May 7, 2025 • 22 mins
In the ninth episode of “Listen, Mental Health Matters,” Brian Giebink, HDR’s behavioral and mental health practice lead, speaks with Dr. Matthew Siegel, chief of clinical services for the Department of Psychiatry at Boston Children’s Hospital. Together, they explore how mental and physical health are intimately intertwined and the need for new pediatric mental health space that enhances care by design of the experience to address the under-resourced service line of pediatric mental health care.
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(00:04):
You're listening to Speaking of Design,
bringing you the stories of the engineers and
architects
who are transforming
the world one project at a time. Today,
we bring you another episode of a special
podcast series on behavioral and mental health called
Listen, Mental Health Matters.
As part of this series, Brian Giebenk, behavioral
(00:24):
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Geebink, and I hope that by
listening, the series helps us consider new perspectives
in our quest to create transformational mental health
(00:47):
facilities that improve the quality of life for
individuals and families and promote a shared sense
of community.
Thank you, Doctor. Siegel, for joining me today.
And you're in beautiful, sunny Boston right now
at Boston Children's Hospital. Doctor. Siegel is the
chief of clinical services for the department of
(01:08):
psychiatry here. It's really great to to have
you sit down with us today. Thanks for
having me. It's really been a great time.
We got to tour some of the spaces
earlier and it really happened at a very
nice campus. So I'd love to hear a
little bit more about you. Can you just
kind of share who you are and your
background and what kind of brought you to
this point?
Sure. So I am from Chicago originally and
then went on a educational journey around the
(01:31):
country and ended up becoming a pediatrician and
a child psychiatrist.
Had the first part of my career in
Portland, Maine for about fifteen years building services
there, particularly focused on kids with developmental disabilities
and behavioral health needs.
And then I started to hear about this
tremendous
(01:52):
opportunity and work that is happening in Boston
at Boston Children's Hospital. And so that drew
me here. How long have you been here
at Boston Children's? So I've been here just
about a year, and I was drawn here
by
what is really I think it's not hyperbole
to say is kind of a generational
opportunity, at least in New England,
(02:12):
to
evolve and improve children's mental health services.
Coming
during the pandemic,
I think many places, including Boston Children's Hospital,
came to a point where it became quite
evident that
we needed to start doing things differently.
Children piling up in emergency rooms, in behavioral
(02:34):
health crises,
not enough services,
families waiting long periods of time.
And so there was a real strategic
relook at this issue, at how children are
doing and
what role is is the hospital
system playing in in this both locally and
nationally.
And there was out of that process a
(02:57):
commitment from the board and CEO all the
way down to
really make it a new day for children's
mental health. And that has brought a huge
investment in our services and department, which has
included
hiring many faculty, expanding
programs, and
we're kind of capping that off and amplifying
(03:18):
it by building a whole new campus that
will be the regional
pediatric mental health campus for New England, I
think.
The story you're telling about how there's such
a need
in the community and Boston Children's recognized that
and really grabbed on to it. Is there
a pivotal moment when that is still happening?
I mean, was it COVID? Was it pre
COVID? Was was there a specific time or
(03:40):
point when Boston Children said we really need
to do something? Children's mental health has been
kind of under resourced and focused on for
a long time in our society.
And these issues have been building for a
long time.
I think that the pandemic
and the
effects on children really
sort of revealed what was already there and
(04:02):
then amplified it.
And so I think that really
struck many people and kind of brought the
concept of it that we're in a children's
mental health crisis to the fore.
And then specifically
at
many hospitals and certainly at Boston Children's,
there was a point where it really struck
(04:23):
people where
there was
a time when there were sixty,
seventy children
a day
boarding in our hospital. Meaning, they were
sitting in beds waiting to go to higher
levels of care, also known as inpatient or
psychiatric unit care,
and they weren't able to proceed. And it
(04:44):
reached the point where
in order to take care of those children,
even temporarily and house them, we're sticking them
in medical beds, beds, surgical beds, then kids
who need surgeries and pneumonia and etcetera is
not happening.
Plus, those kids are not getting the care
we'd like them to get. And so
it was kind of a way that I
think it crystallized
(05:05):
the as a crisis. And I think what
it really brought was a shift in many
people's thinking to,
we can do a terrific job with children's
health, but if we're not taking care of
their mental health,
we are not really reaching children in the
way we need to. It is an artificial
separation
(05:25):
to say mental health and physical health that
the two are intimately entwined
and many of the children that
we take care of as a hospital system
who have complex
congenital and cardiac and many other challenges that
we help them with, they are actually more
vulnerable to mental health challenges than perhaps your
(05:48):
average child for many reasons. I really appreciate
you saying that there's sort of this disconnect
between mental health and physical health, but there's
not. In reality, there's not. Mhmm. Health is
health. Mental health is health. Right?
I think we're all starting to
slowly as a community understand that mental health
is health. Right? And it needs to be
cared for. You mentioned some of that, you
had 60 to 70 kids boarding. Mhmm. You're
(06:10):
doing a lot now and you're continuing to
expand your services. Is there
anything in particular that the community really needs?
Is there a specific service or a service
line? What does the community really need right
now and and how are you helping to
address that? There are. There are many things
I think our community needs because we're kind
of
emerging from that pandemic state but the needs
(06:32):
have not really decreased very much. We have
actually,
unfortunately, we've seen a rise in suicide and
suicide attempts among adolescents, particularly adolescent females.
And so
we're not seeing
that really an ebbing, if you will, of
this,
challenge and needs. And so
(06:53):
there are a number of things we're doing
and and building. So essentially, what we're doing
is building our programs into a full continuum
of behavioral health care for children and families.
And so what I mean by that is
we are taking the many excellent programs we
already have, connecting them, making them much more
(07:13):
accessible
for families and children
to enter and go to the right place
at the right care at the right time
and starting to work on filling in the
gaps. So as an example,
people are often familiar with kind of the
two extremes or ends of the continuum of
care being there's outpatient
office based care where you might be seeing
(07:35):
a therapist once a week or once every
couple weeks or a psychiatrist or psychologist or
other mental health
practitioner maybe at a lower frequency.
And then there's being hospitalized in a mental
health unit.
But there's a vast world landscape in between
those two where you can deliver a great
deal of care and get a lot done,
(07:57):
but keep children at home and with their
families and guardian.
And there are various pieces of that such
as something called intensive outpatient programs. There are
partial hospitalization
programs. There are day treatment programs.
So there's school based services, there's many pieces
there, and
many of those are underdeveloped
(08:17):
across the country and in fact are underdeveloped,
it turns out, in the Boston region and
in New England. And so
specifically and they are underdeveloped in our current
system. And so we are looking to fill
those in. So we are planning
several different intensive outpatient and partial hospitalization programs.
And we are in the process of designing
(08:38):
and then building out a whole new campus
that half of which will be pediatric mental
health, but we can't wait for that. We
need that space, but in the interim, we're
looking at starting these programs
in other space and then we will move
them onto the campus cause we really can't
wait. It's a great segue. I was gonna
ask about what some of the barriers and
maybe roadblocks you experienced in some of this
(09:00):
growth because you need these now. Right? You
need more services now. You need more space
now. Can you talk about some of the
some of the roadblocks that you might be
experiencing? Yeah. I think there's a few challenges
that we work with as we're trying to
accomplish this that we're so used to. We
don't maybe even think about,
that much as challenges, but they are very
much there. So
(09:20):
one is the ways that mental health services
are funded are very different than other areas
of health care. And some of the economics
are very challenging in terms of
just
literally what you get reimbursed for a mental
health visit
as a provider
versus a, you know, primary care visit. Let's
(09:42):
say going to see your pediatrician.
There's there are significant differences often in those
things. And so the economics can be challenging.
And so we're
constantly working with that and trying to figure
out how to bridge those
gaps, both as a hospital system and then
as a department. And this is something that
nationwide, I think most mental health providers are
(10:04):
wrestle with. So that's
one. Second is that relates to that is
we see real gaps in parity as it's
called and meaning
parity and insurance benefits.
So
in many insurance plans,
there
is not necessarily parity between or equivalence
(10:24):
between the benefits you can get for a
physical health problem
versus if you have a mental health need.
And so that, just may not be paid
for or there may be many barriers to
having it paid for. So that's another
major issue and that's nationwide.
There are federal laws that attempted to address
this. They have only been, I would say,
(10:46):
modestly successful. There's a lot of work
to to further do in in that area,
and we're involved in advocacy with that locally
and nationally.
We have a wonderful community here in Boston
and regionally and nationally who support us. They
They support us philanthropically.
It helps us lead in our various arenas.
But I think a third challenge
(11:09):
is that we need support for our programs,
but we also we do need
much better physical space to do some of
our programs.
And
it is not as easy to people are
not as excited about supporting a building or
construction as they are necessarily in supporting a
program that we could start in six months
because buildings take a while. So that's a
(11:31):
challenge. It's a challenge we're working with. And
I think having some success is helping people
see that
a building is not just a building. A
building is actually
part of your care model. It is part
of the way you address
mental health. So in other words, the building
we're designing
is
(11:51):
part of the therapeutic experience from the moment
you enter the building. The materials,
the light, the way
you can the spaces you have, etcetera.
And our current buildings and spaces really
don't support that. They were built in a
different era. And I'm speaking
to a architect, a health care architect, so
(12:12):
you know this, but that's that's the huge
opportunity. And
a lot of our community is understanding that
now that this is it's part of the
care. It's not just a building in which
you are doing care. The building in itself
is a clinician in a way. Right? Actually,
especially when it comes to mental health care.
Right? We don't there's not a lot of
fancy equipment or x-ray machines and MRIs and
(12:33):
CT scanners and operating theaters. It's the compassionate
care that you provide and it's the environment
and the access to natural daylight and and
that therapeutic milieu that that really helps support
support mental health healing. Exactly. It's really great
to hear that you do have some support
nationally to, accomplish these these visions that you
have. We're fortunate that because of the work
Boston Children's has been doing for decades,
(12:56):
families, children have come from across the country
and so have gotten exposed to the work.
You know, we're fortunate that some of those
families
want to continue to support us and help
in various ways, so we're very lucky in
that way. Is there anything specifically that you
feel like you do very well, maybe differently
than your peers? You know, it's a huge
place and there's many areas
(13:17):
within medicine that Boston Children's is a real
leader in behavioral health. I think what I
would say is where we are and where
we're heading is
to take care of kids with really complex
challenges.
So kids who,
for example,
adolescent who becomes depressed maybe is having suicidality
and has insulin dependent diabetes
(13:40):
and doesn't wanna take their insulin anymore.
And then we're having this complex interplay between
that that is acutely
medically risky.
And when you don't take your insulin regular,
your brain is not functioning as well,
and you're already depressed. And so it's this
complex interplay.
(14:00):
And to help that child, particularly if they're
in an acute state, there are not a
lot of places really where you can
have practitioners who can keep you safe from
a medical
and psychiatric perspective and work with both of
those things and kind of understand that interplay.
So that's kind of an example of the
(14:20):
type of complexity which we might or
purely
psychiatric or mental health complexity. I mean, unfortunately,
there are some children
the most common things, luckily, for children can
be
not super complex at times such as basic
anxiety or ADHD.
Unfortunately, that is a lot of children, but
there are other children, adolescents who do develop
(14:42):
very complicated psychiatric
challenges. And so that's who we are particularly
there for and
whether that's kind of to give some examples,
development of early psychosis,
schizophrenia, very intense OCD,
children with neurodevelopmental
disabilities such as autism or Down syndrome or
(15:03):
intellectual disability who then develop
further mental health challenges or behavioral challenges, that
those are many of the children that I
think we are
helping and well positioned to help. And it's
not realistic
that
lots of places can do that. I mean
that a lot of those things take a
lot of resources and specialization.
(15:24):
I have to agree. I think Boston Children's
is doing some things very very well that
probably aren't able to be replicated elsewhere and
throughout the country there there are states struggling
to provide certain specialties. So kids are going
across state lines to receive care Mhmm. In
certain areas.
Yes. That certainly happens. And then, you know,
another aspect is we are also trying to
(15:44):
be quite intentional though in
no one can do everything and in fact
you're not gonna be successful if you're trying
to do everything. So what can we do
really well and then who can we partner
with that they do something really well and
perhaps we can support them in some way
and kind of at least share patients if
(16:05):
not elevate what they're doing. And so we've
we've tried to be pretty intentional
about that. So we have many partnerships in
the
area and in the region. You mentioned, you
know, partnerships with others and you also mentioned
really advocating for policy especially with parity and
and things like that. Are there any other
partnerships that come to mind that that might
be worth mentioning?
(16:25):
So we're
partnering with, in order of priority, we're partnering
very heavily with schools,
and school systems and we're doing that at
a couple different levels. So
we are providing direct service in school. So
we have through our larger
network of Boston Children's and our affiliate Franciscan
(16:45):
Children's,
we have clinicians directly embedded in 22
schools in the Boston region.
And we are also providing
a couple other levels of support to a
wider range of schools, which is we have
a extensive training
program for school administrators,
school for teachers,
(17:06):
for other school mental health professionals. And so
we do a lot of training. We also
do evaluation and research in schools. So we
have a pretty large school based mental health
program
in other people's schools. We're not running the
schools. We are helping public and other schools
to do things. So they are our partners
in this and it's very exciting because that
(17:28):
isn't
where people were in the past and it's
increasingly where kind of we're seeing we need
to be. Right? Because as we go on
and access to mental health services, it's a
huge issue.
And many of the families that we wanna
reach and who need help, they are not
gonna get into Downtown Boston to access services.
(17:49):
Right? Like, we need to go where the
children
are. And so they're at school, most of
them. And so that's a huge kinda
shift really in the process. And Boston Children's,
specifically has been doing that actually for almost
twenty years. So it's impressive, but it's really
expanding. And some other partnerships just to mention
of workforce
(18:10):
in behavioral health is also a major issue
as it is for many industries, but it's
particularly, I think, in our industry. And we
are a
very much often an in person endeavor, particularly
for some of our more intensive services.
So we have to have a significant and
well trained workforce. We've kind of developed into
actively partnering now with community colleges, local
(18:32):
four year colleges, graduate schools, so that we
can really
help develop a workforce. The The days of
sitting back and waiting for people to Yeah.
Come in your door and be hired, those
are over. So we're very active in that
and our community is supporting us in that
too. Is there anything else you wanna share
with our listener group? We have a workforce
(18:53):
who, particularly in our intensive treatment programs,
we could call our direct care staff. So
these are our floor staff
who we call mental health specialists or behavioral
health technicians,
and are critical to the work that we
do. These are the staff who are with
our kids and patients
hour to hour, twenty four hours a day
(19:15):
in those environments.
And they are just as important and just
as hard to develop and recruit and retain
as the rest of our workforce. And so
we've really put a focus on that group.
And so there, we're partnering with high schools,
community colleges,
other
kind of places to help them enter and
(19:36):
and stay in our workforce. And it's a
huge opportunity
because many of those positions don't have
significant educational requirements. And so it's a huge
opportunity for people to move into the workforce
and do very meaningful
work, working with children,
you know, working in a mental health setting,
and they get exposed to all these wonderful
(19:57):
other disciplines, nurses,
medical students,
psychologists, etcetera.
And we actually see many of them then
go on those tracks. And it's very important
for us in order to be able to
deliver the care, but it's also a very
important kind of economic
escalator, if you will, for people moving into
the workforce. Just driving here, we're right past
(20:17):
the Harvard School of Medicine
the physical connection, the physical adjacency of Boston
Children's to the School of Medicine, that has
to be a benefit as well. That's a
huge benefit. I mean, we are a Harvard
Medical School teaching hospital and system. I believe
we're one of five in the city and
that is a enormous benefit because
we have Harvard Medical School learners
(20:39):
spread throughout our services,
our faculty, our Harvard Medical School appointments.
And it brings both great resources
and also a culture and expectation of teaching
and research
and excellence that we strive to to meet.
And so it's a huge benefit.
(21:00):
It's just woven into the fabric really of
of what we do.
But we're very fortunate because you don't always
have access to that kind of thing in
every city or every setting.
We're only able to do this work and
be on this incredible
journey of growth and developing new models and
(21:20):
services
because of the support we have and
that goes all the way from the board,
CEO, our senior leadership team,
to our community
philanthropists
and partners in the community And then we
have incredible
leadership within our department,
really visionary leadership with our chair, Stacy Drury,
(21:42):
and expertise throughout the department. So I'm really
grateful to be here and thrilled to be
in the midst of this. This and it's
really a generational opportunity for all of us
and certainly I feel very lucky you get
to do something like this once in a
career if you're lucky and so I feel
very lucky. Well, Boston Children's is lucky to
(22:03):
have you here. Well, doctor Siegel, thank you
very much for your time. This has been
great and very insightful. I'm sure our listeners
are gonna really enjoy listening, and they'll have
a lot to learn. So Great. Thanks for
having me.
For more information on our Listen Mental Health
Matters series,
please visit hdrinc.com/listen.
(22:25):
There, you'll find more on HDR's approach to
behavioral and mental health design, meet our team,
and see samples of our work.
If you like what you heard, be sure
to rate us or leave a comment on
Apple Podcasts,
Spotify,
or wherever you get your podcasts.
You're listening to Speaking of Design,
bringing you the stories of the engineers and
architects
who are transforming
the world one project at a time. Today,
we bring you another episode of a special
podcast series on behavioral and mental health called
Listen, Mental Health Matters.
As part of this series, Brian Giebenk, behavioral
(00:24):
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Geebink, and I hope that by
listening, the series helps us consider new perspectives
in our quest to create transformational mental health
(00:47):
facilities that improve the quality of life for
individuals and families and promote a shared sense
of community.
Thank you, Doctor. Siegel, for joining me today.
And you're in beautiful, sunny Boston right now
at Boston Children's Hospital. Doctor. Siegel is the
chief of clinical services for the department of
(01:08):
psychiatry here. It's really great to to have
you sit down with us today. Thanks for
having me. It's really been a great time.
We got to tour some of the spaces
earlier and it really happened at a very
nice campus. So I'd love to hear a
little bit more about you. Can you just
kind of share who you are and your
background and what kind of brought you to
this point?
Sure. So I am from Chicago originally and
then went on a educational journey around the
(01:31):
country and ended up becoming a pediatrician and
a child psychiatrist.
Had the first part of my career in
Portland, Maine for about fifteen years building services
there, particularly focused on kids with developmental disabilities
and behavioral health needs.
And then I started to hear about this
tremendous
(01:52):
opportunity and work that is happening in Boston
at Boston Children's Hospital. And so that drew
me here. How long have you been here
at Boston Children's? So I've been here just
about a year, and I was drawn here
by
what is really I think it's not hyperbole
to say is kind of a generational
opportunity, at least in New England,
(02:12):
to
evolve and improve children's mental health services.
Coming
during the pandemic,
I think many places, including Boston Children's Hospital,
came to a point where it became quite
evident that
we needed to start doing things differently.
Children piling up in emergency rooms, in behavioral
(02:34):
health crises,
not enough services,
families waiting long periods of time.
And so there was a real strategic
relook at this issue, at how children are
doing and
what role is is the hospital
system playing in in this both locally and
nationally.
And there was out of that process a
(02:57):
commitment from the board and CEO all the
way down to
really make it a new day for children's
mental health. And that has brought a huge
investment in our services and department, which has
included
hiring many faculty, expanding
programs, and
we're kind of capping that off and amplifying
(03:18):
it by building a whole new campus that
will be the regional
pediatric mental health campus for New England, I
think.
The story you're telling about how there's such
a need
in the community and Boston Children's recognized that
and really grabbed on to it. Is there
a pivotal moment when that is still happening?
I mean, was it COVID? Was it pre
COVID? Was was there a specific time or
(03:40):
point when Boston Children said we really need
to do something? Children's mental health has been
kind of under resourced and focused on for
a long time in our society.
And these issues have been building for a
long time.
I think that the pandemic
and the
effects on children really
sort of revealed what was already there and
(04:02):
then amplified it.
And so I think that really
struck many people and kind of brought the
concept of it that we're in a children's
mental health crisis to the fore.
And then specifically
at
many hospitals and certainly at Boston Children's,
there was a point where it really struck
(04:23):
people where
there was
a time when there were sixty,
seventy children
a day
boarding in our hospital. Meaning, they were
sitting in beds waiting to go to higher
levels of care, also known as inpatient or
psychiatric unit care,
and they weren't able to proceed. And it
(04:44):
reached the point where
in order to take care of those children,
even temporarily and house them, we're sticking them
in medical beds, beds, surgical beds, then kids
who need surgeries and pneumonia and etcetera is
not happening.
Plus, those kids are not getting the care
we'd like them to get. And so
it was kind of a way that I
think it crystallized
(05:05):
the as a crisis. And I think what
it really brought was a shift in many
people's thinking to,
we can do a terrific job with children's
health, but if we're not taking care of
their mental health,
we are not really reaching children in the
way we need to. It is an artificial
separation
(05:25):
to say mental health and physical health that
the two are intimately entwined
and many of the children that
we take care of as a hospital system
who have complex
congenital and cardiac and many other challenges that
we help them with, they are actually more
vulnerable to mental health challenges than perhaps your
(05:48):
average child for many reasons. I really appreciate
you saying that there's sort of this disconnect
between mental health and physical health, but there's
not. In reality, there's not. Mhmm. Health is
health. Mental health is health. Right?
I think we're all starting to
slowly as a community understand that mental health
is health. Right? And it needs to be
cared for. You mentioned some of that, you
had 60 to 70 kids boarding. Mhmm. You're
(06:10):
doing a lot now and you're continuing to
expand your services. Is there
anything in particular that the community really needs?
Is there a specific service or a service
line? What does the community really need right
now and and how are you helping to
address that? There are. There are many things
I think our community needs because we're kind
of
emerging from that pandemic state but the needs
(06:32):
have not really decreased very much. We have
actually,
unfortunately, we've seen a rise in suicide and
suicide attempts among adolescents, particularly adolescent females.
And so
we're not seeing
that really an ebbing, if you will, of
this,
challenge and needs. And so
(06:53):
there are a number of things we're doing
and and building. So essentially, what we're doing
is building our programs into a full continuum
of behavioral health care for children and families.
And so what I mean by that is
we are taking the many excellent programs we
already have, connecting them, making them much more
(07:13):
accessible
for families and children
to enter and go to the right place
at the right care at the right time
and starting to work on filling in the
gaps. So as an example,
people are often familiar with kind of the
two extremes or ends of the continuum of
care being there's outpatient
office based care where you might be seeing
(07:35):
a therapist once a week or once every
couple weeks or a psychiatrist or psychologist or
other mental health
practitioner maybe at a lower frequency.
And then there's being hospitalized in a mental
health unit.
But there's a vast world landscape in between
those two where you can deliver a great
deal of care and get a lot done,
(07:57):
but keep children at home and with their
families and guardian.
And there are various pieces of that such
as something called intensive outpatient programs. There are
partial hospitalization
programs. There are day treatment programs.
So there's school based services, there's many pieces
there, and
many of those are underdeveloped
(08:17):
across the country and in fact are underdeveloped,
it turns out, in the Boston region and
in New England. And so
specifically and they are underdeveloped in our current
system. And so we are looking to fill
those in. So we are planning
several different intensive outpatient and partial hospitalization programs.
And we are in the process of designing
(08:38):
and then building out a whole new campus
that half of which will be pediatric mental
health, but we can't wait for that. We
need that space, but in the interim, we're
looking at starting these programs
in other space and then we will move
them onto the campus cause we really can't
wait. It's a great segue. I was gonna
ask about what some of the barriers and
maybe roadblocks you experienced in some of this
(09:00):
growth because you need these now. Right? You
need more services now. You need more space
now. Can you talk about some of the
some of the roadblocks that you might be
experiencing? Yeah. I think there's a few challenges
that we work with as we're trying to
accomplish this that we're so used to. We
don't maybe even think about,
that much as challenges, but they are very
much there. So
(09:20):
one is the ways that mental health services
are funded are very different than other areas
of health care. And some of the economics
are very challenging in terms of
just
literally what you get reimbursed for a mental
health visit
as a provider
versus a, you know, primary care visit. Let's
(09:42):
say going to see your pediatrician.
There's there are significant differences often in those
things. And so the economics can be challenging.
And so we're
constantly working with that and trying to figure
out how to bridge those
gaps, both as a hospital system and then
as a department. And this is something that
nationwide, I think most mental health providers are
(10:04):
wrestle with. So that's
one. Second is that relates to that is
we see real gaps in parity as it's
called and meaning
parity and insurance benefits.
So
in many insurance plans,
there
is not necessarily parity between or equivalence
(10:24):
between the benefits you can get for a
physical health problem
versus if you have a mental health need.
And so that, just may not be paid
for or there may be many barriers to
having it paid for. So that's another
major issue and that's nationwide.
There are federal laws that attempted to address
this. They have only been, I would say,
(10:46):
modestly successful. There's a lot of work
to to further do in in that area,
and we're involved in advocacy with that locally
and nationally.
We have a wonderful community here in Boston
and regionally and nationally who support us. They
They support us philanthropically.
It helps us lead in our various arenas.
But I think a third challenge
(11:09):
is that we need support for our programs,
but we also we do need
much better physical space to do some of
our programs.
And
it is not as easy to people are
not as excited about supporting a building or
construction as they are necessarily in supporting a
program that we could start in six months
because buildings take a while. So that's a
(11:31):
challenge. It's a challenge we're working with. And
I think having some success is helping people
see that
a building is not just a building. A
building is actually
part of your care model. It is part
of the way you address
mental health. So in other words, the building
we're designing
is
(11:51):
part of the therapeutic experience from the moment
you enter the building. The materials,
the light, the way
you can the spaces you have, etcetera.
And our current buildings and spaces really
don't support that. They were built in a
different era. And I'm speaking
to a architect, a health care architect, so
(12:12):
you know this, but that's that's the huge
opportunity. And
a lot of our community is understanding that
now that this is it's part of the
care. It's not just a building in which
you are doing care. The building in itself
is a clinician in a way. Right? Actually,
especially when it comes to mental health care.
Right? We don't there's not a lot of
fancy equipment or x-ray machines and MRIs and
(12:33):
CT scanners and operating theaters. It's the compassionate
care that you provide and it's the environment
and the access to natural daylight and and
that therapeutic milieu that that really helps support
support mental health healing. Exactly. It's really great
to hear that you do have some support
nationally to, accomplish these these visions that you
have. We're fortunate that because of the work
Boston Children's has been doing for decades,
(12:56):
families, children have come from across the country
and so have gotten exposed to the work.
You know, we're fortunate that some of those
families
want to continue to support us and help
in various ways, so we're very lucky in
that way. Is there anything specifically that you
feel like you do very well, maybe differently
than your peers? You know, it's a huge
place and there's many areas
(13:17):
within medicine that Boston Children's is a real
leader in behavioral health. I think what I
would say is where we are and where
we're heading is
to take care of kids with really complex
challenges.
So kids who,
for example,
adolescent who becomes depressed maybe is having suicidality
and has insulin dependent diabetes
(13:40):
and doesn't wanna take their insulin anymore.
And then we're having this complex interplay between
that that is acutely
medically risky.
And when you don't take your insulin regular,
your brain is not functioning as well,
and you're already depressed. And so it's this
complex interplay.
(14:00):
And to help that child, particularly if they're
in an acute state, there are not a
lot of places really where you can
have practitioners who can keep you safe from
a medical
and psychiatric perspective and work with both of
those things and kind of understand that interplay.
So that's kind of an example of the
(14:20):
type of complexity which we might or
purely
psychiatric or mental health complexity. I mean, unfortunately,
there are some children
the most common things, luckily, for children can
be
not super complex at times such as basic
anxiety or ADHD.
Unfortunately, that is a lot of children, but
there are other children, adolescents who do develop
(14:42):
very complicated psychiatric
challenges. And so that's who we are particularly
there for and
whether that's kind of to give some examples,
development of early psychosis,
schizophrenia, very intense OCD,
children with neurodevelopmental
disabilities such as autism or Down syndrome or
(15:03):
intellectual disability who then develop
further mental health challenges or behavioral challenges, that
those are many of the children that I
think we are
helping and well positioned to help. And it's
not realistic
that
lots of places can do that. I mean
that a lot of those things take a
lot of resources and specialization.
(15:24):
I have to agree. I think Boston Children's
is doing some things very very well that
probably aren't able to be replicated elsewhere and
throughout the country there there are states struggling
to provide certain specialties. So kids are going
across state lines to receive care Mhmm. In
certain areas.
Yes. That certainly happens. And then, you know,
another aspect is we are also trying to
(15:44):
be quite intentional though in
no one can do everything and in fact
you're not gonna be successful if you're trying
to do everything. So what can we do
really well and then who can we partner
with that they do something really well and
perhaps we can support them in some way
and kind of at least share patients if
(16:05):
not elevate what they're doing. And so we've
we've tried to be pretty intentional
about that. So we have many partnerships in
the
area and in the region. You mentioned, you
know, partnerships with others and you also mentioned
really advocating for policy especially with parity and
and things like that. Are there any other
partnerships that come to mind that that might
be worth mentioning?
(16:25):
So we're
partnering with, in order of priority, we're partnering
very heavily with schools,
and school systems and we're doing that at
a couple different levels. So
we are providing direct service in school. So
we have through our larger
network of Boston Children's and our affiliate Franciscan
(16:45):
Children's,
we have clinicians directly embedded in 22
schools in the Boston region.
And we are also providing
a couple other levels of support to a
wider range of schools, which is we have
a extensive training
program for school administrators,
school for teachers,
(17:06):
for other school mental health professionals. And so
we do a lot of training. We also
do evaluation and research in schools. So we
have a pretty large school based mental health
program
in other people's schools. We're not running the
schools. We are helping public and other schools
to do things. So they are our partners
in this and it's very exciting because that
(17:28):
isn't
where people were in the past and it's
increasingly where kind of we're seeing we need
to be. Right? Because as we go on
and access to mental health services, it's a
huge issue.
And many of the families that we wanna
reach and who need help, they are not
gonna get into Downtown Boston to access services.
(17:49):
Right? Like, we need to go where the
children
are. And so they're at school, most of
them. And so that's a huge kinda
shift really in the process. And Boston Children's,
specifically has been doing that actually for almost
twenty years. So it's impressive, but it's really
expanding. And some other partnerships just to mention
of workforce
(18:10):
in behavioral health is also a major issue
as it is for many industries, but it's
particularly, I think, in our industry. And we
are a
very much often an in person endeavor, particularly
for some of our more intensive services.
So we have to have a significant and
well trained workforce. We've kind of developed into
actively partnering now with community colleges, local
(18:32):
four year colleges, graduate schools, so that we
can really
help develop a workforce. The The days of
sitting back and waiting for people to Yeah.
Come in your door and be hired, those
are over. So we're very active in that
and our community is supporting us in that
too. Is there anything else you wanna share
with our listener group? We have a workforce
(18:53):
who, particularly in our intensive treatment programs,
we could call our direct care staff. So
these are our floor staff
who we call mental health specialists or behavioral
health technicians,
and are critical to the work that we
do. These are the staff who are with
our kids and patients
hour to hour, twenty four hours a day
(19:15):
in those environments.
And they are just as important and just
as hard to develop and recruit and retain
as the rest of our workforce. And so
we've really put a focus on that group.
And so there, we're partnering with high schools,
community colleges,
other
kind of places to help them enter and
(19:36):
and stay in our workforce. And it's a
huge opportunity
because many of those positions don't have
significant educational requirements. And so it's a huge
opportunity for people to move into the workforce
and do very meaningful
work, working with children,
you know, working in a mental health setting,
and they get exposed to all these wonderful
(19:57):
other disciplines, nurses,
medical students,
psychologists, etcetera.
And we actually see many of them then
go on those tracks. And it's very important
for us in order to be able to
deliver the care, but it's also a very
important kind of economic
escalator, if you will, for people moving into
the workforce. Just driving here, we're right past
(20:17):
the Harvard School of Medicine
the physical connection, the physical adjacency of Boston
Children's to the School of Medicine, that has
to be a benefit as well. That's a
huge benefit. I mean, we are a Harvard
Medical School teaching hospital and system. I believe
we're one of five in the city and
that is a enormous benefit because
we have Harvard Medical School learners
(20:39):
spread throughout our services,
our faculty, our Harvard Medical School appointments.
And it brings both great resources
and also a culture and expectation of teaching
and research
and excellence that we strive to to meet.
And so it's a huge benefit.
(21:00):
It's just woven into the fabric really of
of what we do.
But we're very fortunate because you don't always
have access to that kind of thing in
every city or every setting.
We're only able to do this work and
be on this incredible
journey of growth and developing new models and
(21:20):
services
because of the support we have and
that goes all the way from the board,
CEO, our senior leadership team,
to our community
philanthropists
and partners in the community And then we
have incredible
leadership within our department,
really visionary leadership with our chair, Stacy Drury,
(21:42):
and expertise throughout the department. So I'm really
grateful to be here and thrilled to be
in the midst of this. This and it's
really a generational opportunity for all of us
and certainly I feel very lucky you get
to do something like this once in a
career if you're lucky and so I feel
very lucky. Well, Boston Children's is lucky to
(22:03):
have you here. Well, doctor Siegel, thank you
very much for your time. This has been
great and very insightful. I'm sure our listeners
are gonna really enjoy listening, and they'll have
a lot to learn. So Great. Thanks for
having me.
For more information on our Listen Mental Health
Matters series,
please visit hdrinc.com/listen.
(22:25):
There, you'll find more on HDR's approach to
behavioral and mental health design, meet our team,
and see samples of our work.
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