site for physicians for example, who want to come into the state, they have, you know, who are, who are licensed, for example in Texas or or Mississippi to your example, and they wanna do telemedicine services in Louisiana. They have to get that special purpose telemedicine license. So are you finding that the social work boards from various states haven’t caught up to allow this telemedicine reciprocity? is that what you’re seeing like in Mississippi and other, Is that what you’re looking at in, in, in terms of your board?

Brandy Klingman (40:26):
I, I have both. I have physicians and social workers and counselors cuz it’s an outpatient clinic, so I’m used to having to navigate it for all different licenses mm-hmm. . And it is, it is difficult for social workers. It’s not as difficult for social workers as it is for counselors. And it’s even less difficult for physicians. But, you know, there’s different states that, you know, have their own boards. And so then we’re having for each little nuanced license to call that board and get approval or get the paperwork done and submitted to that board. If my patient has been moved for whatever reason across the country or is on vacation or got stuck on a covid, you know, quarantine in California, then I’m having to like work with these state boards for these different tiny little license things. And, and I don’t know that that’s necessarily the best idea, especially if we’re opening up telehealth nationally. I think that maybe we should start to have national boards that we answer to, not necessarily just the state

Conrad Meyer (41:19):
Boards. And of course, the counter argument to that is a lot of boards, you know, they wanna protect their own backyards and of course. And so we have a lot of political swings going on within the boards within that state who don’t want to open it up to this reciprocity or the, or like the, the, the special purpose telemedicine license at the physician level. So, but but so you’re finding barriers to access really from the, from the regulatory standpoint at the boards of different states?

Brandy Klingman (41:45):
Yeah. I find it slows my staff down, so it just slows us down. And I don’t necessarily think it should be no holds bars kind of thing. But I think that there’s gotta be a middle ground. And of course we wanna protect our state and we wanna protect our providers and our patients in this state, but we have to acknowledge that the world is different now. You know, so we’re, we’re a nation that’s all over now. Our patients are everywhere, so we have to be able to access them with some ease and it’s just gonna, I know it’s gonna take time and I’m trying to encourage my staff and my physicians, my therapists to take their time, but it will take time right now to kind of just navigate through unknown waters.

Rory Bellina (42:24):
Yeah. I mean, Brandi, that, that’s a great point. And, and has gone, Conrad brought out the licensing issue is we hear that from our physician providers as well as, you know, every, everyone that that’s licensed had a licensing boards can, it can cause delays. So that’s really good information to hear. So, you know, kind of on a closing thought from both of you, if you could, you know, continue going forward in time, what’s something that you’d love to see stick around or what’s something that you still would like to see changed? So where you as providers can continue to give the most access, the most valued access to your different patients, you know, going forward from this time?

Tanya Stuart (43:06):
for me, I think that again, working with the insurance companies for reimbursement for the telehealth, but I would like to see more providers taking advantage of the telehealth. Also, there are some that just do not feel comfortable either way. They feel like they don’t wanna be in person anymore because of the, the fear of C and then you have ’em on the other side who likes the, the telehealth and, and doesn’t wanna be in person anymore. So I think to having our providers be a little bit more flexible with and meet the needs of our clients so that we can have some services for ’em. Because once they reach out for help, you have to strike while the iron’s hot. So you gotta be able to swoop in there and just kind of manage the crisis. And I think that’s what we’re getting at to the point of we’re not even able to manage the crisis and it just gets bigger. So I’d like for more expansion and more flexibility with the providers, the insurance companies. And overall I do, I am adapting to the telehealth .

Conrad Meyer (44:12):

Rory Bellina (44:12):
Good. That’s good

Tanya Stuart (44:14):
Unwillingly, but I’m doing it. Brandy, I mean, mine’s similar to Tanya is, I would like to see that insurance continue to reimburse. And even I’d like to see a little bit more training for us as providers out there around telehealth. I think that so many young providers, I remember in March I was on bedrest, you know, and stressed out myself and they’re all calling and asking, What about hipaa? What if we accidentally violate hipaa? Everyone was so scared of that. Mm-hmm. , I’d love to see more training around that, around telehealth and encouraging people to, you know, take the opportunity to use it if they can. I, I am in no way a techie person, you know, but I just know that people need help and we’ve gotta step up and be able to provide help, right? So I’m willing to just kind of roll with this tech and, and move forward as long as we’re helping more patients. I’d love to see legislation support social workers and therapists as a parody kind of problem. You know, this is killing more Americans and other issues in our country at times. And so I just think the mental health parity is really important. I’d love to see energy and money and attention go to that federally

Conrad Meyer (45:21):
For sure. Good answers. Good answers. And, and, and, and listen, I I, I think all of this has been very helpful. I wanted to ask one final question and, and I wanted to just kind of have you both for, for our listeners here, especially parents, because of the access issue, right? Because of the barriers that we’re seeing now. What resources would you both recommend to parents who might have to wait a month, two months, three months to see someone for their children? What, what would you recommend to those people those parents and, and, and, and even the kids? What resources are available to help in any way that they could maybe point to?

Tanya Stuart (46:03):
I’ve, I’ve been advising them to reach out to the school counselor and maybe doing a check-in in person, but I’ve also empowered the parents to get some literature from, you know, they can go to the bookstore and work on cognitive behavioral therapy, mindfulness, relaxation techniques, coping skills things like that that they can at least get the kids to start working through. And then maybe processing it with the kids. You know, I think parents are the kids’ best therapists. They just don’t know it yet. They feel like you have to have a degree, but I feel like parents, if they can just engage and connect with their adolescents, it can soften some things up for them until they’re waiting to see an outpatient therapist. And I would also encourage parents not to wait. When I tell parents, here are this, here are the referrals, please call to schedule.

It’s two, three weeks before they schedule. So they need to, to, to jump on it immediately. get some services through school, with the school counselor and gaining some literature for them to work at home with their adolescent. Yeah, mine. I, I agree. I think they can go online. There’s so many great books now. You can download it to your Kindle. You could listen to some podcasts about parenting. I think the very first thing that you can do as a parent is start having meals with your kid at home because, or giving conversations during carpool rides, giving carpool rides. That just starts conversations. And that can lead to healthier relationship and more understanding of what the kid is going through. And that’s what I think is the parent’s biggest fear, is they don’t understand and they don’t know what to do. So if they could just start having some conversations, open list opening and listening, not to the kids, just asking questions and hearing their feedback, not giving your critical feedback. As a parent as we want to do, I normally want to tell my kids what I know, but really just listening is the most important part. Yeah.

Conrad Meyer (47:54):
Excellent. Excellent. Excellent. I think I want to tell first off, this has been, I mean, Rory, extremely helpful, I think for, for not only me personally as a parent, right? But I think this has been a, I mean, what a timely topic is.

Rory Bellina (48:08):
Yeah. This has been really good. Very good information. Brandy and Tanya, thank y’all so

Conrad Meyer (48:13):
Much. Yes. I wanna personally thank Brandy and and Tonya for coming on the show today. Covid Mental Health and Children I couldn’t have asked for a better a better panel of speakers. I mean, you know, in the trenches dealing with this every day. And so we wanna thank you for coming on the show today. And we’re gonna come up, I think we have our next part. Part two is gonna be coming up soon. we’re gonna be focused on Covid Mental Health and the family unit. Yes. So we’ll be, we’ll be pushing that soon. But we wanna thank both of you for coming on today and we really appreciate all of your time and effort. Thank you all. Thank

Brandy Klingman (48:46):
You. No problem. Thanks for having us. Thank you.

Rory Bellina (48:51):
Thank you for listening to Health Law Talk presented by Chehardy Sherman Williams. For more information or to contact us, please visit our website, LinkedIn in the description below. Also, please be sure to subscribe to our podcast and follow us on Facebook, Twitter, LinkedIn, in YouTube – links in the description below. Thank you for listening.

The Covid pandemic has changed the behavior and social interactions for millions of people. Various mandates, including mask mandates and social distance mandates, along with online classes or business closures have affected millions of people across the world. One of the most affected groups of individuals are adolescents and young children. Adolescents and young children are now required to wear masks at school as well as socially distant from their peers. Some schools have required vaccine mandates for adolescents. These mandates and the current state of Covid has put a tremendous mental burden on adolescents and young children. Please join us on our show where we have a panel discussion with two mental health experts: Tanya Stuart, owner of Genesis behavioral health services and intensive outpatient program in Baton Rouge, Louisiana, and Brandy Klingman, owner of Legacy Behavioral Health, and outpatient psychiatric clinic with counseling and medication management services for adults and adolescents in Baton Rouge, Louisiana.  Mrs. Stuart and Mrs. Klingman sit down with us to discuss the mental effects of the Covid mask mandates along with the social distancing requirements place on young children and adolescents.  We discuss and provide details regarding what to look for in young children and adolescents to help parents and families address these mental health issues before they become a crisis. In addition, both Mrs. Stuart and Mrs. Klingman provide detailed information on resources and support to help families and parents support their young children and adolescents during this pandemic and help cope with the various mandates, social distancing, online class, and other factors that are ever-changing during this pandemic. This podcast is a must listen for all who have young children and adolescents and are dealing with this.  We hope you join us on part 1 of this part 3 series.

Health Law Talk, presented by Chehardy Sherman Williams, one of the largest full service law firms in the Greater New Orleans area, is a regular podcast focusing on the expansive area of healthcare law. Attorneys Rory Bellina, Conrad Meyer and George Mueller will address various legal issues and current events surrounding healthcare topics. The attorneys are here to answer your legal questions, create a discussion on various healthcare topics, as well as bring in subject matter experts and guests to join the conversation.

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