Dr. Roger Harrison joins us on this episode of the podcast. Together we delve into his work as a pediatric psychologist in the greater Wilmington, Delaware area, a role he’s held at Nemours Children’s Health for 20 years, and his longstanding passion for health equity and inclusion.
Carol Vassar, producer
Roger Harrison, PhD, Clinical Psychologist, Nemours Children’s Hospital, Delaware
Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
MUSIC (00:24): Let’s go well beyond medicine.
Dr. Roger Harrison, Nemours Children’s Health (00:27):
I’m Roger Harrison. I serve in different capacities, and so primarily, I’m a psychologist within the division of Behavioral Health, and so I work very closely with Nemours’ pediatricians in our primary care clinics. I’m also more recently, so within the last year plus, have taken a more formal role within the Office of Health Equity and Inclusion, where I serve now as a senior diversity and inclusion practitioner.
Carol Vassar, podcast host/producer (00:58):
Today I’m joined by Dr. Roger Harrison, whose voice you just heard. Together we’ll delve into his work as a pediatric psychologist in the greater Wilmington, Delaware area and his longstanding passion for health equity and inclusion.
Dr. Roger Harrison, Nemours Children’s Health (01:17):
I always knew that I was going to work with children. I just didn’t know in what capacity I was going to work with children. And so I started my undergraduate training as a pharmacy major and due to a series of unfortunate incidents, mostly in the chemistry lab involving maybe sulfur and being kicked out of lab, I needed a new major early on in my undergraduate career. And so I chose psychology because it felt like a good choice at the time, but I wish I could tell you that I had something that was a lot more thoughtful and intentional. As a goofy undergraduate sophomore, I just knew I was going to work with children, and psychology seemed like a really good fit for my interest and my passions.
Carol Vassar, podcast host/producer (02:06):
And that’s far away from sulfur.
Dr. Roger Harrison, Nemours Children’s Health (02:08):
It is far away from sulfur and open hoods and, yes, complicated other situations.
Carol Vassar, podcast host/producer (02:15):
And you said you always wanted to work with children. That’s probably one of the reasons you came to Nemours, but I don’t want to put words in your mouth. What drew you to Nemours?
Dr. Roger Harrison, Nemours Children’s Health (02:25):
So I matched at Nemours through the Psychology Residency match, and that itself is an interesting story because the truth is, as someone who grew up in New York City and in my graduate work in Utah, I didn’t actually know where Delaware was technically. And so, at some point in the process of looking over programs that I’d be applying to to complete my psychology residency, I ran into this hospital, AI DuPont Hospital. It seemed close enough to a large city, it seemed like it was outside of a big city, and my spouse was like, “We can’t live in a big city.” So geographically it felt like, “This is a good idea,” but then I interviewed here and met some of the psychologists, several of whom have now retired, but some of who are still here actively working.
And I just found the community of psychologists and the community at Nemours, and then the opportunities to work with families and communities that I’m passionate about, all of that was present. And so I went from having Delaware being like, “I think it’s a state,” as I go through the song about where the states are to quickly elevating what was then AI DuPont Hospital for Children up the list of places that I would match for residency. And that is how I got here. And so, I remained here for residency and then continued through my postdoctoral fellowship, and after that, I became a member of the faculty here.
Carol Vassar, podcast host/producer (03:56):
You’ve been in the community for 19 years. What is the state of mental health of children right now, post-pandemic or near it, from your perspective?
Dr. Roger Harrison, Nemours Children’s Health (04:04):
I chuckled a little bit because, as you reference, near post-pandemic, I’m not that sure that we’re near post-pandemic, but that’s neither here nor there. What I will say for listeners who might be aware, in December 2021, the Surgeon General, Vivek Murthy, put out a youth mental health warning, and that is well worth reading because, in that youth mental health warning, he essentially said that we are at a crisis state for young people in America, and that crisis state isn’t a crisis state that emerged within the pandemic. And so within that report, he pointed out that prior to the pandemic, so going back even 2019, we saw that there had been a 40% increase in the percentage of high school students in America who reported experiencing some kind of lingering sadness or depression. That’s a 40% higher number than they had surveyed in 2000. And if you look at data coming out of the CDC, the data is really just heartbreaking as we look at the tremendous increase in suicide attempts that require a visit to the emergency room or some form of medical intervention for young people over the course of the pandemic.
And so really, we are at a crisis state when it comes to the mental health of young people in America. And that is for multiple reasons, exacerbated by the pandemic, but wasn’t caused by the pandemic. One of the facets of this pandemic that I think has been under-discussed, there was some research put out by CHOP and a couple of other children’s hospitals, maybe within the first year of the pandemic, that looked at one topic, and that was the number of young people who had gained a significant amount of weight while they were home during virtual school. And so these were also anecdotal stories and data from shifts in BMI about young people who were gaining 30, 40, 50, 60, 70, 80 plus pounds within the first year of the pandemic. And so we know that as young people deal with social stress and deal with bullying, one of the reasons that young people get bullied, one of the most common reasons, is body size.
And so not even thinking about the isolation, the disconnect from their peers, being at home and dealing with all those stress in that enclosed environment, but there were so many young people who are now having to go back to in-person instruction with a body that looked different from the body that people last saw when they saw them. And just then dealing with that and wondering whether the infrastructure in schools were even prepared to deal with that, given that we live in a society where body shaming and fatphobia is such a key kind of driver of harm and hurt and pain, but it’s also a bias that’s like one of the last remaining biases that seems acceptable in our society as we’ve moved to create a more inclusive society for young people and old people.
Carol Vassar, podcast host/producer (07:19):
Now, I know that diversity, equity, and inclusion is a huge passion for you. I want to ask this of you, are there some populations among the pediatric group that are more affected by the child youth mental health crisis that has actually been in process for many years?
Dr. Roger Harrison, Nemours Children’s Health (07:36):
Yes. I don’t know if this is common knowledge, but the CDC has kept data on not just suicide attempts but completed suicides. And historically, the demographic within America that has had the highest rate of completing suicide. Most people think that for young people, it’s young white youth, but it’s not. It’s actually Native American, Alaska native young people, and they continue to have the highest relative rates of suicide. We know that after that white youth have the next highest rate, but in terms of numbers, they certainly have the highest raw numbers of completed suicide. As the CDC has been tracking data over the years, they noticed a small shift. The completed suicide rates among the different racial and ethnic demographics have really changed. And beginning in 2020, the only demographics that have seen an increase in their overall suicidal rates are Black young people and Asian young people.
We’ve seen suicide rates remain relatively stable for Hispanic youth and actually decrease slightly for white youth and for Native American and Alaska Native youth. And if you just think, when you ask what has the pandemic exposed, it’s not just the Coronavirus pandemic; it’s also like the increase in racial tension and what seems to be like an active movement away from inclusion and understanding and more towards intolerance. And so, in light of that, it really helps me appreciate why it is those two demographics, Asian youth and Black youth, who are actually seeing an increase in completed suicides in the time period of the pandemic.
Carol Vassar, podcast host/producer (09:33):
I’m looking at your face, and I’m listening to your voice, and I can tell you have a passion for this and that that statistic is amazingly terrible. Talk about your passion for diversity, equity, and inclusion. Where does it come from? Why is it important in the healthcare setting?
Dr. Roger Harrison, Nemours Children’s Health (09:51):
Well, I guess I could start by saying that my hope, my goal, my wish is for every person who places themselves in service of the patients will share the same passion for equity, for belonging, for inclusion, and for diverse communities. I noticed something in my work as a clinician. Over the years, I have been increasingly impressed by the young people who come in to talk with me. They have developed such an eloquence and an amazing way of articulating how their distress has been tied to racism, how their distress has been tied to poverty, how their distress have been tied to communities that have been historically marginalized, that have been under-resourced, where they’re experiencing community violence, police violence, et cetera. And so I realized that as a clinician, I am spending a lot of my time as a psychologist addressing the consequences of poverty and the consequences of racism and the consequences of other forms of oppression.
As I’ve met more and more youth who do not identify as straight or who do not identify in a typically expected way along the gender binary, I’ve met just too many young people, they’re coming into therapy, but what they’re bringing, their pain is connected to these core parts of their identity or the experiences as it relates to poverty. And so I’m thinking, “Here I am, and I am trying to clinically address person by person by person who’s dealing with the consequences of racism or poverty and other forms of oppression when I operate and live within a huge healthcare system that has a responsibility, in my opinion, to think about the systematic and the institutional forms of harm, how we could do things in our system to reduce the harm that I am now trying to heal on a person by person basis.”
And truly, I credit my young people; I credit the young people that I work with for really orienting me from like a purpose and a moral perspective to make this my own moral imperative. And I credit them for really driving with me the passion to work within systems, whatever the systems are, to create conditions of equity.
Carol Vassar, podcast host/producer (12:26):
How are we doing in that regard in Nemours as an enterprise?
Dr. Roger Harrison, Nemours Children’s Health (12:30):
I understand why it is important for us to step back, relax, celebrate our wins, pat ourselves on the back for progress that we’ve made, and we have, as an organization, had some significant wins. But in my mind, I do not spend any of my time pulling back to look backward to see what we’ve accomplished to date. I’m really laser-focused on where do we need to go.
Carol Vassar, podcast host/producer (13:03):
Is it fair to say that diversity, equity, and inclusion is really a massive cultural change and that cultural change, it takes time? Is that a fair assessment?
Dr. Roger Harrison, Nemours Children’s Health (13:16):
The truth is the only reason cultural change takes time is that people who hold power have no sense of urgency to create the change that is needed within the culture. The time is really an artifact of passivity among people who hold power. And so, for example, if you go back to the 1960s and you go back to the Civil Rights Act from 1964 and the establishment of the Equal Employment Opportunity Commission, prior to the EEOC and the Civil Rights Act, you could simply, in every single state choose to discriminate because you didn’t want women in the workplace or you didn’t want Black people in the workplace. You could simply choose to discriminate. Now with that federal act and the establishment of the EEOC and actual legal consequences for companies who continued to practice discrimination, you see that the change in the policy actually led to an immediate opening of opportunity.
It didn’t lead to a change of people’s hearts, however. And so, while I agree that cultural change takes time, I do believe that effective policies are needed in order to drive the kind of change, whereas a lagging indicator, whatever people think and feel in their hearts is reflected. But first, we really need moral clarity and bravery from our leaders, and I think that actually helps speed up the time that cultural change takes. Again, this is what I think about all the time, all right? And I think I spoke to one aspect of diversity. I didn’t speak anything about equity and addressing health inequities. And if we are going to be serious as an organization, it is to recognize that the whole enterprise of health equity and considering inequities is based on a simple premise. Historically in America, if you live in a white body, you’ve had a better experience and better outcomes within the healthcare system.
That is truly the basis of all health equity and inequity research. And when we look at data today in the year 2022, we still see that as far as most outcomes, there are people who are receiving fantastic healthcare; they have great access to healthcare. When they enter into the healthcare system, they are treated with respect; they’re listened to. They feel cared for; they connect with their care providers because it feels like we have something in common in our own humanity, and they have good outcomes coming out of the healthcare system. And there are other families who do not have equitable access to care. They do not have an equitable experience when they enter the healthcare system because they don’t feel equally cared for. They don’t feel equal in their humanity. They don’t feel like they’re listened to the way that some other people are listened to, and also, the outcomes are the same.
So when we just look at the raw outcomes of care, whether we’re talking about surgical outcomes, treatment outcomes, how long they remain with a provider, the outcomes… And so, for Nemours to become a national leader in equity and health equity, we really should be focusing on the access that our community has to care, the experience that patients are having based on their identities when they enter our system, the quality of care that they receive depending on who you are in all the ways that you identify yourself, and then finally the outcomes. And if we aren’t really focused on these aspects by collecting meaningful data, being transparent in what we are, and then sharing our plans for improving whatever the data reveals, then I think what we’re doing is paying lip service to health equity, but actually operating a system where if you happen to live in a white body, where if you happen to not be poor… Because, again, it’s not all white people.
It tends to be people who hold white identity but who aren’t too poor, where if you are straight, where if you are Christian, where if you are born in America, and English is your primary language, then you are likely to end up having better access, better experience, better quality of care, and better outcomes. And until we have kind of clarity around these areas, collect good data, and make meaningful plans, then again, I have little, very little interest in stopping, turning around, and going, “Wow, guys, let’s celebrate how far we’ve come.” I know it truly matters, it truly matters where we’ve come, but I don’t want to spend too much time there because we’ve got more to do. All that is required to speed the workup is moral courage and the will of people who hold power and influence in our system. That’s it.
Carol Vassar, podcast host/producer (18:41):
Any hopeful words in this area as we move forward? Is there anything that you see that Nemours is doing, however small, however large, that is moving us in that direction?
Dr. Roger Harrison, Nemours Children’s Health (18:52):
So understand that in order to do this work, it requires an unwavering degree of hopefulness in humanity, an unwavering degree of optimism and hope. And I will tell you, just even today, I had an experience talking about deriving hope. I look at our trainees, I look at the new generation of providers who are coming into our care, and I see how already, as students and trainees and residents, they are already oriented towards justice. They are already oriented towards a value for diversity, equity, and inclusion. And so we have new generations of care providers coming into the system for whom it is simply going to be unacceptable to maintain the status quo. And so actually, I have a lot of hope and a lot of confidence because I work with young people, because I work with children and I see how they’re wired.
I see how they are focused. I see the moral clarity they have around this issue. I also have hope because I work with a very wide range of identities that people hold. And so working alongside me, my key, let’s call them collaborators and co-conspirators, they are engaged in this work not because they hold marginalized identity. And so I’m working with people who are Black and people who are white and people who are Hispanic and people who are Asian, and people who are straight and people who are not straight, and people who are cisgender and people who are non-binary, but I find myself connected to all kinds of people.
And what holds us together is that this passion that we hold and this value that we hold for inclusion keeps us working towards the same goal. And I think the other thing that we all hold in common is that we are learning and we’re growing each day to use our voices, to use the privilege that we hold of being invited into spaces like this. I was invited here, just minding my own business, into this space to have this conversation with you. And so I feel hopeful because of the generation behind me.
Carol Vassar, podcast host/producer (21:21):
Is there any one particular student, coworker, or patient that you remember through the years who kind of continues to inspire you in doing this work and doing your clinical work as well?
Dr. Roger Harrison, Nemours Children’s Health (21:34):
Part of the beauty of the work that I do, being embedded in a primary care pediatric office, is that many families will not change their pediatrician unless they have to change their pediatrician. And so I have had the honor of getting to know some young people from they were very young when their parents first brought them in. I have one particular patient who comes to mind. I have many, but I met this particular patient when she was five years old. She is now 19 years old and getting ready to enter her second year of university. I met her in kindergarten. And when I say my patients really inspire and drive me, I remember she contacted me when she was graduating high school, and she was stressed. She was stressed out, and she was saying, “Hey, listen, I want to talk to you. I actually don’t know what to do.” Mom is a single parent. Mom does not have a lot of educational achievement. And so she left school before she was able to graduate from high school, and she has struggled through her life and she has this one daughter.
And so she comes to me, and she says, “I’ve got paperwork. I don’t even understand this. I don’t understand what the financial aid situation looks like.” She says, “School is going to start in two weeks. And the truth is I don’t have anything. I’m supposed to be going on campus, but a lot of my clothes have come from food bank, clothing bank, donations.” And we kind of talked and reflected on her experience of high school of being ashamed because “The kids know that my backpack was a backpack from the donated backpack. The kids know that the food that I opened for my lunch bag is food that comes from the food pantry. The kids in school know that the shoes that I wear are shoes that were part of a clothing donation drive. And so now I’m getting ready to go to college.” And we’ve spent so much time through the years of high school really helping her to deal with the consequences of poverty and deal with the bullying that she’d experienced. And now she’s in high anxiety about what this will mean. Plus, she’s like, “I don’t actually have anything.”
And so we were able to coordinate with a social work team in our clinic, because we do have an in-clinic social worker, to help connect the family to resources, but then it was again, heartwarming and people might listen to this and think, “You were helping this family,” but to me, to have the honor of being a trusted person that this young adult knows that she could turn to when “This isn’t even about my mental health. This is about practical, logistical things that I don’t know. And my mom, even though she’s loving, can’t help me with because she doesn’t understand all this process. She didn’t graduate high school, much less attend college,” that, for me, is the experience of becoming a part of someone’s support system in a way that is really meaningful throughout their development. That really just drives the work that I do, not just clinically, but within our system to make our system more responsive to the needs of the families that we serve.
Carol Vassar, podcast host/producer (24:57):
Thanks for listening in to my conversation with Dr. Roger Harrison. I’m Carol Vassar. When it comes to mental wellness and health equity, what’s working in your community? Where do you see opportunity? Visit nemourswellbeyond.org to submit a comment or leave us a voicemail. While you’re there, check out our other episodes and subscribe to the podcast.
Thanks to Che Parker, Cheryl Munn, and Rachel Salis-Silverman for this week’s production assistance. Join us next week when we hear about one woman’s 9/11 experience and how it inspired her to enter healthcare. She’s now Nemours’ Chief Value Officer, and we’ll talk about defining value in pediatric healthcare too. Until then, remember, together, we can change children’s health for good well beyond medicine.
MUSIC (25:52): Let’s go well beyond medicine.