Chat with Charissa Andreotti

We wanted to know what it means to be a lead clinician for the Healthy Brain Network, and what motivates someone to come to work here.  So, we sat down for a chat with Dr. Charissa Andreotti, a NYS licensed clinical neuropsychologist and Clinical Manager for the study.

HBN: Could you tell me a bit about how you got to HBN and what sparked your interest in child psychology?

CA: I went to grad school and got a PhD in clinical psychology at Vanderbilt, which has a strong child development program. When I started grad school I had no interest in working with children, I was more interested in working with adults. A couple years in I had the opportunity to do some work with kids, and at that point I’d seen enough of it that it seemed like something I at least wanted to give a try. I worked at a summer program for kids with developmental disabilities to get some clinical hours, and to get experience and I really loved it. I started moving in the child direction and started to reframe my research in terms of more of a developmental approach, and how factors in childhood influence later outcomes in adulthood, in terms of childhood stress. And then it came time to apply for internship, and I wasn’t sure whether to apply for an adult internship, a child internship, or something that was more lifespan, so I applied to all different types of internships, thinking the system would kind of choose me. I got an internship that spanned teenage years to adulthood at a hospital at Yale. I was working with teenagers and adults who had psychiatric disorders that were causing cognitive impairment, so it was focused on neuropsychology and neuropsychological assessment. That was awesome—after that I was trying to figure out what to do next, and I had the opportunity to work at Sloan-Kettering, which is a cancer hospital, but one of the reasons that it appealed to me was that I got to take a lifespan approach. I worked with both kids with brain tumors and women with breast cancer, and how their illnesses were affecting their cognition. After that I needed a job and I had decided that although it was really interesting and I got really good experience at Sloan-Kettering, the intersection of cancer and mental health and cognition was pretty profoundly depressing and not something I wanted to pursue forever. I started looking for jobs and saw this job posting for something called the Healthy Brain Network at the Child Mind Institute and CMI has a great reputation in NY. It basically said new research project– they were looking for a clinical psychologist to train other clinicians on testing and to head up the clinical research aspects of the project. It seemed like a really cool job, something I probably wasn’t qualified for yet, but I decided to apply anyways, and I got a great email from Jasmine saying they wanted to interview me. I was really taken with the scope of the project, which was that it was a research project, but that we were very clinically involved in the community, providing this clinical service to kids and families who really need the service. It spoke to my interests in research and clinical work and working with kids. Anytime you see kids there are adults around because kids don’t raise themselves, so I get to hang out with older people too. And here I am a few years later.

HBN: What do you think is the most rewarding part of working with children specifically as a unique population?

CA: I think working with kids there is so much hope. Everything can be framed in a positive light of making progress and helping this child reach their potential, whereas a lot of adult assessment and neuropsychological evaluations focus on making do with what is there. With kids I like to think in terms of the strengths and weaknesses model, of not only where does this child have deficits, but where are her strengths and how can we essentially cater to those strengths to make this child successful, because in most cases I think we can.

HBN: Could you talk a bit about your day to day schedule, what are some of the most stressful and some of the most rewarding parts?

CA: I think that working with the kids and the families is a little bit of both because people come in, and a lot of times they come in because they tried lots of other things and they are at the end of their rope– they want answers or solutions or both. The families come here often in a pretty stressed out place, and that can make it a bit more difficult to connect with them or to get them to a place of comfort saying we’re going to do the best we can. Ultimately, it is very rewarding when we get to the end of the evaluation, write up the feedback report, and meet with the parents and say, this is what we saw, and the parent says yeah, that’s my kid, to which I always say I’m glad we got the right kid. They feel that in the few hours we spent with them, we were able to understand their child, and then at least make a few suggestions that they have not heard before that might be helpful going forward. As far as stress, I think our goal is a big goal. We’re trying to see 10,000 kids, so there’s a lot going on. It’s pretty chaotic—even in the best of circumstances, we’re juggling people and spaces and materials, so logistically it can be a little stressful day to day.

HBN: When someone walks into your office for an appointment for the first time, what do you want to make sure happens or what are your priorities?

CA: I think my first priority is understanding what brought them in. What I like to say is everyone comes in with a problem, and in another setting, like a private practice, or a more specialty clinic, our evaluation would be focused on the problem they come in with. We, on the other hand, essentially take all comers. We’re essentially providing a high-quality, full-body scan, regardless of if you come in with a broken leg or a heart problem—everyone gets the same great full-body scan. That being said, I think it is still helpful to understand exactly what their concerns are. So although we are still going to give the full-body scan, I can tailor how I’m going to direct my time and energy when I write the report in making the best recommendations to help with what they’re most concerned about.

HBN: What do you think is one of the most important things for HBN clinicians to keep in mind on a daily basis?

CA: The overarching goal of this is we’re a research study. So we’re trying to create this big data, open-share dataset to share with the scientific community in order to further understand how the brain develops. In doing that, to collect that data, we are providing this highly-needed service to the community. I think our clinicians, unlike in other settings, have to keep in mind that although they want to provide the most high-quality service possible, they have to do it in the context of research, which means making sure that the assessment is reliable and valid and standardized and that we are getting all the pieces of data we need for our research project.

HBN: When you look at the field of child psychology today versus when you first entered it, what’s happening—how has it shifted for better or worse?

CA: I think we are going more and more in the direction of trying to understand how the brain and brain development influence the emergence of learning and emotional disorders. We are also looking more at brain-body interactions, and overall health and how they influence overall mental and emotional status. Maybe it’s the lens I see the field through, but I think for example Bruce McEwan has done really great work on stress and how stress affects not only the brain and the body, but also brain development—it can impact whether you develop anxiety, depression, obesity. I think what we are doing is really important because we’re not only scanning the brain, but we’re getting blood and saliva to look at markers within the body as a whole. I like how HBN continues to move in that direction in terms of examining contextual factors that impact the body system as a whole, factors that drive mental health.

HBN: If you could tell a parent or a child who is considering enrolling in this study one thing, what would it be?

CA: First of all, we understand that we’re asking for a lot. I think sometimes parents don’t think that we know that—we know we’re asking for a lot of their time, we’re asking them to sometimes travel a decent distance from where they live to one of our offices, and we’re asking them to do a lot of things—among them a scan, blood and saliva samples—but I do think that we have a lot of fun. We get that feedback quite a bit, that kids really do enjoy a lot of the activities. We try to make it as much fun as possible.

HBN: What are you most proud of when it comes to your work here?

CA: I think when it comes down to it, I’ve always been a researcher at heart. It’s important to me that we’re contributing to research and creating this dataset, which I think is really important in the field. I think day to day, it’s working with the individual families who come and have either found no other resources, or no one has been able to provide the service that they are really looking for without enduring a long waitlist or paying an often ungodly amount of money. We can provide a service that gets a child the basic services in school and in the community that they need to be successful and to function like some of their more typically developing peers. These are services that should be available to people who need them, that’s how they’re designed—everyone is entitled to a free and appropriate education. It can be really difficult to get that for your child. In a lot of cases, parents with special needs children have a lot of trouble navigating the system or are often denied services that their children absolutely need. I think doing this evaluation that we now have down to a science, that we do efficiently and smoothly, and in writing these reports, kids may get these services that they are otherwise denied. That is always heartwarming to me when I hear that.

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