Mental healthcare isn’t a luxury; it’s a fundamental right, akin to physical healthcare, and it should be treated that way. Unfortunately, that is not the norm for pediatric behavioral health.
Nearly one-third of youth in the U.S. will have an anxiety disorder by the age of 18. In 2022, 13.3% of children ages 3-17 received mental health care in Rhode Island2. Unfortunately, only about 20% of children with behavioral health disorders in this country receive care from a specialized mental health care provider.
Too many children and families encounter barriers to mental healthcare and the desperation of parents waiting on long waitlists while their child’s condition worsens is common. Families make immense sacrifices, including draining their retirement savings and depleting their child’s college funds, some resorting to traveling long distances, crossing state lines, or even temporarily relocating, just to get their child the right mental healthcare.
Take, for instance, a 17-year-old male (hypothetical case) who is experiencing multiple panic attacks a day. He has stopped going to classes and instead spends most of his day in the nurse’s office at school. On weekends, he mostly stays in bed, unable to motivate to do his missed schoolwork—which causes even more anxiety. His mom has had to take a leave of absence from work to be home with him, and she is overwhelmed, not knowing where to turn or what type of care to seek. Unfortunately, this scenario is not uncommon; my colleagues and I have witnessed many similar situations, and this is what served as our motivation to create a solution through InStride Health.
Cognitive Behavioral Therapy (CBT) with Exposure Therapy in the Real World
InStride is a specialty care provider for kids, teens, and young adults (ages 7-22) with anxiety and/or OCD and their families, and based on nearly a decade of work at McLean Hospital in Massachusetts. Its evidence-based care model is grounded in Cognitive Behavioral Therapy (CBT), which is widely recognized as the gold standard therapy for treating anxiety and OCD. The model emphasizes individual and family therapy, coaching, groups, and medication management, if indicated.
Each patient gets a dedicated 3-person care team including a psychiatrist, therapist, and exposure coach. They work together with the individual, family, school, and outside providers to ensure that everyone is aligned on goals and treatment plans. Treatment is delivered in real-world situations—the places where anxiety and OCD are triggered—using everyday tools like video, phone, and texting. Individuals work with their care team to identify the locations and situations that cause them fear, and they then participate in exposure therapy in stores, restaurants, at school, the neighborhood, and more. They receive support and accountability from their exposure coach between sessions. This real-time, real-world approach accelerates learning and builds lasting resilience.
To best care for and support a young person with anxiety and/or OCD, the community around them must also be mobilized. To achieve this, the care team develops close, collaborative partnerships with families, schools, and physicians. Importantly, parents and caregivers are incorporated into the therapy and skill-building process because they need to understand how their actions can support their child in managing anxiety or OCD.
What Does it Really Look Like? Walking Through an Example Patient’s Experience
Meet Sara, a hypothetical 14-year-old with a fear of vomiting and nausea, dating back to early childhood. Over time, her fear led to avoidance of certain foods and restaurants and of going to places where she thought people could throw up. She obsessively checked expiration dates on the few foods that she ate, and this caused family strife at mealtimes. As Sara’s fear grew, she began having frequent panic attacks.
In the first phase of her InStride treatment, Sara and her therapist identified her specific fears and developed a personalized treatment plan to address them. She started participating in skills groups with her peers, learning how to manage anxious thoughts and feelings more effectively. Additionally, she underwent a psychiatric evaluation to assess the potential role of medication. Her parents actively engaged in family sessions to improve communication with their daughter and took part in caregiver groups to learn skills and strategies to most effectively support her.
One of Sara’s major fears was eating food and then feeling nauseous as a result. Historically, when Sara would reach the dairy aisle of the store she would compulsively check all the expiration dates. Her therapist planned a real-world exposure where Sara would visit a grocery store while on the phone with her exposure coach. In the store, her coach encouraged her to take small steps—first by just standing in the aisle, then by picking up a yogurt container without checking the date, and then buying it. Later, when Sara sat down to eat the yogurt at home, she found herself feeling a little stuck, so she texted her coach for encouragement. Through this real-time support and encouragement, Sara practiced numerous exposures in the community and at home, repeatedly learning that she could handle it and breaking the cycle of anxiety and avoidance.
Today, Sara is in the third and final phase of treatment and continues to do weekly exposures with her coach and attend exposure group with peers struggling with similar fears. She is back to eating most of the foods that she enjoys and going to restaurants and stores. She is no longer having panic attacks. When Sara periodically experiences stuck moments, she uses the skills she has learned to coach herself and get back on track. Her relationship with her family has improved, and her parents and school feel equipped to support her in the road ahead.
InStride Health in the Providence Mental Health Landscape
As the parent of an InStride graduate recently shared: “When our pediatrician gave me referrals for my daughter, the waitlists were over 6 months! When your child is spiraling and getting worse by the day, it’s heartbreaking to think that you’ll have to wait that long for help. The team was able to start working with her right away and I quickly saw my daughter learning the skills and strategies she needed to get better.”
While this is a unique, specialized program, it’s important to recognize the other mental health resources available in Providence and the surrounding areas. Private therapists provide individualized care, and institutions like Butler Hospital, Bradley Hospital in East Providence, and Hasbro Children’s Hospital have long been pillars of mental health support in the community. These facilities offer a range of services, including inpatient and outpatient care, and are vital parts of the mental health landscape in Rhode Island. Yet demand continues to outpace availability. Families often face long waitlists to access care or learn that it is not covered by insurance. This leaves many parents feeling helpless as they watch their child struggle. We hope to help fill some of the gaps in pediatric mental health services for the Providence community.
Providence Pediatric Mental Health Services other than private therapists:
InStride Health (services are covered by Blue Cross/Blue Shield)
Dr. Kathryn (“Kat”) Boger, a board-certified child and adolescent psychologist has devoted her career to helping young people with anxiety and OCD. She is passionate about innovative, research-based approaches to improving care and relieving suffering.
Dr. Boger co-founded the McLean Anxiety Mastery Program (MAMP) at McLean Hospital, nationally recognized for providing evidence-based, intensive anxiety and OCD treatment for youth. She served as an assistant professor of psychology at Harvard Medical School and has published a variety of peer-reviewed journal articles, delivered regional and national talks (including a TEDx) and provided training to hospitals, schools, and the community. She continues to share her insight in talks nationwide, and in 2024 was honored as a Top 50 in Digital Health Frontline Hero.
Dr. Boger, in conjunction with Dr. Mona Potter, co-founded InStride Health to bring timely, effective treatment to more children, teens, and young adults with anxiety and OCD.
In addition to her InStride leadership as Chief Clinical Officer, Dr. Boger engages young people. She authored the children’s book Step by Step to empower children and families to face their fears. Also, a mom to three energetic boys, she enjoys playing sports like soccer, baking any cookies with chocolate in them, and catching up at the dinner table.
