(soft music) - Welcome back to Family Health Matters.

I'm Shelly Irwin.

With me today, Dr. Krissa Kirby, licensed psychologist, Pine Rest Christian Mental Health Services.

Vicki Kavanaugh, prevention Manager at Arbor Circle.

And Sandy Stasko, program coordinator for Ottawa County Community Mental Health.

Power women in studio and necessary experts for this topic.

Childhood anxiety and depression, how are you involved, Sandy?

- I am the program coordinator at Community Mental Health Ottawa County.

And I am in the family services department, which is mostly the kids stuff.

But since kids don't raise themselves, we do include the families.

So I work with a lot of different providers in the area to make sure that the kids that seek services through Ottawa County get the help they need.

- Vicki, tell us about you and your work.

- I work mostly in the prevention side, so really working on increasing those protective and risk factors, doing a lot of mental health trainings in the community.

And then we also offer a lot of prevention services to kiddos from third grade all the way through young adulthood.

- Are you busy?

- Yes, very busy.

We'd love to be more busy too.

- Dr. Kirby, your day job is?

- I am a therapist at the Christian Counseling Center at Pine Rest on Leonard Street in Grand Rapids.

- And are you busy?

- Yes.

Very busy.

- Yes, which leads me to bring in this topic of childhood anxiety and depression.

Give us some definitions, one versus the other, one causes the other.

Tell me more.

- They are two separate diagnoses, so, but children can have both as well.

Anxiety, some of the characteristics of anxiety are nervousness, chronic worry, difficulty relaxing, and it can also cause sleep troubles or appetite disruptions.

So that's anxiety.

And it can go with depression too, or it can just be a diagnosis that's separate.

- How early can we see these in children?

- Quite early actually.

So even in kids under the age of six, but most of the children I see we're looking at, you know, six and above or most of the kids that I see.

But it's probably the primary diagnosis that I'm treating now in my work with kids.

- What about your world?

What do you see the difference between the two?

- Sometimes not a lot.

They overlap a lot.

There's the, like as mentioned, the sleep disturbances, the appetite disturbances, but there's also that irritability that can go into both of them.

Anxiety leans toward a little bit more of a worry and avoidance, especially in kids, where the depression is more of a, I don't feel like doing it anymore and kind of that loss of want to do things that usually they would find some joy in.

So we see a lot of that in the kiddos.

- Vicki obviously will spend time in prevention, but do you work with both those who are anxious and depressed?

- I would say yes.

I mean statistics are showing us that this is just growing in all areas of childhood and adolescence.

And so it's something that we work to make sure our staff are aware of it and then work so that our programs are structured because when they're structures, there's safety and when kids feel safe, then some of these, some of these symptoms can really decrease.

- Dr. Kirby, when is it time to ask for help versus a child just having a bad week?

- I think a time to ask for help is when they're starting to, when the parents are starting to see things like with depression, social withdrawal or isolation, anxiety, you know, they can also isolate themselves, but sometimes we're looking to at things like their grades and their academic performance, things like that.

Certainly there are patterns of eating and sleeping and whatnot.

Also social relationships and how they're doing there with their peers and things like that.

- Is there a DNA component?

If mom and dad have had some issues, could there be some link?

- Yes, there are.

There are components that predispose kids to depression and anxiety.

So if it runs in your family, you may get some good looks from your family, but you may get some anxiety and signs of depression from your family too, depending on what your family history is.

Yeah, it does run in families as well.

- Sandy, when is it time to come see you?

- We help primarily Medicaid consumers in the community and our job is to kind of help the worst of the worst.

So we get a lot of referrals from schools, we get a lot of referrals from primary care physicians, from other therapists in the area.

So it's always best to try and see if you qualify for services with us, we can always help refer out if that's not the case.

But it is definitely, you wanna be as preventative as possible.

If it's not us, then go see someone else.

Go to another therapist that can help 'cause it's always great to have someone that's gonna be non-judgmental and just listen to you.

- Is early intervention key?

- I believe so.

I think the earlier the better.

If you notice that your kid's starting to withdraw, you notice changes in their behavior, changes in patterns of things that they do, be aware and it's never a bad idea to say, Hey, is everything okay?

And having those conversations parent to child too, is really, really important.

It's something that a lot of parents try to avoid, but it definitely should not be.

- How early do you start talking to the kids with your work, Vicki?

- We have a program that works with third to fifth grade male identifying students that we really focus on talking and creating those connections.

And part of that is having honest conversations about how we're doing today.

And Shelly, we actually do a lot of it when we're running.

So that's a great thing.

I think that anytime as a parent, you can open up those means of communication and just say, you know, I noticed that you're really worried about this test, let's talk about that.

Or when I was your age, I also worried about those tests.

So just really bringing it down to their level, letting them know that you notice what's going on and that also, it's okay to be worried about things.

It's okay to not always be happy.

It's like Krissa and Sandy said, when these things start taking over and changing your quality of life, that's when we really need to kick in.

But as parents, if we can see those things starting to happen, I think that early intervention.

Because kids can learn things so quickly, we can teach coping skills, we can do different strategies to really get it before it gets worse.

- Before I go into obviously more treatment, can one be just test anxious and that's it.

Or if I'm diagnosed with test anxiety, then, you know, then I have a label.

- It can be both.

You can have both.

You can have one or the other or both.

So yeah, I think with all of the kinds of different anxiety disorders, it's key to help the kids get a tool belt developed in terms of coping skills, things like relaxation skills or mindfulness meditation, different skills that they can use.

And in my work I try to work with the parents as well on a systemic approach to try to get the parents to be an at-home coach, to kind of cue the kiddo.

Hey, maybe you could go do some relaxation skills or do some mindfulness meditation.

And those things can help kind of bring it down evidence-based treatments.

- Because putting our physiological hats on being anxious means tightening up, constricting, increased blood pressure, increased heart rate.

Probably not good for us.

- Yeah, no.

- So a parent seeks out help and shows up for an evaluation.

What happens after this?

- Well, I like to, in my work, talk with the parents and involve them because I do more of a systemic approach and so they're involved in the work as well.

So we do the evaluation and try to work on rapport and gaining trust and see if it's a good fit with the therapist as well.

Not only just the child, but the parents too.

And so from that point, if everything's going well that way with rapport, then we go ahead and move into individual treatment and maybe integrate some family treatment as well.

- Are the parents always involved in the room of treatment?

- Not always every time.

So there's a lot of parent consultation.

Maybe the child would be in the room.

Sometimes you would have separate parent consultation where the child doesn't even come to the appointment, but most of the interface is with the child in the room in the therapy session.

- And your sessions on prevention can be one-on-one with the little kiddo.

- Right.

A lot of times it's more of a team or a classroom, but again, teaching different skills, different coping skills and even we just had fun.

That is a way to cope with when you're feeling sad or when you're feeling anxious.

So really pointing out you do have control and you can find things that will help alleviate some of these feelings.

- Would be a first time visit to your clinic?

- There's, you know, kind of the introduction, getting to know you.

Their first visit's gonna be with our access center who does a lot of the history and gets kind of what's really going on and gets to the meat of what services they need and what they want to get out of therapy and work with us.

Then it's a determination of to what type of services they would best benefit from.

And we do a lot of rapport building at the beginning, both with the parents and the kids and it's just kind of getting to know you.

And it can feel a little benign sometimes, but it's really important.

You don't wanna tell deep dark secrets to a complete stranger.

You want them to feel comfortable in the room.

So we do a lot of, sometimes they're silly activities, depending on the age and just kind of make them feel comfortable whether they go and are seen in their home or in our offices or at our community providers.

- Dr. Kirby, are medications indicated at this point?

- I'm a psychologist so I try to do my best to do my magic and if I am not able to get the child's where they need to be, then I would definitely ask for help from psychiatry.

And we have that continuum of care at Pine Rest.

So I like to try to use evidence-based strategies and if after a while we're not seeing much of a treatment effect or we need to call the heavy hitting prescribers in, then we will do so.

- Do you include siblings with any talk therapy?

- Not particularly.

It's mainly most of the thrust of my work is with the identified child and then the parents.

Very rare do the siblings come along for the sessions or the family sessions.

- And then when do we know that we are able to say goodbye to Sandy and their team and move on to life?

- It kind of varies.

We have like a rating system.

So there is some clinical type of thing saying you no longer qualify for our level of services, let's set you up with someone in the community.

But a lot of times it's the family.

They're like, you know what, this is so much more tolerable and it may not be to where we want them to be or where we would love to see, you know, this happy, shiny, you know, family, but they're doing well and they're doing good and they're okay.

So with the skills that they have, they can go forward and use them in other situations too is kind of how we try to make sure that they know it.

It's not just for when you are nervous about a test.

This can be, you know, when you start driving and you're a little bit nervous, this is how you do some breathing activities, this is how you can kind of center yourself and focus.

So we try and help them throughout going forward, knowing that they may come back if something happens and we always tell them it's a revolving door, it doesn't lock behind you.

You can come back, you can get help from anyone anywhere.

So we just try to make it a good experience so that they want to do therapy later on if they feel they need to.

- How are we doing with the stigma of my child needs help.

I'm an eight year old and I think I need help.

Start me here.

- I think the younger kids are not as mindful of the stigma.

I think there still is a stigma and so a lot of times it's more so the parents.

But some of the teenagers that I work with definitely, you know, they feel that stigma that I have to come and talk with someone.

I have to come and talk with a psychologist or a social worker and kind of lay on the table the problems that I'm dealing with, and so am I crazy for doing that, you know?

So we try to work with the stigma too in the beginning to kind of normalize that, that it's okay to not be okay.

It's okay to come in and talk and work through your problems.

- And is it easier in a group that's exercising to kind of talk about your issues?

- I think that for the most part, our younger generation is much more open to this.

They are very well-versed.

They almost self-diagnose at will.

So what we might call anxiety, generalized anxiety disorder is not what they actually have.

And I think that continuing to have those conversations helps decrease the stigma.

What I find it's more in the older generations, parents or grandparents that have kind of, well we don't wanna talk to anyone, we can handle this within the family.

So I think continuing to have those discussions, whether it's one-on-one or in a group situation with the littles and the adolescents, and then have them bring that home, that ease of talking about it, that really helps in all areas.

And again, we wanna make talking about this a good thing.

It's a comfortable thing.

It's nothing to be ashamed of.

And I think that is where the younger generations are really leading us.

- I guess I'll let have you add to that Sandy, my next thought.

- I really think that the family is kind of the core to it and understanding and trying to change generationally some of those that stigma and it's really hard.

And it depends on culture, it depends on your family status.

We got this and changing that mindset can be really, really hard.

Vicki does a lot of with movement and I love it because I've always said, you move the body, you move the mind.

So getting people and families to go for family walks where they can talk about things or something is just so useful.

And kind of modeling that and getting them out of an office setting and taking walks and doing some talks and stuff like that can be really, really helpful.

And just making it normal.

- What else Dr. Kirby do parents need to know?

- I think they need to know maybe some of the signs and symptoms of anxiety and depression, know what to look out for.

And so we did cover a little bit about anxiety, but I just wanna share some about depression as well.

- Please.

Yep.

- So sadness, loss of interest in things that the child might've enjoyed before, self-isolation, changes in appetite and sleep, irritability.

Also, if it's really a higher level of depression there can be some other kinds of things that are more concerning, such as self-mutilation, skin cutting, or even signs of suicidal ideation, intention or a plan.

So we wanna look out for those kinds of things as well and just be vigilant, and be checking in with our children too.

But really knowing what to look for too.

- Sandy, let's talk a little bit about the depression child that may be treated at your clinic.

- We see a lot of different pieces of depression.

Not only is it, can it be straight depression, but also understanding the history being that we see a lot of the more severely disturbed kids, it can be a lot of toxic stress where it's continual stress or traumas.

And whether it's post-traumatic stress disorder or not, traumas impact and can change the mind and how it relates to things.

So where something that can come across as depression can have a history and a basis for where it's coming from.

So sometimes kind of figuring that out and working with the family and the kids to resolve some feelings around that and remove blame and doubt and just kind of work with them get to a better place where it's not nothing that happened, it's just something that happened.

- And Vicki, again, back with your lifestyle approach do you bring up education on good foods to eat, and yes, we need eight hours of sleep and other habits to get into that may help with the depressed attitude.

- I think totally.

I think really focusing with the family on those healthy coping skills, movement, eating better, sleeping better, having fun as a family and talking as a family, I think those are things that can grow out- - Like at the dinner table.

- Like at the dinner table, right, exactly.

From one of our other great programs Talk sooner, I think those are great things that can grow out of kiddos and families coming to see Dr. Kirby and Sandy and then they can share with the family.

And even the littles can can show the bigs how this is working.

But all of those things that sometimes we as adults don't pay enough attention to, taking care of ourselves.

We've gotta model that.

And sometimes it takes effort on our part to realize, no, it's important that I show that I'm gonna go take time for myself, get that eight hours of sleep, go for that walk by myself.

And then we can say, I did it, let's do it together and then next time you can do it by yourself.

So again, it's like really incorporating all of those strategies along with seeing our professionals that I think really help families to learn those different ways of coping.

And that's a way we can intergenerationally look at this issue 'cause probably mom and dad and other siblings might need some help too.

- I'm gonna turn to you Dr. Kirby.

Is it good for mom and dad to ask for help as well?

- It can be good too.

Sure.

And sometimes that comes up, especially in a more systemic approach that maybe mom and or dad have some issues too that maybe they need to address on an individual basis.

And so sometimes moms or dads or both are referred to their own therapist too.

And that is nice modeling to say, you know what?

I want to take care of my mental health care.

And that's part of healthcare too.

And so sometimes they are referred out and I'm often surprised at how willing people are to do that.

- You mentioned Talk Sooner.

Tell me more about this.

- So Talk Sooner is an initiative that we really focus on empowering parents to have those difficult conversations with their family, with their kiddos, talk early, talk often and talk sooner.

And really by making those lines of communication open, you really build on so many ways to help everyone cope.

We focus on having tough conversations around the issues of substances, but really tough conversations around anything are just being developmentally appropriate.

Learning a few things about the subject before you go in so you can be that trusted resource.

And then asking your kiddos, your adolescents what they know and letting them lead the conversation too.

A great place is dinner time.

Another great place is the car.

There's lots of opportunities to take these little teachable moments.

And we can talk about things like anxiety and depression too.

And really what does that mean?

What are their friends talking about?

What are they seeing at school?

And that can be another way to really open up that conversation.

- What's the answer to the child that asks, will I always have this anxious problem?

- Maybe, that's the honest answer.

And some anxiety is good.

We learn best with a little bit of butterfly in our stomach.

You know, you need that sometimes in order to react to things.

And there are certain things that should make us anxious.

So we will always have some anxiety in our lives, but we can also, whether it's through therapy and coping skills or sometimes medication, it can be managed.

- So let's bring up the topic of social media.

Good, bad, ugly.

I'll start with you.

'Cause you're taking a drink, I'm gonna go with you, Dr. - Social media, I think it's here and it's been here and so it's a force to be reckoned with.

And with kids it's a matter of learning how to negotiate it.

I do have a number of cases now where there's been some issues with social media and some boundary transgressions and there's been some unsafe things that have happened.

So just providing the parents to a psychoeducation about some of the dangers out there on the internet.

And then also threading that through the therapy with all of the kids that I work with too.

And just making sure that they know about safety on the internet, social media.

- Tell me more about boundary transgressions.

- That is when you're crossing over.

And you're crossing over and maybe getting into an area that now is over your head or scary and you know, just letting the kids and the parents, educating them about that.

But also working with the child to say, you know what, that did happen and now let's talk about safety and what are the appropriate boundaries when you're out there on social media so that you can remain safe.

So you can do it, but how to do it in a way that's safe and that it's meaningful to you.

- What does social media in your world play?

- You know, it's everywhere.

I mean, who doesn't see everyone on their phones.

And I think again, it goes back to really empowering those conversations.

It's gotta be a negotiations 'cause we all know just telling a kid not to do something doesn't work.

So I think that's another good place to have a conversation and have the parents tell those boundaries.

But also be that safe place so if there is something that goes wrong, they can go back to the parents and say, I messed up.

And the parents will be like, you have to, you know, not get angry.

How can we fix this?

And then yes, with every action there is an equal and opposite reaction.

So there might be a consequence, but phrase it really more as a learning experience.

And it's a learning experience for all of us because none of us grew up with this.

So we all have to kind of own up to that.

We don't know everything either about it.

So we have to learn together.

- What else is important that we discuss here, Sandy?

- I just think that there's so much importance to open communication.

And having someone somewhere a trusted adult that a kid can talk to, it can be a teacher, it can be a neighbor, it can be an aunt, it can be my friend's mom, it can be your parents, it can be whomever it needs to be.

But making sure that every kid is connected with that one person and able to reach out if they need something.

- And how are we doing in our schools?

Are educators being introduced to signs and symptoms of a child that may need help?

- I think so.

In the Grand Rapids area, I've been pretty impressed with the teachers that I've interfaced with.

And so I think so.

I think they do know what to look for and there's counseling that's available in the schools.

And I think that the school counselors too know when to refer out.

So I've been impressed with, at least in Grand Rapids, you know, the teachers know.

They know what to look for with anxiety, depression, and even some other childhood disorders as well.

And we have a lot of resources here in the greater Grand Rapids area to draw upon.

So I think that's positive.

- Such as you three, they say.

As we start winding down, obviously we're most likely controlling versus curing.

But every individual is different.

What do you leave us with Sandy, regarding the glass half full when it comes to this conversation and maybe a resource from you?

- It can be a really overwhelming thing when you look at the big picture and the impact, everything that's going on, whether it's social media, whether it's COVID, bullying, peer pressure, all those things, it can be very overwhelming.

But to realize that in every single day and in everyone's life, you can look out and find little good pieces and helping people to find those little specks of light that can kind of come in and give them the opportunity to look for good things as opposed to always trying to find the negative and changing that mindset.

Ottawa County community mental health can be found on our website for miottawa.org.

That's probably the easiest way to find it.

We've got little tabs all over on there in order to get into it.

- Ask for the therapist with the purple hair.

That's my favorite.

Thank you for you.

Vicki Kavanaugh, give us your summary.

- I just think it's so important to have these conversations and to make it okay to talk about anxiety and depression.

And also to focus on the fact that, you know what, the truth is life is hard and we're all gonna feel a little anxious and we're all gonna feel a little sad at times and that's okay.

It's when we can't control those or they kind of take over our lives that we really need to look for help.

But as parents and even as kids, if we're feeling those ways, talk to somebody.

Like Sandy said, it is so important to have someone that you can talk to, and it really doesn't matter who it is.

But just continuing to have those conversations.

We're able at Arbor Circle to offer a lot of trainings for free.

So if you just go to our website, that's a great way to also find lots of mental health resources, but those trainings too on our calendar.

- And trainings are, I come to you, you come to me.

- Oh, I will go anywhere and we will set up anything.

We do have some already set up, but people can reach out to me and I will literally go anywhere to do a training.

- Great, alright.

Set it here.

Go running with Vicki.

Tell me how we found out more information again for you, Vicki.

- Oh, sorry.

Arborcircle.org, and you can find me there.

- As easy as that.

Let me leave the last minute and a half for you, Dr. Kirby.

- Well I think it's great to have these kinds of forums and just have open forums and open discussions about these things, and putting kids, you know, to the forefront because there are so many pressures nowadays with the kids coming up post pandemic and everything too.

As both of the ladies mentioned too, all of these things.

So having open forums and talking with your family, thinking too about resiliency factors with each child.

What do you have that's on your side?

Who's on your side?

What makes you tough?

What makes you bounce back?

Who are the people that help you?

What are the talents that you have or the things that you have about your character that help void you up when times get hard?

And I think it's important to remember that just because you're having a bad day, it doesn't mean you're having a bad life.

We can work through all of this together, with your family, with your therapist, and you know, psychoeducation is great too.

So I think it's just really good to have these kinds of forums and hopefully parents are tuning in and to know what to look for.

- Yes, because it's good conversation about the child, but it's probably good conversation for the adult as well on that.

Where are you located?

- Pine Rest Christian Counseling Center on Leonard Street in Grand Rapids.

So that's where I am based.

But Pine Rest is a big mental health organization here in Grand Rapids and actually Michigan.

So we have lots of resources here in and around Grand Rapids.

- Wonderful.

Thank you ladies.

Were you anxious for this a little bit?

- Yeah.

- A little bit.

- I was, yeah.

- Thank you for your time.

- Thank you.

- Thank you.

- And thank you for watching Family Health Matters.

Take care.

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