Dr. Whitney: Hey everybody, it's Dr. Whitney and I'm so happy to be here with you today. I have Nicole Pounds from Dot Com Therapy. She's sitting with me and we're gonna talk about all things kids' mental health, which as you all know, if you have been listening to this podcast for any length of time, is near and dear to my heart. I have anxiety. My husband has ADHD. My one daughter has Autism. My youngest daughter has OCD. So we're like alphabet soup over here. And I have benefited personally from the help of therapists, personal therapists, from couples therapists, and also for therapists for my kids. So I love what Dot Com Therapy is doing. I invited Nicole on to talk about that, but also to talk about how to help families who are maybe struggling to find someone to go see for their kids, who are struggling with trying to think outside the box of just traditional therapy. Like, what are the other things they need to be considering for their families? And then also if they've decided they wanna do therapy via someone in their community, with someone at their primary care doctor, or with something like Dot Com Therapy, how to help their kids and really make the most of the opportunity. So Nicole, welcome to the show.

Nicole: Yeah, thank you so much for having me. I'm excited to be here.

Dr. Whitney: All right, so start with telling people you know who you are, what Dot Com Therapy is all about, why you created this, and why it felt like there was really a need in the marketplace.

Nicole: So like Dr. Whitney said, my name is Nicole Pounds. I work for Dot Com Therapy. I've been with this company since really close to the inception of it. Our founder, Rachel Robinson, started Dot Com Therapy in 2015 as really a need-based company, because she's a speech language pathologist. I'm also a speech language pathologist by trade. And as she was working with kids and clinics and hospitals, she realized that there were huge waiting lists in order to see a therapist. And so, in order to address that need, she started Dot Com Therapy, which is a primarily teletherapy company.That's how it started-- to meet this need, to get more access to therapy services, because we know that those wait lists are incredibly long. So Dot Com Therapy provides speech therapy, occupational therapy, and mental health therapy. Obviously with the pandemic the last few years, we have seen a huge mental health crisis come about for kids and teens especially. Really everyone, but you see this huge crisis when it comes to our kids.

And so we've really stepped in to provide extra resources in the mental health space especially. And so we partner primarily with school districts, but also employer organizations or other community-based organizations to be able to provide resources to families, including direct therapy services. So my personal role within the company is the director of community and content. So I am one of the people who get to put together all of our programming and resources for families. And then, as I said, I am a speech therapist by trade, so I've also done a lot of direct therapy prior to moving into this role. I'm also a parent of four, so I think that's relative to this conversation today. My oldest two are adopted through the foster care system and have some special needs. My second child has Autism and then my oldest is pretty complex medically. I know you kind of mentioned sensory sensitivity, but he has a lot of sensory needs as well. So we're kind of navigating all of that as a family too. So topics like this are near and dear to my heart. Just helping families find resources and get access to resources that they need.

Dr. Whitney: One of the biggest things on my heart always is so many of the career-focused women that I work with feel like it's all their fault. They feel like they're failing every day. They feel like they're trying their best and they're working so hard to make their families work and to make their jobs work and to make their homes work. And at the end of the day, they feel disappointed. They feel resentful, they feel sad, they feel like it's just not working. And so I'm really excited about resources like yours that hopefully help parents to work a little smarter, not harder, at finding solutions for their families, so that way they don't feel like they're just running on empty constantly, right? The goal is to find solutions and systems that actually work for you, not against you. So I love this. Now you mentioned speech therapy, occupational therapy, and traditional mental health therapy, like psychotherapy. So tell me about that, because of course, there was a need just for straight up mental therapy, but you guys really wanted to focus on something more holistic, the broader range of things. Talk to me and to people who maybe are listening who don't really understand what that's all about, like the why behind that and then what that actually looks like for families.

Nicole: Absolutely. So when we're looking at a child, their needs are so holistic and everything sort of plays off of one another. So when you're looking at a child who maybe struggling with something like anxiety, you really have to look at the root cause of what's causing that anxiety. And maybe that has something to do with the fact that they can't communicate appropriately, or maybe that has something to do with the fact that they are really sensitive to stimulation. And those three things that I just said include all three of those disciplines: So communication in the speech side, sensory sensitivity with OTs or occupational therapy and, in anxiety with mental health. And so everything is so connected when we're really looking at a person holistically. If you talk to some of our mental health therapists at Dot Com, they'll talk about building blocks of self-care, building blocks of mental wellness. And often the things that they talk about are things like sleep, things like nutrition. These things that sometimes you would find in what you would think of more as a medical resource, but they affect your mental health so much. So everything within just being a human being is so interconnected. And so we definitely have a heart to treat kids holistically and really focus on those developmental milestones, helping kids develop the areas of their life that they need help with. And we've just found that it's so interconnected.

Dr. Whitney: You know, in medicine we talk about this idea of genes plus environment and there is some wiring that people have, right? There's wiring that I have that's passed down from generations of anxious women in my family, that I'm never gonna get away from that. That's just the way I'm wired and actually, there's some pieces of that that have made me very driven and that've been helpful to me, right? And if I was living in a caveman world, it would've been super helpful for me to be really anxious because I would've been on my toes constantly. In this world, not as much, but still. So there's genes, but then there's also environment. And for me and my family, you guys can see me now, I'm in my office here. This is a new house that we just moved into and I wanna let you guys know about a personal story.

We had lived in a little shoebox house for a very long time and it was fine. No shade to shoebox houses, but we've been there for 12 years and we had our dog. It was a 40 pound dog. And then we had one kid and then we had another kid and then it's Portland. So then you really can't be outside most of the year because it's raining and whatnot. And over time it made it really difficult actually for my kids (who are both highly sensory seeking and also really sensitive to noise) to be able to relax and be in their own spaces, right? Someone would be loud, not even intentionally in a bad way, but just be kind of loud and it would be really overwhelming and you could see everybody kind of wind up, myself included.

And in this new home that we have, there's a bit more space. And I knew environmentally that everybody having their nook and cranny that they could retreat to if someone was having a tantrum, and my ability to pull that person over to someplace where nobody really could hear it very much, that that would be helpful for my entire family. Similarly, actually, we paired with another woman and her child we've known for a long time and they live in our basement now and they help to take care of my kids. And so we have this situation now, where environmentally I'm doing all the things that set us up for the most success. Environment's not gonna change everything, right? If you never change the thought patterns, if you don't address the speech issues or the sensory issues, it's not gonna change everything. You can't just go on vacation and move to Hawaii and everything's gonna be amazing, right? But I do think that environment, that sleep, that nutrition, that exercise, that fresh air, all those things, they make such a huge difference for parents, but also for kids. We can't minimize that. It's huge. So I love that you guys are focusing on that.

Nicole: Absolutely. And I think when we really think about what the root of what therapy is, it's looking at a person and individualizing our care path for them and being able to address the things that that family needs. And yeah, sometimes that is environmental things. That's things like finding social support, that's things like removing things from your physical space, like you're talking about with your family. Being able to have a space where if a child's having a meltdown, you can remove that person. So I think environment is very crucial when we're looking at a child's holistic wellness. And then when we're working with a therapist, they're able to teach these other skills that they need to learn.

If it's in the mental health space, maybe that's skills of positive self-talk.Maybe that's implementing practices like meditation or positive affirmations or like I mentioned, finding community or social support. You know, maybe that's helping a parent learn how to emotionally regulate themselves to be able to help their child emotionally regulate themselves. And all of that feeds off of one another. I was talking with an OT one time on the podcast that I host, Helping Kids Thrive with Dot Com and the OT mentioned during our conversation that parents have sensory sensitivity too. And it was this light bulb moment for me as a mom. No wonder I feel so overwhelmed all the time!

Dr. Whitney: Absolutely! Think about all the touching our kids do on us. It's terrible. You know, my little one still has this sensory thing where (I write about it in my book, so I'm not divulging too many of our secrets) she wants to still put her hand down my shirt and she's too old for it. She's almost seven, right? So I'm like, oh my God. But even the act of me having to constantly say, "Get off of me!" That's so taxing to a parent. The over touching, the smooching, the kissing, the smacking, all the things that happen with a kid when you are a parent. Not to mention the yelling that kids do to each other, the squabbling, the whining, all of those things, those build up for a parent too. Talk to me about this idea of some people, adults and kids, being highly sensitive. Because I think some people can just roll with it. My friend, the one that lives with us, people will be screaming and yelling and she's unphased. She might get to her edge once a year, but otherwise, it's like she's wired to not really care at all. Versus people start yelling, and immediately my senses turn up.

Nicole: I do think too, your past experiences have a lot to do with how sensitive you are, because I feel like my sensitivity has increased probably as I've added more children to my environment, really. So kids that are highly sensitive, or even just people in general who are highly sensitive, another kind of word or term for this is sensory processing sensitivity. So you'll hear this sometimes from mental health professionals, like a psychologist. But you'll also hear this in the occupational therapy space. I think occupational therapy, in my opinion, is one of those areas of specialty that sometimes a lot of people don't know about, but they're so important, because they deal with everything that is the day-to-day life of a child or a person. So when we think about occupations, it's not so much job relatedness, necessarily. But just the tasks that you're doing on a day-to-day basis. So for a kid, that would be school that would be cleaning your room or getting dressed, all of those kinds of things. So one of the things that occupational therapists work with a lot is sensory processing and helping kids be able to process this sensory stimulus that's in their environment.

So when we're talking about a highly sensitive person, it really is a person who has just this personal disposition to being sensitive to subtleties in their environment. A lot of times they're overly aroused easily by external stimuli. So you'll find that a lot with people who are highly sensitive. It's about 15 to 20% of the population who fall into this category. So it really is a good chunk of people. And like you're saying, when you're a mom or a kid, especially if you have a lot of people in your family, this can be a really huge issue. And they are just more aware of subtleties. My oldest son, I classify him as being highly sensitive, I need to be aware of even just small gestures of affection. But on the flip side, if I have a flicker of emotion because I'm upset, my son picks up on it immediately.

Dr. Whitney: 100%! It goes both ways. They're highly attuned if you have a sad look on your face and they go, are you okay? It's crazy.

Nicole: And you're like, I didn't want you to know that I wasn't okay. I didn't mean for you to pick up on that.

Dr. Whitney: What you were talking about with the idea of your past experience, it influences this. There is a trauma response that happens as well. So for the moms out there who maybe had a colicky baby or a baby who didn't sleep well and that trigger was that you heard them crying in the middle of the night and then now you hear crying from your kid and that it really triggers you. It brings you back to that moment when you didn't sleep and you felt so worried. Or maybe you have a kid who's in the middle of having a lot of meltdowns and so now maybe that's past and every time I hear somebody have a meltdown, it triggers me. Or maybe there's something in your own personal past, like your childhood, that something happened to you or you lived in a really conflictual household.

So now when people yell or people fight or they even just raise their voice or they have a stern look on their face that triggers you and you feel really sensitive. So all of these experiences accumulate. So if you're feeling something like, I feel terrible that I'm this highly sensitive person, gosh I need to just get it together. It might also be part of your learned experience and the way that your body and your nervous system tries to protect you, because it's had these more traumatic experiences and it's trying to tell you: we have to get out of this, this is dangerous for us, it's no good for us.

Nicole: Absolutely. I love that you bring up that trauma response too, because I think that adds in, and it's a whole other layer. It goes back to what I was talking about earlier about how integrated everything is when we're talking about just the human experience. I would say trauma is a different thing than being highly sensitive to external stimuli, but they go hand in hand. And if you've had some kind of traumatic experience, which by the way, childbirth can be incredibly traumatic. So if you're a person who's dealing with that, my heart is with you. But you know, if you've had these traumatic experiences in your life and then you're also a highly sensitive person who has all of these external stimuli in your life, those two things together can just create this sort of internal storm.

Dr. Whitney: Okay, talk to me about the therapy part because you guys are providing online virtual mental therapy and occupational speech. Talk to me about parents who are trying to get their kids motivated to come to the sessions, parents who are trying to get their kids to be more engaged in the sessions. Because that can be really difficult too. You're sitting here with the computer open, you paid the money, you want your child to participate and they're walking outta the room. Talk to me about that. How do we make this successful for parents and for kids when they're trying to engage in these sessions?

Nicole: Yes, absolutely. I'm glad that you asked this question. Dot Com Therapy does provide all teletherapy sessions. So we actually don't have any brick and mortar space.So everything we do is via teletherapy and our goal is really to work with families in that direct therapy space. But then also we just wanna support families holistically. So providing resources and training for families, providing support via parent coaching and working with families that way. I think those ways are also very supportive of families, which is great. When we're talking about a teletherapy session especially, I think that it's interesting that you bring up this conversation, because it can be an issue. And I think when we're talking about teletherapy for families, sometimes families get concerned about how it will work. 

Will it be engaging for their kids? Will this be something that they will like to do? And I am a teletherapist and have been a teletherapist for several years. So I've sat on this side of the computer giving teletherapy, but I also have been the recipient of teletherapy personally and for my child. So my kids received occupational therapy via telemedicine. And so I've kind of sat on the parent side of things too. So I love this conversation. I think that number one, you need to find the right therapist and the right company to work with because teletherapy can be so engaging. It doesn't have to be something that's boring or hard. 

But I feel especially when we went through the pandemic, all the schools went online. Everybody was pivoting to teletherapy. I know we had some of our therapists that worked for the school district that were suddenly pivoting to this and some of them pivoted very well and did a great job. And then some of them really, it was obvious, didn't wanna be providing teletherapy. It's just some people like it, some people don't. And it's not for every therapist and it's also not for every child. But if you are working with the right person, it can be engaging and it should be engaging. And that can be via the activities that are happening via the screen. So things like games online or flashcards online, even just the therapist holding up a book and working through your kids' emotions with that. 

All of those kinds of things are techniques that you can use, but it can also be really engaging physically. And I always encourage therapists to include movement when they can. So I want families to know that it doesn't have to look like your child's sitting at a table with a therapist. When we had our therapists, I used to run around with my cell phone tracking them as they did obstacle courses in our house that we set up and they would go over the pillow forts and all kinds of things. So there's all kinds of ways that you can use teletherapy. So I think having the right therapist that's engaging and that's working with you and making this an individual experience for your child is important. So depending on their goals, that will look obviously different, depending on what they're looking at and the age of your child. If you're working with a teen, you might not be making a pillow fort. So I think the age of your child makes a big difference too.

But finding the right therapist and really engaging your child in an individualized manner is important. You can also do things like finding a quiet space for them to work in a separate room anytime that the parent can be there. Especially if you're working with a young child. If your child is an adolescent and they're doing mental health therapy, that might not be as appropriate. Especially young kids, it's lovely if a parent can be there just facilitating things, helping redirect their behavior, but also learning from the therapist. I absolutely actually prefer doing teletherapy with my own kids, because as a parent, I find it so empowering to be able to see what the therapist is doing, how they're queuing my kids, what they're working on every single session versus going to a clinic. Sometimes clinics will have that parent interaction and if they do, that's amazing, but sometimes they just wanna take your kid back to the room and you sit in the waiting room and then you don't even really know how to help your kid once they get home.

So I think having that interaction with the teletherapist right there in your home is so crucial and important and empowering as a parent. And, because it happens in the home environment, I think there's something extra special about that, because it's that child safe place. They are naturally more comfortable in that space. They naturally are more aware of the things and just familiar with the things that are in their environment, which I think makes a difference. And then when you're working on things like a picky eater or something like that, they can sit at their own table, they can eat their own food. They can be with their parents who are going to be sitting at the dinner table. So it makes a lot of sense, especially in certain situations and working on certain things. I just personally really love that. Because I think it's very empowering for families to be able to be involved in their kids' therapy like that.

Dr. Whitney: I think the other thing for working parents is just the travel time. You don't have to take your kids out of school for as long. You don't have to travel to an office. You don't have to make sure that you're there 20 minutes early so that you don't miss the appointment. It's so much simpler to jump on a zoom, even on your phone or on your computer. But that has been amazing for me, as a pediatrician, to be able to have more telehealth visits, and also for the therapists in my office. But I also love this idea, just for more access. Also for people who maybe live in a community where they don't have behavioral health providers really available. They don't have occupational therapy. It would take forever to get into speech. Those types of issues are really a big thing too. So tell me, in terms of access for you all, is it with insurance? Is it pay out of pocket? Are there super long wait lists? Talk about that piece of it. Because people, they're getting excited right now, thinking, oh my gosh, there's a resource with actual people that know what they're talking about online.

Nicole: I love that you bring that up. I actually feel like I forgot the most practical reasons why teletherapy is important. Being able to cut out that commute is huge. Being able to even step out of the room and toss clothes in the laundry while your kid's having a therapy session is huge. In terms of access, this is a huge reason that teletherapy is so important and is such a great resource for families, because, like I mentioned earlier, there are really big wait lists, especially for certain areas of specialty. Some therapists have more experience in a specific area or they have an additional certification or additional training in a specific area. So being able to match with therapists that have an extra area of expertise in what your child needs is also incredibly important.

So I can speak kind of from Dot Com Therapy’s perspective to the questions that you're asking about wait time and whether we take insurance and those kinds of things. Those are going to vary depending on the teletherapy company that you're working with. At Dot Com Therapy, we are matched with the insurance companies. So we do accept some forms of insurance. Obviously, we're not in-network for all insurance, as is no one. But we're continually adding to that list. And so we do accept insurance or you can pay out of pocket if we are out of network or that works better for your family for some reason.

We also have been working on a new model. We're moving into providing mental health therapy on a wider basis across school districts. So we actually are partnering with school districts and the school district is saying, "Hey, we recognize that mental health is a priority for our kids and our families and it needs to be a priority, but we need help being able to provide that therapy service." So they are agreeing to pay for X amount of therapy sessions for all of the students in their district. So some schools that we're partnering with are providing that access to care, which is really cool. To see that school district kind of come behind saying, "Hey, this is important. We wanna provide access to this." And then also working with them, we have access to all the families. It's not just kids on an IEP or kids that have been identified as having behavior problems or something like that. This can be for all kids, which is really cool in a district.

But we work with school districts and families and employers or organizations across the country. So we have therapists that are licensed kind of all over the place. So it will vary a little bit depending on where you're located as to which therapists from Dot Com you'd be able to work with, because they have to be licensed in that state of course. But yeah we service across the nation.

Dr. Whitney: I know that there are so many of you that are out there like, "Oh, I can't believe this resource is there and that I could potentially have my child meet with someone, sooner than later. I sit there in my office and give people referrals all the time. And more often than not, they come back and they said they were full. Or it's a one-year wait list. And so to be able to have a larger network, I think for people to consider accessing in a way that is more approachable for people is amazing. I'm sure you're not the end all, be all or the solution for every single family, but this type of solution I know is the wave of the future and is so helpful for families, especially since you're also holistic. I wanted to point people to your blog that is about highly sensitive kids on your website and also they can find out more about resources there. Is there another way they could access you? Any place else that they should be listening? You mentioned your podcast. I just want people to have all the cool resources about taking care of their kids and themselves.

Nicole: Absolutely. So yeah, the main place to find us dotcometherapy.com. That's our website. Like you said, we have a blog. We have parent resources on there. All of the information about how to partner with us, especially for schools and organizations. And yes, we do have a podcast. It's called Helping Kids Thrive. You can find us anywhere that you find podcasts. So Spotify, Apple Podcasts, all of those. Or you can find us on the website too. There's links to our podcast there too. And we do a podcast every other week. I actually host that podcast and we interview some experts in the field. So it's usually on a topic of child development, mental wellness, sensory sensitivity, all of these kinds of things we talk about on the podcast. Communication disorders, developmental milestones, anything in that parenting resource space. So yeah, those are great ways to find us.

Dr. Whitney: Awesome, Nicole. I love it. Thank you so much for being here. I know there are parents out there feeling so much more hopeful. Again, Nicole Pounds from Dot Com Therapy and we'll see you next time. Thanks Nicole.