- [Announcer] Live from your public media studios, WVIA presents Keystone Edition Health, a public affairs program that goes beyond the headlines to address issues in Northeastern and Central Pennsylvania.

This is Keystone Edition Health.

And now, moderator, Tonyehn Verkitus.

- Good evening and welcome to Keystone Edition Health.

I'm Tonyehn Verkitus.

Thank you for joining us tonight.

From an early age, children grapple with a myriad of emotions, navigating a world filled with both joys and challenges.

In today's complex world, where pressures and uncertainties are always lingering, the need for comprehensive mental healthcare for children has been needed more than ever.

Having easy and affordable healthcare is always a must for any family, but the toughest decision is where and who to turn to.

By addressing issues such as anxiety, depression, trauma, and behavioral challenges early on, we can equip children with the resilience and coping mechanisms needed to thrive throughout their lives.

But first, WVIA's Tom Ries has more.

- [Tom] Mental healthcare for children is important as it lays the foundation for their overall wellbeing and future success.

Just as physical health needs attention and care, so does mental health, especially during the formative years.

Early intervention and support can prevent long-term issues and equip kids with the tools to navigate life's challenges.

In the US, the COVID-19 pandemic caused one in five children between the ages of three and 17 to have a mental, emotional, behavioral, or developmental disorder.

That's according to the American Psychological Association.

A supportive environment helps children feel understood, valued, and empowered to express their thoughts and emotions.

By prioritizing mental health for kids, we not only ensure their present happiness and stability, but also contribute to the development of a healthier and more resilient generation.

For "Keystone Edition Health," I'm Tom Ries, WVIA News.

- Joining us tonight, we have Dr. Bernardine Suppa, licensed psychologist with Dr. John G. Kuna and Associates, Summer Krochta, vice president of programs at the Children's Service Center, and Dr. Megan Velo-Zorzi, owner and licensed psychologist with Redbird Mental Health Services and Loftus-Vergari and Associates.

Thank you all for joining us.

- Thank you.

- Thank you.

- Summer, I'm actually gonna start with you.

Most people have heard of Children's Services Center.

It has a very long history.

Can you tell us a little bit about the services that you provide there?

- Sure, at Children's Service Center, we provide services for the whole array of ages, so from birth until adulthood, actually.

We have services for adoption, autism, school-based services, our crisis program.

We have a partial hospitalization, outpatient services, medication management, so a vast variety of services available.

- Bernardine, I know you're a provider with John G. Kuna and Associates, but you do a number of different other things, too.

Can you tell us a little bit about your background?

- Well, I do private practice with Dr. Kuna, and then I also supervise five school-based behavioral health programs for the Lezard Intermediate Unit in five different school districts.

And then on Fridays, I test people with the Autism Diagnostic Observation Scale, so from ages two through adulthood to determine if they have autism or not.

- Thank you.

Megan, you've been working with children for a while.

Can you tell us a little bit about your practices and the types of services that you provide?

- Sure, I'm a clinical psychologist, and I own Redbird Mental Health, and our agency is really dedicated to trauma therapy for children in our county and in our surrounding areas.

We have an office in Wilkes-Barre, and we also have an office in Drums, and it's really focused on that work.

And then I also am the clinical director for Loftus-Vergari Associates, which is a private adoption and foster care agency as well.

- Now, just for people who might not know, can you just tell folks what the difference is between a clinical psychologist and a psychiatrist?

- Absolutely, so a psychiatrist is typically a medical doctor.

That went to medical school and did rotations and all of that.

And a psychologist is somebody that went and got a doctorate in psychology.

The big difference is that psychologists can't prescribe medication because we're not medical doctors.

- Thank you.

Bernardine, can you tell us about how these behavioral health programs are working in the five schools that you're with?

We've actually had school nurses on the program, and they're often talking about the need for behavioral healthcare in schools.

And I think this is rather unique that these five schools have this program because I know a lot of people are struggling with the students that they have.

- Actually, there's a lot.

The Children's Service Center has way more than IU for SBBH, they're called, programs.

But basically, the teams consist of at least one mobile therapist, which is a master's level therapist, and then at least one behavioral health technician, which is a bachelor level staff.

And the kids are evaluated, and then they get into the program.

A variety of diagnoses.

And the staff go with them into the classroom, so they meet them where the need is for the child.

So instead of a TSS worker, which traditionally would have been with a child that's prescribed hours every day, it's when the child needs it.

So it's a little bit better.

And plus, they do crisis, they do family therapy in the home, so it's a very comprehensive package for the children.

- And is this K through 12?

- Yes.

- Okay.

And I know you provide services, but a school on campus, how is that different from what they're doing?

- So we do have school-based programs as well in multiple different school districts, but our school on campus is called partial hospitalization.

So a psychiatrist would need to make that recommendation.

So it's a medical placement.

Those kids are referred to us for primarily mental health treatment.

So they receive individual family group therapy, as well as medication management by their psychiatrist onsite in school.

And then they receive their education.

So it's a small therapeutic setting.

Every classroom has a classroom therapist, a special ed director, or a special ed teacher, and a classroom aide.

And then we have clinical therapists that also work with the children in the school.

And that's also K through 12.

- And about how many children are in this program?

- We average between, I would say, 65 and 70.

- And are these referrals from the school, or can parents try to get their children enrolled in the program?

- Yeah, parents, outpatients, school-based providers.

If a child is really struggling with their mental health in a public school setting, then the school could make the recommendation as well.

But ultimately, the psychiatrist has to do a psychiatric evaluation to determine the need.

- And you mentioned that you're working with a lot of children who have experienced trauma.

Can you, A, describe what you mean by trauma, and then maybe share some symptoms?

- Absolutely.

So trauma in the mental health field typically refers to a really difficult or stressful event that somebody's experienced.

So these can be things like car accidents, they can be natural disasters, they can be child abuse, domestic violence, really anything that stresses us out significantly.

And when children experience trauma because of their age and where they are developmentally, often the symptoms that they experience are so much more difficult and long-lasting, unless they get services.

So when a child experiences trauma, what they have is basically effects that are global.

So you'll see issues with schoolwork.

Grades might go down.

They might see differences in friends or relationships with their parents or their peers.

More emotions sometimes come out.

So kids experience strong feelings of fear or anxiety or anger or irritability or sadness and depression.

So we see those symptoms.

We also see all kinds of thinking that can be really harmful for a child, like blaming themselves for what happened or blaming, thinking that the person is not somebody they can trust or also worrying about the future.

Those kinds of things affect them.

And then often what brings kids into our services are difficult behaviors.

So kids will act out and maybe get more aggressive or yelling at other people, argumentative, or they act in.

And so they might start to self-harm or they might medicate themselves with drugs and alcohol as they get older.

So really what we look at as trauma therapists is a global perspective on what symptoms that child's experiencing.

- Well, I would imagine that you all see children that maybe folks just thought were misbehaved.

So where do you cross that line?

When is it that someone says, "Oh, this isn't just a problem child, "but this is someone who may be screaming for help."

Do you wanna speak to that?

Or either of you actually.

- Yeah, I mean, I'm sure you could too, but I know that the way we view behaviors is it's a form of communication.

So I don't think any child intentionally wants to misbehave or be difficult to be around.

So it's really kind of trying to find out what is the why?

Why is this child communicating in this manner?

Like, where are these symptoms coming from and addressing that why?

Instead of asking what's wrong with you is what's happened to you.

- Yeah, that's a great point.

I don't really think there are problem children.

I think children are born perfectly fine.

And as a trauma therapist, what happens is they experience something that's really hard.

And that can be like a loss of a caregiver, or like we said, abuse or bullying at school.

And sometimes kids don't have the ability or the language to say, "Hey, this happened to me.

Can you get me some help?"

And so what they do is exactly what you said.

They act in a way that should be communicating to us that they're in distress.

So that's where I start to say, let's get the child in and at least get an assessment or talk about what's happened to them and see if we need to do any sort of trauma therapy.

- And I know we sometimes find that autistic children act out as well.

When you're testing, we actually did talk about autism last episode.

What types of tests are you doing?

But you did also mention a new test for children under two that I would like to hear more about.

- So it's called Early Tech.

And what it is is it's based on, it's a computer program and the child sits on the parent's lap and they look at a computer screen and it plays different videos and it tracks the child's eyes to see what they're focusing on.

Are they focusing on the face?

Are they focusing on other parts that somebody that would be more on the spectrum would focus on?

And then we take that plus we would also do the ADOS too.

So we have two measures then to say, yes, this child definitely seems like they are having an autism spectrum disorder.

- And what's that other test you just mentioned, the ADOS?

- The Autism Diagnostic Observation Scale.

So it has different ranges.

There's like the module one, which is for like nonverbal children.

Then there's another module two, which is for children that are verbal.

Then there's an adult or adolescent one.

And then there's an adult version too.

- Okay.

You also mentioned, Megan, that you're working with a program for foster children and adoption.

I would imagine that you probably find lots of trauma there.

What are you helping these children with primarily?

- Well, the very act of being removed from your primary caregiver and placed in another home is a trauma.

So every child in trauma in foster care has experienced at least one trauma.

And getting there often, the reason that they're removed is a trauma.

So we're talking about kids that have had multiple incidences of something really terrible happening.

And a lot of times in our county, they're placed with family members.

So at Loftus-Vergari, one of the programs that we run is called a kinship program, where we work a lot with grandparents.

And there's actually a very large number of grandparents these days taking care of their grandchildren.

And it's kind of a specialty that we do to really help them because we understand the challenges that grandparents face when taking care of a generation that they didn't plan on, right?

Like they probably were set up for themselves for retirement, but not thinking, oh gosh, I'm gonna have to go to baseball games and dance recitals and like all this stuff that they didn't plan for.

So we really try to help them in order to be able to be the best parent that they can to their grandchild.

And what we also find with kinship, which is neat, is that when children are placed with family, they're more likely to have permanency there.

Because every move that a child has in foster care is another trauma.

So that's why there's a big push for that kinship and that family-based care too.

- And Summer, when we spoke, we talked about how important it is to care for the family as a whole, even though you're called the Children's Service Center, you're providing more than that.

Can you talk a little bit about how you're supporting the family to help support the children?

- One thing that we really emphasize when we're working with the families is to view the parents as they're parenting to the best of their capability and their capacity.

And that we really work on embracing the parent where they're at and building up their skillset so that they can better parent their child or better understand where their child's symptoms are coming from so that we can keep the family together successfully.

One program that we have been working a lot with that's been very successful is including family peer supports.

So that's somebody that has had lived experience themselves.

They've raised children through mental health systems so they can really relate to the family members.

So they form a different relationship and they're a huge support to families for them to be open with receiving services.

- So you're actually going into the home with the children?

- Yeah.

- Okay.

- I think another program that Children's Service Center has also that's really great is called Family Home-Based Services.

So sometimes school-based isn't enough.

So Family Home-Based will go up to three times a week two therapists into the home to work with the families more intensively.

- And were these programs happening, I know they mentioned during the intro COVID were the home-based programs happening during COVID or was that having to be done via telehealth?

- We were trying to go into the home as much as possible.

I know there was a time during the pandemic that it was mandated that everybody stayed away.

And so a lot of stuff was done telehealth.

And I think we all understand that was a huge detriment to children as well as adults' mental health.

It has a significant impact.

And even our crisis services, trying to provide crisis support when individuals are experiencing a mental health crisis telehealth was very difficult.

So we would do a lot of face-to-face in those moments during that.

- I think also on the flip side, for some populations telehealth actually has been very helpful because it's allowed for us to be able to reach people that we wouldn't necessarily have been able to reach.

We can see people all over Pennsylvania now.

They don't have to just be here.

I work with people over the phone that are in their homes because they can't leave.

Sometimes like senior citizens can't leave to come in or people with significant medical issues or transportation issues or financial issues.

So there's a benefit I think of the pandemic was expanding telehealth services.

But I also agree like for some populations especially children, it's not ideal and really getting children into an office or being in the home with a child is the best way to help them.

- Yeah, I would imagine, especially when we're talking about these school-based programs, teachers are probably that first contact, right?

They're the ones who are seeing a change in a child's life.

So they're the ones likely to make a referral.

Would you agree with that?

- Yes.

- Teachers often make a referral, but we talked about that pandemic.

I think one of the things that really scared me during it was that teachers weren't seeing the children.

And so children that were referred to children to make sure that they were safe because of abuse, the referrals were down.

Our referrals were down for a time because people weren't seeing what was happening.

And now I think as a clinician, what I'm noticing is that there's a rebound.

So kids that maybe weren't seeing therapists or being in services are now starting to have symptoms come out that maybe weren't before, which is actually a hallmark of trauma.

So when you're in the trauma, like the pandemic was, right?

We go into kind of a survival mode and kind of get through it and now here we are a few years later and people are experiencing increases in depression and anxiety and drug and alcohol addiction and all of these things, I think because it's like a delayed response.

- Recently WVIA's Tim Novotny met with Lynn Evans-Vega, executive director of Luzerne County Head Start, along with Amanda Evans-Drum, a parent and information technology manager at Luzerne County Head Start.

They both share how their organization provides children with many different programs to assist them in their everyday lives.

- [Narrator] The need for Head Start in Luzerne and Wyoming County continues to grow each year and we see a need of children applying for Head Start services and those continuing to be on our waiting list that we have.

- He's gonna move in there but he's thinking that it looks a little plain.

- My name is Lynn Evans Biga and I'm the executive director for Luzerne County Head Start in Pennsylvania.

- [Narrator] Luzerne County Head Start as well as many other Head Start programs in Pennsylvania and across the country offer services to families who are income eligible who have children from birth to age five an opportunity to learn, to be healthy, to be well and to be ready for school when the time comes.

- I became involved in Luzerne County Head Start as a parent when my son was three.

He did lose his best friend to a genetic condition that she was born with.

So we knew at that point that he would need help for the mental health aspect as well as the socialization aspect due to the closure of everything during the pandemic.

- I think that COVID and the time of COVID has really helped us to focus in on mental health and that is sometimes where we come to a roadblock because there are not enough trained mental health professionals in our community.

- Before beginning involved with Head Start our daily life was extremely challenging.

We did have a lot of difficulty getting him to detach from me but once I was able to assure him that he was in a safe place with people who cared about him each day it became easier for him.

In what letter is that?

- Y.

- No, it's your V. - V. - If I could sum up our experience in Head Start I would say that it was a rollercoaster of emotions.

We were given so many opportunities for both him as well as ourselves and the supports for both our family and him during the Head Start program helped us to be able to have him transition to kindergarten successfully.

So it was a great experience.

- One of our mottos is that children need to be well to do well and so we do everything that we can to make sure that our children are well, do well, that they are connected with their families in school and ready for kindergarten.

Anyone who's interested in coming to Luzerne County Head Start for services should go on our website www.lcheadstart.org Our recruitment time for next school year is happening right now.

- So it's my understanding, she was just talking about COVID, that children entering preschool right now are the last round of COVID babies.

So what is the expectation then, right?

If we have all these children who were, I don't wanna call them socially inept, but different, right?

You're gonna have this new generation of children that may be more advanced than them.

How do we keep these older children feeling like they're still part of the program?

Thoughts?

- I think that, so it was what you're asking, how do you keep the kids that had gone to school and been taken out of the pandemic kind of in the mix when you have kids that are gonna be able to go through school without interruption?

- [Tonyehn] Right.

- I think teachers are working very, very hard to try to make sure that the kids are catching up as much as they can.

But one of the best things we can do is make sure that the schools are well-funded and well-staffed because that's what's gonna make sure that the kids that are there are able to reacclimate.

And I've worked with kids who had social anxiety issues and weren't able to be able to make friends.

They forgot how to do that or felt like they were depressed and didn't know how to be able to reach out and have relationships.

So I think in the school, it would be wonderful to be able to include some social programs to teach kids stuff that they would have learned in kindergarten, right?

Like everything we learned in kindergarten, there's that book, right?

- I also wanna talk about access to care.

I mean, I feel like there's two different issues here.

Of course, there's insurance, but then there's also lack of providers.

Is this something that you're experiencing at the Children's Service Center because you have a lot of programs happening.

So I assume you need a lot of people to manage these programs.

- Yes, at Children's Service Center, we are very busy with referrals.

We do have a lot of programs.

I think the biggest concern that we see is the wait time.

It's really unfortunate when somebody is really in need of a service and they're referred and we get the intake done, but then we have to wait two to three weeks to start outpatient therapy or to start a family home-based.

So it is something that we are always looking at on how to address that with doing brief treatment, trying to really look at cases and discharge when appropriate so that we have availability to meet the needs as they come in.

- And what about insurance?

Because I know people oftentimes talk about the cost of care and you have a private practice.

Do you hear this often?

- I do.

So we do accept most private insurances and we don't accept medical assistance because we're small.

And there's a lot that goes into taking that.

And as a small agency, we're just not able to do that.

And that's, I think as a clinician, as a therapist, as a psychologist, as an owner, really sad that we can't serve all of the people that we would like to be able to and that it does impact access for kids.

- And then they also spoke a little bit about making sure, you did, these school programs remain funded.

How are these programs funded?

And do we see that there might be an end in sight?

- Through medical assistance, it's funded.

And what I wanted to say is that in the state of Pennsylvania any child with a mental health disorder can get medical assistance.

So it doesn't matter what their parents' income is or anything like that.

It's just based solely on the diagnosis.

- Thank you for sharing that 'cause I'm sure most people do not know that.

So that is a very good point.

And then just speaking about children, we don't have that much longer.

I just wanna talk about how to recognize when your children might need help.

- I mean, the one thing that I always suggest that parents or caregivers look for is a change in behavior.

Are they isolating a little bit more?

Is there a change in their appetite?

Are they showing more emotions?

Are their emotions bigger?

Are they crying when they don't normally cry?

Are they isolating when normally they'd be very social but also activities that they normally would participate in, are they're showing less interest in those activities would all be significant signs, I would say.

- Yeah, and the only thing I would add is you're their parent, right?

So if you feel like something's off, get help, find somebody, right?

I know when something's off with one of my children and I do what I can to make sure that they're okay.

- And that's the next question.

Where do you look for help?

I mean, you can ask friends but one person's provider might not be the best person for you.

Do you think there's kind of a try different shoes until they fit type approach or do you stick with the person you first start with?

- I think certainly asking friends and family if they have anybody that they've worked with that they felt was really good is a great place to start.

But as I can speak as a trauma therapist, there are certification programs that we go through to make sure that we know what kind of treatment we're doing.

So that's another good place to start.

So for instance, the Children's Traumatic Stress Network is a really great resource for parents if they've had a child experience trauma and then you can find providers that are certified in that type of therapy.

- I was gonna say also the school counselors are also a good person to ask 'cause they have lists of all the different outpatient services and other providers that they could look into.

- Thank you so much.

I'd like to say thank you to all of our guests for their insights and to all of you for joining us.

For more information on tonight's episode and to see other episodes, go to wvia.org/keystonehealth.

For "Keystone Edition Health," I'm Tonyehn Verkitus.

Have a good evening.