A New Path to Mental Wellness for Youth with Dr. Laura Tully, Vice President of Clinical Integrations & Partnerships at Kooth Digital Health

[00:00:02] [SPEAKER_00]: Hey everyone, welcome back to the Outcomes Rocket.

[00:00:06] [SPEAKER_00]: So excited to launch another episode today.

[00:00:09] [SPEAKER_00]: Today I have the privilege of hosting the amazing Dr. Tully on the podcast.

[00:00:16] [SPEAKER_00]: They are a licensed clinical psychologist and neuroscientist, focus on scalable technologies

[00:00:22] [SPEAKER_00]: and public policy to create universal access to high quality, inclusive mental health

[00:00:28] [SPEAKER_00]: support for young people.

[00:00:30] [SPEAKER_00]: I'm excited to have them on the podcast to really uncover some of the great work

[00:00:35] [SPEAKER_00]: that Kuth is doing in the space.

[00:00:37] [SPEAKER_00]: Dr. Tully, thanks so much for being with us.

[00:00:40] [SPEAKER_02]: Thank you so much for the opportunity. It's a delight.

[00:00:43] [SPEAKER_00]: Thank you. Thank you. The pleasure is ours.

[00:00:45] [SPEAKER_00]: So to kick things off, you know, I always enjoy understanding where folks are coming from

[00:00:51] [SPEAKER_00]: and why their inspiration and healthcare can you share a little bit more about yours?

[00:00:55] [SPEAKER_02]: Sure. I think like many individuals in the behavioral health space

[00:01:00] [SPEAKER_02]: I came to clinical work and clinical research through lived experience.

[00:01:04] [SPEAKER_02]: So I have family members and friends who've had difficult mental health recovery journeys.

[00:01:09] [SPEAKER_02]: You know, I've experienced mental health challenges myself like many of us do.

[00:01:14] [SPEAKER_02]: And when I was finishing university, I had fallen in love with research and decided

[00:01:19] [SPEAKER_02]: I want to try and find out what's going on in the brain when folks are experiencing mental

[00:01:23] [SPEAKER_02]: challenges and then how do we design treatments that can help them on their recovery journey?

[00:01:30] [SPEAKER_02]: So that's how I ended up in this career.

[00:01:32] [SPEAKER_02]: And I spent the largest portion of my career today in an academic setting doing a lot

[00:01:37] [SPEAKER_02]: of research and clinical work around community based mental health and scalable solutions

[00:01:41] [SPEAKER_02]: for young people.

[00:01:43] [SPEAKER_02]: And recently, about a couple of years ago, made the hop over to industry because I'd

[00:01:46] [SPEAKER_02]: seen some really exciting things happening over there.

[00:01:49] [SPEAKER_00]: That's great. Well, we're excited that you made that choice.

[00:01:52] [SPEAKER_00]: We need these perspectives to be successful in the mental health spaces.

[00:01:57] [SPEAKER_00]: There's so many things impacting all of us.

[00:02:01] [SPEAKER_00]: And so let's dig into Cooth.

[00:02:03] [SPEAKER_00]: Talk to us about what Cooth is up to and what they're doing to add value to the healthcare ecosystem.

[00:02:09] [SPEAKER_02]: Yeah, so Cooth is a UK company.

[00:02:13] [SPEAKER_02]: It was founded about 20 years ago at the kitchen table to digitally transform mental

[00:02:19] [SPEAKER_02]: healthcare for young people, right at kind of the birth of the internet.

[00:02:23] [SPEAKER_02]: The founders had the brilliant idea that we could use that to reach young people in a way

[00:02:27] [SPEAKER_02]: they hadn't been reached before.

[00:02:29] [SPEAKER_02]: And since then, the company has grown to be the number one digital mental health provider

[00:02:32] [SPEAKER_02]: for young people in the UK.

[00:02:35] [SPEAKER_02]: And in 2023, the company was awarded a contract with the State of California Department

[00:02:41] [SPEAKER_02]: of Healthcare Services to provide free mental health support to all telephone

[00:02:47] [SPEAKER_02]: youth aged 13 to 25.

[00:02:49] [SPEAKER_02]: So this was part of Governor Newsom's big initiative called the Children in Youth Behavioral Health

[00:02:54] [SPEAKER_02]: Initiative.

[00:02:55] [SPEAKER_02]: He and his administration have dedicated over $4 billion to these initiatives to provide

[00:03:01] [SPEAKER_02]: coverage for every single kind of California young person from 0 to 25.

[00:03:06] [SPEAKER_02]: So really kind of walking through that childhood to young adult who journey.

[00:03:11] [SPEAKER_02]: And Cooth won the contract to provide mental health support through our digital platform Saluna

[00:03:17] [SPEAKER_02]: And so we're part of one of the work streams in that big funding from the governor

[00:03:23] [SPEAKER_02]: is called the Behavioral Health Virtual Services Platform.

[00:03:26] [SPEAKER_02]: And essentially it represents the State of California's digital strategy.

[00:03:31] [SPEAKER_02]: They've recognized that there needs to be a digital strategy in order to do scalable

[00:03:37] [SPEAKER_02]: high quality mental health support for young people.

[00:03:41] [SPEAKER_02]: They've decided to invest it and they've recognized the importance of public private partnerships

[00:03:45] [SPEAKER_02]: to do that really well.

[00:03:48] [SPEAKER_02]: And Cooth's Sips is really filling the gap between that first moment that the young person

[00:03:53] [SPEAKER_02]: might start having questions about what's happening for them and their brain and the experiences

[00:03:58] [SPEAKER_02]: they're having to when they might need to enter more formal outpatient treatment or beyond.

[00:04:04] [SPEAKER_02]: So we're at that beginning of the mental health continuum of care and conceptualize ourselves as

[00:04:10] [SPEAKER_02]: sort of the digital front door is often the first step into mental health spaces

[00:04:15] [SPEAKER_02]: that young people have.

[00:04:17] [SPEAKER_02]: It's really easily accessible right now.

[00:04:19] [SPEAKER_02]: The platform is available on smartphones.

[00:04:21] [SPEAKER_02]: We will be releasing it web-based and tablet-based by the end of this year.

[00:04:27] [SPEAKER_02]: And so it's in their pocket.

[00:04:28] [SPEAKER_02]: It's a front door to support an information and trusted safe spaces to get help from their peers.

[00:04:35] [SPEAKER_02]: So I can talk a little bit about the platform if that makes sense.

[00:04:38] [SPEAKER_00]: I would love to hear more and just wondering how do people find out about it?

[00:04:42] [SPEAKER_00]: Are they released it in California?

[00:04:45] [SPEAKER_00]: How do people find out about it?

[00:04:46] [SPEAKER_00]: I feel like that's half the battle sometimes.

[00:04:48] [SPEAKER_02]: Yeah and actually it's probably the largest battle that I think we have in digital mental health

[00:04:53] [SPEAKER_02]: in general is getting the platforms in front of the people that need it and maintaining engagement.

[00:04:59] [SPEAKER_02]: So this is where I think the public private partnership is a really strong approach because

[00:05:04] [SPEAKER_02]: in order to bring these platforms to the people so to speak, you need really strong marketing

[00:05:11] [SPEAKER_02]: and messaging and you need really far reach.

[00:05:14] [SPEAKER_02]: And when you put the state of California together with a private company that has a strong

[00:05:19] [SPEAKER_02]: marketing approach, you're able to kind of get those messages in front of people.

[00:05:24] [SPEAKER_02]: So it could be hearing from your school-based mental health providers, your primary care practitioner,

[00:05:29] [SPEAKER_02]: your teachers, could be hearing about it in a podcast ad break or seeing it in a YouTube ad break

[00:05:37] [SPEAKER_02]: or hearing about it from friends that have already started using it or even hearing about it

[00:05:42] [SPEAKER_02]: from your district members and legislatures who are doing community engagement events and telling

[00:05:47] [SPEAKER_02]: people about these resources. It's 100% free. I mean the state has invested this money so it's

[00:05:52] [SPEAKER_02]: free at the point of service and so getting it in, yeah, getting into people's hands I think is

[00:05:59] [SPEAKER_00]: the challenging part. And it sounds like the company you guys are using your marketing muscle

[00:06:05] [SPEAKER_00]: and communication with their footprint and access to be able to educate everyone.

[00:06:10] [SPEAKER_00]: Sounds like it's digital, sounds like it's online offline but it's getting to the people which is

[00:06:15] [SPEAKER_00]: amazing. So yeah that's our head. Yeah. Oh go ahead Dr. Tully.

[00:06:21] [SPEAKER_00]: No no, no, okay. And so what is it that is different? So you know the approach when you need the help

[00:06:29] [SPEAKER_00]: it's a digital front door to when you actually start to need the services that are more serious.

[00:06:36] [SPEAKER_00]: What is it that you would say is a big differentiator for Cooth?

[00:06:39] [SPEAKER_02]: Just a quick summary of the platform saluna, it provides support to young people through

[00:06:44] [SPEAKER_02]: kind of three major pillars. So the first one is self guided resources so this is a collection

[00:06:49] [SPEAKER_02]: of informational articles or videos as well as coping skills and self assessments where the

[00:06:56] [SPEAKER_02]: person can discover what they want to discover based on the questions they have. So they get

[00:07:01] [SPEAKER_02]: to design their own journey through those resources. The second pillar is our peer community forum

[00:07:07] [SPEAKER_02]: where young people can post questions to other users on the platform and respond to other

[00:07:14] [SPEAKER_02]: users' questions and provide peer support. It's fully moderated so what we've done is we've

[00:07:19] [SPEAKER_02]: taken all the good stuff from the internet which is you know information and community building

[00:07:24] [SPEAKER_02]: and we've left all the bad stuff to the side so the bullying, the troll, the inappropriate

[00:07:28] [SPEAKER_02]: content and created this safe space for young people to help each other because lived experience

[00:07:34] [SPEAKER_02]: and peer to peer experience I think is probably one of the most powerful ways of reducing

[00:07:39] [SPEAKER_02]: psychological distress. So this peer community forum is a place where services can help each other

[00:07:46] [SPEAKER_02]: do that. So that's the second pillar of support and in the third pillar is our behavioral health coaching

[00:07:52] [SPEAKER_02]: so you can get one to one coaching either in-at via text or video coaching with one of our

[00:07:58] [SPEAKER_02]: behavioral health coaching team members and again we're emphasizing lived experience which I think

[00:08:04] [SPEAKER_02]: is you know one area differentiation is that we're recognizing this power of lived experience for

[00:08:10] [SPEAKER_02]: support. So about three quarters of our coaches are individuals who are what are

[00:08:15] [SPEAKER_02]: calls certified peer support specialists so these are individuals that have lived

[00:08:19] [SPEAKER_02]: experience of mental health recovery or other life challenges like being on house or food

[00:08:25] [SPEAKER_02]: in security, financial insecurity and they have received training and support to help them use

[00:08:32] [SPEAKER_02]: that lived experience as a way of supporting a young person in reaching their goals

[00:08:36] [SPEAKER_02]: and figuring out how to navigate their own lived experience. The remaining group of our coaches

[00:08:42] [SPEAKER_02]: are a mix of substance use counselors, general behavioral health professionals and licensed individuals

[00:08:47] [SPEAKER_02]: that do all of the things that licensed individuals do like supervision and safeguarding

[00:08:53] [SPEAKER_02]: risk management and things like that. So it's this three-pronged approach and it prioritizes

[00:08:57] [SPEAKER_02]: autonomy for the young person so I think this is another differentiator is that we know that

[00:09:04] [SPEAKER_02]: young people want to have an autonomous journey through their support experience and the reason we

[00:09:10] [SPEAKER_02]: know that is that we co-designed the platform with them and this is a core principle of

[00:09:15] [SPEAKER_02]: truth is that it should be used in formed use-led. We should be building platforms for young people

[00:09:21] [SPEAKER_02]: by and people what might work for me as a middle-aged person is not necessarily going to be

[00:09:26] [SPEAKER_02]: what works for a 13-year-old and I should not put myself in the position of assuming that I know

[00:09:31] [SPEAKER_02]: what that is. So having a youth-led approach is going to be one of the main sort of drivers of success,

[00:09:39] [SPEAKER_02]: I think, of getting young people engaged and using the platform. Now that's really great

[00:09:43] [SPEAKER_02]: please continue. Yeah, thank you. So that code is I'm with youth and there's two other things

[00:09:49] [SPEAKER_02]: that I really love about it and actually there are two reasons why I ended up choosing to work with

[00:09:53] [SPEAKER_02]: coups as a company. So the first piece is what is that coaching model? It's not therapy,

[00:09:59] [SPEAKER_02]: it's coaching and it's designed to be goal-based and where the young person kind of achieve some

[00:10:06] [SPEAKER_02]: movement towards their goal in a single session. So you can have repeat sessions over time if that's

[00:10:13] [SPEAKER_02]: what you want as a service user. But the approach has been designed to get you kind of maximal

[00:10:18] [SPEAKER_02]: output or maximal benefit through just one coaching session and it's like I said it's goal-based.

[00:10:24] [SPEAKER_02]: So traditionally, in mental health care, the focus is on symptom reduction, right? It's like,

[00:10:30] [SPEAKER_02]: how do we help you reduce your anxiety? How do we help you reduce your depression? And most

[00:10:35] [SPEAKER_02]: companies out there are due to fully measuring those things using validated questionnaires like the

[00:10:41] [SPEAKER_02]: HQ or the God and then seeing how their interventions reduce the scores on those questionnaires,

[00:10:49] [SPEAKER_02]: which are really important. And we measure those things too. But the next step is figuring out

[00:10:53] [SPEAKER_02]: like what is the life that that young person wants to build? Right? And what are the goals to get there?

[00:11:00] [SPEAKER_02]: Right. And once you have those goals that the young person sets themselves, now you can identify

[00:11:06] [SPEAKER_02]: what the barriers are. And it might not actually be symptom reduction. It might be getting a library

[00:11:11] [SPEAKER_02]: card. It could be figuring out how to ask that person out on a day. It could be getting some

[00:11:17] [SPEAKER_02]: financial support or food insecurity support. So by having this goal-based focus, we are again

[00:11:24] [SPEAKER_02]: sucking back to that youth-led design that the young person gets to set their journey towards

[00:11:28] [SPEAKER_02]: the life that they want to have. So yeah, those are two really important differentiators.

[00:11:33] [SPEAKER_02]: I have another one, but I am aware of time. Bring it on. Let's hear it.

[00:11:39] [SPEAKER_02]: Yeah. So this is the second reason I, I, you know, because we had a job with this company.

[00:11:43] [SPEAKER_02]: So I spent a long part of my career in academia doing clinical training of providers and

[00:11:48] [SPEAKER_02]: community professionals. Yeah, music David's. And I got the honor of part actually contracting with

[00:11:55] [SPEAKER_02]: DHCS, California's Department of Healthcare Services, and their mental health commission to

[00:12:01] [SPEAKER_02]: create a training and technical assistance center for community behavioral health members.

[00:12:06] [SPEAKER_02]: And one of the things that I really wanted to focus on is how do we provide consistently

[00:12:10] [SPEAKER_02]: high quality care? So in general, in this country, when a person like myself goes and does a clinical

[00:12:18] [SPEAKER_02]: degree, I learn the things that I need to learn in school. I go out into the community and do my

[00:12:25] [SPEAKER_02]: hours of training. I take my licensure exam and offer go into the field to practice as a

[00:12:31] [SPEAKER_02]: clinician. And from that point on, unless I'm in a special scenario, I typically receive very

[00:12:38] [SPEAKER_02]: little oversight, very little quality control and very little supervision. And this means that

[00:12:44] [SPEAKER_02]: nobody is checking in to make sure that I am doing good treatment, evidence-based work, and actually

[00:12:50] [SPEAKER_02]: impacting my clients' lives in a meaningful way towards their goals. It's very little quality

[00:12:56] [SPEAKER_02]: control. And that means that you have this huge variety in the clinical practice field. And as a

[00:13:03] [SPEAKER_02]: consumer, you really have no way of knowing if the person you contract with to do therapy or

[00:13:09] [SPEAKER_02]: mental health support is good at their job or not. And there's lots of people that are brilliant

[00:13:13] [SPEAKER_02]: at it and there are lots of people that would benefit from additional support. At coups, we have

[00:13:18] [SPEAKER_02]: developed a proprietary clinical model for evaluating and auditing our practitioners to make sure

[00:13:24] [SPEAKER_02]: that they are providing consistent high quality care. So is it integrative responsive, person-centered,

[00:13:31] [SPEAKER_02]: data-driven, you know, is it goal-driven by the person? And every three months, our practitioners

[00:13:37] [SPEAKER_02]: get evaluated against that model, both by their supervisors and their peers, and receive the

[00:13:42] [SPEAKER_02]: necessary training and support to maintain that high quality of care, which means no matter

[00:13:47] [SPEAKER_02]: which coach that young person lands with, they can feel confident that that coach is going to

[00:13:52] [SPEAKER_02]: do a good job and will be high quality. And that I think is like a key differentiator in mental

[00:13:58] [SPEAKER_00]: health spaces in general in this country. Totally. Yeah, that standardization of care delivery

[00:14:04] [SPEAKER_00]: is huge in this space. And sounds like you guys have a formula for it. And then the thing that sticks

[00:14:11] [SPEAKER_00]: out the most is really this self-guided journey from, I just need some information and I could

[00:14:19] [SPEAKER_00]: educate myself to maybe I need to talk to a peer to okay, I'm at a point where I maybe need some

[00:14:26] [SPEAKER_00]: direction and coaching and guidance. And it sounds like the platform really incorporates all that

[00:14:32] [SPEAKER_00]: along with evidence-based practices that layer-end standardization on top of that, taking it to a

[00:14:39] [SPEAKER_00]: level. So I think this is really great stuff for everybody listening, you know, obviously worth

[00:14:44] [SPEAKER_00]: checking out if you're working to get better in this area, whether you're a pair or an employer

[00:14:52] [SPEAKER_00]: seeking for ways to take care of your people because we all know at the end of the day it's productivity,

[00:14:57] [SPEAKER_00]: it's happiness, it's, you know, all of this stuff matters and mental health is at the core of it.

[00:15:03] [SPEAKER_01]: Healthy brains is a healthy economy, right? Healthy brain, healthy society, healthy economy,

[00:15:07] [SPEAKER_00]: healthiness in general. Yeah, amen to that. And so look, I mean this has been an outstanding

[00:15:14] [SPEAKER_00]: and you do such a nice job of kind of just laying out the message so clearly, I could tell you

[00:15:19] [SPEAKER_00]: you have a passion for it and you really love what you do. What would you tell our listeners today

[00:15:26] [SPEAKER_00]: as a call to action, you know, as a closing thought? What do they need to be thinking about?

[00:15:31] [SPEAKER_02]: I think for listeners who are in the mental health service provision space, I think the

[00:15:38] [SPEAKER_02]: call to action is to check out Saluna and think about how you might want to integrate this into

[00:15:43] [SPEAKER_02]: your practice. I think we've done a really amazing job over last decade creating some really

[00:15:50] [SPEAKER_02]: interesting digital platforms and the next step is we need to start integrating it into the

[00:15:55] [SPEAKER_02]: existing system of care and give practitioners confidence in how to use those as a tool. So if you're a

[00:16:01] [SPEAKER_02]: primary care practitioner and you're doing these screenings for depression and anxiety with young

[00:16:05] [SPEAKER_02]: people, think about Saluna as an opportunity for an add-on tool or a initial tool for them

[00:16:12] [SPEAKER_02]: to get support as you figure out the next steps. So check it out like I said it's free in California

[00:16:17] [SPEAKER_02]: we're out in some other states, Pennsylvania and we're launching in a couple of others as well

[00:16:22] [SPEAKER_02]: hoping to go nationwide soon. So yeah, for practitioners that's what I would say to do for parents

[00:16:28] [SPEAKER_02]: and other young people I would check it out and spread the word. It doesn't really matter where

[00:16:34] [SPEAKER_02]: a young person is on their journey. Saluna is a great tool to have in your pocket for those days

[00:16:40] [SPEAKER_02]: when you just need to let a little extra support or a little extra boost.

[00:16:44] [SPEAKER_00]: Love that Dr. Tally, thank you so much. This has been a really insightful conversation.

[00:16:49] [SPEAKER_00]: I've learned a lot and I know the listeners have as well. Folks, if you're listening to this,

[00:16:54] [SPEAKER_00]: check out the show notes. We'll leave Dr. Tally's information. They and their team are very

[00:16:58] [SPEAKER_00]: interested in pursuing further conversations with you, your organizations, your family, your loved ones

[00:17:06] [SPEAKER_00]: to really make this experience a lot easier because that's it in the end what we need. So Dr. Tally,

[00:17:11] [SPEAKER_00]: thank you so much for being with us. Thank you. It's been a pleasure.