Episode 18: Kennedy Krieger Institute On Supporting Adolescent Mental Health

Carmen Lopez-Arvizu, MD, Medical Director of the Psychiatric Mental Health Program at Kennedy Krieger Institute, joins the podcast to discuss how Kennedy Krieger supports the mental health needs of adolescents.

Show Notes

02:11 About Kennedy Krieger Institute

3:10 About Dr. Carmen Lopez-Arvizu

4:19 Challenges to seeking mental health care

8:38 Youth vs adult mental health

10:30 Where to start when seeking mental health support for adolescents

12:26 How early childhood experiences can impact brain development

15:03 Impact of social media on adolescents

16:25 How language barriers impact access to mental health care

19:40 Patient-centered focus

22:23 What is psychotherapy?

24:09 Improvements in the mental health industry

25:14 What is self-care

26:45 Services at Kennedy Krieger Institute

27:30 Preparing for transitions like going back to school

If you know an adolescent struggling with their mental health, connect them to MDYoungMinds. The text message support program provides encouraging messages focused on teen mental health concerns. Text MDYoungMinds to 898-211.

Kennedy Krieger Podcast Transcript

Quinton Askew, CEO and President of Maryland Information Network

Welcome to “What’s the 211?” podcast. I’m here today with a very special guest, Dr. Carmen Lopez-Arvizu, Medical Director of the Psychiatric Mental Health program at Kennedy Krieger Institute and Assistant Professor of Psychiatry at Johns Hopkins School of Medicine. So, it means we’re in great hands today.

Tell us a little bit about Kennedy Krieger Institute and the services you all provide.

About Kennedy Krieger Institute

Carmen Lopez-Arvizu, MD (2:11)

Yeah. So you know, Kennedy Krieger Institute has been around for about 30 years now. And we are primarily a rehabilitation hospital, a pediatric rehabilitation hospital.

So the area that we serve children, adolescents, and some adults across the whole institute. And, it is about brain disorders that affect some realm of life.

In my particular program, we focus on treating brain disorders that affect:

• Development
• Emotion
• Thinking
• Behavior

And we see mostly children and adolescents.

We focus in the developmental trajectory and the co-morbidities that can be present at any given time. We focus on interdisciplinary care that it’s patient focused. My program is one of several programs that address mental health development and behavior across the state.

About Dr. Carmen Lopez-Arvizu

Quinton Askew (3:10)

So, what can you tell us a little bit about what got you inspired in this psychiatric mental health field?

Carmen Lopez-Arvizu, MD (3:18)

Well, interestingly enough, it all started as being a family member. And you know, I’ve told this story many times. So, if anybody’s hearing it again, I apologize. But it was really what started the fire on, like what I call my personal mission.

So, my uncle had a traumatic brain injury when he was about 18. He fell off a moving truck back in the day when people ride the pickups in the back. And he had significant behavioral problems afterward. So, living with somebody, at that time as an adult, and experiencing the difficulties, the barriers for care, and the realities of being a family member with somebody that needed so much support in daily life was what kind of brought me to the neurodevelopmental disabilities world.

At that time, the lifeline for us was the psychiatrist. That’s all we had access to. And, he was really a very important part of me making a decision to go into that field.

Challenges to seeking mental health care

Quinton Askew (4:19)

Well, thank you. Thank you for sharing that. You mentioned psychiatric mental health a couple of times. Is psychiatric and mental health the same thing?

Carmen Lopez-Arvizu, MD (4:27)

You know, this is very interesting. The name of the clinic, I didn’t pick it, just to say. But, I think the word psychiatry has a lot of negative connotations and implications that are historical.

So, it is sometimes very difficult to explain what that means. It is an area of medicine that addresses brain disorders and mental health. So, they go together.

In other disciplines that are non-medical, the label mental health or behavior is what applies.

But yes, the reality is that psychiatry is the branch of medicine that addresses mental health related to any kind of brain function.

Quinton Askew (5:11)

Perfect. Thank you for explaining that. So, you know, with your vast experience in the field, can you share insights on the current landscape? What do you see as some challenges for folks that are often seeking treatment or just challenges you’ve seen in general?

Carmen Lopez-Arvizu, MD (5:25)

There’s definitely barriers to care. And. it has different levels. One of them is systems. The other one is definitely the stigma. Which one do I think it’s harder? I think stigma because stigma affects systems and affects the way in which people get services, reimbursement, and workforce because people want to do good and want to start in a path of career to support other people in mental health. Definitely the stigma of even belonging to this group of healthcare professionals, it’s a stigma that we actually carry.

So, it’s very interesting how stigma is really what moves and is the primary barrier to all of it.

Now, the second one is access to services. It is very difficult to know in the bigger landscape what door to knock.

• Where do I go?
• People are confused about what do I see – a therapist?
• And what does that mean?
• What kind of discipline is a therapist?
• What kind of treatment are they going to offer?

So, I think it’s confusing if my child is having some behavioral difficulties. Or maybe it’s having some concerning depression.

• Where do I start?
• Where do I go?
• What door?
• Do I go into therapy?
• Do I see a psychiatrist?
• Do I go to the hospital?
• Do I go to the clinic?
• Where do I go?

I think we need to do better, as healthcare professionals, to establish better access and be clear on what services do we offer from the start.

Quinton Askew (7:02)

That’s great. With the stigma, that’s some of the things that we’ve been focusing on a lot here, too, in Maryland, and across the state with stigma. Do you see organizations becoming more supportive and kind of helping patients in the public around, you know, stigma? It’s okay to receive help, and, come to us for this help? Or still many barriers for, you know, individuals who are kind of ashamed to?

Carmen Lopez-Arvizu, MD (7:27)

I absolutely think that the stigma remains. We talk about it. I often say this, but I believe it. I’m done with the talking. We need to have action. And you know, we can talk about stigma, but until we actually do something about it, until we actually are more open and more receptive, and not segregate people that have mental health problems from the bigger healthcare system, it’s going to continue to be stigmatized.

So, we definitely need to have the action. We see often individuals that have mental health problems. You know, you hear it in the media, everywhere. People talk about words that are inappropriate. And, words matter!

You know, people that are crazy. People, they’re insane. They make fun of and make jokes about these kinds of things that perpetuate the stigma. And you know, I often always say that it’s so funny until somebody you love is the one that is experiencing the difficulty. There’s nothing funny about having a mental health difficulty, a mental health diagnosis or mental health symptoms. It can be devastating. And we know it’s life-threatening.

Youth vs adult mental health

Quinton Askew (8:38)

Thank you. That is also true. As someone who has dealt with several family members with their mental health, including myself, as you said, the stigma is one of the important things. And so, you always see the psychiatric mental health program for youth and adolescents. What differences do you see, with youth experiencing mental health issues than adults? Is there a difference?

Carmen Lopez-Arvizu, MD (8:58)

There’s definitely a difference. And there’s also a difference between younger children and adolescents. And then adults.

People talk and joke about how “Oh, the terrible twos are the worst. Well, those are the best years because you can pick up your kid and move them, and they still have to do what you want them to do.

Making an adolescent do something that you want them to do that is a whole new different reality. If you cannot make them make their bed, what do you think happens when somebody needs mental health treatment and they do not want to participate? That’s a huge barrier.

Many times as a parent, you can make an appointment, but you cannot make them attend. You cannot make them participate and really engage in treatment, which is, I think, one part of education that we need to do better in health care about. What does treatment imply?

And then the other part about adults is that it applies similarly in the sense that you have to want to participate in treatment, and you have to be able to engage in treatment.

One of the difficult parts, especially in transition age when you have a child that turns 18, you cannot make them seek treatment. And in most places, they will not even talk to you. Because they are an adult. They have the right to refuse treatment. So, it can be a very difficult situation.

I would say transition years are very difficult. And, it is very important that whenever we see kids that are adolescents, the process of transition and how the mental health treatment landscape changes. So, it is very important to be informed.

Where to start when seeking mental health support for adolescents

Quinton Askew (10:30)

Okay, just want to go back to one quick thing you mentioned in reference to where parents or individuals were coming in seeking services and the difficulty knowing where to start.

How does someone know where to start if I’m having certain feelings? Or, you know, I’m acting out with mom or dad? Or, just mom is struggling. When folks come, where do they start?

Carmen Lopez-Arvizu, MD (10:50)

So, I always suggest, because the closest door to most people is to start with your primary care. So, if you speak with the kids, they usually have a better connection with their pediatricians who knows them from life. The pediatrician might be able to have a first round of assessment to see how to guide them to treatment; then the second option is approach somebody that they can refer you to.

Also, other things or other people that are part of your life. You know, it might be maybe somebody from your faith, somebody that is from church. Maybe they’re more comfortable with your pastor or with somebody that is the youth group leader. Somebody else. Or, it might be a teacher that they want to approach. So, that’s the first line.

And then the second line, I would say, if you can start with a psychiatric evaluation. That is great, but it will be probably a little bit harder to get. So, approach anybody that can offer you any kind of psychotherapeutic support.

Now, one thing that I think is very important – we talk about healthcare, consumers, and mental health is also very diverse. And there are a lot of different disciplines that can be confusing to people. It is very important that you educate yourself as a consumer. Ask, okay, I have some concerns about depression or my child is behaving a certain way.

• What are your credentials?
• What are you going to offer me?

So, I think that is very important. So, a psychotherapy of some kind. But ask the questions.

• What kind?
• These are my goals for treatment. Can you help me reach them?

How early childhood experiences can impact brain development

Quinton Askew (12:26)

Thank you for that. I also would like to also offer the state’s 988 line, which is federal line. It’s available 24/7 for anyone to access that can offer quick assistance to crisis support, as well.

So, how do experiences in early childhood shape a person’s development? If someone’s starting early, and they may have some signs of symptoms of depression or trauma experiences. Does that continue as an adult if it’s not treated or not treated properly?

Carmen Lopez-Arvizu, MD (12:55)

All early experiences shape who we become as adults, just like my past experiences made me who I am today, and the reason why I’m here, and my personal mission in life.

So, whatever we experience, good or bad shapes us. We do know that things like trauma, have an effect on even our genetic build as we grow and develop. It shapes your brain, and the way the experiences you have shape the future responses. Trauma is an example. When you experience trauma as a child, it will shape the funeral responses to a similar event or something that resembles a traumatic event that you responded to before.

We know that parenting is very important. We know academics and school experience are very important. And, all of those details and all of the exposures that you have as a growing individual will affect your future trajectory. That’s what we call epigenetics. You know, everything that surrounds you shapes you.

When you address a child, and this is across the board, you don’t address a child in a bubble. What matters is everything that surrounds them, their immediate environment, being the close family, parents, and siblings, but then it doesn’t stop there. It’s the next step too. Neighborhoods, schooling, city, state, everything that surrounds you. Not only your immediate family but the socio-political environment that is next to you. All of those things shape the way you respond to an event. So, nobody can be seen in a bubble. You have to always consider the context.

14:43

That’s great, and so sometimes we may try and work with the person to provide the services, but the environment and other areas can also play contributing factors, and you cannot ignore that.

14:52

If you think you are going to be addressing just the individual in front of you, you are not doing your job correctly. You have to think about the context.

Impact of social media on adolescents

Quinton Askew (15:03)

15:03

We are in a world where social media and the Internet is readily available for our youth. In your opinion, what role does that play in the mental health of our youth today?

15:14

I think it has good things and bad things. I think social media has added a lot of opportunity for education, but at the same time, it has allowed for a lot of mis-education and information and perpetuation of stigma or perpetuation of incorrect information because anybody can put it out there. So again, we go back to being an informed consumer. We need to be aware of who is saying what and what are they basing their sayings on.

Now, it is very difficult, especially as a parent, because you do not know, or you might not be so savvy, technically, about what your child is looking up, and you might not even be aware of, what are those things that they’re looking at. It is very important that you have communication and open communication with your child. So they are able to share with you what they are looking into.

I think social media, and in general, the internet has opened up a way for us to exchange information that is very relevant and helpful to all of us. But, it has also opened an avenue for misinformation and to be exposed to things that otherwise we would not be exposed to. And that involves negative experiences.

How language barriers impact access to mental health care

Quinton Askew (16:25)

Maryland is such a diverse state. How do you think cultural language barriers impact someone’s ability to either communicate their health needs or just access health care professionals in our state?

Carmen Lopez-Arvizu, MD (16:37)

Yes, I do see it. And I agree with you, even though we at Kennedy Krieger we have interpretation services, but even then, there will always be little cracks for people to fall into if you’re not careful about it. For initiation of services, you have to call in a number, or have an email, or have the ability to connect with somebody. And, I think that first step is very difficult if you do not have access to an interpreter service, or if you do not have the ability to explain in words that are similar to what is used in mental health to access the services you want. We often hear the words, “We need. I need, my child to be evaluated.” And that can mean all kinds of things.

So,  the context of what you’re asking might be different in different languages. So, there is definitely a barrier for access to services.  

Depending on where you are located in Maryland, you might have some more access to some of the languages or not others. And, it gets very tricky.

Now in mental health in particular, it makes it a little bit more complex. Now I’m of Hispanic descent. So, I am very aware of the different cultural perceptions of mental health in the Hispanic population. I try to do my best to connect and explain to our access people how to ask the questions. So, I think that it’s important to be culturally competent whenever you deploy any kind of services, including just an intake line.

[Editor’s Note: If you or someone you know needs help navigating health and human services, call 2-1-1. Translation is available in 150+ languages.]

Quinton Askew (18:18)

Cultural competency is very important.

What would be your advice for someone who’s struggling with their mental health, you know, hesitant to seek help because there may be a cultural or language barrier, or just any general other related reasons?

Carmen Lopez-Arvizu, MD (18:33)

You know, I think that is tricky. That’s very, very tricky part because you always have the aunt that has an opinion on what you should or should not be doing. And, I think whenever somebody has any kind of mental health concern, you need to think of you first. You hear it all the time when you go on a plane,  they always tell you to put your oxygen mask on first, and then you help the others. If you do not take care of yourself, you cannot help anyone else. Nothing else matters. You need to focus on getting treatment for yourself.

We don’t think about the treatment of a disorder. Think about well-being and perpetuating and improving your well-being. So, words matter. And, I think the history of the psychiatry ward is a problem. And, it really kind of still remains a barrier and a cultural stigma for people to accessing services. So, think about well-being. Don’t think about a disorder. Address you first. Because if you are not okay, you cannot take care of your parents, you’re going to take care of your children, you cannot work you cannot do anything else. So, you need to focus on what makes you better.

Patient-centered focus

Quinton Askew (19:40)

Is there any particular things that Kennedy Krieger does to ensure that it has a patient-centered focus and are really focusing on the individual?

Carmen Lopez-Arvizu, MD (19:58)

Yes. So, we are not perfect. I’m the first one to say that.

So, one of the things that we are working on very hard is to revamp our access and our intake, you know, our main door to be able to provide the services that you are asking for, but most importantly, the word that you need, and it will be patient first and family first. That’s our first step.

Quinton Askew (20:22)

How does collaboration play a role in that? I know that you mentioned you have to take care of the individual but also the community. In other areas, do partnerships and collaboration also help?

Carmen Lopez-Arvizu, MD (20:32)

So, one of the things is that just as that child you cannot address in a bubble, you have to also collaborate with other disciplines that work with this child. So, it is very important with me as a psychiatrist to have communication with a therapist that is addressing the needs of this child, the parents, and have feedback from the school.

We do have some collaborations across the Institute regarding education, health, nurse, education, and we have also a podcast, [Editor’s Note: The podcast is called Your Child’s Brain] with WYPR, where we cover different topics of health. We really are working on one thing, that I think is part of our biggest mission, which is collaboration and education. I mean about education about health care.

One of my main goals is to make sure that I prepare others to be able to take my place when I’m gone, hopefully not until I am gone. Not before. So, we do have child psychiatry fellows, there are physicians that are here in their last two years of training, to get to see more patients and more experience and we participate on those efforts. We have postdoctoral psychology trainees and interns and externally as well in our clinic.

And, the one other thing that we are actually launching and studying recruitment in January is we’re going to do a social work clinical fellowship to train social workers in evidence-based psychotherapy.

So, our biggest workforce that you will see around are social workers that do psychotherapy, and we have those in our clinic, we have all of that. The importance of the role is something that I’m not sure has been always in the forefront. And, we are going there. We do want an interdisciplinary workforce. So, we hire them, and we train them here. We want to continue to do so.

What is psychotherapy?

Quinton Askew (22:23)

What will psychotherapy provide?

Carmen Lopez-Arvizu, MD (22:27)

Psychotherapy for mental health, and I often say this is in comparison with physical therapy. When you have sprained your ankle, you do not run a marathon the next day. You take time, you have to go to physical therapy, they teach you what exercises to do, how to decrease the pain, and how to improve your strength. So, you can go back to running, and then you go little by little and you start taking step by step until you’re ready to run again. And then, once you can run a marathon again, you do it on your own, and you use the tools and the exercises that you learn in physical therapy to do so. That is the equivalent to physical therapy for the soul. That’s psychotherapy. You learn the tools, you learn the exercises, they do them with you, and then you go on your own and continue them. So, you can run a marathon again.

Quinton Askew (23:14)

That’s a great analogy. You know, Maryland is pretty lucky to have a great cause and a network of crisis centers here. You mentioned the importance of early intervention. How important is early intervention as a young adult or an adolescent just seeing a therapist, if it’s needed?

Carmen Lopez-Arvizu, MD (23:37)

Even at a very early age, if you notice that your preschooler is having difficulties, you need to address them. When school starts, if you’re having any kind of behavioral difficulties or emotional distress, it’s going to affect your learning. And remember, you’ll learn everything that you need to know in third grade. So, if that interferes in your learning, it’s going to follow you for the rest of your life. So, the moment you see it, you need to move on it. It will affect not only academics but it will also affect peer interactions. So, it’s both of them.

Improvements in the mental health industry

Quinton Askew (24:09)

Interesting, interesting. So, just being in the field as long as you have, in your experience, have there been any good advancements with trends that you’ve seen in the mental health field that look promising or exciting? Do we look forward to it?

Carmen Lopez-Arvizu, MD (24:21)

I’m not that old. Thank you Quinton.

Quinton Askew (24:24)

From experience.

Carmen Lopez-Arvizu, MD (24:27)

So, I think there’s certainly been a change for the good of a little bit more acceptance. However, I think there’s still a lot more to do, especially in educating that group of teenagers that are so difficult to engage in treatment. You cannot make them participate in treatment, but we can educate them about how this intervention might help them in the future. I think we have to do better on that. Also, it’s a good education in educating the parent when a child has a difficulty is not here, fix my kid. We are a team. I need you to be part of my team. We can do this together. But, it cannot be only the kid alone or me alone. It has to be all of us.

What is self-care?

Quinton Askew (25:14)

You also mentioned earlier the role of self-care. Can you explain what that actually means? And even for yourself? Like how do you how do you provide that for yourself?

Carmen Lopez-Arvizu, MD (25:25)

We often put others needs first before you.

If you have children, they probably all went to the dentist, you took them to the pediatrician, whatever. But,…

• Did you go to your primary care?
• Did you take a walk to clear your mind?
• Are you doing exercise?
• Are you eating healthy?

Because the world gets into your life and into your determination to improve your quality of life. The reality is, that if you do not give yourself a little bit of time for yourself everything else will get there. You know, it will fill the void.

So, you really need to think about how to put your oxygen mask on first before you help everybody else.

Carmen Lopez-Arvizu, MD

This message is really important when we see any children as patients, to address this for the parents. Many times they will be absolutely present for the kids’ appointments, but they will not address their own mental health. So, just like go to the dentist. Go to the other things. Well, yeah, yeah, yeah, I’m going to focus on Johnny first. Well, you know, then you’re going to have a cavity. And then it’s going to be worse if you do not do the preventative measures. So, it’s very important to have a balance.

Now I say this, do I do it? I’m not that great at that. But, it’s one of my goals for this year. It’s a goal.

Services at Kennedy Krieger Institute

Quinton Askew (26:45)

How can someone learn more about the services that Kennedy Krieger?

Carmen Lopez-Arvizu, MD (26:49)

Well, we have a website, Kennedy Krieger Institute. We’re always and forever trying to improve the access and the view of it so it’s easier to navigate. So, that’s the best way to go because all the programs or the services or the phone numbers are listed in.

Quinton Askew (27:05)

I also want to say before we kind of wrap up. I’m still forever grateful that you reached out to us to help us to better understand how to make sure that we make our language more helpful and adaptive to the populations that we’re serving. So, I definitely want to thank you again, for just reaching out to us and offering your guidance about being able to support those who are in need.

Preparing for transitions like going back to school

Definitely, thank you again. In closing, is there anything else that you would like to share that we need to keep in mind as summer is winding down and we’re getting ready for school?

Carmen Lopez-Arvizu, MD (27:34)

One of the things that we see more often is transition. You need to start preparing for school time. Make sure everything’s ready and be prepared. Every transition is difficult. So, when we’re talking about maybe the last school year, or the first grade, all of those little details might be simple to us as adults, but the kids are experiencing them now. So, it’s important to remember how things work for you at that time.

I’m not saying and I will never say, we were all in the same boat or I have been in your shoes, because that’s not true. We’re in the same ocean, but we are all riding different boats. And, I think it’s very important to remain aware of our differences and similarities whenever we make a recommendation or where we try to connect with somebody, I think that is very important.

Carmen Lopez-Arvizu, MD

Quinton Askew (28:27)

Thank you. That is great information. Dr. Lopez want to thank you again for taking the time to speak with us and we do appreciate your partnership and words of wisdom. Thank you.

Carmen Lopez-Arvizu, MD (28:36)

No, thank you for having me. I think one of the things that I can really tell you is that I’m speaking from experience, I am a first-line mental health clinician who lives in the system and addresses these issues every single day. So, I am very grateful for being given the opportunity to share my experience.

Quinton Askew (28:57)

Thank you so much.

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