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Today's guest says, A major driver
of today's youth mental health
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crisis may be the inaccessibility of
timely, effective mental health care.
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Dr. Jessica Schneider aims to
solve this problem with a bold
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evidence-based approach, single
session interventions or ssis.
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These are structured research-backed
programs designed to deliver
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meaningful mental health support to
young people in just one encounter.
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Her research shows that even
one well-designed session can
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lead to lasting improvements in
youth and adult mental health.
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She's an associate professor of
medical social sciences at Northwestern
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University, Feinberg School of
Medicine, and the director of the
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lab for scalable mental health,
where she's experimenting with what
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accessible, scalable care can look like.
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We welcome her to the show today to talk
about her research and the power of a
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first and only intervention, and the fight
against the youth mental health crisis.
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Welcome to the show.
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Thank you so much for having me.
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Well, it's wonderful to have you here, and
I first want you to set the stage for us.
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You've described the youth mental health
crisis as not only a crisis of increasing
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illness, but of inadequate access.
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Talk to me about that, and what do
you think are the most important
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factors driving this crisis that
we're seeing here in America?
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So this crisis is nothing new.
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Although I think that the news media
and public conception of the crisis has
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really spiked since the onset of the
COVID-19 pandemic and the sudden loss
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of access to supports that many folks,
especially young people experienced
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across the country in the world.
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But there are really three
driving factors among many.
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But three that I think are particularly
important in helping us understand
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why this crisis has emerged.
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First of all we've spent, you know,
50, 60 years as a field clinical
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psychology, psychiatry, mental
health research, identifying and
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developing effective interventions
for youth mental health problems.
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Unfortunately.
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Those interventions are broadly
not being delivered and not being
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accessed by those who need them.
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And today about 80% of young people with
significant mental health needs in the
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United States don't ever access services.
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That has to do with a variety
of barriers that they face,
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including provider shortages.
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That's a huge one.
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Yeah So there simply
aren't enough providers.
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There's not enough supply to
meet the immense demand for
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youth mental health support.
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beyond provider shortages, a second reason
that many youth fail to access mental
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health support when they need and want
it is because supports aren't located
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where youth can actually access them.
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Most traditional evidence-based supports
or if therapies in general are located in
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health systems sta freestanding clinics.
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Places where youth have to actively
travel to and the logistics of
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traveling and continuously paying for
services are often infeasible for many
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families in need who are facing all
sorts of logistical barriers to care.
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Youth, if we, if we actually talk to
them and ask them how they'd like to
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access and seek support, most of them
say, well, I just go on my phone.
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Or I just go online or
I talk to my friends.
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So supports aren't located where
youth are actually looking first
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and sometimes exclusively for
the support that they need.
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The third reason that so many
interventions don't have their
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intended effect for youth is because
despite our efforts to develop
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multi-session interventions that last
weeks or months that are effective.
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The most common number of times that
somebody actually interfaces with any form
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of mental health support based on national
insurance reimbursement data is one.
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So we've spent a really long time
creating treatments that simply
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don't match how people are actually
interfacing with healthcare.
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This one single encounter covering
this, was this a big revelation in the
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mental health community that folks are
only really having this one encounter.
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I wanna say that it was a big joint
revelation and we all realize this
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together and are collectively shifting
our, our thinking and models of care.
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But not so much.
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This statistic is often news to
audiences I present to of my colleagues.
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Despite working in the field for.
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Sometimes many decades often, you
know, clinical psychologists and
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psychiatrists are trained to treat folks
who do show up for services, right?
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These are the lucky 20% of individuals
who get through all of these
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difficult barriers, get in the door.
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And although early dropout as a,
is a common concern many of these
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clinicians aren't close enough
to the problem to really see the
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scope of it across the nation.
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So.
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I do think it's been a bit of a blind
spot for clinical psychologists who
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are, of course, because that's all that
we are exposed to, operating from the
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perspective of serving those who are able
to get through all of those obstacles.
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You actually published a study in
JAMA Pediatrics where you found
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that state parental consent laws
also have a miserable impact on
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whether or not teens get treatment.
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What does that mean?
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Talk to me about these state
laws and the significance that
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this has on these barriers to
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Sure.
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So this is so important to our
work right now and in shaping
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how we think about what truly.
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Scalable interventions need to look
like because it's not just the logistics
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and the cost of care, it's also
policies that make them intermittently
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accessible to young people who need them.
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So what we've learned throughout our
research with youth digital mental health
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interventions and youth interventions
in general, is that we get very, very
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different populations of young people
and very different sample sizes when we.
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Require parental consent for youth
to take part in our trials, which
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is standard versus when we secure
a waiver of the requirement.
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That's typically there for parental
permission for adolescents to self-refer
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into interventions, specifically
when we waive that requirement.
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When adolescents are suddenly empowered
to choose whether or not they want to try
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out a low intensity, safe mental health
tool that they can go through completely
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on their own, we get far more diversity.
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The folks coming into our studies,
we get racial ethnic diversity
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that is totally uncharacteristic
of traditional clinical trials.
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We get sexual and gender minority
participants that would otherwise
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be excluded from care often
because they're not comfortable
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asking their parents for help.
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And that led us to dig into
what is it about this single.
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Change this requiring or not
requiring parental permission.
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That makes a big difference.
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So we started doing qualitative
studies with teens and when we asked
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teens who couldn't access care for
depression, which is one of our
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focus areas, what got in the way?
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I. About 32 to 42% across multiple
samples said it was their families,
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their parents not necessarily that
their parents were declining their
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requests to seek out treatment, but
that they simply weren't comfortable
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going to their parents to ask for help.
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And if you live in a state where a
parent is required to refer their
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under 18-year-old child for treatments,
and you're not comfortable going to
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your parent, you are out of luck.
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So we, we decided to do a policy mapping
study, which was the one that was
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published in JAMA Peds late last year.
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And we actually found that state level
policies have a measurable impact on
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their own, on whether or not teens
with depression access treatment.
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mean, could this be a message to parents
as well, the results of this study?
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What could parents take away
from this new information?
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I think it's a message to everybody who
cares about young people's mental health.
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And I think it's a prompt and
reminder for parents to proactively.
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Approach these kinds of conversations
with their, with their adolescent
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children in particular, but
also their younger children.
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So they grow up knowing that
they're able to ask for help in
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the environments that they're in,
and they know how to ask for help.
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So modeling that early on.
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Signaling acceptance of support, seeking
and signaling that you're going to be
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there for your child and you're going
to help them and advocate for them.
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And finding the support they
need is critical because if those
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conversations don't happen, teens
are left being uncertain and
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hesitating at points of actual need.
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Well, your research lab, you are
really going all in on these single
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session interventions and in a recent
study you published in the annual
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review of Clinical Psychology, you
confirmed that these single session
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interventions can significantly
improve mental health outcomes.
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So talk to me about this, your approach,
what's happening right now, and.
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How you're designing these
interventions to work in your lab?
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Absolutely.
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So I wanna preface this by
saying that, well, two things.
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First of all, I don't believe that single
session intervention should replace
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anything else that is already available
in the mental healthcare ecosystem.
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That's one of the initial questions I get
from fellow clinicians and colleagues in
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my field is, but how can you say that all
treatments should just be one session?
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That's not what I'm saying at all.
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I am saying that we need something like.
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Single sessions and other types of low
intensity interventions to bridge the
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gap, that would be totally unfillable.
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And we know it's already unfillable
by existing interventions.
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So that's the first piece.
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the second piece is that single
session interventions are nothing new.
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I did not invent them.
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They have been practiced
since before I was born.
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So the first book that was published
on single session interventions came
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out written by a clinician named
OSHA Talman an Israeli psychologist.
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Who had been practicing single
session therapy in his, his practice
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and finding that one session was
sometimes surprisingly impactful
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and reduced the need for additional
care for many of his clients.
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And so we're building on a long
history of practice based evidence.
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As well as drawing from brief
intervention research and other
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neighboring fields to psychology,
like social psychology and public
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health, which aren't often integrated.
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But those are the histories and
traditions that we're drawing
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on in, in doing this work.
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So it's not just us my journey
into studying single sessions
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started more than 10 years ago.
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As a graduate student in clinical
psychology, I got incredibly
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frustrated working in you know,
low resource community clinics and
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seeing that many families that I was.
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Treating could not come back
after the initial assessment
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by no fault of their own.
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And all I do in the initial
assessment is ask a bunch of questions
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that don't actually help them.
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So I started to wonder, is there
something I could be doing in that
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first session that could help them
even if they couldn't come back?
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So I started looking into the
literature and found there was a whole.
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scope of studies on this topic, but they
were all kind of called different things,
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so nobody had synthesized all of it.
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And that initial meta-analysis that I
published in 2017 became the basis for
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the work that my lab does studying what
can be accomplished in a single session.
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So in terms of how we think about
developing and designing single
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session interventions we think
of single session interventions,
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first of all, as an umbrella term
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that can include, supports that
are designed to affect some kind of
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clinically meaningful change in one
encounter that can be either digital
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and self-guided interventions.
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So things completed online or
on devices and things that are
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provider delivered, delivered by
clinicians, either lay providers,
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so providers without professional
training or licensed professionals.
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And we see the digital single session
interventions as bridging gaps for folks.
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Who don't ever make it in the front
door of a mental health clinic, right?
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Folks who are looking on social media
for support, who can be connected with
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a digital single session tool right
away, whereas the provider delivered
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single sessions, we see as more bridging
gaps within healthcare systems, such
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as for folks on long waiting lists for
treatment, which were a huge problem and
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actually lead to deterioration if they're
too lengthy once folks seek out help.
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So in either case.
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These single sessions are structured such
that they promote a sense of autonomy.
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The idea that, you know, your
actions affect your future.
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The notion of relatedness, like there's
somebody out there who understands
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and cares about you and has been
where you are and gotten through it.
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It.
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And competence, like all of the ssis
teach a really specific granular skill
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that helps somebody learn better how to
deal with a problem in front of them.
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And those facets, autonomy
competence and relatedness.
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Those are really the mechanisms
of change through which a single
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session encounter can help people
take that best next step towards.
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future that's better, that's valued.
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And that's a little bit freer
of their, of their symptoms.
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You mentioned tools that someone can
take away from this one time encounter.
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Can you gimme an example of
what those might look like?
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What tools they could
take out into the world?
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I.
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Absolutely.
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These tools are also nothing
new to psychologists.
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We've been studying them in longer term
multi-session interventions for decades.
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But each single session intervention
essentially takes a kernel of a
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longer multi-component evidence-based
treatment and synthesize it down
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to a unit, a minimally viable unit
that can still have an effect.
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So one of our interventions, as
an example, teaches the idea that.
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What you do can shape how you feel.
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It's extremely simple.
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But what that corresponds to is
the skill in cognitive behavioral
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therapy of behavioral activation.
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So we help people understand
through interactive, self-guided
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exercises personal mood experiment
that we guide people through and
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the creation of an action plan.
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We actually show and tell
them, here is how you can take.
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Steps to engage in activities that
you value, that make you feel like
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you, to help you support a better
mood when you're feeling stuck.
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And every single person who goes
through this behavioral activation,
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SSI, which we call the A BC
project, action brings change.
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They end up with a personalized
action plan for taking valued
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based steps in their own life to
manage their mood more effectively.
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And this is one of several single
session interventions that we've
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tested in large RCTs, randomized
controlled trials found actually can
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reduce adolescent depression even
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Wow.
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later compared to active
control conditions.
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And it's available for free for
anybody to use on our lab website.
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And your lab website has a lot of tools.
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I mean, how many different projects
are you piloting right now with these
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digital tools?
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Too many arguably.
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We, I mean, the goal is to create
single session experiences, encounters
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that are accessible anywhere, anytime
for whatever problem or difficulty
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somebody happens to be presenting with.
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So we need a library of them.
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To really be able to pivot so people
can select, that's what that problem is.
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The one I resonate with that
skill is the one I need right now.
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I'm gonna try this one.
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00:15:38,728 --> 00:15:42,988
And especially, you know, if time is so
precious, and especially for folks who
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are not necessarily treatment seeking,
who are finding these interventions
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online, while they're scrolling through
a social media feed, we need to make sure
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we're hitting exactly the right target.
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So as a result, we're.
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Testing, deploying, disseminating,
implementing at least, 20 different
265
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single session interventions in different
settings all over the country and the
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world, including primary care schools
within social media platforms, is just
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in time supports for folks who type for,
for example, suicide into the search bar.
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So indicating that they
need some help right away.
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Through one of our nonprofit partnerships,
they actually do get offered a single
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session intervention in those moments.
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So we're, we're trying all the things
we can think of to figure out how to
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disseminate these brief interventions
that we have sufficient evidence for
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at this point to really scale up.
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00:16:31,783 --> 00:16:34,363
And you mentioned these are
going to people around the world.
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Accessibility huge part
of what you're doing.
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These are coming to folks in their own
native language in many cases as well.
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00:16:41,113 --> 00:16:44,713
Tell me about this undertaking
and how important it is to add
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00:16:44,713 --> 00:16:47,053
that kind of cultural competency
into what you're doing.
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I.
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Sure.
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So we've been incredibly fortunate
as we've expanded this work.
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And I think because we make all of our
intervention materials freely available,
283
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which is unfortunately atypical in the
intervention science field colleagues
284
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and, and, and potential collaborators
all over the country have approach
285
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and, and the world really have, have.
286
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Reached out to our lab asking if they
can embark on a project, a collaboration
287
00:17:13,040 --> 00:17:17,540
to culturally adapt and translate
the evidence-based digital single
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session interventions that we've built.
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00:17:19,296 --> 00:17:24,006
So we've been in incredibly lucky to
partner with so many different folks and
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00:17:24,006 --> 00:17:26,466
talented individuals to do just that.
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00:17:26,628 --> 00:17:30,411
The suite of single session digital
self-guided tools for teens on our
292
00:17:30,411 --> 00:17:33,831
website are now available in at
least nine different languages.
293
00:17:33,831 --> 00:17:36,381
We're working on several more
that will be posted soon.
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it's been a really rewarding process, not
just to build these interventions for,
295
00:17:41,541 --> 00:17:43,743
youth living in parts of the world where.
296
00:17:43,973 --> 00:17:47,573
The mental health infrastructure for
young people is non-existent, but
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00:17:47,573 --> 00:17:53,273
getting to actually test the utility and
acceptability and effectiveness of these
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00:17:53,273 --> 00:17:57,823
interventions in different languages such
such as Polish and Ukrainian and Arabic
299
00:17:57,823 --> 00:18:01,423
and Spanish, and a host of of others.
300
00:18:02,143 --> 00:18:05,641
But it's, it's been really exciting
to see, how much this model
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of providing support resonates
302
00:18:07,621 --> 00:18:12,391
with what folks who are close to the
daily problems and accessibility actually
303
00:18:12,391 --> 00:18:14,041
see as, as being a good solution?
304
00:18:14,386 --> 00:18:18,646
Can you share some anecdotes or success
stories with me of what you've heard as
305
00:18:18,646 --> 00:18:20,716
a result of some of these interventions?
306
00:18:21,451 --> 00:18:22,171
Absolutely.
307
00:18:22,171 --> 00:18:27,991
So one of our team's favorite parts of
doing this research is going through
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00:18:27,991 --> 00:18:32,521
the qualitative feedback, the written
feedback that we get from adolescents.
309
00:18:33,661 --> 00:18:36,361
On how they responded
to our interventions.
310
00:18:36,663 --> 00:18:40,983
much as I love to see the numeric
points on their depression score
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00:18:40,983 --> 00:18:46,803
go down months later, it's a little
bit more exciting to see them write
312
00:18:46,803 --> 00:18:51,243
a personal note to you that says, I
feel understood for the first time.
313
00:18:51,693 --> 00:18:55,773
Or, I feel like I can talk, I can
verbalize what I'm experiencing now,
314
00:18:56,073 --> 00:18:58,623
or I feel ready to ask for more help.
315
00:18:59,013 --> 00:19:01,413
And that's really important
too, is what we see is.
316
00:19:01,813 --> 00:19:05,293
Not only are the single session
interventions that promote, you know,
317
00:19:05,293 --> 00:19:10,663
autonomy competence relatedness,
helping to reduce symptoms directly,
318
00:19:10,663 --> 00:19:13,213
but they're also supporting young people
319
00:19:13,483 --> 00:19:18,583
in feeling motivated and able to ask
for more support if they need it.
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So the effects are, are really twofold.
321
00:19:20,806 --> 00:19:26,176
I think one of the, the best ways to
see the, the impact that Teens report
322
00:19:26,176 --> 00:19:31,036
having from these interventions is to go
to our website and click on Project yes.
323
00:19:31,276 --> 00:19:33,826
Project, yes stands for Youth
Empowerment and Support.
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00:19:34,606 --> 00:19:40,006
And if you click on the advice center
in Project Yes, that is actually, a
325
00:19:40,006 --> 00:19:44,296
repository that we keep, because after
every single session intervention that a
326
00:19:44,296 --> 00:19:47,716
team completes, we ask them, Hey, do you
wanna give advice based on what you just
327
00:19:47,716 --> 00:19:49,456
learned in your own experience to others?
328
00:19:50,656 --> 00:19:54,196
And if you want us to, we'll share
that advice publicly on our project.
329
00:19:54,196 --> 00:19:54,676
Yes.
330
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And anonymously on our project Yes.
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00:19:56,986 --> 00:19:57,526
Website.
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00:19:57,826 --> 00:20:01,876
So you can actually scroll through
and see feedback from teens.
333
00:20:02,416 --> 00:20:05,776
Across the country and across the
world on what they learned from the
334
00:20:05,776 --> 00:20:09,766
interventions and what they would advise
their peers to do in times of distress.
335
00:20:10,786 --> 00:20:14,026
Which I think really speaks to the
impact that these interventions can have.
336
00:20:14,026 --> 00:20:16,486
And of teens to
337
00:20:16,546 --> 00:20:16,846
Hmm.
338
00:20:16,966 --> 00:20:18,616
wanna help themselves,
but help others too.
339
00:20:19,381 --> 00:20:23,101
I mean, this whole project in your
lab is a really beautiful illustration
340
00:20:23,101 --> 00:20:25,531
of implementation science in action.
341
00:20:25,771 --> 00:20:26,071
Tell
342
00:20:26,206 --> 00:20:26,496
Tell
343
00:20:26,496 --> 00:20:26,656
me.
344
00:20:26,851 --> 00:20:30,121
Tell me about moving your lab here
to Northwestern and the Infras
345
00:20:30,181 --> 00:20:33,271
and the infrastructure here that's
allowed you to really dive into
346
00:20:33,271 --> 00:20:35,671
this implementation of the research.
347
00:20:36,166 --> 00:20:36,886
Absolutely.
348
00:20:36,886 --> 00:20:43,426
So this move was just so ideal
for the work and mission that we
349
00:20:43,426 --> 00:20:45,166
share in, in, in so many ways.
350
00:20:45,166 --> 00:20:50,056
And you know, I started the lab
in 2018 and spent the first.
351
00:20:50,401 --> 00:20:55,201
Five years of my career at a university
that I thoroughly enjoyed being at.
352
00:20:56,011 --> 00:21:00,541
And learned pretty quickly after five
years of doing randomized trials and
353
00:21:00,541 --> 00:21:03,121
effectiveness testing of do SSIS work.
354
00:21:03,811 --> 00:21:04,831
We had our answer.
355
00:21:04,831 --> 00:21:07,771
Yeah, they can work for some
people in some circumstances.
356
00:21:07,771 --> 00:21:12,151
They can both reduce symptoms and
increase motivation for further outreach.
357
00:21:12,636 --> 00:21:16,476
And it came to this point of I
can't just keep running the same
358
00:21:16,476 --> 00:21:18,426
clinical trial over and over again.
359
00:21:19,536 --> 00:21:20,946
We already know the answer.
360
00:21:21,306 --> 00:21:24,726
We really need to shift our focus
from intervention science to
361
00:21:24,726 --> 00:21:29,226
implementation science, the science
of getting what works out there in
362
00:21:29,226 --> 00:21:31,326
a systematic and sustainable manner.
363
00:21:32,091 --> 00:21:37,101
To actually reduce disparities in
access to care and implementation
364
00:21:37,101 --> 00:21:39,591
science is inherently a team sport.
365
00:21:39,981 --> 00:21:42,261
It is not a solo activity.
366
00:21:42,591 --> 00:21:47,991
So I knew that our lab needed to
move to a place with a community
367
00:21:48,321 --> 00:21:51,771
of implementation, scientists
doing community partnered research.
368
00:21:52,156 --> 00:21:56,206
Multi-sector research at a
large and impactful scale.
369
00:21:56,476 --> 00:21:59,296
I knew I needed to begin a community
with other folks doing digital
370
00:21:59,296 --> 00:22:04,246
mental health research at a large
national scale to really move
371
00:22:04,246 --> 00:22:05,896
the needle on population health.
372
00:22:06,916 --> 00:22:10,696
And I. Northwestern was the
obvious place to do that.
373
00:22:11,163 --> 00:22:14,979
with the influx of experts in
implementation science and with the
374
00:22:14,979 --> 00:22:18,309
Center for Behavioral Intervention
Technologies here, it's, it's a huge
375
00:22:18,309 --> 00:22:22,239
hub for all of the things that our
lab tries to integrate, which is
376
00:22:22,239 --> 00:22:26,139
this population health perspective,
implementation and intervention science
377
00:22:26,144 --> 00:22:28,299
and digital mental health for scale.
378
00:22:28,379 --> 00:22:31,679
situating our work within this
environment has just allowed us to.
379
00:22:32,549 --> 00:22:38,579
Really skyrocket the scope of, of our work
expand the array of community partners
380
00:22:38,579 --> 00:22:45,059
we're able to meaningfully work with and
really grow towards the goal, which is to
381
00:22:45,089 --> 00:22:49,079
get evidence-based tools out to everybody
who needs them at precise moments of need.
382
00:22:49,469 --> 00:22:52,379
I would like to hear a little bit more
about the community partners that you've
383
00:22:52,379 --> 00:22:54,299
been able to work with and establish here.
384
00:22:54,329 --> 00:22:55,019
Tell me about that.
385
00:22:55,604 --> 00:22:56,264
Sure.
386
00:22:56,264 --> 00:22:59,864
So moving to Northwestern, one of the
great things was that I moved from a
387
00:22:59,864 --> 00:23:03,014
position where a lot of my time was
spent teaching and doing clinical
388
00:23:03,014 --> 00:23:06,884
supervision, which I love to an
environment where I felt like I could
389
00:23:06,884 --> 00:23:12,134
be most effective in what I'm, I feel
I'm best at, which is the science I.
390
00:23:12,799 --> 00:23:16,909
And running a team that extra
bandwidth and the infrastructure at
391
00:23:16,909 --> 00:23:21,979
Northwestern to support non-traditional
kinds of partnerships and research
392
00:23:21,979 --> 00:23:25,759
contracts and services agreements
has given us so much freedom to
393
00:23:25,759 --> 00:23:29,749
explore new types of partnerships
with different agencies and entities.
394
00:23:30,079 --> 00:23:34,549
One that I'm particularly excited about is
a partnership that involves many different
395
00:23:34,549 --> 00:23:40,369
partners including in the nonprofit
space and the state government space.
396
00:23:40,429 --> 00:23:40,509
Hmm.
397
00:23:41,459 --> 00:23:46,284
So for this project, we're actually,
our lab has a established a, a
398
00:23:46,289 --> 00:23:48,119
relationship with the state of Montana,
399
00:23:48,359 --> 00:23:48,649
Okay.
400
00:23:49,229 --> 00:23:52,799
Which is almost entirely a federally
designated mental healthcare provider
401
00:23:52,799 --> 00:23:57,359
shortage area to disseminate single
session digital interventions
402
00:23:57,359 --> 00:23:59,639
across the state and create.
403
00:24:00,059 --> 00:24:05,729
Basically toolkits for pediatricians,
for schools, and for parents to be
404
00:24:05,729 --> 00:24:09,929
able to learn about what single session
interventions are and offer them
405
00:24:09,929 --> 00:24:11,819
sustainably in their organizations.
406
00:24:12,059 --> 00:24:16,529
So for this project, we're working
with a psychiatry clinic called
407
00:24:16,529 --> 00:24:21,509
Frontier Psychiatry as well as a
nonprofit pediatric pri primary care
408
00:24:21,509 --> 00:24:23,399
organization called Montana Pediatric.
409
00:24:23,954 --> 00:24:30,704
We have funding from the state as well
as donors to basically deploy, test, and
410
00:24:30,764 --> 00:24:35,654
sustainably implement a platform of single
session interventions across the state.
411
00:24:35,954 --> 00:24:38,534
And that platform is something
that we've built in collaboration
412
00:24:38,534 --> 00:24:40,664
with a nonprofit partner, cocoa,
413
00:24:41,054 --> 00:24:47,024
which is a digital, mental health
nonprofit company that builds basically
414
00:24:47,024 --> 00:24:48,284
they're our, they're our tech partner.
415
00:24:48,294 --> 00:24:48,804
Right.
416
00:24:49,494 --> 00:24:53,964
They help us build the ssis into
an infrastructure that we as
417
00:24:53,964 --> 00:24:55,434
scientists are not equipped to.
418
00:24:55,619 --> 00:24:56,009
Right.
419
00:24:56,399 --> 00:24:56,879
app
420
00:24:57,834 --> 00:25:02,184
so it's actually a, just a
publicly available website.
421
00:25:02,219 --> 00:25:02,549
Yep.
422
00:25:03,444 --> 00:25:05,784
and it's available
through Coco's interface.
423
00:25:05,784 --> 00:25:09,354
And the reason it's not an app is
because downloading something is
424
00:25:09,354 --> 00:25:12,144
actually a barrier to access and a lot
425
00:25:12,149 --> 00:25:12,324
of.
426
00:25:12,329 --> 00:25:13,379
to the URL, type
427
00:25:13,409 --> 00:25:17,669
Exactly, and that makes it anonymous
for teens to use too, so they don't have
428
00:25:17,669 --> 00:25:21,389
to give away any personal information
in order to access the intervention.
429
00:25:21,389 --> 00:25:24,689
Which we found in our focus groups with
young people is extremely important
430
00:25:25,349 --> 00:25:28,229
because they're worried about what
will happen to their information or who
431
00:25:28,229 --> 00:25:30,359
will be told that they're using this.
432
00:25:30,693 --> 00:25:33,513
with all those partners,
we're, we're working on this
433
00:25:33,513 --> 00:25:35,493
mixed methods implementation,
434
00:25:35,748 --> 00:25:36,168
Wow.
435
00:25:36,273 --> 00:25:41,193
intervention science, large scale
statewide study where hopefully
436
00:25:41,193 --> 00:25:45,093
we'll be able to see at scale, what
can these really do when deployed
437
00:25:45,093 --> 00:25:46,218
sustainably across the state.
438
00:25:46,268 --> 00:25:50,168
There's been a recent Feinberg study
published showing that there is a lack
439
00:25:50,168 --> 00:25:54,278
of access to mental health care in
these rural areas, and this is a big
440
00:25:54,278 --> 00:25:56,198
problem for teens and young adults.
441
00:25:56,198 --> 00:25:58,328
Can you just talk to that
a little bit as well?
442
00:25:58,683 --> 00:25:59,823
A hundred percent.
443
00:26:00,303 --> 00:26:04,413
And you know, one of the, another faculty
member or research assistant professor
444
00:26:04,413 --> 00:26:10,503
in my lab, Dr. Erica Kody this is a big
focus of their research, is understanding
445
00:26:10,503 --> 00:26:13,653
how single session interventions
can support rural populations.
446
00:26:13,943 --> 00:26:17,733
they Previously did a year of their
clinical training in Alaska in a
447
00:26:17,733 --> 00:26:23,103
super small town where really there
are no options for care and they're
448
00:26:23,103 --> 00:26:27,153
bringing that passion for the work to
the single session intervention space.
449
00:26:27,573 --> 00:26:32,613
So they actually let us study a year or
so ago looking at whether single session
450
00:26:32,613 --> 00:26:38,493
interventions could produce equitable
effects in young people in rural areas.
451
00:26:38,853 --> 00:26:40,863
Versus urban areas in the country.
452
00:26:40,893 --> 00:26:42,813
'cause we do nationwide clinical trials.
453
00:26:43,563 --> 00:26:45,213
And what we found was
that we were actually.
454
00:26:46,533 --> 00:26:49,833
Coming up with an over-representation
of rural teens in our studies.
455
00:26:49,833 --> 00:26:53,586
So these interventions may circumvent
some of the barriers to access you
456
00:26:53,586 --> 00:26:55,566
know, often facing rural communities.
457
00:26:56,136 --> 00:26:59,616
But they also were just as acceptable
and just as effective for these young
458
00:26:59,616 --> 00:27:03,781
people as for their urban counterparts
which was really exciting and.
459
00:27:03,986 --> 00:27:06,746
Kind of set the stage for
this partnership with Montana.
460
00:27:07,856 --> 00:27:10,736
And that's one of the reasons that
the community partnership we're
461
00:27:10,736 --> 00:27:16,526
pursuing is so critical because it's
not just that we drop this preexisting
462
00:27:16,526 --> 00:27:20,966
intervention suite into this, the state
and say, okay, now it, it'll just go.
463
00:27:21,266 --> 00:27:22,766
We have to actually tailor.
464
00:27:23,346 --> 00:27:27,066
The components of the interventions, the
stories, the narratives that are included
465
00:27:27,066 --> 00:27:31,056
in the single session interventions to
make sure that people in that community
466
00:27:31,056 --> 00:27:34,536
see themselves in this platform and
program that it's built for them.
467
00:27:34,536 --> 00:27:36,846
That it's clear that we took
their needs into account.
468
00:27:37,776 --> 00:27:41,916
And the dissemination toolkits that we're
creating for pediatricians and schools
469
00:27:42,156 --> 00:27:44,076
have to be fit to the context that
470
00:27:44,136 --> 00:27:44,466
Hmm.
471
00:27:44,496 --> 00:27:46,716
and the resource limitations
that they're up against.
472
00:27:47,376 --> 00:27:51,636
So because we're partnering with Montana
Youth, Montana Providers, Montana.
473
00:27:51,641 --> 00:27:55,271
Schools to build out and
refine all of these tools.
474
00:27:55,271 --> 00:27:58,571
We're optimistic that what we
end up with will actually be able
475
00:27:58,571 --> 00:27:59,646
to sustain in their community.
476
00:27:59,856 --> 00:28:00,073
There's
477
00:28:00,073 --> 00:28:03,403
so many exciting things happening in
your lab right now, and in some ways
478
00:28:03,403 --> 00:28:04,723
it feels like just the beginning.
479
00:28:04,723 --> 00:28:06,733
You're just launching a
lot of these programs.
480
00:28:06,883 --> 00:28:08,383
What is your hope for the future?
481
00:28:08,383 --> 00:28:12,433
What would you like to see happen in
the next five or 10 years in your lab?
482
00:28:12,728 --> 00:28:17,168
My hope for the future is that single
session interventions are a ubiquitous
483
00:28:17,228 --> 00:28:22,438
layer of support that exists in this, in
the country's mental healthcare ecosystem.
484
00:28:22,438 --> 00:28:24,151
A layer of support that can.
485
00:28:24,661 --> 00:28:28,351
Serve people as and when and where
needs arise, such as when they first
486
00:28:28,351 --> 00:28:29,881
seek out support on the internet.
487
00:28:29,885 --> 00:28:33,901
Or they first call into a clinic and
they're put on a six month wait list.
488
00:28:34,171 --> 00:28:38,671
They if, if they, if all clinics
just offered single session
489
00:28:38,671 --> 00:28:42,601
supports for folks waiting for
treatment, we could actually see.
490
00:28:42,841 --> 00:28:48,835
population scale reductions in
severity of problems that people are
491
00:28:48,835 --> 00:28:51,548
starting treatment with population
level increases in the speed
492
00:28:51,548 --> 00:28:52,778
with which people could recover.
493
00:28:52,895 --> 00:28:56,945
And if single session interventions
were just built into, you know,
494
00:28:56,945 --> 00:28:59,195
large online platforms that.
495
00:28:59,460 --> 00:29:01,800
Millions of people
access every single day.
496
00:29:02,520 --> 00:29:05,370
We could catch so many problems
before they worsen to crisis points.
497
00:29:05,370 --> 00:29:10,650
And we know that once they do, it's much,
much harder to treat people effectively.
498
00:29:10,650 --> 00:29:13,860
And we increase risk exponentially
for outcomes like suicide.
499
00:29:14,610 --> 00:29:20,130
So I wanna see a, a change in the
mental healthcare ecosystem where
500
00:29:20,760 --> 00:29:22,410
single session interventions are just.
501
00:29:22,775 --> 00:29:26,285
Something that everyone knows about
and everyone can access as needed.
502
00:29:27,185 --> 00:29:31,805
I also wanna see systems like insurance
reimbursement change to accommodate
503
00:29:32,465 --> 00:29:33,875
single session interventions.
504
00:29:34,175 --> 00:29:38,045
Right now, there's no real mechanism
through public insurance anyway,
505
00:29:38,045 --> 00:29:41,645
for reimbursing for an intervention
for somebody on a waiting list, for
506
00:29:41,645 --> 00:29:44,615
example, because they're technically
not a patient yet and they haven't
507
00:29:44,615 --> 00:29:45,995
gotten a diagnosis yet, so.
508
00:29:46,170 --> 00:29:47,220
What code are you gonna use?
509
00:29:47,820 --> 00:29:50,880
We're actually working with community
health agencies in the department of
510
00:29:51,420 --> 00:29:56,280
mental health in Pennsylvania to test
out a new temporary reimbursement code
511
00:29:56,280 --> 00:30:00,090
for that exact purpose that we're hopeful
if we can show through our pilot in the
512
00:30:00,090 --> 00:30:03,360
state that single session interventions
for folks on wait list are helpful.
513
00:30:03,360 --> 00:30:05,100
We'll become permanent and maybe other
514
00:30:05,120 --> 00:30:05,690
Yes.
515
00:30:05,790 --> 00:30:06,300
to take it up.
516
00:30:06,349 --> 00:30:10,159
think just openness to single
session supports that needs to
517
00:30:10,159 --> 00:30:11,479
change knowledge that needs to
518
00:30:11,494 --> 00:30:11,674
Yeah.
519
00:30:12,739 --> 00:30:15,679
and structures and systems
that support their sustainable
520
00:30:15,729 --> 00:30:17,259
implementation would need to change.
521
00:30:17,259 --> 00:30:20,049
And hopefully our lab can be
a part of all those shifts.
522
00:30:20,324 --> 00:30:24,044
Thank you so much for sharing all the
work that's happening in your lab and
523
00:30:24,044 --> 00:30:25,904
your vision for the future as well.
524
00:30:25,904 --> 00:30:26,984
We really appreciate it.
525
00:30:27,434 --> 00:30:27,974
My pleasure.
526
00:30:27,974 --> 00:30:28,994
Thanks so much for having me.
527
00:30:30,378 --> 00:30:31,468
Thanks for listening.
528
00:30:31,508 --> 00:30:34,578
Please click the bell to receive
notifications about our latest
529
00:30:34,578 --> 00:30:39,278
episodes and follow us on social
media at NU Feinberg Med to stay
530
00:30:39,298 --> 00:30:41,188
up to date with our latest research
531
00:30:41,188 --> 00:30:41,868
findings.
00:00:04,617 --> 00:00:08,517
Today's guest says, A major driver
of today's youth mental health
2
00:00:08,517 --> 00:00:13,767
crisis may be the inaccessibility of
timely, effective mental health care.
3
00:00:13,777 --> 00:00:17,377
Dr. Jessica Schneider aims to
solve this problem with a bold
4
00:00:17,407 --> 00:00:22,837
evidence-based approach, single
session interventions or ssis.
5
00:00:23,053 --> 00:00:26,743
These are structured research-backed
programs designed to deliver
6
00:00:26,743 --> 00:00:30,823
meaningful mental health support to
young people in just one encounter.
7
00:00:31,180 --> 00:00:34,570
Her research shows that even
one well-designed session can
8
00:00:34,570 --> 00:00:38,260
lead to lasting improvements in
youth and adult mental health.
9
00:00:38,413 --> 00:00:41,773
She's an associate professor of
medical social sciences at Northwestern
10
00:00:41,773 --> 00:00:44,859
University, Feinberg School of
Medicine, and the director of the
11
00:00:44,859 --> 00:00:48,639
lab for scalable mental health,
where she's experimenting with what
12
00:00:48,639 --> 00:00:50,829
accessible, scalable care can look like.
13
00:00:51,005 --> 00:00:55,235
We welcome her to the show today to talk
about her research and the power of a
14
00:00:55,235 --> 00:01:00,155
first and only intervention, and the fight
against the youth mental health crisis.
15
00:01:00,245 --> 00:01:01,535
Welcome to the show.
16
00:01:02,210 --> 00:01:03,290
Thank you so much for having me.
17
00:01:03,890 --> 00:01:08,270
Well, it's wonderful to have you here, and
I first want you to set the stage for us.
18
00:01:08,330 --> 00:01:13,040
You've described the youth mental health
crisis as not only a crisis of increasing
19
00:01:13,070 --> 00:01:15,890
illness, but of inadequate access.
20
00:01:16,250 --> 00:01:19,070
Talk to me about that, and what do
you think are the most important
21
00:01:19,070 --> 00:01:22,280
factors driving this crisis that
we're seeing here in America?
22
00:01:23,300 --> 00:01:25,550
So this crisis is nothing new.
23
00:01:25,580 --> 00:01:30,830
Although I think that the news media
and public conception of the crisis has
24
00:01:30,830 --> 00:01:36,800
really spiked since the onset of the
COVID-19 pandemic and the sudden loss
25
00:01:36,800 --> 00:01:40,880
of access to supports that many folks,
especially young people experienced
26
00:01:40,885 --> 00:01:42,260
across the country in the world.
27
00:01:42,800 --> 00:01:47,090
But there are really three
driving factors among many.
28
00:01:47,130 --> 00:01:51,930
But three that I think are particularly
important in helping us understand
29
00:01:51,930 --> 00:01:54,480
why this crisis has emerged.
30
00:01:54,690 --> 00:01:59,550
First of all we've spent, you know,
50, 60 years as a field clinical
31
00:01:59,550 --> 00:02:03,240
psychology, psychiatry, mental
health research, identifying and
32
00:02:03,240 --> 00:02:06,660
developing effective interventions
for youth mental health problems.
33
00:02:07,590 --> 00:02:08,670
Unfortunately.
34
00:02:08,900 --> 00:02:13,070
Those interventions are broadly
not being delivered and not being
35
00:02:13,070 --> 00:02:15,740
accessed by those who need them.
36
00:02:16,190 --> 00:02:21,590
And today about 80% of young people with
significant mental health needs in the
37
00:02:21,590 --> 00:02:24,080
United States don't ever access services.
38
00:02:24,620 --> 00:02:28,220
That has to do with a variety
of barriers that they face,
39
00:02:28,490 --> 00:02:30,560
including provider shortages.
40
00:02:30,560 --> 00:02:31,425
That's a huge one.
41
00:02:31,685 --> 00:02:35,045
Yeah So there simply
aren't enough providers.
42
00:02:35,135 --> 00:02:38,915
There's not enough supply to
meet the immense demand for
43
00:02:38,915 --> 00:02:40,805
youth mental health support.
44
00:02:41,248 --> 00:02:45,628
beyond provider shortages, a second reason
that many youth fail to access mental
45
00:02:45,628 --> 00:02:49,558
health support when they need and want
it is because supports aren't located
46
00:02:49,558 --> 00:02:51,538
where youth can actually access them.
47
00:02:52,623 --> 00:02:57,178
Most traditional evidence-based supports
or if therapies in general are located in
48
00:02:57,178 --> 00:03:00,358
health systems sta freestanding clinics.
49
00:03:00,983 --> 00:03:04,703
Places where youth have to actively
travel to and the logistics of
50
00:03:04,703 --> 00:03:09,233
traveling and continuously paying for
services are often infeasible for many
51
00:03:09,233 --> 00:03:12,623
families in need who are facing all
sorts of logistical barriers to care.
52
00:03:13,943 --> 00:03:17,033
Youth, if we, if we actually talk to
them and ask them how they'd like to
53
00:03:17,033 --> 00:03:21,293
access and seek support, most of them
say, well, I just go on my phone.
54
00:03:21,393 --> 00:03:23,853
Or I just go online or
I talk to my friends.
55
00:03:24,723 --> 00:03:29,283
So supports aren't located where
youth are actually looking first
56
00:03:29,313 --> 00:03:31,923
and sometimes exclusively for
the support that they need.
57
00:03:33,093 --> 00:03:36,963
The third reason that so many
interventions don't have their
58
00:03:36,963 --> 00:03:41,973
intended effect for youth is because
despite our efforts to develop
59
00:03:42,033 --> 00:03:45,453
multi-session interventions that last
weeks or months that are effective.
60
00:03:46,043 --> 00:03:50,303
The most common number of times that
somebody actually interfaces with any form
61
00:03:50,303 --> 00:03:54,383
of mental health support based on national
insurance reimbursement data is one.
62
00:03:54,773 --> 00:03:58,523
So we've spent a really long time
creating treatments that simply
63
00:03:58,523 --> 00:04:01,583
don't match how people are actually
interfacing with healthcare.
64
00:04:02,443 --> 00:04:07,873
This one single encounter covering
this, was this a big revelation in the
65
00:04:07,873 --> 00:04:12,043
mental health community that folks are
only really having this one encounter.
66
00:04:12,898 --> 00:04:16,918
I wanna say that it was a big joint
revelation and we all realize this
67
00:04:16,918 --> 00:04:21,103
together and are collectively shifting
our, our thinking and models of care.
68
00:04:21,113 --> 00:04:22,708
But not so much.
69
00:04:22,708 --> 00:04:27,508
This statistic is often news to
audiences I present to of my colleagues.
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00:04:27,923 --> 00:04:29,873
Despite working in the field for.
71
00:04:30,483 --> 00:04:35,223
Sometimes many decades often, you
know, clinical psychologists and
72
00:04:35,223 --> 00:04:39,426
psychiatrists are trained to treat folks
who do show up for services, right?
73
00:04:39,666 --> 00:04:43,836
These are the lucky 20% of individuals
who get through all of these
74
00:04:43,836 --> 00:04:46,326
difficult barriers, get in the door.
75
00:04:46,686 --> 00:04:50,856
And although early dropout as a,
is a common concern many of these
76
00:04:50,856 --> 00:04:54,216
clinicians aren't close enough
to the problem to really see the
77
00:04:54,216 --> 00:04:56,706
scope of it across the nation.
78
00:04:56,706 --> 00:04:57,156
So.
79
00:04:57,846 --> 00:05:02,466
I do think it's been a bit of a blind
spot for clinical psychologists who
80
00:05:02,466 --> 00:05:07,056
are, of course, because that's all that
we are exposed to, operating from the
81
00:05:07,056 --> 00:05:11,483
perspective of serving those who are able
to get through all of those obstacles.
82
00:05:11,923 --> 00:05:14,803
You actually published a study in
JAMA Pediatrics where you found
83
00:05:14,803 --> 00:05:19,063
that state parental consent laws
also have a miserable impact on
84
00:05:19,063 --> 00:05:20,983
whether or not teens get treatment.
85
00:05:21,373 --> 00:05:22,333
What does that mean?
86
00:05:22,333 --> 00:05:25,273
Talk to me about these state
laws and the significance that
87
00:05:25,273 --> 00:05:27,223
this has on these barriers to
88
00:05:27,348 --> 00:05:28,068
Sure.
89
00:05:28,118 --> 00:05:33,548
So this is so important to our
work right now and in shaping
90
00:05:33,548 --> 00:05:34,718
how we think about what truly.
91
00:05:34,828 --> 00:05:39,688
Scalable interventions need to look
like because it's not just the logistics
92
00:05:39,688 --> 00:05:43,708
and the cost of care, it's also
policies that make them intermittently
93
00:05:43,708 --> 00:05:46,048
accessible to young people who need them.
94
00:05:46,438 --> 00:05:51,718
So what we've learned throughout our
research with youth digital mental health
95
00:05:51,718 --> 00:05:56,398
interventions and youth interventions
in general, is that we get very, very
96
00:05:56,398 --> 00:06:01,738
different populations of young people
and very different sample sizes when we.
97
00:06:01,923 --> 00:06:05,733
Require parental consent for youth
to take part in our trials, which
98
00:06:05,733 --> 00:06:09,993
is standard versus when we secure
a waiver of the requirement.
99
00:06:09,993 --> 00:06:13,443
That's typically there for parental
permission for adolescents to self-refer
100
00:06:13,863 --> 00:06:17,643
into interventions, specifically
when we waive that requirement.
101
00:06:17,643 --> 00:06:23,133
When adolescents are suddenly empowered
to choose whether or not they want to try
102
00:06:23,133 --> 00:06:27,513
out a low intensity, safe mental health
tool that they can go through completely
103
00:06:27,513 --> 00:06:30,268
on their own, we get far more diversity.
104
00:06:31,143 --> 00:06:34,863
The folks coming into our studies,
we get racial ethnic diversity
105
00:06:34,863 --> 00:06:38,253
that is totally uncharacteristic
of traditional clinical trials.
106
00:06:38,613 --> 00:06:42,123
We get sexual and gender minority
participants that would otherwise
107
00:06:42,183 --> 00:06:45,573
be excluded from care often
because they're not comfortable
108
00:06:45,573 --> 00:06:46,863
asking their parents for help.
109
00:06:46,983 --> 00:06:52,203
And that led us to dig into
what is it about this single.
110
00:06:52,668 --> 00:06:55,758
Change this requiring or not
requiring parental permission.
111
00:06:55,878 --> 00:06:56,658
That makes a big difference.
112
00:06:56,658 --> 00:07:00,708
So we started doing qualitative
studies with teens and when we asked
113
00:07:00,708 --> 00:07:03,618
teens who couldn't access care for
depression, which is one of our
114
00:07:03,618 --> 00:07:05,958
focus areas, what got in the way?
115
00:07:05,958 --> 00:07:13,188
I. About 32 to 42% across multiple
samples said it was their families,
116
00:07:13,188 --> 00:07:17,778
their parents not necessarily that
their parents were declining their
117
00:07:17,778 --> 00:07:21,228
requests to seek out treatment, but
that they simply weren't comfortable
118
00:07:21,258 --> 00:07:23,028
going to their parents to ask for help.
119
00:07:23,508 --> 00:07:29,598
And if you live in a state where a
parent is required to refer their
120
00:07:29,598 --> 00:07:33,528
under 18-year-old child for treatments,
and you're not comfortable going to
121
00:07:33,528 --> 00:07:34,758
your parent, you are out of luck.
122
00:07:35,598 --> 00:07:40,518
So we, we decided to do a policy mapping
study, which was the one that was
123
00:07:40,518 --> 00:07:42,858
published in JAMA Peds late last year.
124
00:07:43,488 --> 00:07:47,238
And we actually found that state level
policies have a measurable impact on
125
00:07:47,238 --> 00:07:50,508
their own, on whether or not teens
with depression access treatment.
126
00:07:51,453 --> 00:07:54,873
mean, could this be a message to parents
as well, the results of this study?
127
00:07:54,873 --> 00:07:57,483
What could parents take away
from this new information?
128
00:07:57,933 --> 00:08:02,163
I think it's a message to everybody who
cares about young people's mental health.
129
00:08:03,319 --> 00:08:06,979
And I think it's a prompt and
reminder for parents to proactively.
130
00:08:07,244 --> 00:08:11,204
Approach these kinds of conversations
with their, with their adolescent
131
00:08:11,204 --> 00:08:13,484
children in particular, but
also their younger children.
132
00:08:13,484 --> 00:08:17,114
So they grow up knowing that
they're able to ask for help in
133
00:08:17,114 --> 00:08:20,474
the environments that they're in,
and they know how to ask for help.
134
00:08:20,864 --> 00:08:22,498
So modeling that early on.
135
00:08:23,423 --> 00:08:27,953
Signaling acceptance of support, seeking
and signaling that you're going to be
136
00:08:27,953 --> 00:08:30,863
there for your child and you're going
to help them and advocate for them.
137
00:08:30,863 --> 00:08:33,683
And finding the support they
need is critical because if those
138
00:08:33,683 --> 00:08:37,853
conversations don't happen, teens
are left being uncertain and
139
00:08:38,003 --> 00:08:40,403
hesitating at points of actual need.
140
00:08:41,133 --> 00:08:44,733
Well, your research lab, you are
really going all in on these single
141
00:08:44,733 --> 00:08:48,753
session interventions and in a recent
study you published in the annual
142
00:08:48,753 --> 00:08:52,323
review of Clinical Psychology, you
confirmed that these single session
143
00:08:52,323 --> 00:08:55,773
interventions can significantly
improve mental health outcomes.
144
00:08:56,283 --> 00:09:00,153
So talk to me about this, your approach,
what's happening right now, and.
145
00:09:00,918 --> 00:09:03,613
How you're designing these
interventions to work in your lab?
146
00:09:04,153 --> 00:09:04,873
Absolutely.
147
00:09:04,873 --> 00:09:08,413
So I wanna preface this by
saying that, well, two things.
148
00:09:08,443 --> 00:09:12,253
First of all, I don't believe that single
session intervention should replace
149
00:09:12,463 --> 00:09:16,483
anything else that is already available
in the mental healthcare ecosystem.
150
00:09:16,693 --> 00:09:21,313
That's one of the initial questions I get
from fellow clinicians and colleagues in
151
00:09:21,313 --> 00:09:25,603
my field is, but how can you say that all
treatments should just be one session?
152
00:09:25,603 --> 00:09:26,773
That's not what I'm saying at all.
153
00:09:27,553 --> 00:09:30,358
I am saying that we need something like.
154
00:09:30,858 --> 00:09:34,818
Single sessions and other types of low
intensity interventions to bridge the
155
00:09:34,818 --> 00:09:37,398
gap, that would be totally unfillable.
156
00:09:37,428 --> 00:09:40,548
And we know it's already unfillable
by existing interventions.
157
00:09:40,548 --> 00:09:41,928
So that's the first piece.
158
00:09:42,033 --> 00:09:44,883
the second piece is that single
session interventions are nothing new.
159
00:09:45,183 --> 00:09:46,473
I did not invent them.
160
00:09:46,683 --> 00:09:49,263
They have been practiced
since before I was born.
161
00:09:49,923 --> 00:09:54,393
So the first book that was published
on single session interventions came
162
00:09:54,393 --> 00:09:59,073
out written by a clinician named
OSHA Talman an Israeli psychologist.
163
00:09:59,523 --> 00:10:04,173
Who had been practicing single
session therapy in his, his practice
164
00:10:04,173 --> 00:10:08,043
and finding that one session was
sometimes surprisingly impactful
165
00:10:08,553 --> 00:10:12,363
and reduced the need for additional
care for many of his clients.
166
00:10:12,843 --> 00:10:18,843
And so we're building on a long
history of practice based evidence.
167
00:10:19,818 --> 00:10:23,118
As well as drawing from brief
intervention research and other
168
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neighboring fields to psychology,
like social psychology and public
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health, which aren't often integrated.
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But those are the histories and
traditions that we're drawing
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on in, in doing this work.
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So it's not just us my journey
into studying single sessions
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started more than 10 years ago.
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As a graduate student in clinical
psychology, I got incredibly
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frustrated working in you know,
low resource community clinics and
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seeing that many families that I was.
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Treating could not come back
after the initial assessment
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by no fault of their own.
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And all I do in the initial
assessment is ask a bunch of questions
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that don't actually help them.
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So I started to wonder, is there
something I could be doing in that
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first session that could help them
even if they couldn't come back?
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So I started looking into the
literature and found there was a whole.
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scope of studies on this topic, but they
were all kind of called different things,
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so nobody had synthesized all of it.
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And that initial meta-analysis that I
published in 2017 became the basis for
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the work that my lab does studying what
can be accomplished in a single session.
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So in terms of how we think about
developing and designing single
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session interventions we think
of single session interventions,
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first of all, as an umbrella term
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that can include, supports that
are designed to affect some kind of
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clinically meaningful change in one
encounter that can be either digital
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and self-guided interventions.
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So things completed online or
on devices and things that are
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provider delivered, delivered by
clinicians, either lay providers,
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so providers without professional
training or licensed professionals.
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And we see the digital single session
interventions as bridging gaps for folks.
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Who don't ever make it in the front
door of a mental health clinic, right?
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Folks who are looking on social media
for support, who can be connected with
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a digital single session tool right
away, whereas the provider delivered
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single sessions, we see as more bridging
gaps within healthcare systems, such
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as for folks on long waiting lists for
treatment, which were a huge problem and
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actually lead to deterioration if they're
too lengthy once folks seek out help.
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So in either case.
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These single sessions are structured such
that they promote a sense of autonomy.
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The idea that, you know, your
actions affect your future.
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The notion of relatedness, like there's
somebody out there who understands
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and cares about you and has been
where you are and gotten through it.
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It.
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And competence, like all of the ssis
teach a really specific granular skill
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that helps somebody learn better how to
deal with a problem in front of them.
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And those facets, autonomy
competence and relatedness.
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Those are really the mechanisms
of change through which a single
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session encounter can help people
take that best next step towards.
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future that's better, that's valued.
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And that's a little bit freer
of their, of their symptoms.
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You mentioned tools that someone can
take away from this one time encounter.
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Can you gimme an example of
what those might look like?
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What tools they could
take out into the world?
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I.
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Absolutely.
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These tools are also nothing
new to psychologists.
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We've been studying them in longer term
multi-session interventions for decades.
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But each single session intervention
essentially takes a kernel of a
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longer multi-component evidence-based
treatment and synthesize it down
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to a unit, a minimally viable unit
that can still have an effect.
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So one of our interventions, as
an example, teaches the idea that.
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What you do can shape how you feel.
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It's extremely simple.
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But what that corresponds to is
the skill in cognitive behavioral
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therapy of behavioral activation.
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So we help people understand
through interactive, self-guided
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exercises personal mood experiment
that we guide people through and
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the creation of an action plan.
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We actually show and tell
them, here is how you can take.
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Steps to engage in activities that
you value, that make you feel like
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you, to help you support a better
mood when you're feeling stuck.
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And every single person who goes
through this behavioral activation,
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SSI, which we call the A BC
project, action brings change.
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They end up with a personalized
action plan for taking valued
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based steps in their own life to
manage their mood more effectively.
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And this is one of several single
session interventions that we've
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tested in large RCTs, randomized
controlled trials found actually can
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reduce adolescent depression even
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Wow.
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later compared to active
control conditions.
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And it's available for free for
anybody to use on our lab website.
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And your lab website has a lot of tools.
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I mean, how many different projects
are you piloting right now with these
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digital tools?
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Too many arguably.
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We, I mean, the goal is to create
single session experiences, encounters
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that are accessible anywhere, anytime
for whatever problem or difficulty
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somebody happens to be presenting with.
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So we need a library of them.
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To really be able to pivot so people
can select, that's what that problem is.
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The one I resonate with that
skill is the one I need right now.
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I'm gonna try this one.
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And especially, you know, if time is so
precious, and especially for folks who
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are not necessarily treatment seeking,
who are finding these interventions
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online, while they're scrolling through
a social media feed, we need to make sure
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we're hitting exactly the right target.
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So as a result, we're.
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Testing, deploying, disseminating,
implementing at least, 20 different
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single session interventions in different
settings all over the country and the
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world, including primary care schools
within social media platforms, is just
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in time supports for folks who type for,
for example, suicide into the search bar.
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So indicating that they
need some help right away.
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Through one of our nonprofit partnerships,
they actually do get offered a single
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session intervention in those moments.
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So we're, we're trying all the things
we can think of to figure out how to
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disseminate these brief interventions
that we have sufficient evidence for
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at this point to really scale up.
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And you mentioned these are
going to people around the world.
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Accessibility huge part
of what you're doing.
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These are coming to folks in their own
native language in many cases as well.
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Tell me about this undertaking
and how important it is to add
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that kind of cultural competency
into what you're doing.
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I.
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Sure.
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So we've been incredibly fortunate
as we've expanded this work.
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And I think because we make all of our
intervention materials freely available,
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which is unfortunately atypical in the
intervention science field colleagues
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and, and, and potential collaborators
all over the country have approach
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and, and the world really have, have.
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Reached out to our lab asking if they
can embark on a project, a collaboration
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to culturally adapt and translate
the evidence-based digital single
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session interventions that we've built.
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So we've been in incredibly lucky to
partner with so many different folks and
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talented individuals to do just that.
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The suite of single session digital
self-guided tools for teens on our
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website are now available in at
least nine different languages.
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We're working on several more
that will be posted soon.
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it's been a really rewarding process, not
just to build these interventions for,
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youth living in parts of the world where.
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The mental health infrastructure for
young people is non-existent, but
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getting to actually test the utility and
acceptability and effectiveness of these
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interventions in different languages such
such as Polish and Ukrainian and Arabic
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and Spanish, and a host of of others.
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But it's, it's been really exciting
to see, how much this model
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of providing support resonates
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with what folks who are close to the
daily problems and accessibility actually
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see as, as being a good solution?
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Can you share some anecdotes or success
stories with me of what you've heard as
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a result of some of these interventions?
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Absolutely.
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So one of our team's favorite parts of
doing this research is going through
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the qualitative feedback, the written
feedback that we get from adolescents.
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On how they responded
to our interventions.
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much as I love to see the numeric
points on their depression score
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go down months later, it's a little
bit more exciting to see them write
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a personal note to you that says, I
feel understood for the first time.
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Or, I feel like I can talk, I can
verbalize what I'm experiencing now,
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or I feel ready to ask for more help.
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And that's really important
too, is what we see is.
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Not only are the single session
interventions that promote, you know,
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autonomy competence relatedness,
helping to reduce symptoms directly,
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but they're also supporting young people
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in feeling motivated and able to ask
for more support if they need it.
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So the effects are, are really twofold.
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I think one of the, the best ways to
see the, the impact that Teens report
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having from these interventions is to go
to our website and click on Project yes.
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Project, yes stands for Youth
Empowerment and Support.
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And if you click on the advice center
in Project Yes, that is actually, a
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repository that we keep, because after
every single session intervention that a
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team completes, we ask them, Hey, do you
wanna give advice based on what you just
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learned in your own experience to others?
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And if you want us to, we'll share
that advice publicly on our project.
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Yes.
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And anonymously on our project Yes.
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Website.
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So you can actually scroll through
and see feedback from teens.
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Across the country and across the
world on what they learned from the
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interventions and what they would advise
their peers to do in times of distress.
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Which I think really speaks to the
impact that these interventions can have.
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And of teens to
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Hmm.
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wanna help themselves,
but help others too.
339
00:20:19,381 --> 00:20:23,101
I mean, this whole project in your
lab is a really beautiful illustration
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of implementation science in action.
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Tell
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00:20:26,206 --> 00:20:26,496
Tell
343
00:20:26,496 --> 00:20:26,656
me.
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00:20:26,851 --> 00:20:30,121
Tell me about moving your lab here
to Northwestern and the Infras
345
00:20:30,181 --> 00:20:33,271
and the infrastructure here that's
allowed you to really dive into
346
00:20:33,271 --> 00:20:35,671
this implementation of the research.
347
00:20:36,166 --> 00:20:36,886
Absolutely.
348
00:20:36,886 --> 00:20:43,426
So this move was just so ideal
for the work and mission that we
349
00:20:43,426 --> 00:20:45,166
share in, in, in so many ways.
350
00:20:45,166 --> 00:20:50,056
And you know, I started the lab
in 2018 and spent the first.
351
00:20:50,401 --> 00:20:55,201
Five years of my career at a university
that I thoroughly enjoyed being at.
352
00:20:56,011 --> 00:21:00,541
And learned pretty quickly after five
years of doing randomized trials and
353
00:21:00,541 --> 00:21:03,121
effectiveness testing of do SSIS work.
354
00:21:03,811 --> 00:21:04,831
We had our answer.
355
00:21:04,831 --> 00:21:07,771
Yeah, they can work for some
people in some circumstances.
356
00:21:07,771 --> 00:21:12,151
They can both reduce symptoms and
increase motivation for further outreach.
357
00:21:12,636 --> 00:21:16,476
And it came to this point of I
can't just keep running the same
358
00:21:16,476 --> 00:21:18,426
clinical trial over and over again.
359
00:21:19,536 --> 00:21:20,946
We already know the answer.
360
00:21:21,306 --> 00:21:24,726
We really need to shift our focus
from intervention science to
361
00:21:24,726 --> 00:21:29,226
implementation science, the science
of getting what works out there in
362
00:21:29,226 --> 00:21:31,326
a systematic and sustainable manner.
363
00:21:32,091 --> 00:21:37,101
To actually reduce disparities in
access to care and implementation
364
00:21:37,101 --> 00:21:39,591
science is inherently a team sport.
365
00:21:39,981 --> 00:21:42,261
It is not a solo activity.
366
00:21:42,591 --> 00:21:47,991
So I knew that our lab needed to
move to a place with a community
367
00:21:48,321 --> 00:21:51,771
of implementation, scientists
doing community partnered research.
368
00:21:52,156 --> 00:21:56,206
Multi-sector research at a
large and impactful scale.
369
00:21:56,476 --> 00:21:59,296
I knew I needed to begin a community
with other folks doing digital
370
00:21:59,296 --> 00:22:04,246
mental health research at a large
national scale to really move
371
00:22:04,246 --> 00:22:05,896
the needle on population health.
372
00:22:06,916 --> 00:22:10,696
And I. Northwestern was the
obvious place to do that.
373
00:22:11,163 --> 00:22:14,979
with the influx of experts in
implementation science and with the
374
00:22:14,979 --> 00:22:18,309
Center for Behavioral Intervention
Technologies here, it's, it's a huge
375
00:22:18,309 --> 00:22:22,239
hub for all of the things that our
lab tries to integrate, which is
376
00:22:22,239 --> 00:22:26,139
this population health perspective,
implementation and intervention science
377
00:22:26,144 --> 00:22:28,299
and digital mental health for scale.
378
00:22:28,379 --> 00:22:31,679
situating our work within this
environment has just allowed us to.
379
00:22:32,549 --> 00:22:38,579
Really skyrocket the scope of, of our work
expand the array of community partners
380
00:22:38,579 --> 00:22:45,059
we're able to meaningfully work with and
really grow towards the goal, which is to
381
00:22:45,089 --> 00:22:49,079
get evidence-based tools out to everybody
who needs them at precise moments of need.
382
00:22:49,469 --> 00:22:52,379
I would like to hear a little bit more
about the community partners that you've
383
00:22:52,379 --> 00:22:54,299
been able to work with and establish here.
384
00:22:54,329 --> 00:22:55,019
Tell me about that.
385
00:22:55,604 --> 00:22:56,264
Sure.
386
00:22:56,264 --> 00:22:59,864
So moving to Northwestern, one of the
great things was that I moved from a
387
00:22:59,864 --> 00:23:03,014
position where a lot of my time was
spent teaching and doing clinical
388
00:23:03,014 --> 00:23:06,884
supervision, which I love to an
environment where I felt like I could
389
00:23:06,884 --> 00:23:12,134
be most effective in what I'm, I feel
I'm best at, which is the science I.
390
00:23:12,799 --> 00:23:16,909
And running a team that extra
bandwidth and the infrastructure at
391
00:23:16,909 --> 00:23:21,979
Northwestern to support non-traditional
kinds of partnerships and research
392
00:23:21,979 --> 00:23:25,759
contracts and services agreements
has given us so much freedom to
393
00:23:25,759 --> 00:23:29,749
explore new types of partnerships
with different agencies and entities.
394
00:23:30,079 --> 00:23:34,549
One that I'm particularly excited about is
a partnership that involves many different
395
00:23:34,549 --> 00:23:40,369
partners including in the nonprofit
space and the state government space.
396
00:23:40,429 --> 00:23:40,509
Hmm.
397
00:23:41,459 --> 00:23:46,284
So for this project, we're actually,
our lab has a established a, a
398
00:23:46,289 --> 00:23:48,119
relationship with the state of Montana,
399
00:23:48,359 --> 00:23:48,649
Okay.
400
00:23:49,229 --> 00:23:52,799
Which is almost entirely a federally
designated mental healthcare provider
401
00:23:52,799 --> 00:23:57,359
shortage area to disseminate single
session digital interventions
402
00:23:57,359 --> 00:23:59,639
across the state and create.
403
00:24:00,059 --> 00:24:05,729
Basically toolkits for pediatricians,
for schools, and for parents to be
404
00:24:05,729 --> 00:24:09,929
able to learn about what single session
interventions are and offer them
405
00:24:09,929 --> 00:24:11,819
sustainably in their organizations.
406
00:24:12,059 --> 00:24:16,529
So for this project, we're working
with a psychiatry clinic called
407
00:24:16,529 --> 00:24:21,509
Frontier Psychiatry as well as a
nonprofit pediatric pri primary care
408
00:24:21,509 --> 00:24:23,399
organization called Montana Pediatric.
409
00:24:23,954 --> 00:24:30,704
We have funding from the state as well
as donors to basically deploy, test, and
410
00:24:30,764 --> 00:24:35,654
sustainably implement a platform of single
session interventions across the state.
411
00:24:35,954 --> 00:24:38,534
And that platform is something
that we've built in collaboration
412
00:24:38,534 --> 00:24:40,664
with a nonprofit partner, cocoa,
413
00:24:41,054 --> 00:24:47,024
which is a digital, mental health
nonprofit company that builds basically
414
00:24:47,024 --> 00:24:48,284
they're our, they're our tech partner.
415
00:24:48,294 --> 00:24:48,804
Right.
416
00:24:49,494 --> 00:24:53,964
They help us build the ssis into
an infrastructure that we as
417
00:24:53,964 --> 00:24:55,434
scientists are not equipped to.
418
00:24:55,619 --> 00:24:56,009
Right.
419
00:24:56,399 --> 00:24:56,879
app
420
00:24:57,834 --> 00:25:02,184
so it's actually a, just a
publicly available website.
421
00:25:02,219 --> 00:25:02,549
Yep.
422
00:25:03,444 --> 00:25:05,784
and it's available
through Coco's interface.
423
00:25:05,784 --> 00:25:09,354
And the reason it's not an app is
because downloading something is
424
00:25:09,354 --> 00:25:12,144
actually a barrier to access and a lot
425
00:25:12,149 --> 00:25:12,324
of.
426
00:25:12,329 --> 00:25:13,379
to the URL, type
427
00:25:13,409 --> 00:25:17,669
Exactly, and that makes it anonymous
for teens to use too, so they don't have
428
00:25:17,669 --> 00:25:21,389
to give away any personal information
in order to access the intervention.
429
00:25:21,389 --> 00:25:24,689
Which we found in our focus groups with
young people is extremely important
430
00:25:25,349 --> 00:25:28,229
because they're worried about what
will happen to their information or who
431
00:25:28,229 --> 00:25:30,359
will be told that they're using this.
432
00:25:30,693 --> 00:25:33,513
with all those partners,
we're, we're working on this
433
00:25:33,513 --> 00:25:35,493
mixed methods implementation,
434
00:25:35,748 --> 00:25:36,168
Wow.
435
00:25:36,273 --> 00:25:41,193
intervention science, large scale
statewide study where hopefully
436
00:25:41,193 --> 00:25:45,093
we'll be able to see at scale, what
can these really do when deployed
437
00:25:45,093 --> 00:25:46,218
sustainably across the state.
438
00:25:46,268 --> 00:25:50,168
There's been a recent Feinberg study
published showing that there is a lack
439
00:25:50,168 --> 00:25:54,278
of access to mental health care in
these rural areas, and this is a big
440
00:25:54,278 --> 00:25:56,198
problem for teens and young adults.
441
00:25:56,198 --> 00:25:58,328
Can you just talk to that
a little bit as well?
442
00:25:58,683 --> 00:25:59,823
A hundred percent.
443
00:26:00,303 --> 00:26:04,413
And you know, one of the, another faculty
member or research assistant professor
444
00:26:04,413 --> 00:26:10,503
in my lab, Dr. Erica Kody this is a big
focus of their research, is understanding
445
00:26:10,503 --> 00:26:13,653
how single session interventions
can support rural populations.
446
00:26:13,943 --> 00:26:17,733
they Previously did a year of their
clinical training in Alaska in a
447
00:26:17,733 --> 00:26:23,103
super small town where really there
are no options for care and they're
448
00:26:23,103 --> 00:26:27,153
bringing that passion for the work to
the single session intervention space.
449
00:26:27,573 --> 00:26:32,613
So they actually let us study a year or
so ago looking at whether single session
450
00:26:32,613 --> 00:26:38,493
interventions could produce equitable
effects in young people in rural areas.
451
00:26:38,853 --> 00:26:40,863
Versus urban areas in the country.
452
00:26:40,893 --> 00:26:42,813
'cause we do nationwide clinical trials.
453
00:26:43,563 --> 00:26:45,213
And what we found was
that we were actually.
454
00:26:46,533 --> 00:26:49,833
Coming up with an over-representation
of rural teens in our studies.
455
00:26:49,833 --> 00:26:53,586
So these interventions may circumvent
some of the barriers to access you
456
00:26:53,586 --> 00:26:55,566
know, often facing rural communities.
457
00:26:56,136 --> 00:26:59,616
But they also were just as acceptable
and just as effective for these young
458
00:26:59,616 --> 00:27:03,781
people as for their urban counterparts
which was really exciting and.
459
00:27:03,986 --> 00:27:06,746
Kind of set the stage for
this partnership with Montana.
460
00:27:07,856 --> 00:27:10,736
And that's one of the reasons that
the community partnership we're
461
00:27:10,736 --> 00:27:16,526
pursuing is so critical because it's
not just that we drop this preexisting
462
00:27:16,526 --> 00:27:20,966
intervention suite into this, the state
and say, okay, now it, it'll just go.
463
00:27:21,266 --> 00:27:22,766
We have to actually tailor.
464
00:27:23,346 --> 00:27:27,066
The components of the interventions, the
stories, the narratives that are included
465
00:27:27,066 --> 00:27:31,056
in the single session interventions to
make sure that people in that community
466
00:27:31,056 --> 00:27:34,536
see themselves in this platform and
program that it's built for them.
467
00:27:34,536 --> 00:27:36,846
That it's clear that we took
their needs into account.
468
00:27:37,776 --> 00:27:41,916
And the dissemination toolkits that we're
creating for pediatricians and schools
469
00:27:42,156 --> 00:27:44,076
have to be fit to the context that
470
00:27:44,136 --> 00:27:44,466
Hmm.
471
00:27:44,496 --> 00:27:46,716
and the resource limitations
that they're up against.
472
00:27:47,376 --> 00:27:51,636
So because we're partnering with Montana
Youth, Montana Providers, Montana.
473
00:27:51,641 --> 00:27:55,271
Schools to build out and
refine all of these tools.
474
00:27:55,271 --> 00:27:58,571
We're optimistic that what we
end up with will actually be able
475
00:27:58,571 --> 00:27:59,646
to sustain in their community.
476
00:27:59,856 --> 00:28:00,073
There's
477
00:28:00,073 --> 00:28:03,403
so many exciting things happening in
your lab right now, and in some ways
478
00:28:03,403 --> 00:28:04,723
it feels like just the beginning.
479
00:28:04,723 --> 00:28:06,733
You're just launching a
lot of these programs.
480
00:28:06,883 --> 00:28:08,383
What is your hope for the future?
481
00:28:08,383 --> 00:28:12,433
What would you like to see happen in
the next five or 10 years in your lab?
482
00:28:12,728 --> 00:28:17,168
My hope for the future is that single
session interventions are a ubiquitous
483
00:28:17,228 --> 00:28:22,438
layer of support that exists in this, in
the country's mental healthcare ecosystem.
484
00:28:22,438 --> 00:28:24,151
A layer of support that can.
485
00:28:24,661 --> 00:28:28,351
Serve people as and when and where
needs arise, such as when they first
486
00:28:28,351 --> 00:28:29,881
seek out support on the internet.
487
00:28:29,885 --> 00:28:33,901
Or they first call into a clinic and
they're put on a six month wait list.
488
00:28:34,171 --> 00:28:38,671
They if, if they, if all clinics
just offered single session
489
00:28:38,671 --> 00:28:42,601
supports for folks waiting for
treatment, we could actually see.
490
00:28:42,841 --> 00:28:48,835
population scale reductions in
severity of problems that people are
491
00:28:48,835 --> 00:28:51,548
starting treatment with population
level increases in the speed
492
00:28:51,548 --> 00:28:52,778
with which people could recover.
493
00:28:52,895 --> 00:28:56,945
And if single session interventions
were just built into, you know,
494
00:28:56,945 --> 00:28:59,195
large online platforms that.
495
00:28:59,460 --> 00:29:01,800
Millions of people
access every single day.
496
00:29:02,520 --> 00:29:05,370
We could catch so many problems
before they worsen to crisis points.
497
00:29:05,370 --> 00:29:10,650
And we know that once they do, it's much,
much harder to treat people effectively.
498
00:29:10,650 --> 00:29:13,860
And we increase risk exponentially
for outcomes like suicide.
499
00:29:14,610 --> 00:29:20,130
So I wanna see a, a change in the
mental healthcare ecosystem where
500
00:29:20,760 --> 00:29:22,410
single session interventions are just.
501
00:29:22,775 --> 00:29:26,285
Something that everyone knows about
and everyone can access as needed.
502
00:29:27,185 --> 00:29:31,805
I also wanna see systems like insurance
reimbursement change to accommodate
503
00:29:32,465 --> 00:29:33,875
single session interventions.
504
00:29:34,175 --> 00:29:38,045
Right now, there's no real mechanism
through public insurance anyway,
505
00:29:38,045 --> 00:29:41,645
for reimbursing for an intervention
for somebody on a waiting list, for
506
00:29:41,645 --> 00:29:44,615
example, because they're technically
not a patient yet and they haven't
507
00:29:44,615 --> 00:29:45,995
gotten a diagnosis yet, so.
508
00:29:46,170 --> 00:29:47,220
What code are you gonna use?
509
00:29:47,820 --> 00:29:50,880
We're actually working with community
health agencies in the department of
510
00:29:51,420 --> 00:29:56,280
mental health in Pennsylvania to test
out a new temporary reimbursement code
511
00:29:56,280 --> 00:30:00,090
for that exact purpose that we're hopeful
if we can show through our pilot in the
512
00:30:00,090 --> 00:30:03,360
state that single session interventions
for folks on wait list are helpful.
513
00:30:03,360 --> 00:30:05,100
We'll become permanent and maybe other
514
00:30:05,120 --> 00:30:05,690
Yes.
515
00:30:05,790 --> 00:30:06,300
to take it up.
516
00:30:06,349 --> 00:30:10,159
think just openness to single
session supports that needs to
517
00:30:10,159 --> 00:30:11,479
change knowledge that needs to
518
00:30:11,494 --> 00:30:11,674
Yeah.
519
00:30:12,739 --> 00:30:15,679
and structures and systems
that support their sustainable
520
00:30:15,729 --> 00:30:17,259
implementation would need to change.
521
00:30:17,259 --> 00:30:20,049
And hopefully our lab can be
a part of all those shifts.
522
00:30:20,324 --> 00:30:24,044
Thank you so much for sharing all the
work that's happening in your lab and
523
00:30:24,044 --> 00:30:25,904
your vision for the future as well.
524
00:30:25,904 --> 00:30:26,984
We really appreciate it.
525
00:30:27,434 --> 00:30:27,974
My pleasure.
526
00:30:27,974 --> 00:30:28,994
Thanks so much for having me.
527
00:30:30,378 --> 00:30:31,468
Thanks for listening.
528
00:30:31,508 --> 00:30:34,578
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00:30:34,578 --> 00:30:39,278
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530
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