Outcomes Rocket Podcast_Mercedes Oromendia: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey everybody! Welcome back to the Outcomes Rocket Podcast. So glad you tuned back in today. I have an awesome guest that I want to introduce you to kick things off this morning. Dr. Mercedes Oromendia is with us. She is a trilingual, bicultural psychologist with expertise in parenting, children and families, and trauma. She’s particularly interested in leveraging technology to decrease barriers to quality mental health access for underrepresented groups. Currently, she’s the chief clinical officer at Manatee, a pediatric mental health startup supercharging the traditional therapy model with tech-enabled support for kids and families. As we all know, it’s a huge need in today’s community, and I’m so excited to have her here on our podcast today to talk about the work that they’re doing at Manatee. So, Dr. Mercedes, welcome to the podcast.
Dr. Mercedes Oromendia:
Thank you for having me, Saul. This is great, just a fun way to start a Friday.
Saul Marquez:
Yeah, for sure. And look, thanks for joining me. I know it’s earlier over there in LA where you’re at, so appreciate you joining me so early. Look, let’s get things kicked off. One of the things I really enjoy hearing about, and our listeners enjoy hearing about, is what got the people we work with on the podcast started. What is it that inspired you to get into healthcare?
Dr. Mercedes Oromendia:
That’s a great question. So, for me, it’s more than just healthcare, it’s more pediatric mental health. So why kids, right? Why kids and why families? And for me, when I was in grad school, there was a professor that said, research is me-search. And really, what is the thing that resonates with you? And for me, I’m one of five kids and lived in three different countries back and forth, we moved a lot, and I really wanted to understand parenting, and how to support 14-year-old me that was adjusting to a new culture and country, and why was I having different difficulties than my siblings, and what parenting needs are different for each of us, and how could we? We had a lot of resources, and we still struggled at different times. And so really thinking about what are the needs of each child, how do we know it helps, and how can we really help parents help their kids?
Saul Marquez:
That’s wonderful. I love that tagline. Research is me-search.
Dr. Mercedes Oromendia:
Yeah, and you know, and I find that clinical work is also, I wish I could make it rhyme, but it’s, you know, there’s always a personal reason, I think, why we choose to do what we do.
Saul Marquez:
Yeah, I love that. Thank you for that. I could tell you care deeply about your work, and that’s the type of empathy and care that we need in, really, you know, mental health, especially for kids. Talk to us about Manatee. We had Damayanti, the CEO there, on a few years ago, but a lot has changed. So, talk to us about what the organization is up to and how you’re adding value to the healthcare ecosystem.
Dr. Mercedes Oromendia:
Yeah, absolutely. So I’ve been our chief clinical officer for two and a half years, and things have changed, right? You know, when I started, I was the only therapist. I started developing our clinical program and thinking about what kind of care do we want to provide and looking at what does the evidence show in the literature and in best practices that helps, and what is not as helpful, and how can we make it better with tech. And so we started way back when, and now we have a team of 45 providers, so that includes therapists and parent coaches. We’re live in six different states. We are providing, now we expanded, so we’re providing therapy to kids anywhere from 0 to 18 because, for the younger ones, we recognize they actually need a lot of either family therapy or parent coaching; so we added parent coaching to really support the parents, and in the past six months, we also added now therapy, individual adult therapy for the parents. So, recognizing that oftentimes it’s not just a child who needs help, or it’s not really the child that needs help. To really get our higher ROI, we really need to help the parents, and that’s a big focus of what we’re doing now is really working on helping the parents help the children. And we’re seeing that it helps with engagement, so our families are staying with us longer. We’re seeing that it helps with outcomes, and not just for that one child, but also for the siblings, if there are siblings in the family too. So for us, really being able to involve parents, which we always know is important to do, but it’s not easy to do. If you think about our modern life, we’re busy. We’re running around from work to the other stressors, to driving kids around, and so our app really makes it easier for families to be involved. They can message therapists. We set goals every week so parents know what their child is working on in session if they weren’t able to join that week. The kids can now message the therapist, always within boundaries, right? So, it’s text therapy. We do make it very clear we stand by the importance of being able to also have the framework of sessions, but also, hey, what happened with Sammy this week? How was she? Is there anything that would be important for me to know before I meet with her? And so then the therapist and the parent or caregiver are able to connect before. So it really helps streamline communication and practice those skills outside of therapy.
Saul Marquez:
That’s great. So, first of all, congratulations on the growth.
Dr. Mercedes Oromendia:
Thank you. Yeah, it’s been very exciting.
Saul Marquez:
Incredible, right? From therapist one to what you’re doing now and a team of 45, like I just have to pause and say congrats, like that’s just huge, I’m super happy for you guys. And look, the results that you drive are a testament of your growth and also this expansion from the point of care to those that influence the point of care parents. It’s a huge thing, and we need help, right? I mean, I say, as a parent, we need help, you know, we all need help. And so I think it’s wonderful that you guys have expanded the program to also take care of the parents that mean well, but don’t possibly always do well. So, as you think about what makes you guys unique or different, what would you say is the secret sauce, or would you point to one thing that Manatee does?
Dr. Mercedes Oromendia:
I would say two things. The first one is really the focus on families. It might be, you know, I come from Argentina, so more of this collectivist, Damayanti, and we’re not thinking as much from like the individual. It’s really thinking about the whole family; it’s going to give us the highest ROI, the highest support for the entire family. So it doesn’t make sense to just treat the child and have the parent drop off the child and then come pick them up later and not really know what’s going on and hope that they’re going to complete the worksheet or that they’re going to do the homework that you ask them to do. So we’ve built the app to really facilitate the entire family, and when I mean family, I mean whoever’s an important person for you. I come from working with a lot of kids in foster care, so thinking family can be chosen, family can be a really wide range of grown-ups that are important and helpful to this child. And so, with the appropriate releases of information, we can really involve other caregivers. So we had grandparents on the app, we’ve had nannies, we’ve had kids that have actually four parents on there because they have stepparents, and then they’re all collaborating and together knowing how to support this child as he transitions from home to home. So, really thinking about the complexity of being a kid now and how to create a team of support around it that has a therapist, might have a parent coach, might have other caregivers, really thinking creatively, who’s there. And then I would say the other one is our parent coaching, we really leverage parent coaching. We have an incredible director of parent coaching that has developed a curriculum that is evidence-based, that is based on developmental psychology, and really drives the results and helps parents know how to handle these difficult behaviors and what they can do to support the child, and that’s been really helpful. As a therapist, I can always, you know, when I have a family that’s struggling a lot, just to be able to have a parent coach on the team makes an incredible difference on not just the outcomes, but my level of engagement, because then I can really focus more on the child and know that someone’s also helping the parents and we can all collaborate.
Saul Marquez:
It takes a village. I remember my wife, and I were on vacation, and we were in Thailand one year, and there was a bunch of kids on the island, you know, it was … island, and they’re all running around. And we were talking to one of the owners of the restaurant, and he looked at us, and he’s like, The village takes care of the kids. It takes a village. And my wife and I always think about that, raising our son. He’s six years old, and it does take a village. And I think it’s wonderful that you guys take that into account because ultimately, when we sort of take a step back and think, put the lens of a payer or somebody, for example, when you’re thinking about patient journeys, you’re mapping out a patient journey, you’re going to capture all of these things, and it sounds like Manatee and the team over there have definitely done a good job. So, Doctor Mercedes, kudos to you and the team over there for being able to map these journeys out and help where it’s most needed. You mentioned outcomes-based, and you know, that’s an important thing for us here at Outcomes Rocket. Talk to us about how you’ve improved outcomes better for the families or maybe for the payers that you serve.
Dr. Mercedes Oromendia:
Yeah, absolutely. So from the beginning, when we think about outcomes, we think of, you know, the quadruple aim of healthcare. So, not just the clinical outcomes, but really looking at patient engagement, how quickly are we getting them care and provider care, or not even care, but just their well-being. How are they feeling? Because we know what we know is if providers are not engaged to believe in Manatee and just feel like a number, the care is going to be lower, the quality of care is going to be impacted. So at Manatee, we really focus on also what kind of team are we building, what are we bringing on, how are we supporting our providers to make sure that they get the support that they need and they get the access to the data they need to know if they’re doing a good job and then we can support the ones that might be needing more support, right? And so we definitely have, and our app measures the standard, you know, the, we use the PSC, we use the Gad Seven, the PHQ. We also added our own parenting measures because, again, how are parents doing? We want to know, do they feel confident and effective as parents? And that’s something that we track over time, and we reassess all of these measures every six weeks. So we have seen, we’ve seen improvement across the board, and we’ve noticed that there’s a really big difference in the behavior of parents who are confident in their parenting skills and those that are not confident in their parenting skills, and really supporting those that are not confident that they can support their child has made a really big difference in the outcomes. So there’s a different cohort that we’re really focused on.
Saul Marquez:
That’s great. Yeah, and you guys are measuring the results. Oh, go ahead. You were about to say something.
Dr. Mercedes Oromendia:
Yeah, no, we are, and then something else that we do is we ask about suicide. You know, you ask us how we were different. We ask about suicide directly. We lean into those difficult conversations. And this was an internal team conversation initially because we use the PHQ, and PHQ has, they you can use the eight or the nine, and the nine asked directly about suicide, and this is for kids over the age of 12. And back and forth, we were advised perhaps not to use it, and, you know, because once you ask, you open a can of worms, and for us internally, we had to really think, and there was no way we could not ask. We just made sure we had the right systems in place to escalate and provide the support, and we’ve identified over 60 kids at this point that were indicated having suicidal thoughts. And so we have, again, because of technology, we can let the parents know right away, and then we have content in the app that’s all evidence-based, but it’s me walking them through exactly what to do, and then we give them a call, and we can refer them to higher level of care if they need or just address their needs right there. And then, but really making sure that that’s part of our outcomes too, right? And it’s in the process, not just waiting until they’re done with treatment to see how they’re doing, but really measuring as they go, so that’s been another really big focus of ours.
Saul Marquez:
Love that. That’s fantastic, thank you for sharing that. And yeah, you got to ask the questions. Folks, if you’re not asking the hard questions, you’re not going to get the results you’re looking for, so very thoughtfully done. And so, let’s take a step to like building a business. One of my things here, you’ve been there for a while, and you’ve been there through the growth. What’s one of the biggest setbacks you guys have experienced and a key learning that’s come out of it?
Dr. Mercedes Oromendia:
When we first started, we had what we thought was a great program for anxiety, right? We’re like, okay, let’s figure out what are kids struggling with the most. Back then, it was anxiety because they were starting to go back to school in person, and there’s a lot of anxiety, a lot of school refusal, and anxiety, and parents didn’t know those were the key search terms that parents were using. There’s just a lot of anxiety. And so we’re like, okay, we’re going to build a really solid anxiety program, and it was beautiful. You would get a box, because we’re like, kids need physical things, too. You get a physical box with these worksheets, and I became very close with their post office here, you know, hand delivery or delivering them there. It was just great.
Saul Marquez:
Yeah.
Dr. Mercedes Oromendia:
In a practice, it was a little bit different. So what we realized is once you send the worksheets, you can’t tailor it to the parents’ or the kids’ needs, right? And so-
Saul Marquez:
Yeah.
Dr. Mercedes Oromendia:
It was not, there were beautiful worksheets, but you can’t tailor it. And so part of the beauty of therapy and tech also we’re used to things being more tailored to us, to our family. And so getting something was really exciting for the kids, but then, sometimes it missed the mark a little bit on what it is that they were struggling with that week. So that was one of the big things. And then the other part was parents weren’t always looking for anxiety. They were more looking for the behaviors. So they may not recognize it was anxiety, but it could be more tantrums, more defiance, like my kid won’t listen. And so when we branded more a program for anxiety, it didn’t always speak the language of the parents. And so, then we expanded, and we’re able to build a lot more on, let’s just open it up. And it turns out, yeah, the vast majority were coming in still for anxiety, but we were telling them their child had anxiety instead of asking the parent to recognize that first.
Saul Marquez:
Interesting. That’s very cool. It’s …, all right, you know, we’re going to label it right now, versus why don’t you, the door is open, we want to welcome you in and talk to us what’s going on, right? And then you peel back the layers and find out, so.
Dr. Mercedes Oromendia:
And what’s important to you? Let me get to know you first. Like, maybe anxiety, yeah, sure, the child had anxiety, but what was most pressing was that the sibling rivalry and just conflict was really important at that moment, it was really salient, or the family was going through a divorce. Okay, let’s focus on that first. You need to really start addressing what’s most important to the family first, that’s where they’re going to be most motivated to do the work.
Saul Marquez:
Love that.
Dr. Mercedes Oromendia:
… was a really, you know, we saw some of the boxes, and at some point, we will go back to sending something physically to you, but it delayed the beginning of treatment, right? And that’s something we really want to avoid. For payers, too, we want to be able to get quick access to care, and the post office has its delays.
Saul Marquez:
Oh, yeah, that’s a great one. What are you most excited about today?
Dr. Mercedes Oromendia:
I think the role of coaches and parents and peer supports. So we know there’s not enough therapists, there’s not enough, it doesn’t, you know, social workers, psychologists, we just don’t have enough. And we can’t really just increase caseloads and hope that people don’t burn out, right? We see therapists are burning out. It’s hard, it’s hard work, and it’s something that’s difficult for people that aren’t therapists to understand, but it’s, you can’t just look at a week, and you’re like, okay, you have 40 hours. 30 of those are going to be face-to-face, and then 10, documents, you’re done. It’s an emotional toll, and like a spiritual toll almost, that it takes to hold each family when they’re struggling, too, and we just don’t have enough. And kids are struggling, parents are struggling, schools are struggling. So really thinking of how can we leverage thoughtfully paraprofessionals or other types of professionals, and I’m seeing that being done more and more and in a thoughtful way, right? I say thoughtful because you can go either way, and really using it in a way that leverages what we know in research helps, and being able to train parents and to support each other; that’s a really big part why at Manatee, we’re focused on our parent coaching model too, making sure that we have parent coaches that are trained, that follow our modality, that know exactly, that we know what parents are going to get when they get assigned a parent coach. But I think that’s the way to go so we can start supporting more families.
Saul Marquez:
That’s exciting. And by the way, I’ll pause and say, Hey, are you a therapist out there? And are you overwhelmed? You know, are you looking for something better? I think Dr. Mercedes is hiring.
Dr. Mercedes Oromendia:
We are hiring, yes. We’re always hiring. That’s the other thing I learned, right? You can’t just wait until we need therapists, really making sure, because we work hard to find the right therapists. That’s important to provide great care. It’s not any therapist. We’re not all the same, and really thinking who’s passionate about kids, who’s passionate about innovating care and using data to know if you’re providing great care and how we can tweak things and giving us feedback and, you know, being that excitement of a startup. It’s a little bit different than just your brick-and-mortar community mental health agency, so it’s exciting and different. So yeah, absolutely, if you’re looking for something different, we are definitely hiring and always looking for new therapists.
Dr. Mercedes Oromendia:
Love that. And folks, I say this every episode, but look in the show notes. In the show notes, we’ll have ways to get in touch with Dr. Mercedes, links to their company, their hiring websites, and everything you might want to hear from a payer perspective, looking to make an impact on the work that you’re doing for your population. Certainly, a company you need to take a look at. Dr. Mercedes, before we conclude here, we’d love to just get your closing thought, the call to action to the listeners here, and then the best place they could reach out to you and the Manatee team.
Dr. Mercedes Oromendia:
Yeah, absolutely. You can find me on LinkedIn. So again, if you’re looking to maybe explore a job in health tech, if you’re interested, just talking more about how we can help more kids, you know, I’m a firm believer we’re not competitors at all. If you’re thinking you have a great idea, let’s work together. There’s definitely enough need in this space, and there’s a lot of learning that we can do from each other too. So yeah, you can find me on LinkedIn, you can send me an email at Mercedes@Manatee.com, follow Manatee on LinkedIn. We just, yeah, we’re kind of everywhere. So just keep following us, and I’m excited, yeah, we’re going to be in a year from now, so stay tuned.
Saul Marquez:
Love that. Folks, stay in touch with Dr. Mercedes. Everything’s going to be in the show notes. So rather than just listen, take action, make it happen, now’s the opportunity. Don’t waste time, make it happen. So, look, Dr. Mercedes, really appreciate having you on the podcast. Thanks for doing it.
Dr. Mercedes Oromendia:
Thank you. Have a great day.
Saul Marquez:
You too.
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