By Gaan Akers, LPC, NCC | June 16, 2021
Speaker 0:00
Welcome to the weekly checkup brought to you by Georgia neurology. I’m your host, Dr. Bruce Feinberg. And there are a few areas of healthcare that have had so few advancements that get so little attention, as does mental health, it’s been talked about in this country for decades now. So many of the social skills that we’ve faced are directly related to mental health, and recognized as such, whether it’s gun violence, suicide, opioid addiction, substance abuse, the list goes on and on. And mental health is always discussed as a root cause and yet, so little attention is paid to it. So little support from a public health perspective is paid for it. And now we have the pandemic. And the crisis in public health is particularly in mental health that the pandemic has created and will continue to create because starting to be the point now where half the country is vaccinated and those who are vaccinated can no longer have to wear masks doesn’t end the problems that the pandemic created. And so, we’re going to focus today on mental health. In America, we’re going to focus a lot of that conversation on children and families who have suffered the most as a result of the pandemic impact and the closing of schools, and are often at the center when it comes to opioids when it comes to suicide. And so, and substance abuse and the list goes on, and gun violence Even so, so, so much to talk about as we focus on a topic that we just don’t cover enough. And I’m thrilled today to have the folks from Hillside back with us.
Speaker 1:46
Hillside’s mission, since I think it’s 1888 – we’ll get that confirmed, has been to help children and families thrive by providing outstanding residential and community mental health services. Hillside provides specialized cutting-edge behavioral treatment and education to children and their families.
Speaker 2:09
Hillside is led by Emily Acker. She is the President and CEO serving since 2014 and has served children adolescents for over 30 years in a variety of nonprofit organizations.
Speaker 2:22
And with her today is Gaan Akers who serves as clinical education and refer relations manager, she’s a licensed professional counselor, and nationally certified counselor learn more about them and the organization at hside.org. That’s hside.org. And give us a call at 404-872-0750. Share your experiences, ask your questions. The experts are here at 404-872-0750. So, Emily, good to have you back. It’s been a long time since we had you on the show. And no time more meaningful, more pressing than right now.
Speaker 3:04
Absolutely. Thank you for having us back. I hope that in this next hour or two that we can be helpful to your audience.
Speaker 3:13
Well, I don’t know how you can’t be you know, if just by shedding light, just by understanding by normalizing and removing stigma. It just if nothing else, you know, it’s the line that I love. And I’ve used, which I think actually was coined by Socrates, although I think it’s been credited to Freud and others but something along the lines of a life not examined is a life not lived or a life not examined as of life not fulfilled. But we’ve all got issues.
Speaker 3:45
Not all of them rise to the level that requires formal counseling, although I guess some would argue that everybody would benefit from counseling. But certainly, in terms of the health crisis, there are 10s of 1000s and millions of Americans who would benefit from help. And certainly, we want to see more awareness and hopefully, with more awareness, there’ll be recognition and the hearing of the cry for help will lead to policy changes, investment, the things that are necessary, to hopefully turn the tide. Alright, so let’s start with a little bit about Hillside before we get into kind of the things that you’ve observed and some of the stats around, you know what’s been going on pre-pandemic and how the pandemic has inflamed things. So this Hillside really goes back to 1888. Hillside really goes back to 1888. We were founded by caring and active women in Atlanta, who saw a need to help children and family. And through the years we have evolved as needed to meet the most pressing demands. So over time, we have served almost as an orphanage, which you may remember way back in the days when families not because they didn’t want to, but because of various circumstances couldn’t raise their children well, safely, appropriately. And so sometimes they were sent to Hillside to grow up and be supported while their families improve their situation that could bring them back home. And then through time, we have become more and more of a specialized psychiatric facility, adding dialectical behavior therapy as our program model and making sure that we are a very strong group of professionals that can really help children struggling and help their families and help both head toward healing and maintain a life worth living.
Speaker 5:51
And it’s both residential and outpatient.
Speaker 5:56
Hillside has a variety of services. So we started as a residential program where children would come and live with us and have very intensive therapy 24 hours a day, seven days a week. And since we’ve expanded so now we have intensive in-home therapies where our licensed professionals are going into family’s homes, to help them and help their child regulate, you know, different symptoms of mental health, different behavioral needs, and create a safe and effective home environment that will go into the home two to three times a week and really help strengthen that family system. We also have a day treatment program where kids can come to our Hillside campus and Midtown Atlanta five days a week, almost like attending school, but it’s very intensive DBT skills building social skills building and psychiatric care. We also as a result of the pandemic created a virtual intensive outpatient program, so that kids throughout Georgia who weren’t able to drive to the Hillside campus to get help, can have help four days a week, virtually, with our licensed therapist. And this has been a highly effective intervention. Like I said, for the many who do not have access to appropriate counseling services in their home counties or hometowns, that we’ve really expanded our continuum so that we can meet families and children where they are, and address their more pressing needs.
Speaker 7:36
So I don’t know if this is for you, or for Gaan. But how many families just in the past year, have you directly engaged with and helped? Well, we count the number of children we serve. So we’ve served over 700 children in the past year. And then with those children, there’s obviously a whole network of families, siblings, fathers, mothers, aunts, uncles, grandparents, we all know that a child requires a whole system in order to be strong and to thrive and to be healthy. And so you’re never just serving one individual, you’re serving the whole system. But we certainly count the individuals or the clients that we have really focused our care on. So over 700 this year.
Speaker 8:30
So when you’re dealing with children, it seems to me or maybe false assumptions, but that so often their problems are related to problems with other members in the family and in the home. And so, will you extend that service to the others? Or do you bring in partners, so let’s just say dad’s an alcoholic, and there’s, you know, so that the child is expressing the effects of that trauma, but you’re not going to you don’t know how well you fix it if you can’t start to address the root cause. So how does that work? Absolutely. Like I said, it takes the whole system. So when a child is in any of the services at Hillside, there is family therapy and family skill-building involved. And through that process, we’re looking at what is the home base look like what other problems may be in existence? in that family, we are always going to partner with other providers, other professionals who can provide whatever help the parents in the family that caregivers in the family, the siblings in the family may need because yes, that the whole system has to be impacted. It has to be strengthened, there has to be safety. So safety is really important teaching families what it looks like to have their home safe.
Speaker 10:00
We want to avoid any type of suicidal risk or anything that would put the family, the child, the parents or anyone at risk. And sometimes it’s just a lot of teaching and educating. That’s why our in-home program has been so effective is because when you’re in a home, and you can see the setting, and you can really work with the family, in partnership, to create a heat more healing and healthy environment, then everyone’s impacted. So yes, we will partner with anyone helping that family, we will make, you know, references and certainly recommendations, we will partner with schools and teachers and churches, whatever’s needed to really help that family function as a whole and healthier system.
Speaker 10:57
Alright, we’ve got so much to cover, it was great to get introduced to Hillside and the program. And I want to as we get back, we’re gonna understand both how families in need, you know, get to work with you. But I also want to then, you know, dive into COVID. And, again, what was pre-COVID in terms of children mental health and how it’s been the issues that have been exacerbated, created new and issues related to that. We have a lot more to cover Monday about help by The Beatles, Nina even says it. That’s our song of the week, send us the songs you’d like to hear, and we may start playing them as early as next week. We’re back on the weekly checkup. I’m your host, Dr. Bruce Feinberg. And we’re live today with Emily Acker and Gaan Akers of Hillside which provides community mental health services to children and families. Learn more at hside.org. And join us in the conversation at 404-872-0750. Let me remind you that our show is produced by lens Atlanta’s healthcare marketing experts. And with that, I’ll also introduce Gaan Akers. Gaan serves as clinical education and referral relations manager at Hillside.
Speaker 12:12
Emily does a really nice overview of the program. I’m sure that people listening know someone and want to know how do we get access to the programming? So how do patients come into the system? Yeah, thank you for having me. So one really unique thing about Hillside as well is that we specialize in working with young people who are needing slightly higher level care than your typical outpatient services. I think with mental health, it’s really difficult to navigate the system because people don’t know what the system is. I oftentimes take phone calls from parents and say, Hey, I really want my kids to come to Hillside. And I would ask Have they ever been in any treatment before? And they say no, not really. And so what Hillside does is that we generally work with children and adolescents and families who have tried at least regular outpatient therapy for they normally have a therapist or a psychiatrist they’ve worked with, and they’re continuing to struggle. They’re not making progress. And once a week therapy, so most of the Hillside clients, or clients who are being referred by the professionals they are working with. And these are the therapists and the psychiatrists who are seeing them and saying, you know, the once a week, therapy session is not quite enough to stabilize, or giving enough relief or making enough progress. Hillside could be the next step in treatment that can give some intensive services, whether that’s, you know, coming into the home or having the kids come to do an intensive outpatient program online, or coming in person for a day treatment program. And so for most of Hillside’s, kids and the families access services through a clinical referral.
Speaker 14:08
And so that telephone for it was coming from the family. It’s not only referred from other professionals. Families often call and sometimes we’re able to say, Oh, yes, you know, intensive outpatient program or intensive in-home program could be really helpful. And then we can, you know, work with the family and start services that way. But for the higher levels of care, like residential treatment, or a day program treatment, where you know, kids are coming to campus five days a week, most of the time, the families actually access services through a clinical referral from their outpatient provider.
Speaker 14:51
Got it. Okay. So I think that’s pretty clear and how that happens. And what’s the tip
Speaker 15:00
The number of referrals that come in on a month and in a month’s time.
Speaker 15:04
You know, what’s really interesting is our admissions team field over, you know, 200 calls a week. 400 calls a week, easily. So you’re turning tons of people away. And that’s because they’re just not appropriate given where they are. I want you to hold that thought because we’re going to go to break and when we come back, tell me more about your obviously handling, you know, the excessive demand beyond what the supply of services you have. And let’s talk about we’re brought to you by Georgia neurology. I’m your host, Dr. Bruce Feinberg. And today we’re talking live with Emily Acker and Gaan Akers of Hillside, which provides community mental health services to children and families Learn more at h side.org. Like Hillside h side a.org. And of course, give us a call at 404-872-0750. Emily, those numbers were staggering. You’re able to take care of 700 children a year and then all the extended family that’s related to those kids, you’re getting 200 calls, literally, a week taught, you know that references demand? I have to believe that so much of that is directly related to the pandemic. Although, again, the remarkable absence of a national mental health policy makes this demand probably great even before the pandemic. But I want to get back to a little bit of understanding about what were the major deficiencies.
Speaker 16:46
And this is not political, because this has been going on for decades across both political parties, whoever’s been in power, but whether the stigma of mental health, whatever the issues are, but the deficiencies that existed in mental health care, and then what has become even more pronounced with the pandemic.
Speaker 17:03
Yeah, the stigma is real. And we have been working for years to help fight that stigma and make discussions about mental health part of everyday communication. What we really work with families on is that this is not taboo, this should not be secret. Anyone who’s struggling with mental health symptoms and challenges really needs to be able to openly discuss this. And families need to be able to reach out for assistance and support from their community, their loved ones, their churches, their support systems. So this happens to be a mental health awareness month, and we have done a lot of work to put information out there in our reframe mental health campaign, to hopefully promote discussions, promote communication, promote education, because the less we’re siloed, and the less we’re isolated, the more help that is available to anyone who needs it. So yes, the pandemic has made things more difficult, especially in this past year, when we had to be very, very careful about how we interacted with each other and how we had to social distance and even wearing a mask where you can’t see someone’s facial expressions, their smile, their sadness, you know, so many things hidden behind that mask, has made it very, very challenging. Hillside was able to continue all of its services through the pandemic. And we are seeing an uptick in need in calls for help. And you know, and we know that more is coming as people begin returning to school returning to community returning to events, I think we’re just at the tip of seeing probably a greater need as we move forward the next few months.
Speaker 19:15
Yeah, and I would like to add to you know, that I’ve seen several articles coming across about how in the last year in 2020, the number of reimbursement claims for Adolescent Mental Health has roughly doubled from the year before in 2019. So we’re definitely seeing this increased need in mental health services for young people.
Speaker 19:42
And one of the really important thing as we talk about reframing mental health, is that oftentimes we think of mental health solely in a negative sense, right? Even the examples we generally think of at the beginning is people who are suicidal and extreme really depressed. And you know, they’re having issues with outbursts and violence. And we don’t talk about mental health in terms of wellness enough. Emily and I were having this conversation the other day, and how often times we forget to think about mental health and physical health being kind of linked in parallel, right? How often times, you know, if a child has a sore throat, or they have a stomach ache, they know that something’s wrong. And that’s something that they come to their parents, they let people know, like, I don’t, I don’t feel well. And we oftentimes don’t have the same kind of criteria for our kids, or even for people in general to say, you know, what, how I feel about myself, it’s not great, you know, this feeling when I wake up in the morning and wishing that I wouldn’t wake up. That’s kind of not normal. And so people oftentimes don’t think about mental health in those terms of like, there are warning signs that saying, we’re not doing as well as, as we should be. How do we feel about ourselves? How are we functioning in our relationship?
Speaker 21:10
Those are some of the clues and things that could help people start to be aware of their mental health, and actually seek early intervention, instead of waiting until things get really, really bad. A lot of the calls that we get are parents who are saying, Well, yeah, my kid’s been sad or been isolated for the last year and a half. But, you know, we didn’t really think about doing anything until last week, then when they had some, you know, suicidal thoughts.
Speaker 21:39
So there’s kind of these levels of care, and mental health that kind of parallels that as well, you know, going to regular therapy and just kind of getting a railer outpatient services kind of helped maintain our mental wellness, our relationships, how we feel about ourselves, how we’re functioning in day to day life, could be that kind of first step in accessing mental health care.
Speaker 22:16
I would comment to Hillside you had mentioned the over 200 calls we get a week.
Speaker 22:25
Our team of admissions counselors are really good at listening to the needs, and determining if Hillside is not the best option, or an appropriate option for services, what services are helpful. So one of Gaan’s primary responsibilities at Hillside is to be very well engaged and knowledgeable about all the other services in Georgia. So we are partners and good friends and colleagues, with many professionals who provide a variety of mental health and emotional behavioral health treatment. And so often we are guiding a family to another resource if we can’t be of service, or if they need something different, or if they’re in a location that is not accessible to Hillside. So you know, all these calls we get, we’re feeling very carefully. We are serving the families and the children who should be served at Hillside. And then we’re giving them connections and referrals, when those are needed, so that, you know, families can better navigate what is a complex and sometimes very confusing system.
Speaker 23:48
Crazy, sorry, bad choice of words, but I’m thinking about the fact that, you know, 200 calls coming in your the vast majority, you’re serving as a navigator. You’re not necessarily bringing them into the system. And yeah, yeah, such a huge service you’re providing for the community that you’re kind of underwriting. And that’s the part that I was saying was crazy from a business model.
Speaker 24:12
You know, how do you support that? How do you continue to be able to provide that service? Because the reality is there, you know, there isn’t there isn’t that hotline? We were just having a conversation last night where our friends had witnessed someone on the street and trying to call, I think it’s what 311 or 313 the hotline for a city-wide, I think for mental health, and you know, couldn’t get a response. And you know, and so, by simple fact that you guys respond, and then you not only respond but navigate.
Speaker 24:46
You become kind of critical to the community. It’s a huge value.
Speaker 24:52
Yes. So of course, you know, our admissions counselors are helping the families who call navigate and on the other end. We also work in conjunction with schools, and we work with school social workers and counselors, and we partner with churches and people in the community to do education on mental health. I think you know, one of the things, when I talk about there are levels of mental health care, and people are like, What do you mean?
Speaker 25:19
You know, that, oh, there’s regular outpatient, there’s more intensive services, you know, sometimes parents call us and they’re like, my kid needs to come to Hillside because, you know, they’re really struggling, and they’ll tell me more about what’s going on. And we realize that they don’t need to live at Hillside and be in a residential treatment, they can do really well in intensive outpatient services, you know, where they can continue to deal with day to day stressors, you know, go to school, deal with the sibling that you don’t like very much. And also get therapy and be able to practice this new skills that you’re learning in the real world. Ideally, you know, we want kids to get early intervention, so that we’re stabilizing them, and keeping things from getting worse. Also, it reduces a lot of suffering. You know, instead of struggling and being in emotional pain for a really long time. Let’s do something about that now, so that we don’t end up in a high levels of care, like residential treatment, or in an inpatient hospital.
Speaker 26:22
Right. So So seeing them, you know, it’s better to see them when they demonstrated signs of depression, rather than when they had thoughts of suicide ideation, rather than when they actually attempted suicide, like you can start to see where the earlier the better? And why, why have that additional burden on them of having those other events, you know, plague them as far as the guilt and the other things that are part of that storytelling.
Speaker 26:49
So when we’re gonna go to break in a second, few seconds, and before we do, what I wanted to tee up is the role of a primary education in school, because I can, I can see where it could be a difficult problem, and that, on the one hand, you’re expecting socialization. And you might have a lot of adults who have been, who are partially trained or somewhat trained to recognize these issues. And so for early recognition, on the other hand, you’re putting kids back in an environment with peer pressure, bullying and, and some of the things which may provoke worse outcomes for them. And so something to think about as we go to break, kind of the role of school and how much value you know, the positive value, the negative value, and how is there something we can learn from that. So let’s talk about that. When we come back. This is the weekly checkup. We’re in live today, with the folks from Hillside, Emily Acker, and Gaan Akers and really brought to you by George urology. We’re today live in conversation with Emily Acker and Gaan Akers of Hillside, which provides community mental health services to children and families learn more at hside.org. That’s hside.org. And as always, we’re taking your calls 404-872-0750, that’s 404-872-0750.
Speaker 28:18
All right, so So Emily, the role of school because I can see that it could track both ways. It’s an environment when Sometimes kids are bullied, they can suffer from the negative effects of peer pressure. On the other hand, you’ve got, hopefully some skilled trained adults, who are another potential source of observation about these kids, and maybe have certain insights that parents lack and see them in an environment maybe, where some of these things are exposed. So what’s that role good and bad of school? And how did we the kids suffer or benefit during the pandemic?
Speaker 28:58
Well, we’ve definitely had kids that have experienced both, for many children, the connectivity to their peers, to their teachers, to their PE teachers, you know, all the different adults that engage with them in their school setting, having that loss has been tremendous. I’ve talked to many parents who have said they’re once very active and talkative and energetic children have become more solemn and more afraid of various social situations, and they’ve seen more shyness and have had real concerns about that change for their kids. Then there’s other kids that we see at Hillside who have for years struggled with social anxiety. And so at the time that they could then move to virtual school and be at home and engage to their teachers through a screen, it actually became very comfortable for them. So we definitely have very different needs and very different groups of kids.
Speaker 30:12
What is true is, in either situation, a child needs to feel a sense of purpose, they need to feel like they contribute to something. So whether that’s, you know, physically being in their school and engaging with their friends and teachers, or doing an online learning opportunity, where they are gaining and growing and feel some sense of connectivity, that way, it’s whatever’s comfortable to them. Certainly, social emotional learning is vital in school settings. And resiliency is vital, teaching kids that a bad few minutes or a bad decision doesn’t need to mean a bad day, we can all be resilient, we can learn to use our skills and turn the day around, we just need the opportunity to to shift things up and move forward.
Speaker 31:08
So when we look at an upcoming school year, that begins in the fall, where it’s anticipated that all children will be returning to school full time, unmasked, very likely, based on what’s happening with the vaccines, do you anticipate that that’s going to become it’s going to it’s going to expose kids who are thriving in a virtual environment? Two more trouble, or I guess it’s going to do both? And yeah, and so it’s just right. So it’s going to be like kind of wait and see, when we come back? What I want to do is maybe help parents or you know, what are their learnings? Are there mnemonics or, you know, tricks that conversations, they could be having ways they could gain more insight than they might have? So let’s talk about kind of from a general mental health perspective, what can parents should parents be doing? The kinds of conversations they should be having? And let’s that return checkup. I’m your host, Dr. Bruce Feinberg, this hour is presented by Georgie uralla, G’s kidney stone hotline 1855 Stone one available day or night for scheduling an appointment within 24 business hours. We’re live today, with the folks from Hillside, we’re talking mental health and there’s no more important topic almost ever, because of the crises that face this country from suicide, gun violence, opioid epidemic substance abuse, the list goes on and on that these are at their root our mental health problems. And we continue to really do sick care, which is managing the problems after they’re formally manifest, rather than wellness care, preventing these problems by understanding their root causes. So that’s what we’re getting into today. And it’s never been more apparent in terms of the need, then coming out of the pandemic. And the impact particularly on children. They’re being in lockdown out of schools, parents and children, you know, often together much more than they ever had been before. observations of kids behavior being so in other issues, and where do they seek help? What kind of help do they need? And that’s the conversation we’ve been having today with the folks from Hillside Hillside has been around since 1888. Its mission is to help children and families thrive by providing outstanding residential and community mental health services. They provide specialized cutting head behavioral treatment, that specific cutting edge therapy is called dialectical behavioral therapy. We’ll hear about that in the segment. With me today from Hillside are Emily Acker, who’s the president and CEO. She’s been in that role since 2014. And Gaan Akers who serves as clinical education and refer relations manager. She’s a licensed professional counselor, Learn more at h side.org. That’s Hillside capital H side.org. And of course, join the conversation at 404-872-0750. So, a couple things I want to get into. And I want to start with understanding this specialized type of counseling, this dialectical behavioral therapy. And then I also want to be able to kind of from there segue into given the need is so great, you’re getting 200 calls a week, but last year, you cared for 700 the most, I think, children you cared forever, and you’re not just caring for them, but their extended families that’s just not even their immediate families, but their further extended families indirectly and directly.
Speaker 34:45
And so there is a huge need. And part of that is how can what can parents do on their own? What assessments can they make, what tools are available for them to them? How do they recognize the problem so they can intervene early rather than late rather when there is a suicide attempt?
Speaker 35:00
So a lot to cover here. Let’s start with though, the type of treatment and why dialectical behavioral therapy who wants to take it?
Speaker 35:11
I’ll take it. And so dialectical behavior therapy is an evidence-based treatment that is founded by Marsha Linehan in kind of the late 1970s, early 1980s. And it’s really an adaptation of the cognitive behavior therapy, which most people have heard of, to really deal with adult women who struggle with chronic suicidal ideation and self-harming behavior. A lot of women who were diagnosed with borderline personality disorder, that’s the origin of DBT dialectical behavior therapy. However, since then, DBT has been adapted and use and studied with many different population. And now it really is kind of the choice treatment for people who really struggle with mood dysregulation. And people who have really strong intense feelings, and they don’t know what to do with that feeling. And they end up using ineffective coping behaviors, to deal with those strong, unwanted feelings. Sure, they’re showing like pillars of this treatment that define it.
Speaker 36:31
Yeah, so I’ll start with dialectics. And so dialectics is kind of this idea that, you know, two things that might seem to be opposite can both be true, the major dialectic in DBT. And treatment is to balance, change and acceptance. We have to accept that this is life, as it is right now. You know, life as this being live, it’s kind of miserable. And we also have the ability to change that. Another dialectic that we see oftentimes in DBT, is that people are doing the best that they can. And they have to do better. Because most of the time, when you see someone who’s struggling, they really are, the best they can in that moment was what they have. And in order for them to be in a different space, they have to do something better. And so DBT, you know, helps people think the dialectic helps people think outside of the black and white terms. Right, a lot of times we become kind of trapped in our own thinking, when we think that everything is just either or, you know, black or white. And so DBT expands the way that we think about things in a both and kind of way that you know, more than one thing can be true at once, even though they seem to be opposite. DBT is very skill based. And so these are skills that we have a curriculum that Marsha Linehan started and these skills are studied. And so we teach them in a very specific way. So we can’t invent our own DBT skills. There are a set curriculum. And the skills in DBT covers, really four main modules. The first module in DBT, is mindfulness. And I know mindfulness is a big buzzword in last few years. But really, mindfulness is just our ability to pay attention, and become aware, being present in the moment without judgment, so that we can see I gotta ask you, so. So when it became the buzzword, was that like killing you that it’s been around for like decades, and everybody should be doing it? And why is it all of a sudden, something special?
Speaker 38:42
Well, I think there were a lot of research on mindfulness.
Speaker 38:48
And it’s, and then, you know, we saw an onslaught of apps like headspace, and all these kind of apps about mindfulness, and then people talking about mindfulness a lot.
Speaker 38:59
And part of it is because it works, right, like people are finding that it’s really helpful to practice mindfulness. And just like anything that is popular, right, oftentimes, you know, we kind of get a distorted version of it, by just getting a snapshot.
Speaker 39:18
We teach kids, how to be mindful, how do we pay attention to you know what is in the moment, oftentimes, you know, our distress comes from not being in the moment, it’s either worrying about what’s going to happen in the future, or ruminating about mistakes or some, you know, bad decisions I made in the past. So in order for us to kind of cut down some of that anxiety and some of that, you know, emotional distress.
Speaker 39:46
If we could just stop, stop ruminating about the past, stop just worrying about what might happen in the future, and just be present in that moment. And so helping them be aware is the first module of DBT. And everything in DBT is kind of based in mindfulness. And so that’s a really important skill. And when you’re developing these skills, these are skills that can be done, whether they are inpatient, residential living, or whether they are being managed in their home in an outpatient way, the skill set and the training may be more intensive in versus out, but it’s still the same, that you’re using the same approach. Yes, there is the same approach. There are the same skills and you know, DBT can be taught in the outpatient level. I think the difference with DBT in our, you know, higher levels of care setting, like residential or day program, isn’t this built into their activities, we’re making sure that they are having opportunities to practice these.
