We're exploring youth mental health as children navigate reopenings and recovery.

That's this week on Nevada Week.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt and additional supporting sponsors.

(Kipp Ortenburger) Parents, youth advocates and public officials alike advocated for schools to reopen to address children's mental health concerns during the pandemic.

Now that schools are open and the county prepares to lessen restrictions, some mental health experts are quick to remind the public that many stressors children have faced during the pandemic will not go away with reopening alone.

The toll of the pandemic on children, experts say, means that schools and other youth services will need extra resources now to prepare for an influx of children in crisis.

Let's not forget also that prior to the pandemic, our state's capacity to address our children's mental health needs was definitely a concern.

In fact, Nevada ranks 51st in youth mental health according to Mental Health America.

On the other hand, municipal and community based agencies have stepped up their efforts to incorporate mental and behavioral health into their services.

On this week's show, local experts will examine what new and continuing challenges our kids and young adults face, how the existing infrastructure can best support them, and what new solutions should be on the table.

Please welcome Joe Roberts, director of the Crisis Response Team at Clark County School District Psychological Services; Char Frost, parent representative at the Clark County Children's Mental Health Consortium, and Andy Bischel, CEO of the Boys and Girls Clubs of Southern Nevada.

Joe, Andy and Char, thank you so much for joining us for Nevada Week.

We really appreciate it.

I want to jump right into something that CCSD Superintendent Jesus Jara said, and this is pertaining to when schools were preparing to open.

He said even when they end up going back-- they being students-- mental health and suicide prevention needs to be high up on everyone's awareness because even going back will create stress for certain segments of people.

That leads us to our first discussion topic today.

Since schools have reopened, what is the state of our children's mental health?

Joe, I want to go to you first.

Three weeks in now to reopening phases, where are we at?

What are you seeing?

(Joe Roberts) We're seeing-- the indicators to me are skewed.

In other words, the numbers that I see with respect to wellbeing and mental health are down as far as what I see coming through the district with respect to say of hospitalizations.

Those numbers are down, but we know they're not really down.

The issues are still there.

They're just hidden.

They're underneath the surface, and I think we'll start to see an uptick quite a bit as we move forward and things start to resume and we start to work through the recovery of typically what we would see during normal school operation.

They're there, the indicators are there.

A lot of them have shifted to different sources of indication like say wellness checks by school police or by local law enforcement, whatnot.

-Can I ask you, I apologize.

Let me jump in really quick.

What about teachers?

What are teachers saying in classrooms right now in these first three weeks of having children present?

Are they noticing any differences in behavior, any warning signs at all?

-Well, there I'd go back to what we see coming through say the SafeVoice system or through the Handle With Care notifications.

It's just a different reporting mechanism that we would normally see coming from school campus to say my office.

So the numbers are there.

We're just not seeing them in the normal reporting themes, and we are seeing that, we have seen all the way through the pandemic an uptick in say wellness checks for suicidal ideation.

And I think that's going to continue, and I think we're not going to really turn the corner until maybe, you know, mid-fall provided we don't have any additional setbacks with an uptick in the COVID rates as things get back to normal.

-We'll get back to those indicators in just a second.

I want to get Andy's perspective here.

Andy, you bring a very interesting perspective to this conversation being that in some way, shape or form, Boys and Girls Clubs have continued in-person service, so you've got a little bit of a different perspective.

I want to ask you the same question, and maybe you compare and contrast six months ago when we were kind of in the meat of closures in the pandemic to where we are now.

What are you seeing?

What are you seeing that kids are confronting and struggling with now?

(Andy Bischel) Yes, and especially for us, it's the age gap that we serve, so 6 to 18.

So your littles, or I will say 6 to 12, highly adaptable, got accustomed to wearing masks, social distanced, you know, all those things.

They adjusted pretty well.

Some of the home life, you could see kids acting out a bit, and we had them for 12 hours a day.

And then it shifts into our teens, or tweens and teens, and they reacted very differently.

It was harder to cope, didn't like the restrictions, you know.

They just had a difficult time adapting or a more difficult time adapting.

So we wanted to be really sensitive to that, and again, you know, the big thing is giving them voice in setting those norms in the club so they feel like they have a piece of it and a way to get out their feelings and then supporting them through our staff and leadership.

-And since we've moved into a reopening phase, at least schoolwise, and of course let's not forget that we do have a more significant reopening community base-wise coming up in just a couple days here.

What's the sense you're going, and let's talk specifically about the teen population here.

Are you feeling that light at the end of the tunnel?

Is there optimism there, or are you seeing a higher level of anxiety and maybe stress?

-Oh, for sure.

So we brought on counselors.

We have just two, but we have them, and we're deploying them throughout our 13 clubhouses throughout the community to respond to that suicidal ideation and really trying to equip staff to identify it: What are the key words that they're using?

Are the teens sharing their conversations?

I'm really worried about X, Y, so those kinds of things.

That's a key component.

I will also say it's not just the pandemic.

It's the social unrest, especially for our teens.

Our teens, they live in-- they're exposed to it on a daily basis, and it's very real for them.

They don't-- and they're trying to figure out where to get good information, so we really try to be a source for that.

You know, try to take out the politics and really get down to okay, this is what it means, this is history behind it, those kind of things, to really again give them voice.

They need to be able to be heard so they can get some of these frustrations out and hopefully get them to a point where they're not acting out but they're talking it out.

-Yes, that's a great point.

Char, I want to come to you, and let's jump ahead and let's talk about the importance of exactly what Andy's talking about here, misinformation, disinformation, the quest for the correct information.

So many of our children and our youth now of course are engaging in social media to get information, and let's bring it back around to the mental health conversation here, of just being able to understand warning signs and resources that are available and things like that.

When you're looking at the landscape of social media, particularly locally, how good of a job are we doing at providing the correct information?

(Char Frost) So, you know, social media is everywhere and kids obviously have access to it, and there is good with the bad.

But when there's bad, it seems like it's really bad, and I don't know that our kids are necessarily equipped to be able to discern the difference between this is bad information.

I think adults struggle with this as well, so it really is.

It's helpful to have people in the community because, you know, it takes a village.

You know, we've heard that before.

We would be able to teach our kids some critical thinking skills so they can drum down to what they should doubt and what maybe is not so great or what is.

But the other piece of-- the one thing that is really good about social media is kids have a platform to kind of talk to one another about their own experiences-- because a lot of times, our kids really feel like they're experiencing struggles and it's very easy to become isolated.

-Yes, the isolation.

-And I'm sorry, Char, we lost you there for just a second but I'm going to jump from what you were talking about there, and I wanted to mention we do have organizations in town and new organizations that have developed to focus on providing the right information.

Hope Means Nevada is one of those.

Joe, I want to come to you, and let's talk more specifically about the correct information here.

Some concerning trends early on in just increase of demand for mental health services.

One of the indicators I saw is just emergency room visits and pediatrician visits went up for mental health care for things like eating disorders, anxiety, depression, suicidal thoughts, even obsessive compulsive disorder.

Let's go back to where we are now.

The indicators are more explicit, like some of those I just listed, or maybe some of the more implicit signs that we as parents or our family members or neighbors or friends should be looking at if we're engaging with children right now.

-So you nailed it, Kipp.

So warning signs, things like noticeable changes in eating or sleeping habits, hygiene, withdrawal from family members, agitation, restlessness, giving away prized possessions, having expressions of not having a will or reason to live, lack of hope, dramatic personality changes, talking or even writing about suicide even jokingly, not caring about their school, drop in grades.

Those are indicators that there's something going on and you need to talk with your child.

Other risk factors that could play into it, a lack of social or family supports.

Those human connections are so important and that's what a lot of kids, youth struggled with with the pandemic, that social isolation.

An increase in drug or alcohol use, and a huge thing for families to be aware of.

To reduce risk factors, access to lethal means and then we're talking about the obvious, right?

If you own firearms, lock them up.

Keep them locked up.

But the not so obvious, medications and over-the-counter medications, even something as simple as a bottle of Tylenol.

If you have a youth that's at risk for suicide, lock those things up.

Get them out of the house, give them to a neighbor, keep them safe.

-Yes, and we're going to talk about some of the funding and financing in a minute, but some of the federal care relief of course has gone to, just as you mentioned, gun safes and medication safes as well to be able to lock those up for exactly what you're talking about.

Joe, what about eating pattern changes, things that might be really small?

Obviously we have children that have been inside a lot, fears of going outside and things like that.

I mean, if we have children in our lives that are dealing with things like that, are those potential indicators, and if they are, what is the next step of getting those children connected to services?

-There's free resources available.

Mobile Crisis Response Team is an excellent resource if there's an issue with finances in the home.

The Harbor Juvenile Assessment Center, there's four locations in the valley right now, just simply Google that, also free.

It's a multi-agency center where Mobile Crisis Response Team actually has membership there.

So those are some good resources.

On our school district website, our main website, on the "community" tab, midway down you'll see a second tab called "mental health resources," and there on that tab, you'll have all of your crisis response phone numbers from SafeVoice, the Suicide Crisis Hotline, all the way down to the hospital treatment centers.

And then at the very bottom of that page is a community resources guide that has just a treasure trove of agencies throughout the valley that can support families.

Many of them operate off a sliding scale, so I would encourage parents to take advantage of that.

-Char and Andy, I want to come to both of you.

Let's talk about that encouragement factor.

As I understand it, one of the biggest limitations to getting access to mental health care is the stigma behind this of even engaging or understanding or acknowledging that there might be a problem there with your child.

Char, let's talk about that aspect of this, and who particularly.

Are there specific populations that that's affecting more so?

-So I don't know that it's affecting a particular population more than others, but some of that access piece is really affecting one population more than others because, you know, transportation issues or mom and dad are both working multiple jobs, what have you, we have to find a way to really get into people's homes in a way that makes sense to them and that works for them as a family and understand that, you know, yes, there are some stigma issues and I think that crosses racial, religious, every kind of boundary you can possibly imagine.

But we have to get to the point where nobody thinks twice when they're not feeling well, when their stomach hurts or, you know, whatever their malady is to go to the hospital or go to the doctor.

We really need to find a way to normalize mental health care in a way that makes sense for people because your brain is still a part of your body.

It is part of your physical health and, you know, being able to talk openly about it is a good first step to get there.

-Yes.

Andy, I want to come to you.

You've already mentioned some of the resources you've put in place at your centers, the therapists, the counselors you mentioned, and then of course just a focus on children being able to express their feelings.

First off, are you seeing stigma as a barrier?

Are you seeing children and youth within your centers easily and freely accessing those resources?

-Well, I will say yes because we disguise it, if you will.

Our counselors are in a Boys and Girls Club T-shirt, so it doesn't look like they're talking to a counselor.

They're just talking to a staff member, again eliminating some of those barriers of it's not a sterile doctor's office.

It's a Boys and Girls Club where it's fun, it's interactive, and our therapists will go outside and weed a garden or harvest a garden and actually do the therapy session outside.

Kick a soccer ball, whatever it is, to really get-- to release some of those things.

Again, if a child's going to talk about one of the most traumatic aspects of their entire life, it's really difficult to do without building that social-emotional connection to the person that you're actually going to talk to.

So that's really what we're trying to create.

Again, we have two counselors for 13 clubhouses.

What we're working on right now is to get Medicaid billing eligible, getting our credentials to do that so we can sustain more counselors and really provide counseling at all of our clubhouses on a regular basis and again really providing that, eliminating or reducing those stigmas.

The other thing that Char talked about is transportation, and it is tough.

To get that consistency of care, a working parent really has to commit to taking time off work to get the child back and forth to services, and what we're trying to do is eliminate that.

So when they're in the club, they can not only get the counseling services, both individual and group, but actually practice what they're learning.

So they're starting to learn social-emotional connections and how they fit into a group, and then they are going to be in a group where they actually have to practice those things.

For example, de-escalation of conflict.

When a kid is agitated and they need to bring it down, okay, we can teach them those techniques of how do I reduce this stress, but then they're going to be out in a situation either on the ball court or playing pool or just in a discussion of, you know, topics where if they get agitated, what are the techniques that they bring it down and they start to see a different point of view.

So those are really the things that we're trying to work at and creating an environment where these kids have that opportunity.

And again, that has different pieces as a team and as a little, if you will.

So how do we teach that, even the very young so that they don't get to those disciplinary points in school, at the club.

That's one of the things that we really looked at is if a child was acting out, we would have to expel them from the club.

Well, that doesn't serve anybody.

It doesn't serve the child, it doesn't serve the parent, and we're not fulfilling our mission.

So how do we address it, and how do we address it young so we give them those skills to actually work towards their future.

-Give them the skills, and something that Char also said, it takes a village, and there you go, a perfect example of the top-down program delivery as well, all of your staff being trained in those skills as well.

I want to then transition that of course to the district conversation here, Joe, and how important it is for teachers also to have these types of skills and be able to teach the social and emotional learning as well, and let's talk about the future, particularly where we are right now and over the next couple years.

Let's talk about the training and support teachers need to make sure that they are able, particularly with some of these issues that you mentioned that might rise to the surface, being able to identify those but also provide the support that kids are going to need here.

-Clark County School District prior to the pandemic, we went through an extensive process in which we revised our suicide risk assessment protocol to align with the Columbia screener which is a recognized international screener used in governments and corporations and whatnot.

We aligned with that; it's in alignment with the state.

That was one of the things that we did moving forward.

Another thing that we did to equip our teaching staff or all of our staff in the school district was we developed a suicide prevention training, and to date we've trained well over 32,000 of our employees on suicide prevention.

We exceeded the bill that that's tied to, which was known as Senate Bill 204 in the 80th session.

We also provided training for-- and have conducted training for self-care for our educators so when they're feeling stressed, when they have had a lot on their plates, they are able to take care of themselves.

To date we've trained over 39,000 of our employees in self-care.

And trauma 101, being able to recognize when a youth has been traumatized and maybe they're bringing that to the classroom, roughly close to 17,000 of our employees have been trained in trauma 101.

So moving all of that, those were in development and working on, we were working on pre-pandemic with-- thank gosh, you know.

And then moving through pandemic, we've conducted all those trainings.

And now as we come forward, where we need to go down the road to help our students, to help our teachers.

We need to work collaboratively as a district to build multi-tiered systems of support that support all children, all levels, academics, behavior, social-emotional learning from pre-K all the way through 12th grade.

We need that.

We need a social-emotional curriculum, and we need a framework to play that with, and that's multi-tiered systems of support.

-Yes, and so reflective of a lot of the things that Andy was talking about.

And again, Char, back to the comprehensive care model here.

So many different touch points that we're talking about in a child's life, of course so much of this is dependent on two key things, funding and of course policy.

So let's jump to those really quick.

We don't have a lot of time; we've got about another minute.

But I want to talk specifically about the funding aspect of that and bring it back to something Andy said through some of the therapists he has and trying to get Medicaid to pay for that.

This is something we've talked about on the show a lot.

It is a very dense and complex network to get through the policy for Medicaid, and I just want to ask you, when we're looking at one of the most simplest ways to bring funding into mental health care, is it simply maybe easing the policy and the system a little bit to navigate to that funding?

-Well, we can ease it.

Yes, I mean, easing the system and being able to get providers in there would be great because we know that the more community based providers we have and the earlier we can get to a child or youth who is struggling and to not only help them but their family, the better the outcome is and the less likely they are to end up in a hospital setting, which is scary for any child whether it's, you know, a psychiatric hospital or a regular health hospital like UMC or something.

So those communities, we need robust community-based services, and we need to be able to pay those providers at a rate that encourages them to come to Nevada, or if they're already here to pursue those careers, because nobody wants to go to college and be in debt for the rest of their lives.

But we need to make sure that we're not only paying for the services, but we're delivering those services in whatever manner makes sense for the child and the family.

And we need to make sure that we're paying the provider so it makes sense for them to provide those services, whether it's in the office or by telehealth or by telephone, whatever works for that family, whatever works for that kid.

-Well, thank you as always for joining us this week on Nevada Week.

For any of the resources discussed on this show, please visit our website at vegaspbs.org/nevada-week.

You can also find us on social media at @nevadaweek.

Thanks again, and we'll see you next week.

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