Seven Ways to Help Our Stressed Kids (with Dr. Nzinga Harrison)

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Our nation’s children are experiencing some of the highest levels of stress in history due to the pandemic, yet they lack the skills to properly verbalize and manage their mental health. The good news? It’s not too late for adults to lend a hand, and you don’t have to be a primary caregiver to do so. Mental health expert Dr. Nzinga Harrison teaches Andy about the seven Positive Childhood Experiences (PCEs) that build a child’s sense of belonging, and how to help any young person in your life access them. She also reflects on the positives of the pandemic, including a decreased stigma in requesting mental health support.

Keep up with Andy on Twitter @ASlavitt.

Follow Nzinga Harrison on Twitter @NzingaMD.

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Andy Slavitt, Dr. Nzinga Harrison

Andy Slavitt  00:17

Welcome to IN THE BUBBLE . This is your host, Andy Slavitt. It’s Wednesday, May the 18th, a special show today that is dedicated to the kids in our lives. The kids in our country, the kids in our world. And what they’ve been through these last few years, many of whom, Mr. Graduation, many of whom lost things in their lives, whether it’s memories, parents, family, and a lot of whom are dealing with a lot of issues right now. So joining us is Dr. Nzinga Harrison, a psychiatrist and amazing person, we’re going to talk through some of the issues and some of the solutions for what kids have been going through. And we’re going to try to interpret some of these really tragic numbers that we’re seeing around teen mental illness around the country think is amazing. And we’ll also play for you my commencement address at the University of Minnesota Medical School that I gave last week, it was my message to kids in that particular context. And we’ll talk a little bit about what we should be doing what we should be saying. And Nzinga has a lot of excellent ideas and solutions that we should be talking about. And we really need this dialogue as much as we need anything. So let me welcome Dr. Nzinga Harrison.

Andy Slavitt 

Welcome to IN THE BUBBLE.

Dr. Nzinga Harrison

Thank you, Andy, glad to be IN THE BUBBLE.

Andy Slavitt 

So maybe you can help us understand some of the news we keep seeing. You’re my source for kind of many things, mental health, and help us understand what our kids have been through over the last few years. Maybe I’ll read you some stats, which are, I think pretty well known. You know, that we have a third of high school students reported a mental health issue during the pandemic. There’s some higher number. I think 44% self-reported feeling perpetually sad or hopeless. There’s a number that report having experienced trauma in their families, either parents losing a job, losing a family member, and pediatric emergencies are up pretty significantly from mental health issues. You help us sort through what’s happening in this country with kids right now.

Dr. Nzinga Harrison  02:45

Yeah, I mean, the country period is at one of the highest levels of distress that we’ve seen in a long time. And you figure as adults, we have our entire childhoods, adolescence, adulthood, to learn skills for how to verbalize that distress that we’re experiencing, how to manage the thoughts and feelings and physical sensations that come along with that stress, how to build a support network that we can reach out to during those periods of stress. And our young people and adolescents have not yet had that life experience to be able to fall back on that. And so for our elementary aged kids who would really be learning kind of in developing that social support network in elementary school, many of them spent that time now isolated at home with parents, and for adolescents for whom the number one developmental milestone is developing that peer group, spend that time at home with their parents missed going away for the summer for college, missed internship, missed a graduation, many of them last year missed prom. And so these big, huge developmental milestones, that we’ve programmed our kids to look forward to a celebratory have kind of been stripped away by this very scary, what is going to happen virus is that ever going to end pandemic, put that on top of the stat you just gave with kids in homes where parents have lost jobs where they have lost people to COVID and when you don’t have that kind of fully built, coping system, emotional management, being able to see that there is a future beyond this having that support system network that you can access. It just leaves you very vulnerable to fear and that sense of loss and not knowing what to do and if anything good will ever come next.

Andy Slavitt 

I’m not sure I’m gonna get the classifications right. And you could tell me how important it is to get these classifications right. And I think it probably is important just to understand what’s going on. But what you’re describing to me feels a lot like people who’ve experienced trauma. And how much of this could you describe is, we just had a number of people experienced trauma, and as you said, they’re not well situated. They haven’t developed all the skills to manage trauma. By the way, even adults, we have it either versus anxiety over the future, which is to say, the world that they’re growing up in is colored by more bad things that people are experiencing on a greater scale.

Dr. Nzinga Harrison  05:58

Yes, and so absolutely a trauma. You know, the, the definition we use of trauma in the DSM five, which is kind of our psychiatry Bible is very narrow. There’s a larger definition that really resonates with me that says, any experience that negatively changes your outlook, about the world, or how you interact with the world, throughout your life. And I think with that definition, undeniably COVID changed the outlook of all of us and our young people, changed the way we interacted with the world changed our concepts of ourselves and each other. And at the same time, when you have an experience like that, what you need most is to be able to get closer to your support system. And so at the same time, we were all experiencing that collective trauma, especially our young people, we were being physically disconnected. For those of us, you know, who were fortunate enough to have a support system, especially for those kids and adolescents that had a shaky support system to start with or who had already experienced trauma, this lays on top of it and compounds, that reaction.

Andy Slavitt 

So what’s the path back from a trauma to the ability to cope from this level of anxiety over the future, to an outlook that isn’t so cloudy? What are we going to be seeing and experiencing over the next few years? Maybe even? I hate to take the negative but maybe all the shoes haven’t even dropped yet? Are we going to see worse things? And then what are what is the path out?

Dr. Nzinga Harrison 

So I think empowerment is always that path out. And I want to talk about empowerment from a couple of different angles for our young people. First of all, those of us adults, who are able to look beyond even what may be coming and kind of keep a sense of optimism and hope. We have to hold ourselves accountable for making sure we are sending that message in a mass way. And so no, we cannot fully predict like there, yes, there will be another variant, maybe we will need boosters, there’s a lot of science. But what we do know is that we know more than we did. And what we do know is that we can keep ourselves safer than we could before. And what we do know is that we can live our lives in a new paradigm in a way that can be fulfilling and meaningful. And we have to make sure as much as the scary information is getting out that that hopeful empowering information is getting out. Very practically, I like to benchmark people to adolescence to this idea of pieces. So have you heard of aces, Andy adverse childhood experiences,

Andy Slavitt 

and we talked about this on the show with Joneigh Khaldun a couple of weeks ago. But why don’t you remind the audience about what aces are?

Dr. Nzinga Harrison  09:14

Yeah, so ACES, Adverse Childhood Experiences are a set of 10 experiences, and I won’t run all 10 of them down. But that if a person has more than four during childhood that predicts chronic health conditions, physical and mental, later in life, and so it is abuse and neglect having a parent go to jail of divorce or separation, there are 10 And so the goal is to minimize the number of ACEs that children experience in their early developmental lives. A lot of people know about ACEs. Andy, do you know about PIECES? Pieces are positive childhood experiences. And what the literature shows us there are seven of them and I’m going to say and the time going through all seven, because I just said, we have to be incompetent to send this message. This literature shows us that if we can stack as many as possible of these seven pieces, they mitigate the adverse childhood experiences. So even a person could have eight ACES, which is a really high score and predicts like a hard time later in life, if they have two to three pieces, that mitigates the risk of those aces 50% If they have four to six pieces that mitigates the risk of those aces, 75 ish percent, right. And so one of the ways I want to empower our young people and the adults that are supporting our young people is to very intentionally introduce PIECES to offset the negative effects of the trauma of this pandemic. So here are the pieces. Feeling able to talk to your family about your feelings. It seems simple, but this is not a widely known cultural phenomenon here.

Andy Slavitt 

It feels simple until you have kids.

Dr. Nzinga Harrison 

Exactly. Right. So feeling able to talk to your family about feelings. Number two, feeling your family stood by you during difficult times. Now, this is difficult times and a study came out early in the pandemic, it has since turned around, but it said our kids are okay. And it was a study of kids. And the number one factor that predicted which kids were doing okay, despite the pandemic was, I feel like the pandemic brought my family closer together. That was the number one factor right? So like, feeling your family stood by you during difficult times, feeling safe and protected by an adult in your home. That goes for this COVID pandemic, how are we making our kids feel safe? How are we transmitting to them that even though the virus is going on, you can feel safe, feeling supported by friends, we have to support our kids being connected, whether that’s virtually going back to school being in a park outside, we have to get our young people, adolescents, especially with their friends, enjoying participation in community traditions. COVID stole a lot of that from us. And so maybe we have to establish new traditions that we’re comfortable with right now until we can get back to our older traditions. But the point is that our young people, and this is all true for adults too, but need to be wrapped in a sense of community feel feeling a sense of belonging in high school. And then the seventh, having at least two non-parent, adults who took a genuine interest in you. And so, I my kids have two parent adults that we me and my husband, we take extreme interest in our kids, we love them, we literally sat down and we’re like, okay, here are the ACES, we’re going to try to keep that zero, here are the PIECES, we’re going to try to get to seven. That’s beautiful. My kids need to other adults. So as adults, how we can practically support our kids, create space, talking about those feelings. Support them during this difficult time. Proactively find community traditions to engage them in, find two other adults besides ourselves to take genuine interest. It

Andy Slavitt  13:40

sounds like you and your husband can also take genuine interest in someone else’s kids and fulfill some of that mission.

Dr. Nzinga Harrison

Well, you know what I told my kids first of all, we went over these ACES and PIECES with the kids. And we’re like we’re trying to keep these zero. We’re trying to get these two seven. I told them if you have any friends that don’t have two adults or need an adult, me and your dad will be that adult for your friends. Like those are very practical things that we can do.

Andy Slavitt  14:10

That message so much reinforce so much to your kids about what kind of caring adults you and your husband are.

Dr. Nzinga Harrison

And that’s who we want them to grow to be right Andy and so, in having this information and being able to intentionally pour pieces on our kids and intentionally try not to have our kids experience aces, then we’re setting up a generational chain.

Andy Slavitt 

I love these seven PIECES. It’s the first time I’ve heard them. And I imagine that a good practice would be to ask you, they’re your kids. Do you feel this way? Skinny? Do you feel this way? Do you feel this way? And where you don’t, that’s okay. Let me help you. That’s right. And let us get you there. Because this is all about how they feel. What’s interesting about them is there’s no objective like, no, no, you should feel that way. Because you have nine friends, and you are on three sports teams and you do ballet, and you went to summer camp, you should feel the weight No, you feel the way you feel. And they’re the ones that have to identify this. But if you don’t know whether your kids are, are two out of seven, or three out of seven, five out of seven or seven out of seven, then that’s where things may be breaking down.

Dr. Nzinga Harrison

That’s right. And that I mean, you just expressed it so perfectly. Andy, why I love the PIECES, because parenting doesn’t come with a roadmap. And this is a little bit of a roadmap, not just for parenting our kids. But for that community sense of all of the young people who are in our lives, like, I can try to give one of these pieces to all of the kids

Andy Slavitt

love to get your thoughts on how you do that I you know; I had the chance. The privilege, I guess you’d say, last week to go in front of a few 100 kids to do give a commencement address was amazing to me was I spent a bunch of time beforehand, trying to think about in a very real and specific way that I had not done before, how to get into the heads of a graduating class, graduating in the year 2022. That was speaking to med school class. So they’d spent four years in school, which you have, and half of those four years were spent during the pandemic, that which you can only imagine is virtual. And in the case of med school students, it’s the also very close to this crisis in a way that they probably hadn’t anticipated.

Dr. Nzinga Harrison  16:45

Yes, it’s so interesting getting into their heads, is, in some ways, getting out of our heads, right? So we’re a generation ahead of these kids, I’m a generation ahead of them in medicine, maybe I won’t make myself be a whole generation ahead of them in life, although I definitely am. But times are different, not just because of the pandemic. But times are different in the ways that we relate to each other, inside and out of medicine in the ways that we accept a concept of being different in the ways that we embrace the concept of belonging in many ways. This generation is already doing the work of pieces in a way that our generations didn’t. And so how do we drive that message of hope and empowerment for, you know, our future leaders.

Andy Slavitt  18:15

Why don’t we listen to this, and let’s come back then, let’s talk about what may be some of the positive things that kids may have been able to get out or we can help them pull out of this experience. And miss all the negatives. I want to warn you in Zynga that you might hear your name mentioned in this speech. That’s how I felt that was done before. I decided to invite you on the show. So just you could be like everybody else. Let’s sit back and we’ll play this free pretty quickly. It’s about 15 minutes. So excuse me talking for 15 minutes, you’ll hear some of the students in background.

Andy Slavitt

Thank you associate dean. That’s not the speech I wanted to follow. Those are some solid jokes, I would say. So welcome, University of Minnesota Medical School graduates, families and friends. Madam President, Dean Tolar. After four years of training, half of its spent during a once in a century pandemic. I can only imagine what this day means to you. And I can’t help but wonder how this class of physicians and scientists has been shaped. By the way you’ve been thrust into a world where our health and our healthcare system had been so overwhelmed. By now you’ve experienced firsthand what many graduation classes probably only learn later. That while you’ve trained to fight an enemy called illness and disease, they’ve learned how to manage cancer and fight infection. There are other deadly forces that will shape your worlds and that of your patients that you must also fight. Not having practiced medicine myself, I’m in certain awe at your commitment, and potential. I’m fortunate that in my career I’ve been surrounded by a number of young physicians who shaped my view of healthcare, and who’ve been part of reshaping the system itself. They see patients many days and others, they work against a broken system, in the case of Dr. Toyin Ajayi, by building a new system for those without access to the block health, in the case of Dr. Nzinga Harrison by building a revolution in addiction recovery, centered on harm reduction. In the case of Dr. Mandy Cohen by crossing the chasm to tie Health and Social and Human Service programs together when she served as Secretary of Health and Human Services in North Carolina. These doctors practice medicine in the tradition of a movement that began 30 years ago, in the legal profession. One lawyer, Gerald Lopez was defending low-income immigrant clients against laws he saw were grounded in racial profiling, and discrimination. So he decided that he needed to do more than just defend his clients, but to fight the very system that disadvantage them. He developed a concept called rebellious lawyering, which began to spark an approach to practicing law by serving the individual while simultaneously fighting the systems that further oppression and discrimination. The movement has taken root. Many law schools now offer classes and how to practice rebellious lawyering. If Lopez pioneered rebellious lawyering, then what I want to talk to you about today might be described as rebellious doctoring. Look, I would like nothing more than to tell you that you’re entering a world where medicine and science and medical professionals are revered, and that if you simply work to heal your patients, without confronting the threats in the world around them, you will succeed. But I cannot the care that most Americans need, its care they often can’t find, and if they can find it, they can’t afford it. Many people very likely won’t get access to someone like you, or any doctor until their health becomes an emergency. There are fewer and fewer doctors and medical professionals, particularly in the communities where you are most needed. This helps account for the desperate and desperate state of our health. People are dying younger. Life expectancy in the US now trails the rest of the developed world by five years. And that’s just if you compare averages. Care in some communities in the US is comparable to care in the poorest countries in the world. Countries with few doctors, clinics, medical supplies, or clean running water. And we’re not dying younger, from lack of know how or sanitation any longer. But if treatable diseases, deaths of despair, deaths that could be mitigated with blood pressure cuff or cancer screenings, deaths caused by lack of basic access to care. We must rebel against this.

Andy Slavitt  23:37

In what should be a golden age for science. junk science is flourishing. At a time when we can edit malformed needs out of our genes and invent new vaccines in a matter of months. Public Trust in science is at an all-time low. The big takeaway from the pandemic in many parts of the country is that public health professionals had too much power, too many resources and too much sway over our lives. To work in public health today is to worry about death threats, and verbal assaults on the street. When expertise is devalued, everyone’s opinion counts equally. Just believe what appeals to you. misinformation and disinformation will be among your most dangerous enemies as a physician. We must rebel against this. Now as bad as the US healthcare system is for patients is as good as the US healthcare industry is for corporate America. There are an increasing number of big and lucrative industries like PBMs, managed care’s, electronic medical records, pharmaceutical marketing, patient collection agencies, employee benefit design, utilization, management and medical supply purchasing to name just a few. Many of the companies in these industries are worth billions. And while some certainly provide necessary functions, I’m afraid that the part of healthcare that supports pay Since directly it’s often a side note in the giant and self-serving medical industrial complex. The growth of the medical industrial complex is undeterred by things like this poor state of our nation’s health. In fact, each new problem with the system creates a new opportunity for more companies. The problems aren’t solved, but the web of complexity and money grows thicker. So just as our health falls further behind the healthcare industrial complex firls polls further ahead. We must rebel against this. And graduate graduates, the healthcare industrial complex is also celebrating your graduation today. But not in the same way your family and friends are. No, they don’t look at you and see a future doctor here to heal us. For the healthcare industry. Today is a day of opportunity, another person to use their machine or prescribe their drug, another future medical director to deny care, another building and referral engine, you’re about to become very popular. So watch out for well-dressed people offering solutions and restaurant reservations. Everyone seems to want a piece of you. Not only do corporations want to influence what you do in the exam room in the operating room, so to governors and judges. There are places in the country that have already made it a crime for you to protect a woman’s right to care for her own body as she chooses, or help her.

Andy Slavitt  26:38

Or to help her even if she’s in physical danger from a pregnancy that threatens her life. These laws and laws like them, like those which stigmatize and harm trans children do not see people for who they are, but fear their differences. Graduates laws that demand that you take away someone’s autonomy, treat them as less than equal and seek mob justice are driven by hate and fear. They are nothing new. But these laws are not your guideposts. They invite your rebellion. Laws that seek to intimidate you exist because those who make them fear you. They are fearful of the power of your oath, the power of your education, the power of your goodness, of your very instinct and the core of your soul to care for a needy patient no matter the need. In accessibility and equity, misinformation, greed, exploitation and justice. These things will impact patients every single day. They’ve become every bit your foe and every bit as dangerous as the illness and disease you’ve trained to fight. But I asked you not to react with resignation, despair or cynicism, but with action. These very threats are similar to the ones recognized by Gerard Lopez 30 years ago in the law. There your call to rebellious doctoring. For all those forces against us. Rebellious doctoring has one major advantage you; it turns out that you not they have all the power. Always remember that you are the first person and often the only one, someone sees at the most frightful, invulnerable time of their lives. No system, no corporate executive, no politician, as much as they try will be there in that moment, and trusted by that patient. And what you do in a single, seemingly routine set of moments will have a more lasting impact than 1000 Other things that happened to that patient before and will color the 1000 things after. Faced with an impersonal system. Show your patients that you will not just care for them, but care about them. rub their sore feet and hands and know that you may sometimes be the only human touch they have experienced in months or even yours. Many patients will enter your world feeling broken, fearful and neglected. Tell the most self-loathing that they are lovable. Show the most lonely, how they light up your day. For the most hopeless. Take the first step on the journey to recovery with them. Recognize not just the clinical diseases you see, but the diseases of society. generational poverty, trauma, racism, sexism, institutional bias, neglect, hate ableism environmental destruction, loneliness, hunger and despair. Lovingly heal the symptoms and aggressively fight the causes that are driving people to you.

Andy Slavitt  29:52

To chip away at the brokenness of the system every day, do not despair, the size of the challenge. Pay attention to the words of the late Bishop Desmond Tutu. Do your little bit of good where you are. It’s those little bits of good put together that overwhelm the world. Just like medicine, rebellion is best played as a team sport. If you want to change things, one person alone can be powerful to combine caring and healing of all of you together. And those you enlist, however, is an unstoppable force. never confuse the person with the patient and their illness or their circumstance. When you meet a new person, don’t think I have seen this 1000 times. Think instead, I am seeing you for the first time and I know you’re experiencing this illness for the first time. Let them all remind you of someone you love. And as you take care of others, it is past time to rebel to take make sure that you too are being taken care of. A system that forces you to fight against it cannot be permitted to burn you out. I can’t pretend to know the stress and the darkness that can creep into what you will face as a doctor. But I’ve been given some tough assignments in my own career, fixing the launch of the Affordable Care Act in 2013. fighting to save it from repeal and 2018 resetting the US COVID vaccination program and 2021, I’ve gotten to see how hard the status quo is to change and how badly people needed to. What I’ve learned is that you have to take care of yourself to be good of any good to others. I’m not talking about seminars on self-care or free soda machines. Do not let people call you heroes and call it a day. If the country owes doctors and nurses a debt of gratitude, we must show it by listening to you about what needs to change.

Andy Slavitt  32:05

You must acknowledge the toll that working in and against a broken system will have on you and demand a more humane system for doctors, nurses and patients. Everyone in the system should be working to support you not work against you. These demands for better treatment of our most precious clinical workforce are not acts of selfishness. They are acts of generosity. There’s a famous quote from American novelist Ursula Gwynn that says to see a candles light, one must take it to a dark place. Well, you are here to be the light where none exist. I’m no expert at what your education hasn’t prepared you for. I’m sure there’ll be moments of real challenge ahead. Moments when your best won’t feel good enough. I want to suggest that you view those moments not as failures. But as tests. The ideals you’re committing to are most assuredly going to be tested. These questioning moments are designed to remind you that it often won’t be enough for you to just do your job within a broken system. That you may not just be able to treat the patient’s complaint, but you will need to fight the forces preventing people from finding relief from shining and from thriving. But this is a lot to ask of yourself. And it may not always be enough. But it will surprise you the number of times that it will and you will not be at this alone. History is replete with stories of rebellious doctoring, which came before you let your path be lit. By Dr. Elizabeth Blackwell, the country’s first female physician, who despite the obstacles she faced, established the New York Infirmary for indigent women and children and open the Women’s Medical College. Let it be shaped by Dr. Charles Drew. The surgeon who developed the first large scale blood banks during World War Two and then had to fight to desegregate blood banks, resigning ultimately from his post at the American Red Cross and protest. And while he was refused admission to the American Medical Association chapter based on his race, he became the first African American to serve as an examiner on the American Board of surgery. Let it be led by Dr. […], who was a prisoner in Auschwitz, substituted her own blood for other prisoners with illnesses so they wouldn’t be killed. And he was subverted […] attempts to experiment on pregnant women. Look, there are easier paths you could have chosen than to be a doctor and a scientist. easier ways to spend your career than with rebellious doctoring. But accomplishing big things is always hard. As I gave you my full congratulations. I think about the many lives you will improve and many things you will disrupt Godspeed with the things you will make better. And with the rebellion that will often be required to do it.

Andy Slavitt  35:17

That’s it. First of all, I wouldn’t say it was a stressful experience because it was such a privilege to do. But, boy, it took a lot of thinking and a lot of conversations to try to put myself in that headspace to do that. Public speaking doesn’t stress me out. It just doesn’t. But I did feel like a responsibility to give 250-300 kids and their families a message that really resonated at a time when there were so many things they’re trying to assimilate about the world around them and what they needed to do next.

Dr. Nzinga Harrison 

Well, we have two concepts of stress, adaptive stress, and toxic stress. And this was adaptive in that you reached a deep inside, you rose to the occasion, you met the responsibility. And so that stress will turn into something positive, not just for you. But butterfly effect. All of those kids that you talked to, this speech was beautiful, and revolutionary, and empowering and hopeful. Those are literally all the antidotes to the level of stress and fear that we’ve all been under for the last two. I mean, I can’t even keep track now. Like it was. I loved it. It was beautiful.

Andy Slavitt  36:41

Well, thank you. Thank you for saying that. And I know that’s only in part because I mentioned you.

Dr. Nzinga Harrison 

That made me cackle so loud in your listeners ears, okay?

Andy Slavitt

So, you know, I mean, I think you know whether the message and in the case of this speech where we’re focused on take this and become a rebel, which may or may not be the right message for your kids at any given time. But use it constructively. How do we think about what kids will take away positively from these couple of years? I mean, I wonder whether or not when these kids just graduated class are adults, whether they will, there will be characteristics that they display, whether it’s empathy, caring, a memory of spending more time with their parents than might otherwise have. That will be sources of strength.

Dr. Nzinga Harrison  38:00

I think all of those are exactly right. And you set up your commencement speech by saying, you know, it really matters, what we do, and what they see us do, and what we model for them. And what I hope our young people will take from the last three years is exactly what you said, which is a sense of victory and resilience, that we literally went through something historical, and survived it, and thrived through it, and innovated through it, and used it as an opportunity to make radical change and disruptive innovation and to bring, like, what I loved about your speech, one it was empowering to you know, I was raised a revolutionary. So I felt like you wrote that message for me. And then for my name to be missed. At the same time, I was like, this is the best. But I really love that last concept you left them with which was rebellion, can be good. Rebellion can be needed. And that’s really what we’ve needed over the last year as we dealt with this pandemic was like the sense of we have to try them through this not even over it through it. And that gets back to modeling. Talking about our feelings, I think the stigma that has fallen down around being able to say you know what, I’m not okay. Since the pandemic is remarkable. Like we’re at the lowest stigma levels for being able to say, I need support.

Andy Slavitt 

Well, that’s a great thing.

Dr. Nzinga Harrison 

That is a great thing. The pace slowed down significantly for a lot of people and a lot of people realized I needed to slow down my pace. That’s a good thing. A sense of belonging, like we’re, you know, in the in the technology connected realm, our low, our younger generations, when they couldn’t go to school, my kids used to complain about going to school, when they got to go back to school in person, they were like, Oh, my God, school in person is so good, right? Well, things that we were taking for granted, time we were not, quote, forcing ourselves to spend with our families, there are so many goods, and I think speeches like yours really give the permission, which is something we all need to do, to see good in the last three years, even in the midst of all of the distress and struggle that we’ve had.

Andy Slavitt  40:51

That’s beautiful. Do you feel a sense of hope and optimism that because of the stigma barriers coming down, which I hadn’t quite put together, because of the renewed sense of purpose and belonging and slowing down? Will there be a light at the end of the tunnel, and I’m particularly focused on the third or 40% of kids, whichever measure you’re picking that are really struggling? I hope one of them, if I had one wish, in the world, if I had a genie and one wish in the world, it’d be that those kids got healed, and that we wouldn’t have 30% of our population becoming adults with these scars, without having dealt with them.

Dr. Nzinga Harrison 

There is a light 100% categorically I have no doubt about that. It is up to us to make sure those kids can see that light.

Andy Slavitt 

And that means I think we start with the PIECES. And then if kids need professional help, what general thoughts would you give people who feel like you know what I just either anywhere from, I want to just be sure my kids are okay, too. I think my kids have experienced some of these issues, and I worry about them to something even more serious. Where should we point people?

Dr. Nzinga Harrison  42:14

Number one is ask. So don’t wait for your kids to come to you. As soon as you listen to this podcast, go talk to your kids do number one on the pieces, create space for feelings. Let them see your feelings. Right? That is very important. If you’re worried that you might need to be worried about your kids. So you’re not even sure you’re worried. That is enough signal. Have a conversation, there are so many options, you can talk to your child’s pediatrician, you can talk to if you’re in a religious or spiritual institution, to a guide there, if there’s a teacher at school that you trust to that person, if there’s a counselor to that person, even if you can look for a therapist, there are lots of online platforms. That’s another thing that COVID has brought us that is beautiful, which is kind of like on demand access to help you can Google it, there is an app for that, you can get connected that way to tell your kids directly a resource, my two favorites, our suicide helpline, sorry, three, Crisis Text Line, our kids to have the safety of being able to text really creates a way for them to be able to communicate their feelings in a way that doesn’t feel so intrusive. And the third is the Trevor hotline, especially for LGBTQ kids who are experiencing even the next level of stress as they go through their adolescent development. All of these are on demand crisis support available right now. So even if you don’t think your kid quote unquote, needs it, one, ask the question, how are you doing? How are you feeling? Share how you’re feeling in the conversation with hope and optimism. Even if you don’t think they need it, give them those resources. Ask them to share those resources with their friends, to have them keep a picture of it in their phones. So if you ever need it, you can access it immediately.

Andy Slavitt  44:22

So we’ll have links to all of those things you just mentioned right in the show notes if you need to find them. And then I’m going to add what you said earlier, which I love, which is be that caring adult in someone else’s life who you think doesn’t have enough of that support around them already. And by the way, even if they do even what the hell go be that one other go be another person who tells them that they’re great, another person that tells them that they’re important. I have conversations with adults all the time that remember and owe their success to the one adult who told them that when they were a kid how special they were, and that they were amazing. And they remembered this as adults. Whether it was a teacher and an aunt, whatever it is, it just the power of that the power to have that big an influence in sales, like we don’t have that much power normally. So go be power hungry and take advantage of that.

Dr. Nzinga Harrison 

Yeah, use your power for good, right? I have a friend Her name is […] right. And she runs a diversity and education empowerment consulting firm is called disruptive partners. And she is the chief executive disrupter. And I was just watching a speech from her over the weekend. And she said something that really resonated with me. So she was a 14-year-old troublemaker. skipping school getting kicked out of class, her mother was dying of breast cancer. Nobody is school new issue, single mother, she was under so much stress. And she gave a spoken word piece. And I probably won’t quote it perfectly, but I’ll quote it the way my heart remembers it. She said, I was a borderline genius on the edge of ingenuity. But so many teachers missed it. Because they didn’t believe in me. And she said, What do we truly believe about the potential of our troublemakers. And so what I want us to make sure to like really emphasize and like I have been carrying that in my heart since I heard her say that because it’s easy to intentionally pour pieces on a kid who is quote, doing well, or is excelling, or has had some change from but our kids who are the quote troublemakers are the kids who need us almost the most all of our kids need us the most. These kids need us to believe in them the way you just said, Andy.

Andy Slavitt 

Wow, that’s really powerful. So just to close, I thought, since I did reference the amazing work that you have revolutionized you revolutionary in this speech, I thought I would that’d be wonderful if you would tell folks just a little bit about your day job. What you do when you’re not on my podcast and how you are transforming people’s lives?

Dr. Nzinga Harrison 

Yeah, no, thank you for the opportunity. So I’m so just grateful to be co-founder and Chief Medical Officer of Eleanor Health. And our mission is to help people affected by substance use disorders live amazing lives. And our charge and the sense of accountability that we feel is to change the way people with addiction are treated in this country, both within and outside the healthcare system. By aligning the financial incentive of the healthcare system with the human incentive.

Andy Slavitt  48:12

And one of the things you do is you measure the heck out of how people are doing everything. What have you learned about how your approach is working? Can you give people some hope that who go on this addiction journey that something positive can come out of it for them?

Dr. Nzinga Harrison 

Yeah, our approach is working. So first of all, our approach is that it is the relationship that matters. So we take care of people during active periods of drug use. That’s really when people need us the most, during early recovery during sustained recovery, like sustain that relationship. And you can measure the impact of that relationship on people getting better. You have to take care of all substances. You have to take care of depression, anxiety, you have to address those other parts of people’s lives, their meaning and purpose, their connectedness, their financial stability, their health, their housing, their physical health illnesses, you have to hit those pieces for our adults. And if you do that, you can quantify the lifesaving, you can quantify the life improvement you can quantify the increase in meaning and purpose that people experience even during periods of active addiction. This is what is critically important. We are measuring. We are showing that even our community members that we’re serving is a mix of people and active use early recovery, sustained recovery relapse to active use 70% to 80% of people even during COVID are seeing an improvement in Depression, Anxiety reduction and substance use improvement in physical health symptoms, increased sense of belonging, pieces, and purpose, and being able to give back to their communities pieces. And so I’m going to go back to what do we really believe about the potential of our troublemakers. We tend to think of people with addiction in this country as troublemakers even though they are people with an illness surrounded by lots of unstable social factors, like what do we really believe about their potential? I think that’s what we have special at Eleanor is that we believe in their infinite potential. And we felt like it is our responsibility as the health care system to help them realize that whatever it means,

Andy Slavitt  50:42

well, I think people just got a sense of why you’re one of the young physicians that inspires me. You’re one of the people that inspires me why I mentioned you and why I think we would do a whole we could do a whole lot worse than to have a whole bunch of kids graduating today, to try to become somebody like you in their own way, in whatever way that is. Dr. Nzinga Harrison, such a great, great pleasure to talk to you and have you in the bubble.

Dr. Nzinga Harrison 

Andy, I loved it. As always, thank you for the hope and empowerment that you’re putting out there.

Andy Slavitt 

That’s gonna take care of our kids.

Andy Slavitt

Okay, thank you for listening to this, I hope you enjoyed listening to Nzinga as much as I enjoy talking to her actually thought the conversation that she had around pieces was really inspiring, really, really, really neat. And very helpful. And just tells me that there’s a lot we can do a lot that I can do as an adult to help and get involved in this problem. And I think it’s sort of the spirit of the last couple of episodes, which you know, going back to last Friday, how do we help inspire women and other people who are underrepresented to get involved in politics, to talking about the election with John King on Monday, and today’s episode, which is what we need to do for kids, another great Friday conversation coming up. So don’t forget to tune in on Friday, before your weekend and then next week, because you got to make a habit of tuning in Monday, Wednesday and Friday. It’s a new habit. Next week and the following. We’ve got Michael Mina, we’ve got Larry Summers, we’ve got better O’Rourke who got Patrice Harris, he’s just got a bunch of great guests and a bunch of great topics coming up on a bunch of things that i No matter to many of us. Have a great couple days. I will talk to you Friday.


Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.

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