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THE IMPORTANCE OF CHECKING IN: CHC Chief Clinical Officer Dr. Ramsey Khasho

CHC Chief Clinical Officer and licensed clinical psychologist Dr. Ramsey Khasho offers invaluable insight on what many children, young adults and families have been facing — and invites parents to take an active approach to their children’s mental health.

Dr. Ramsey Khasho has been at CHC for over a decade and specializes in working with children, adolescents, young adults and families.

The CDC’s statistics on youth mental health are alarming. Do you have specific data about the Bay Area? You can definitely extrapolate from that data what’s playing out in the Bay Area. Specific to our organization, we’re seeing an increase by 150 percent in the call volume to CHC for services. I recently read a stat that California as a state has seen a 150 percent increase in patient visits for more of the higher-risk issues, like suicide, suicide ideation and self-harm in kids. Latinx, African American youth — communities of color — are disproportionately impacted; typically, [at] twice the rate of their white peers.

What are you noticing in terms of issues affecting elementary school children versus teenagers? Generally, there is an increase across the board. We are definitely seeing more preteen and teen and young adult referrals over more elementary school-age kids. That older teen/young adult, what we call transitional age, is a big one. Being transitional age, launching into adulthood, is difficult as is. And then you add the pandemic and not being able to do college or not being able to find a job and moving back home and living with parents and younger siblings. It’s a recipe for challenges and impairments to young adults and older teens.

Were similar issues presenting among your families before the pandemic and this is an increase, or are there also new issues? It’s both. We have people who were in our system before who struggled and maybe got better, [but] are now coming back to us and saying that they are struggling again because of everything that’s going on. The other thing I want to make sure that we’re clear on is, we’re not just talking about the pandemic. We’re talking about the awakening that’s happened around racism and systemic racism and how that’s impacting young people and families. We’re talking about wildfires that have impacted our local community. We’re talking about the political divide and divisiveness. There’s just so much that young people and the community needs to carry right now.

CHC was able to scale up relatively quickly in terms of bringing on more therapists and being able to serve more young people. Just in the last five months we have hired six new clinicians, and when we hire them, [their appointments] fill up literally within a span of about two weeks. I think that speaks volumes to how great the need is.

It certainly affects parents, too. Is that something that is incorporated into treatment of the child? Our philosophy is and always has been, in order to do good work with kids and their mental health, we have to work with parents and guardians. We see kids one, maybe two, hours a week to support them in their mental health. But parents hold their kids the entire week. We need to work with parents to help them, number one, understand what’s going on with their child, so that knowledge is very powerful. And then, number two, how to best work with that child given some of the challenges that they’re experiencing. And number three: How do parents take care of their own mental health so they’re in a space that they can show up to manage and support their child’s mental health. … We’re doing a fair amount of parent-only work and parent coaching.

What should parents be on the lookout for when some issues may be more severe? We always worry about excessive withdrawal and isolation. Any marked changes to sleep habits or eating habits is another one. Marked challenges with attention, concentration and focus. Our marker of when it becomes a problem is when it becomes impairing, meaning it’s beginning to impact that young person’s day-to-day functioning. If there’s an increase in sleep problems and they’re seeing it’s affecting their energy levels, being able to attend to distance learning during the day, making them more irritable — irritability is another thing that parents need to watch out for — that’s when we get concerned. … We’re in a time where you don’t have to wait until you’re concerned to reach out for help. Reach out to a professional and just ask the questions. Is this normal? Is this not normal? Should I be concerned? One of the things I love about CHC in our clinical services division is we have free 30-minute parent consults.

Is there anything else we should know? Our kids used to have a community of adults that were able to keep an eye on them. Parents were one microsystem of their world, teachers were another, coaches were another, tutors, extended family members, aunts and uncles. All these adults who cared about a child had their eyes on that kid and were able to share concerns when they came up. … I believe there needs to be greater hypervigilance and proactive mental health awareness and action on parents’ part. Know that there are potential issues here. Know that there are less adults around your child to identify these issues. And proactively reach out and connect with your child around their social-emotional well-being, their mental health and their wellness. Ask targeted questions. You’re all that they’ve got in many ways right now.

What are some of those targeted questions? I always talk about adding some color to your questions: “This is a really difficult time and I know sometimes young people struggle with feelings of sadness or worry because of everything that’s going on. What have you noticed about yourself? Have you felt any of those feelings recently?” I also talk to parents about the importance of modeling. When you’re in a rough place, being able to share that: “Gosh, this sheltering in place is hard on me, I’m not able to see my friends, it’s making me feel isolated and sad. How are you dealing with that? Because I know you deal with the same thing, not seeing your friends.” When we as adults talk about our struggles — appropriately of course — it normalizes it and gives permission to youths to say, “Hey, these adults are struggling, too.”’ It’s OK to talk about it, and we need to talk about it.

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