Published February 5, 2022

Children’s Hospital Colorado hires its first Mental Health-in-Chief. What it will mean
for rural areas

By Sarah Flower

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Children’s Hospital Colorado has hired its first ever Mental Health-in-Chief. They are the first pediatric hospital in the country to do so. KSUT’s Sarah Flower talks with the new hire about what this position can mean for rural areas.

Transcript [16:32]

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Sarah Flower:
Dr. Ron-Li Liaw is the very first ever Mental Health-in-Chief for Children's Hospital Colorado. Now, Dr. Liaw, as far as I can tell, nobody else has ever carried this title in the nation, in a pediatric hospital setting of this caliber. Dr. Liaw, I'm so excited to have you on here today. This pandemic has shed such a big light on inequities in different races and different classes. And I think Children's Hospital Colorado has certainly done this. And I know that I've covered it here extensively in southwest Colorado, is the crisis of mental health in children that this pandemic has really brought on. And I know a couple months ago, the Children's Hospital put on a round table of the issues that we're seeing here in the Four Corners region, and across the state with a number of hospitalizations, and how much mental health in children has really been on the rise. And, I will say personally, I'm impressed with Children's Hospital for not only sounding the alarm, but then really putting policy in place and creating this first ever position of a Mental Health-in-Chief. So, no pressure here, Dr. Liaw, but let's talk about this position. And, the first of its kind in the nation.

DR. RON-LI LIAW:
Well, thank you for your long form reporting on this topic, because I think it's so important and I really applied to Children's Hospital Colorado for creating this position, because I think we think it's the first of its kind in the country. Um, you'll see in lots of large freestanding Children's Hospital, they're usually the psychiatrist in chief who oversees the section of psychiatry, and usually will be a psychology and other mental health care providers. The Mental Health-in-Chief title represents all of the different types of people who really take care of the mental health needs of children. So, includes our nursing team, nurse practitioners, masters, clinicians and social workers, as well as psychologists and psychiatrists, as well as primary care physicians and providers and school based teams as well. What this role allows us to do is to ensure that somebody is looking out for the mental health needs of children across our entire system. So everywhere we're delivering health care, and services, whether it's at the Anschutz campus, or in one of our school based clinics or tele-health practices, we're thinking about mental health and the total well-being of children and their families. So it's a new role. It's a new role for me, and that I'm excited to sort of inhabit and grow. But it's also, I think, a new role for children's hospitals as well.

FLOWER:
Dr. Liaw, I want to take a minute to talk about this holistic approach of medicine. But I think in focusing on mental health now, it's really like a fun word. It feels like the faux pas, especially in this generation. I have two young daughters myself, and they call it a feelings doctor. So they're really encompassing it. And this is the language that is talked about in the school, which I think it's, it's brilliant and has come such a long way.

DR. LIAW
Yeah, I have. I also have three kids, myself, and they also call me the feelings doctor and mom, but it's one of those. And I'm really impressed. I think with this younger generation, I have a 10-year-old, an 18-year-old and a 29-year-old and their understanding of you know, the complexity and the prevalence, I think of mental health issues like just in general, like as part of life. You know, we used to say one in five kids struggled really significantly with a mental health condition like depression or anxiety, suicidal thoughts or trouble trouble with alcohol and drugs right. Now, it's probably over half. I think there was one of the one of the four corners, school based leaders, Rebecca Dotty, which was talking about, it's actually four and five of the students now coming to the school based health centers really is coming with a mental health crisis or depression or anxiety, something that's that's their number one concern and that's what they're struggling with. And that's, some of that was happening pre COVID and pre pandemic, and is really gaining a lot of attention with the pandemic since everybody's mental health has been impacted in some way through the isolation and disruptions in school and in some of this social sort of supports that we've usually turned to.

FLOWER:
I want to talk about your agenda. Now. I think it's probably pretty big as you've just signed on and been a part of it now. But what are you hoping to achieve in this role?

DR. LIAW:
It is pretty big. And, I think one of the reasons I moved from New York to Colorado was I saw this, this opportunity for us to really reimagine and rethink how we think about children's health care. And well being. You know, you see these the you know, sort of best in class sort of innovation technology, heavy sort of investments that we've made in the in the body and physical health conditions, like at the best sort of cancer centers or, or heart centers in the country, right, how much investment we've made in the physical well being for these chronic complex conditions. And, we have not done the same for mental health, and especially for youth mental health. And so really, my you know, my purpose in coming to Colorado is actually to be part of children's and the Senior School of Medicine in the state of Colorado, as we really rethink how we design systems that care for both, you know, the mental health needs, the emotional health needs, as well as the physical health needs for children. And really, in thinking about children as part of families, however, we define family, right? And that includes kids who are in the foster care system, kids who might be in the justice system, kids through their educational systems, like how do we infuse mental health in everything we do and talk about we pay attention to and investing.

FLOWER:
I do want to take a look at the equity and mental health which, which I think is real. Here in the four corners. And in southwest Colorado, being in the rural area, we don't have a lot of accessibility to inpatient services for mental health and our ability to access care in these rural regions of the state is really shining a light on the problems here on tribal lands, and in the rural parts of Southwest Colorado. Can you talk to that at all?

DR. LIAW
Absolutely. I mean, I, we have a partnership, for example, in Durango, and I'm new to Colorado. So please, you know, I don't if I don't know the full details of this program, but it's one that I've got my eye on and that, you know, it was really a school district in Durango that said we do not have access to the things that we need to help care for the mental health of our young people, whether it's from the tribal nations or from the rural communities. So, the leaders of the school districts have let's partner to develop. So we have Kim Calsay, is child psychiatrist who is, you know, medical lead from our team, who's working with this amazing psychologist on our team and masters level clinicians as well as trainees at this CU school of medicine to partner with the school district in Durango to develop telehealth and telepsychiatry, access to evaluations and assessments, risk assessments, care coordination and navigation, best practice psychological supports, delivered through school based work. And not only that, but they're also capturing outcomes for these kids. So they're one of the few school districts that are actually doing a social emotional screening for all children in that district. And that's not something that's happening in a lot of the group, the metro area schools, right. And so it's really it's a weeding kind of program. And I think also an opportunities for us to think about partnerships between children's hospitals and academic medical centers, and school districts, rural communities, native communities and tribal nations Indian Health Service, research labs, as well, as some partners really thinking about developing a mental health workforce that looks very, very different than the one that currently exists, which is also very short staffed. You know, what would happen if we had pathway programs or pipeline programs, based in tribal nations developing youth, making sure that they had exposure and mentorship and, opportunities to develop but what the pathways might look like for career starting from, we're literally talking about kindergarten through to career. So we started partnering with schools, like what would that look like to have mentorship and exposure to other folks in the mental health care field, who then would come from communities and then provide care and service for the same communities or at least help us, actually think about some of the unique challenges and unique strengths and resources of those communities.

FLOWER:
You're touching on my next question here, which are what are some of your goals that you have in this new role that you'd like to put forward?

DR. LIAW:
Well, one of the things that we're doing right now, and I'm just coming from strategic visioning and planning meetings right now, and so, one of the things I loved about children's actually, Hospital Colorado is it's it's not just the kids that come to the hospital, right to receive care. We're really thinking with the governor's office, with the legislature, with local and state officials, about how can we partner to care for all the children in Colorado to ensure that they have the right support and touchpoints when they need it. In terms of their mental well being in their families, mental health and well being. So in the next six months, we're going to be very, very much involved in a partnership exercise and two stakeholder exercise with all of our local and state officials, but as as well, as well, with community partners and thinking about, you know, we had to really invest in a mental health system that worked for kids for this state, what would that look like? Where would that happen? You know, how can we deliver care in schools, at home, in communities through primary care, using all the levers that we possibly can and all the places that we can invest in need to invest, to ensure the outcomes that we're hoping to achieve.

FLOWER:
You know, we talked earlier on kids and children being so much more woke to these feelings doctors, right. But I think when you talk about that investment, the investments of parents to eliminate that mental health stigma, and I wonder if having a position, like yours at a hospital, like children's can switch that and change that stigma.

DR. LIAW:
In the global health world, as we always talk about, there's no health without mental health, right. So if you talk about health as this big umbrella, and I would say health and well being, and also health and well being not only children, but also their families and their communities, right? We all grew up in a family, we all grew up in a neighborhood, the quality of those relationships, the support we offer to the families and communities have a lot to do with our health outcomes, and our educational outcomes and our occupational and economic outcomes as adults. And so really, you know, having that mental health conversation happening at all the tables, in all the decision making rooms, right? In thinking about how do we partner across the system, because they don't no one entity could do this alone, just like no one parent or family caregiver can raise a child alone, right? I think it'll take all of us in really doing that. And I think if we have that big conversation, then the stigma pieces, we hope will fall away with her young people really leading the way in the way that they think about mental health.

FLOWER:
With leaders here in the Four Corners region. I have heard a lot on this notion of upstream prevention. What does that look like, from where you're sitting?

DR. LIAW:
We're talking about that every single day. Because, you know, we right now have 30 plus kids in our emergency departments who are or are here in our care, because they're struggling with a significant mental health crisis right now. Like suicide attempts, severe depression and anxiety, autism, substance use eating disorders, you name it. So we cannot build our way out of this crisis with more psychiatric beds or emergency departments. We have to move upstream. I think it will be a lost opportunity for this generation, if we do not make investments that are smart, and based on science and evidence that are partnering in prevention. And there is a lot of evidence in best practices for how to prevent sort of more severe mental health conditions and outcomes. We have not made the investments as a society to implement those wherever children live, and learn and work and play. Right? And so what will it take to shift, we talked about a public health pyramid and I know the listeners can't see my hands. But, you know, usually you want to you invest the most in the base of prevention pyramid, right? With community investments with primary care integration, school based integration, screening and assessment for general populations. And then you move up the pyramid to the more specialized care and acute care, our system is completely flipped, where our pyramid investments have been at the tip, and not at the base. And we are really looking to save worth we make some smart investments at the base in partnership with other folks who care about kids' mental health and safety.

FLOWER:
Dr. Liaw, how will you personally measure success in this position?

DR. LIAW:
It's gonna sound kind of engineering your scientific in a way, but I come from an improvement science or implementation science background which is a quality framework, and we think, in the Quadruple Aim is, you know, how do we deliver the best outcomes? And these would be outcomes that really mattered to the kids and to families and to healthcare systems and school systems? Like, what are the things like, what what matters to a teenager? You know, I guess I could tell you from my own experience, what matters is that they feel like they're learning in school that is meaningful, learning that more importantly, that they have friendships and support that they find figure out their own identities and what they love to do in life, so that they can pursue future careers, and you know, be independent adults. You know, at every developmental stage, there are some key developmental milestones that we track as mental health professionals. And, you would want to make sure in outcomes that all the kids in your scope of care reach their developmental milestones, as well as they possibly can get in the system courts they need at different points that are really critical and vulnerable for them. Like this COVID, we're going on year three of the pandemic, this has been a huge stressor. And in many families also huge trauma, with losses and a lot of instability and uncertainty, right. But how do we provide the right scaffolding at the right times for kids, so that they can hit those milestones, is really important. But as a systems leader as well, I think about like, you know, we have these different systems like care for kids, right in different parts of the child's development, how well are those systems working together? And that's the sort of improvement science approach where we're really trying to create systems that deliver on these ultimate outcomes that matter to families who matter to this generation.

FLOWER:
Dr. Ron-Li Liaw, the first ever Mental Health-in-Chief at Children's Hospital Colorado. Anything else you'd like to add?

DR. LIAW:
One, I want to come and visit, if that's all right, I really I think this is such a critical part of the state, in that we do represent several tribal nations as well as rural communities. You have a lot of innovation, and a lot of creative potential and engagement within your communities. And I would love to come and spend some time with you all, and I know our team would as well. And Sarah, really a pleasure. I hope that we can continue this conversation because I've just the beginning at this point and excited to report back on progress in the future

FLOWER:
I look forward to that. Dr. Liaw. Thanks so much for joining us here today on KSUT tribal radio.

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