>> THIS EPISODE OF RHODE ISLAND PBS WEEKLY WAS GENEROUSLY UNDERWRITTEN BY: >> THE SMALLER STATE IN THE UNION HAS OVER 400 MILES OF COASTLINE.

THAT IS WHY RHODE ISLANDERS CAN ALWAYS SEE A BRIGHT DAY AHEAD.

OUT THERE, INSPIRING, CONQUERING , STRIVING.

TRIUMPHING.

RHODE ISLAND RISING.

IT IS WHAT WE LIVE FOR.

>> TONIGHT, ON RHODE ISLAND PBS WEEKLY: >> I THINK AT SOME POINT, EVERYBODY HAS KIND OF SAID IS THIS IT, DO I LOOK ELSEWHERE?

>> AFTER A GRUELING TWO YEARS, MANY MENTAL HEALTH PROFESSIONALS ARE BURNED OUT AND QUITTING, FORCING PROVIDERS TO REDUCE SERVICES.

>> I HAVE BEEN HERE OVER 30 YEARS.

THIS HAS NEVER HAPPENED.

>> I FELT TRAPPED.

I FELT TRAPPED INSIDE MY BODY AND I DID NOT KNOW EXACTLY WHAT THE NAME OF WHAT I WAS FEELING WAS.

>> IT IS A CONCEPT THAT PEOPLE ARE TRYING TO UNDERSTAND BETTER.

WE DON'T KNOW HOW TO APPROACH IT.

THE ONLY PEOPLE WHO KNOW HOW TO APPROACH IT ARE THE PEOPLE WHO ARE DEALING WITH IT.

>> GOOD EVENING AND WELCOME TO RHODE ISLAND PBS WEEKLY.

I AM DAVID WRIGHT.

>> I AM PAMELA WATTS.

TONIGHT, OVERCOMING THE STATEMENT THAT ACCOMPANIES MENTAL HEALTH ILLNESSES.

>> WE BEGIN OUR BROADCAST WITH AN INDUSTRY THAT IS ON THE BRINK.

THERE WERE IN UKRAINE, SCHOOL SHOOTINGS, THE STRESS OF DAILY LIFE HAS MOST AMERICANS ON THE EDGE.

87% OF THOSE SURVEYED BELIEVES THERE HAS BEEN A CONSTANT STREAM OF CRISES OVER THE LAST TWO YEARS.

BUT WHAT HAPPENS WHEN THOSE MEANT TO HELP DURING A CRISIS ARE IN A CRISIS THEMSELVES?

THAT IS THE STATE OF MANY OF RHODE ISLAND'S MENTAL HEALTH PROVIDERS.

>> SOME OF THESE POOR CLIENTS HAVE HAD 3, 4, 5 DIFFERENT CASEWORKERS PER YEAR BECAUSE THEY FINALLY GAIN TRUST IN THIS PERSON AND THEY START OF RELATIONSHIP AND THEN NEXT THING YOU KNOW, THAT CASE MANAGER IS GONE.

?

IS USED TO WORKING IN A STRESSFUL ENVIRONMENT.

HE RETIRED AFTER 23 YEARS ON THE FORCE.

BUT HE SAYS WORKING IN MENTAL HEALTH IS EVEN MORE TAXING.

ESPECIALLY THESE PAST TWO YEARS.

>> I WOULD SEE THESE CLIENTS WEEKLY AND UNFORTUNATELY, BECAUSE OF THE EXTRA CASELOAD I AM CARRYING, I CAN SEE THEM EVERY 2, 3, FOUR WEEKS AT A TIME.

REQUEST THEY WORK WITH PATIENTS WHO HAVE SEVERE AND PERSISTENT MENTAL ILLNESS.

THEY SAY THE MENTAL HEALTH OF MANY OF THEIR CLIENTS HAS WORSENED SINCE THE ONSET OF THE PANDEMIC.

>> IT -- INCREASED ANXIETY.

THERE WERE CLIENTS THAT DON'T WANT TO LEAVE THEIR HOMES.

THERE ARE CLIENTS THAT DON'T WANT TO COME INTO THIS HOLDING.

>> WE HOPE THAT THEY PICK UP REALLY QUICK BECAUSE WE HAVE THE CLIENTELE FOR THEM TO TAKE.

I HAVE A CASE MANAGER WHO HAS NOT EVEN BEEN HERE SIX MONTHS AND SHE IS UP TO 34 CLIENTS.

SOMEBODY FRESH OUT OF COLLEGE?

>> YES.

THIS IS THEIR FIRST JOB THAT REALLY -- THEY REALLY pEXPERIENCED IN THE MENTAL HEALH FIELD.

>> AS SOMEONE WHO IS MANAGING THAT MANY PEOPLE.

>> ATTRACTING MODIFIED EMPLOYEES IS NOT EASY.

THE STARTING RATE AT COMMUNITY CARE ALLIANCE IS $15 PER HOUR. "

THERE IS NO WAY THAT I COULD AFFORD TO WORK HERE.

COURSE THE LARGEST OPIOID TREATMENT CLINIC IS ALSO EXPERIENCING A STAFFING CRISIS.

>> AS THE DEMAND FOR SERVICES HAS INCREASED, OUR WORKFORCE HAS DECREASED.

>> KODAK HAS SEEN MORE THAN 280 ADDITIONAL PEOPLE SEEKING HELP FOR OPIOID USE OR MENTAL HEALTH SERVICES BUT DURING THAT TIME, 113 EMPLOYEES HAVE LEFT THE NONPROFIT.

LINDA HURLEY, THE PRESIDENT AND CEO SAYS IT MAINLY BOILS DOWN TO ONE WORD.

>> IT IS BURNOUT.

WE GET TIRED.

AND INSTEAD OF BEING TIRED -- KINDER TO HUNDREDS RATHER -- INSTEAD OF BEING KINDER TO ONE ANOTHER, WE DO THE OPPOSITE.

THAT CREATES THE SENSE OF ILL DIFFICULT TIME FOR BEHAVIORAL HEALTH CARE IN GENERAL.

>> THE STAFF SHORTAGE FORCED HER TO SHUT DOWN ONE OF THE LOCATIONS AND REDUCE HOURS AT SEVERAL OTHERS INCLUDING SITES IN SOUTHERN RHODE ISLAND.

>> I HAVE BEEN HERE OVER 30 YEARS.

THIS HAS NEVER HAPPENED.

WE HAVE NEVER CLOSED BEFORE.

WE HAVE NEVER CLOSED A SITE BEFORE.

>> HURLEY SAYS IT IS THE PATIENT TO END UP SUFFERING.

ESPECIALLY THOSE WHO ARE ON MEDICATION TO MANAGE THEIR OPIOID WITHDRAWALS.

SOME SPEND HOURS ON A BUS.

IT COMES AS RHODE ISLAND SAW A RECORD 384 OVERDOSE DEATHS IN 2020.

>> HAVE YOU SEEN PEOPLE RELAPSE BECAUSE THEY COULD NOT GET THE MEDICATION ON TIME?

WE SEE THAT.

SPECIFICALLY BECAUSE LOCATIONS WERE CLOSED ON THE WEEKENDS.

>> THIS AS YOU DO NOT WANT THAT TO HAPPEN AGAIN.

AT THAT VERY MOMENT, THAT IS BECAUSE IT FEELS LIKE DYING.

IT REALLY DOES.

IT IS NOT AN EXAGGERATION.

>> TAMMY KNOWS WHAT THAT FEELING IS LIKE.

SHE STOPPED USING OPIOIDS A DECADE AGO.

>> IT IS GOING PRETTY WELL.

BEFORE THE PANDEMIC, THEY WOULD MEET ONCE A MONTH.

BUT SINCE COVID HIT, SHE HAS FELT THE NEED TO TALK WITH HER THERAPIST ONCE A WEEK.

>> THE LST TWO YEARS HAVE COMPLETELY TAKEN MY ENTIRE LIFE AND TURNED IT UPSIDE DOWN.

MY NIGHT TERRORS CAME BACK.

MY CHEST WOULD BE TIGHT BECAUSE I WOULD BE TRYING TO YELL IN MY DREAMS BUT NOT REALIZE IT.

>> THE UNCERTAINTY OF THE PANDEMIC MADE WORSE BY THE DEATH OF SEVERAL LOVED ONES INCLUDING HER FATHER, DAVID WHO HAD CANCER.

>> WHEN MY FATHER HAD PASSED AWAY, IT WAS AWFUL.

HE DIED AT HOME BUT IT WAS JUST NOT AN IDEAL SITUATION.

THERE WAS NO SUPPORT FOR MY FAMILY.

THAT WAS COVID RELATED.

THE HOSPICE UNIT WAS SHORTSTAFFED ALREADY BECAUSE OF COVID.

WE HAD CALLED AT 2:00 P.M. AND NO ONE ARRIVED.

>> MENTAL HEALTH PROVIDERS SAY THAT THE NEEDS OF PATIENTS BOTH NEW AND OLD ONES HAD BECOME MORE ACUTE OVER THE PAST TWO YEARS.

>> WOULD YOU ATTRIBUTE THAT TO THE PANDEMIC?

>> ABSOLUTELY.

>> THOSE NEEDS COME AT A COST.

MOST OF KODAK'S PATIENTS ARE ON MEDICAID WHICH ACCOUNTS FOR 86% OF THE ORGANIZATION BUDGET.

>> THIS IS NOT SHOWING AS IT IS INVESTED IN THE POOREST AND MOST ILL PEOPLE THAT RESIDE HERE.

COURSE HURLEY HAS BEEN URGING STATE LAWMAKERS TO RAISE RHODE ISLAND'S MEDICAID REIMBURSEMENT RATE TO NO AVAIL.

IT HAS BEEN STAGNANT FOR MORE THAN A DECADE.

>> WE HAVE NOT HAD AN INCREASE IN 14 YEARS.

WHAT BUSINESS COULD POSSIBLY SURVIVE?

14 YEARS.

QUESTION HURLEY SAYS AN INCREASE IN THE MEDICAID REIMBURSEMENT RATE WOULD ALLOW HER TO PAY HER EMPLOYEES MORE AND REDUCE TURNOVER.

RIGHT NOW, THE ORGANIZATION IS TRYING TO FILL 18% OF ITS POSITIONS.

>> YOU SEE A LOT OF PROVIDERS CHOOSING MASSACHUSETTS TO BE WHERE THEY PRACTICE RATHER THAN RHODE ISLAND.

>> RHODE ISLAND STATE SENATOR JOSH MILLER HAS BEEN WORKING TO RAISE THE MEDICAID REIMBURSEMENT RATE FOR SEVERAL YEARS.

BUT HE SAYS IT HAS BEEN TOUGH TO GET LAWMAKERS TO CONSIDER THE LONG-TERM BENEFITS.

>> AN INCREASE IN MEDICAID LOOKS LIKE AN INCREASE IN THE BUDGET EXPENDITURE BUT IF YOU LOOK AT IT BEYOND 12 MONTHS AND YOU SEE IT AS FILLING GAPS OF CARE, IT IS A BENEFIT BECAUSE YOU ARE AVOIDING HOSPITALIZATION AND EXPENSE OF CARE AND THE PATIENT IS TREATED IN A NONEMERGENCY SETTING RATHER THAN AN EMERGENCY SETTING.

>> IN THE LONG TERM, IT STANDS TO SAVE TAXPAYERS MONEY.

>> RIGHT.

>> WHY HASN'T IT BEEN RAISED?

>> THERE IS A MENTALITY OF NOT LOOKING BEYOND 12 MONTHS.

>> WHAT IS AT RISK IF THESE RATES ARE NOT INCREASED SOON?

>> WHAT IS AT RISK IS THE BEST RESULTS YOU CAN GET FOR PATIENTS, PATIENTS WILL GO INTO CRISIS RATHER THAN HAVING SOMETHING DEALT WITH PRECRISIS.

>> BUT DISMAL STAFFING LEVELS MAKE IT HARDER TO AVERT A CRISIS.

IT HAS LED MANY MENTAL HEALTH PROVIDERS TO REACH A BREAKING POINT.

>> INABILITY TO SLEEP BECAUSE THEY ARE THINKING ABOUT THEIR CLIENTS, WE HAVE SOME CLIENTS THAT ARE HOMELESS THINKING ABOUT CLIENTS THAT MAY NOT HAVE ENOUGH FOOD, THEY MAY NOT HAVE SHELTER.

A LOT OF THESE PEOPLE WIND UP LEAVING THE JOB BECAUSE IT IS AFFECTING THEM THAT MUCH.

>> HAVE ANY OF YOU THOUGHT ABOUT QUITTING.

>> YES.

AT SOME POINT, EVERYBODY HAS KIND OF SAID IS THIS IT?

DO I LOOK ELSEWHERE?

BUT HERE I AM.

I DON'T SEE ME ACTUALLY LIVING -- LEAVING ANYTIME SOON.

>> WHAT GIVES YOU SHOWING UP AT WORK?

>> I LOVE MY CLIENTS.

I HAVE SEEN MY CLIENTS COME SO FAR AND THROUGH UPS AND DOWNS AND I AM HERE FOR THEM.

>> I LOOK FORWARD TO COMING IN AND MAKING OUR CLIENTS THE BEST THEY CAN BE.

>> COMMUNITY CARE ALLIANCE WAS PART OF A GROUP OF PROVIDERS TO RECEIVE $30 MILLION IN FUNDS.

THE BUDGET ALSO INCLUDED A PROVISION TO EVALUATE THE MEDICAID REIMBURSEMENT RATES THAT BOTH KODAK AND COMMUNICATE ALLIANCE RECEIVE.

IT WILL BE AT LEAST A YEAR BEFORE THEY SEE ANY POTENTIAL INCREASES.

NEXT, AS WE FIRST REPORTED LAST MARCH, THERE ARE 1.4 ONE MILLION AMERICANS WHO OFFER SUFFER MENTAL HEALTH CHALLENGES BUT BECAUSE OF SHAME AND FEAR, THEY SOMETIMES GO WITHOUT TREATMENT.

TONIGHT, WE INTRODUCE YOU TO INDIVIDUALS WHO SOUGHT AND RECEIVED HELP ON THEIR OFTEN PAINFUL JOURNEY TO LIVE THEIR BEST LIVES.

>> TYPICALLY, I WAKE UP AT 3:00.

I AM OUT THE DOOR BY 4:00.

THE WORST PART ABOUT MY JOB IS PROBABLY THE COMMUTE.

IT TAKES ME ABOUT 45 MINUTES TO GET UP THERE.

>> THIS 30-YEAR-OLD IS A PLUMBER BY TRADE.

HE IS YOUR CLASSIC BLUE-COLLAR HARD-WORKING GUY.

BUT HE DID NOT START OFF LIFE THAT WAY.

HE WAS BORN FEMALE.

>> HOW OLD WERE YOU WHEN YOU FIRST REALIZED I AM NOT A GIRL?

>> PROBABLY AROUND FOUR YEARS OLD.

I REMEMBER WANTING TO BE BORN BEFORE MY BROTHER.

I WANTED TO BE HIM.

I WANTED TO NOT JUST BE HIM BUT BE A BOY.

IT FELT MORE THAN NATURAL.

IT FELT LIKE WHO I WAS.

UNFORTUNATELY, MY PARENTS DID NOT UNDERSTAND AND I DID NOT KNOW WHAT WORDS TO TELL THEM AND SO THEY HAD TO -- THEY TRY TO HAVE ME CONFORM TO A MORE FEMININE PATH IN LIFE AND WEAR DRESSES AND STUFF BUT THAT IS WHEN I DOVE INTO DEPRESSION AND HAVING ANXIETY.

I BECAME EXTREMELY CLOSED INTO MYSELF AND DID NOT REALLY TALK TO PEOPLE AND I ENDED UP TRYING TO KILL MYSELF WHEN I WAS 17 BECAUSE OF WHO I WAS.

>> HE REALLY CAME CLOSE TO SUICIDE?

>> -- YOU REALLY CAME CLOSE TO SUICIDE?

>> YES.

I FELT TRAPPED INSIDE MY BODY AND I DID NOT KNOW EXACTLY WHAT THE NAME OF WHAT I WAS FEELING WAS WHEN I LOOKED IN THE MIRROR.

I DID NOT RECOGNIZE MYSELF.

I DID NOT RECOGNIZE WHO I WANTED TO BE.

>> FOR PEOPLE WHO LIKE COAL ARE TRANSGENDER, IT CAN BE CONFOUNDING AND AGONIZING.

TRANSGENDER IS AN UMBRELLA TERM FOR WHEN ONE SAYS A PERSONAL IDENTITY DOES NOT MATCH WITH THEIR BIRTH SEX.

COAL SAYS HE FINALLY FOUND THERAPISTS THROUGH A LOCAL HEALTH CARE PROVIDER.

>> THEY HAVE BEEN SUCH A BEACON OF LIGHT AND THAT DARK TIME I WAS EXPERIENCING.

>> THEY MET OTHER INDIVIDUALS WHO WERE GOING THROUGH THE SAME STRUGGLES.

>> I WAS ABLE TO TRY OUT HE HIM PRONOUNCE AND I WAS ABLE TO TRY OUT BEING CALLED "COLE."

IT FELT SO RIGHT FOR ME.

I REMEMBER THE FIRST TIME IT HAPPENED, I WENT HOME AND WAS CRYING BECAUSE I WAS SO HAPPY.

THAT IS WHEN I KNEW.

>> A 2017 STUDY FOUND ALMOST 20% OF HIGH SCHOOL STUDENTS IDENTIFIED WITH THE OPPOSITE GENDER FROM THEIR BIRTH OR NO SPECIFIC GENDER AT ALL.

MANY OF THESE TEENAGERS CONFRONT SOCIAL STIGMA, BULLYING AND DISCRIMINATION.

TRANSGENDER INDIVIDUALS ARE SIX TIMES MORE LIKELY TO HAVE ANXIETY DISORDERS AND 10 TIMES MORE LIKELY TO COMMIT SUICIDE.

RELIABLE DATA IS HARD TO COME BY BUT ANECDOTALLY, ANY MENTAL HEALTH PROVIDERS REPORT MORE TEENS ARE COMING OUT AS TRANSGENDER THAN EVER BEFORE.

SOME SAY THEY ARE INSPIRED BY THOSE NOW IN THE SPOTLIGHT.

FROM BEAUTY PAGEANT QUEENS TO THE FIRST TRANS-WOMAN WHEN YOU'RE ON JEOPARDY.

TO EXERCISE LIKE LAVERNE COX AND CELEBRITIES SUCH AS CAITLYN JENNER AND CHAZ BONO.

>> WE SEE EVOLVING IDENTITIES, PEOPLE WHO ARE NON-BINARY, PEOPLE WHO ARE GENDER FLUID, ALL OF THESE DIFFERENT SORTS OF LABELS THAT ARE STARTING TO EMERGE TO DESCRIBE DIVERSE EXPERIENCES.

>> DR. JASON RAFFERTY IS A PEDIATRICIAN AND CHILD PSYCHOLOGIST AT BOTH RILEY HOSPITAL AND THE GENDER AND SEXUALITY CLINIC.

HE SAYS THE SOCIETAL SHIFT TO BE MORE INCLUSIVE ALSO HAS STAUNCH CRITICS.

AT LEAST 20 STATES HAVE INTRODUCED ANTI-TRANSGENDER LEGISLATION AIMED AT EVERYTHING FROM BATHROOMS TO SPORTS.

>> NOW WE ARE SEEING BILLS COME OUT THAT ABANDONED GENDER AFFIRMATIVE CARE.

IT IS THE CORNERSTONE, BEING ABLE TO PROVIDE SUPPORTIVE MENTAL HEALTH.

BEING ABLE TO PROVIDE PHYSICAL AND MEDICAL INTERVENTIONS WHEN THAT IS NECESSARY AND THAT IS REALLY ALARMING.

I THINK WE HAVE SEEN THIS BEFORE.

WHETHER IT IS WITH ISSUES OF RACE OR SEXUAL ORIENTATION, AS WE TRY TO BECOME A MORE ACCEPTING CULTURE, THERE IS ALWAYS SOME RESISTANCE.

>> THE NONPROFIT GROUP YOUTH PRIDE SAYS THE OCEAN STATE HAS BEEN FAIRLY OPEN-MINDED.

>> WE ARE PRETTY PROGRESSIVE.

WE HAVE LAWS IN PLACE THAT ARE ON THE SIDE OF TRANSGENDER YOUTH LIKE THE SCHOOL POLICIES IN RHODE ISLAND ARE -- NOT ONLY DO YOU NOT DISCRIMINATE BUT YOU HAVE TO MAKE REASONABLE ACCOMMODATIONS.

>> WELCOME TO GENDER SPECTRUM, WE WILL BE HERE FOR ABOUT AN HOUR.

>> THE GOAL OF YOUTH PRIDE IS TO TRANSFORM GENDER DYSPHORIA INTO EUPHORIA BY OFFERING AFFIRMING CARE.

THESE GENDER SPECTRUM SESSIONS ARE AN EXAMPLE.

>> THOSE KINDS OF THINGS ARE VERY VALIDATING AND AFFIRMING FOR THEM AND WHEN THEY CAN HAVE A STRONGER SENSE OF SELF, IT DOES THAT RESILIENCE BUILDING PEACE AND IT BECOMES A LITTLE BIT EASIER TO DEAL WITH SOME OF THE STUFF THEY MAY BE ENCOUNTERING IN THE WORLD.

>> THE DROP IN CENTER HAS PROVIDED A SAFE SPACE FOR YOUNG PEOPLE LIKE THIS TEENAGER.

>> TELL ME ABOUT THIS PICTURE HERE.

>> THIS IS A PICTURE OF WHEN WE WENT TO COMIC-CON WITH ME AND MY FRIEND LUIS.

>> THE 18-YEAR-OLD WHO RECENTLY GRADUATED IS A FAN OF STAR WARS AND PLAYING VIDEO GAMES.

BY GROWING UP, NOT SO TYPICAL.

AND 14, THERE WAS AN INKLING OF IDENTIFYING AS FEMALE.

>> I BROUGHT A GIRL ON A DATE IN FRESHMAN YEAR.

I FOUND HER VERY PRETTY.

I WISH I WAS HER.

I WOULD NOT BELIEVE IT UNTIL MUCH LATER ON.

QUICK DISCOVERING IT WAS VERY ROCKY.

I TRY TO DO THE MOST MASCULINE THING WHICH WAS THE UNITED STATES MARINE CORPS IN THE HOPES THAT THAT WOULD GET RID OF MY GENDER DYSPHORIA.

HE DID NOT WORK BECAUSE NO MATTER HOW HARD YOU TRY, IT IS NOT GOING TO GO AWAY.

IF IT WAS NOT FOR ME GOING TO THE MARINE CORPS AND HAVING ALL THE WAY DOWN TO THE BARE-BONES STANDARDS OF THEM SHAVING YOUR HEAD AND SEPARATING YOU FROM THE BOYS AND THE GIRLS, AND THE DIFFERENT WAYS OF HOW YOU ARE PERCEIVED IN THE MILITARY, IT REALLY HIT ME HOW I AM INSIDE THE WRONG SPACE.

IT IS A FEELING THAT REPEATEDLY SHOWS UP.

I FEEL THAT I SHOULD BE A GIRL.

>> NOW, A LIFE ALTERING DECISION, GOING BY THE NAME KATIE, SHE IS JUST STARTING HRT, HORMONE REPLACEMENT THERAPY.

SHE PLANS TO HAVE HORMONE -- SHE PLANS TO HAVE GENDER REASSIGNMENT THERAPY -- SURGERY.

>> WE DON'T REALLY KNOW HOW TO APPROACH IT.

THE ONLY PEOPLE WHO KNOW KNOW HOW TO APPROACH IT ARE OTHER PEOPLE GOING THROUGH IT.

>> MY FATHER TOOK SOME TIME OFF FOR MY DOUBLE MASTECTOMY.

>> COLE HAS FOUND SUPPORT FROM HIS PARENTS AND ALSO HIS WIFE.

HE BORN -- HE WAS BORN AND IDENTIFIES AS A WOMAN AND HAD BEEN MARRIED THREE YEARS.

>> WE MET AT A FRIEND'S HALLOWEEN PARTY AND IT WAS IN MINNESOTA.

I INTRODUCED MYSELF AS 'COLE.'

I DID NOT DISCLOSE MY TRANS STATUS UNTIL A COUPLE OF DATES IN.

>> HOW DID YOU BROACH THE SUBJECT?

>> IT WAS LIKE I AM TRANS BY THE WAY.

IT WAS LIKE "OH, OKAY."

>> WERE YOU NERVOUS?

>> A LITTLE BIT BUT IT WAS MORE SO LIKE I HAVE TO GET ON WITH THIS IF I WANT TO GO DOWN THAT PATH OF COURTSHIP AND DATING.

>> DO YOU LOOK FORWARD TO MAYBE HAVING A FAMILY ONE DAY?

>> IT IS DOABLE AND WE PLAN ON DOING EITHER IVF OR FOSTER CARE AND THEN ADOPTION.

>> FOR RIGHT NOW, COLE IS CONTEMPT JUST BEING COMFORTABLE IN HIS OWN SKIN.

>> ARE YOU A HAPPY MAN?

>> YES.

>> I AM LIVING MY BEST LIFE.

>> YES.

I DO MOURN FOR WHO I WAS BUT I AM HAPPY I AM ALIVE NOW.

>> COLE AND HIS WIFE WILL COME TO A NEW ADDITION TO THEIR FAMILY.

A ONE-YEAR-OLD HUSKY POMERANIAN MIX.

KATIE HAS BEEN ON HORMONE REPLACEMENT THERAPY FOR NEARLY FIVE MONTHS AND SAYS SHE IS PHYSICAL CHANGES HOWEVER SHE IS STILL FACING CHALLENGES INCLUDING HARASSMENT WHEN OUT IN PUBLIC.

>> THE FINAL STORY DEALS WITH SOCIAL MEDIA AND ADDICTION.

WHILE THIS ADDICTION CANNOT BE READILY SEEN, ITS IMPACT IS ALARMING AS IT WORKS ITS WAY DEEP INTO THE RECESSES OF THE BRAIN.

THE DOPAMINE HITS THAT KEEP USERS COMING BACK FOR MORE HAVE BEEN LINKED TO ANXIETY, DEPRESSION, LOW SELF-ESTEEM, INCREASED EATING DISORDERS, BULLYING AND EVEN SUICIDE.

AS ABBY ODOM FIRST REPORTED LAST MARCH, ADDICTIVE ALGORITHMS CREATED BY BIG TECHNOLOGY ARE HURTING MILLIONS OF IMPRESSIONABLE MINDS.

>> A MOTHER IS SUING THESE TWO POPULAR SOCIAL MEDIA SITES AFTER HER 11-YEAR-OLD DAUGHTER DIED BY SUICIDE.

>> FACEBOOK'S INSTAGRAM APP IS AWFUL TO A NUMBER OF TEENAGERS AND FACEBOOK KNOWS IT.

>> WE ARE SEEING INCREASED ANXIETY AND DEPRESSION IN TEENS THAT ARE REALLY BLIND ON SOCIAL MEDIA BECAUSE THINGS LIKE GETTING LIGHTS OR APPROVAL IN SOCIAL MEDIA IS A REALLY IMPORTANT THING TO TEENS.

>> ON AVERAGE AMERICAN CHILDREN, THEY SPENT 4-6 HOURS A DAY WATCHING OR USING SCREENS AND FOR TEENS IT IS UP TO NINE HOURS A DAY.

>> 45 PERCENT OF TEENS SAY THEY USE THE INTERNET ON A CONSTANT BASIS.

>> I CHECK IT WHEN I WAKE UP AND ALSO THROUGHOUT THE DAY IN CLASS IF I AM BORED.

>> I HAVE MY SCREEN TIME ON MY HOME SCREEN.

THE HOURS DEFINITELY RACK UP PRETTY QUICKLY.

>> YOU POST SOMETHING AND SOMEBODY LIKES IT OR THOSE LEGS ARE COMING IN, THE KIND OF ACTIVATE THIS PART OF OUR BRAIN AND IT CREATES DOPAMINE SO THE PLEASURE PART OF OUR BRAIN IS ACTIVATED AND WE KIND OF GET A LITTLE PAYOFF FROM THAT.

THE BRAIN IS STILL DEVELOPING.

IT MAKES IT REALLY HARD FOR THEM TO DISCONNECT FROM THAT BECAUSE THAT IS A GOOD FEELING IN YOUR BRAIN WHEN YOU GET THOSE LEGS.

YOU KINDA WANT TO GO BACK FOR MORE AND MORE AND MORE OF IT.

THAT IS WHEN WE SEE THINGS LIKE SLEEP DISTURBANCE.

OR I AM AT THE DINNER TABLE WITH MY FAMILY.

>> WHEN IT COMES TO SOCIAL MEDIA, SEEMINGLY REAL PEOPLE ARE INFLUENCING YOUNG PEOPLE FROM THEIR SELF-ESTEEM TO WHAT THEY BUY.

>> IT IS ALMOST LIKE CORPORATIONS ARE WORKING TOGETHER TO DECEIVE THE PUBLIC AND THE ONLY PEOPLE REALLY BENEFITING ARE THOSE BIG CORPORATIONS.

>> MORE SCREEN TIME SPARKS DEPRESSION, PARTICULARLY IN GIRLS.

>> IN MIDDLE SCHOOL, I HAD A LOT OF BUDDIES DYSMORPHIA AND EATING DISORDERS AND THAT STEMMED FROM THE FACT THAT I SAW ON SOCIAL MEDIA THESE IDEALIZED GIRLS WHO WERE MY AGE WHO SEEMED SO MUCH MORE ATTRACTIVE THAN ME AND MORE FEMININE AND I THINK I WANTED TO ATTAIN THAT.

I THINK IT IS HARD ON SOCIAL MEDIA.

AS HUMANS, WE ARE NOT DESIGNED TO SEE EVERYBODY IN THE WORLD BY SOCIAL MEDIA ALLOWS US TO DO SO.

IT CREATES THIS HYPER-COMPETITIVENESS, NOT EVEN AMONG THE PEOPLE YOU KNOW BUT AMONG THE ENTIRE WORLD.

>> FACEBOOK KNOWS THAT THE AMPLIFICATION ALGORITHMS, THINGS LIKE ENGAGEMENT BASED RANKING ON INSTAGRAM CAN LEAD CHILDREN FROM SOMETHING INNOCENT LIKE HEALTHY RECIPES TO ANOREXIA.

>> AND INPUT -- AN INCREASING BODY OF EVIDENCE SHOWS THAT FOR MANY TEENAGERS, FOR USE OF SOCIAL MEDIA MEANS A GREATER SENSE OF ISOLATION.

>> THIS WAS DEFINITELY SEEN DURING COVID WHEN PEOPLE WERE INTERACTING ON SOCIAL MEDIA BECAUSE THERE ARE NO ACTIVITIES OR ANYTHING.

I THINK THAT DURING A TIME WHEN EVERYONE'S LIVES WERE FALLING APART IN SOME CASES, SOCIAL MEDIA, JUST LIKE SEEING OTHER PEOPLE DOING BETTER THAN YOU, IT CAN DEFINITELY MAKE MENTAL HEALTH WORSE.

>> YOU REALLY WANT TO LOOK OUT FOR IF THERE HAS BEEN ANY MAJOR CHANGES IN BEHAVIOR.

CHANGES IN THEIR INTERESTS TO BE INVOLVED WITH THEIR FRIENDS, SCHOOL ACTIVITIES, ARE THERE GRADES SLIPPING?

ARE YOU NOTICING THINGS LIKE SLEEP DISTURBANCE OR CHANGES IN THEIR APPETITE OR EATING?

IF THEY ARE NOT THEMSELVES AND THAT IS KIND OF GOING ON AND THEY ARE INTERFERING IN THEIR DAILY LIFE, THAT IS A SIGN.

>> ERA THANKS TO ABBY.

IN ORDER TO KEEP YOUNG CHILDREN SAFE AND HEALTHY, SARAH KELLY PALMER HAS A SUGGESTION FOR PARENTS, PUT OFF INTRODUCING YOUR CHILD TO SOCIAL MEDIA AS LONG AS POSSIBLE BECAUSE IT IS EASIER TO GET MORE FREEDOM DOWN THE ROAD THEN TAKE IT AWAY.

THAT IS OUR BROADCAST THIS EVENING, THINK YOU FOR JOINING US.

I AM PAMELA WATTS.

>> I AM DAVID WRIGHT AND WE WILL BE BACK NEXT WEEK WITH ANOTHER EDITION OF RHODE ISLAND PBS WEEKLY.

GOOD NIGHT.

>> THIS EPISODE OF RHODE ISLAND PBS WEEKLY WAS GENEROUSLY UNDERWRITTEN BY: >> THE SMALLEST STATE IN THE UNION HAS OVER 400 MILES OF COASTLINE WHICH IS WHY RHODE ISLANDERS CAN ALWAYS SEE A BRIGHT DAY AHEAD.

OUT THERE, INSPIRING, CONQUERING , STRIVING.