Interview with an Expert: Helen Egger
The latest installment of our “Interview with an Expert” series features Dr. Helen Egger, CEO/Founder of Little Otter, an innovative virtual “one-stop shop” for families needing mental health care for their children. Learn about her 30-year journey in the field and what sparks her passion for improving the lives of families nationwide.
Little Otter is a pediatric mental health company that provides virtual mental health care to children ages 0-14 and their families. Just like a pediatrician who cares for a child’s physical health, Little Otter cares for all aspects of a child’s mental health, along with their family’s mental health and wellbeing. Little Otter provides personalized, virtual care and an integrated care team to support healthy emotional development and treat emerging emotional and behavioral challenges. We provide integrated care with top-notch parenting specialists, early childhood trained therapists, couples therapists, and pediatric psychiatrists.
How did you get into your field? What sparks your passion for your work?
I have been in the field of child mental health for more than 30 years as a child psychiatrist, early childhood mental health expert, digital health expert, and prolific scientist. Despite real advances in the science and practice of pediatric mental health over decades, few families can find quality care that works. The first issue is that it is very difficult to find a child mental health provider with availability. The average wait to see a child mental health provider is 8-16 weeks. Finding a child psychiatrist is even harder. 70% of the counties in the US do not have one child psychiatrist!! We founded Little Otter as a digital-first child and family mental health company because we know that we need to use technology and data science and telemedicine to find new solutions to reach kids and families.
The other huge problem is that very few children who do get care, get evidence-based care. Unfortunately, it is very difficult for families to evaluate whether their child’s provider has the necessary expertise or to evaluate how the treatment is going. At Little Otter, we are trying to change this. We are building from the ground up what good care should look like. We start with a belief in science and a commitment to ensuring that each child will be offered the best care for the challenges they are facing. Children and families deserve to get care that works. The key to this is measurement, just like in other branches of medicine. We have to be able to define the challenges, describe the treatment, and have a shared way to know if the treatment is working! Imagine if you went to a pediatrician who didn’t weigh your child or who didn’t take a throat swab for a potential strep infection or who didn’t do an x-ray if your child’s bone was broken. You would probably not have confidence! In mental health, we have tools-questionnaires and observational assessments-that are like the tools a pediatrician would use to identify physical issues for your child. At Little Otter, we use measures to identify your child and your family’s mental health challenges and then track these measures during treatment to make sure we are on the right track.
Little Otter is built on my experience as a doctor and scientist. It is also built on my experience as a mom. I have four children (including identical twins!). My son Sasha has a rare autoimmune brain disorder called Autoimmune Encephalitis. He first became sick at age 13 and has battled this illness with multiple hospitalizations and extensive treatments for over a decade. Our family’s experiences with a medically-ill child within the medical system of care led to our vision for Little Otter. I co-founded Little Otter with my daughter Rebecca Egger who leads Little Otter as our CEO. We don’t want other families to go through so many of the challenges that we went through. One of the big challenges that I and my husband faced was being dismissed or marginalized by doctors. That is why we say at Little Otter that parents are the experts of their children. Our Little Otter providers bring their expertise in child and family mental health together with the parents’ expertise and with the child’s “expertise” about themselves to create a respectful partnership focused on enabling children and parents to thrive.
Another key insight from our personal experiences was the importance of team-based care. It wasn’t until the doctors and our family came together to create “Team Sasha” that Sasha got the quality of integrated care he needed. Team Sasha met regularly to plan his care together. From this experience, I know that the best care is integrated, team-based care with parents (and children) as equal members of the team. Also, I believe that the care team should be the quarterback calling the plays so that parents do not have to be responsible for communication between multiple providers. We want parents to focus on the loving daily care their child needs. Lastly, only with measurement-based care can all the team members have a shared language and goals. Everyone has to know what the treatment goals are and how to tell if we have met these goals.
What are some pressing issues or trends you see facing children in terms of mental health right now?
Even before the pandemic, we were in a child mental health crisis. 20% of kids, including kids 2-6, have an impairing mental health disorder. 80% of these kids don’t get the mental health care they need. A sobering fact is that suicide is the second leading cause of death for kids 15-18 AND kids 10-14. We have seen ED mental health visits for kids increase by more than 30%. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the National Children’s Hospital Association recently declared child mental health a national public health emergency.
Last year, at Little Otter, we did a study of kids 2-12 years old and found that 80% of the children were at an increased risk for anxiety and depression. Almost 60% of these kids were at risk of developing problems in their social skills. I included the parents in this study since their mental health has a big impact on a child's mental health. We found that half of the parents screened positive for an anxiety disorder and a quarter for depression. We also found, not surprisingly, that families are experiencing high levels of stress which increases the risk for physical and mental health challenges for all members of the family. The pandemic and the other social stresses are making the mental health of families much worse.
The pandemic can impact children’s brain development and mental health in multiple ways. We are learning that infection with COVID, even mild infections, may have neurological and psychiatric sequelae. We also know that 1.5 million children worldwide have lost caregivers to COVID, a trauma that will impact the child’s development and future. However, there is increasing concern that the ongoing stress, uncertainty, and disruption of the pandemic may be impacting the way that we interact with each other and with our children and that these differences may be impacting children’s brain development. In addition, the stress of the pandemic during pregnancy may have impacted children’s prenatal development. This is why it is so critical that we invest in support for children and parents to help them during the pandemic and beyond.
How does working in the digital space enhance your service to families?
We have to leverage technology and data science and particularly telepsychiatry and telemental health approaches if we are going to even get a dent into this. Anyone who has ever hauled their children across town to spend more time in a waiting room than with their pediatrician will tell you what an ordeal that can be. And that’s assuming you can get an appointment and the time away from work or other responsibilities to get to it. For many in this situation, the ability to access telehealth services is an attractive solution because it allows parents to speak with their child’s doctor from the comfort of the couch. Telehealth solutions for children’s mental health give families timely access to the critical support they need. In taking the in-office component out of the equation, parents can now connect with expert child mental health care professionals without lengthy wait times or an exhausting referral process. Telehealth means your family can have a call with a therapist from your sofa in San Luis Obispo, and then sit down for family dinner. Importantly, being at home translates to providers seeing families in their natural home dynamic and having a child be comfortable in their own environment. These cannot be replicated in an office visit.
Can you discuss the role parents and teachers can/should play in a child's mental health treatment?
Even though I have had so many privileges as a doctor and faculty at major medical centers, I also have searing personal experiences where the medical experts dismissed my insights and treated me as “uncooperative” when I had questions and when I challenged the doctors’ plans. Our current system of care does not put families at the center. From this experience, I have the view that Parents are the experts about their children. They know their children best. It is absolutely critical that parents and others engaged in a child’s life - like teachers, daycare providers, even grandparents, and nannies - be fully committed to supporting children’s mental health and facilitating treatment. When we do therapy with a child, we regularly engage with parents. A key part of therapy is learning skills to manage emotions and behaviors. Kids and families need to practice these skills at home. It is really a team effort!
But the other important thing for parents to realize is that their mental health and the health of their relationship with their partner have a huge impact on a child’s mental health. That is why at Little Otter we do a Family Mental Health Check-up, not just a child mental health check-up. We know that one of the most effective ways to help a child’s mental health is to provide support for parents. Parenting is hard. Parenting during a pandemic is even harder and more stressful. At Little Otter, we want to be there for kids by also being there for their parents/caregivers. A lot of parents worry that they will be judged or shamed if they seek mental health care for their child. Parents worry that they are the cause of their child’s challenges. At Little Otter, we want parents to know that they will be welcomed, supported, valued, and accepted without judgment. If the parent needs help for themselves, we will make sure they get the help they need. For example, we provide couple’s counseling for parents at Little Otter because we know that a healthy, supportive adult partner relationship will help a child’s mental health.
Teachers are really on the front line of the child mental health crisis. I strongly believe that Little Otter needs to partner with teachers to support them in supporting the mental health of their students. In my ideal world, we would implement universal mental health screening in school so that we can identify and provide care to all children with clinically-significant emotional, behavioral, and development challenges. Our kids deserve their suffering and distress to be recognized and addressed. And our teachers need the tools and resources to help kids.
I want to end with a note about when you should worry and seek a mental health check-up for your child:
Mental health challenges are dysregulations of emotions, behaviors, and thinking. Managing our feelings and behaviors is a key part of a child’s development. When we see a change in our kid's regulation of emotions or behavior, we should pay attention.
Have you seen a change in emotions or behaviors, eating, sleep, stomach aches, headaches, themes of sadness, worry, danger, or death in their play or conversations.
Are you noticing themes of sadness, death, or danger repeatedly in your child’s play? Is your child repeatedly saying negative things about themselves (“I am a bad person,” “I am stupid,” “I am ugly,” “I hate myself.”) or expressing excessive guilt and worry. Is your child talking about wishing to be dead or “not here” or talking about suicide. Take what your child tells you or what you hear seriously.
Listen to your child. Be non-judgemental and open. You want your child to know you care, take their feelings seriously, and will help them if they are suffering.
Have you noticed a change in your child’s functioning at school, at home, or in relationships? Also, are you noticing that your child’s challenges are adversely impacting your family?
This is very important. If your child’s challenges are impacting their functioning or your family’s functioning, get help because you want to intervene as early as possible so that your child can get back on track and thrive.
At Little Otter, we are here to help with big and little worries-worries about your child, your family, and yourself. We are very grateful for the opportunity to help as many children and families as possible!