Tanuja Gandhi, MD: Welcome back to Mindcast, Healthy Mind Healthy Child. I'm your host, Tanuja Gandhi, and I'm joined by my co-host, Dr. Greg Fritz. Our guest today is Morgan Lindberg. Morgan works with our staff here at Bradley Hospital on quality improvement projects, provides nursing education to staff, collaborates with behavioral health specialists in the care of patients, and I'm sure a whole lot more so. Welcome Morgan, and we are so happy to have you.

Morgan Lindberg, M.Ed, LMHCA: Thank you so much, Dr. Gandhi and Dr. Fritz. As you said, Dr. Gandhi, my name's Morgan Lindberg. I'm the Manager of Operational Development here at Bradley. Just a little bit about me. I have a master's in education, an LMHC, and I'm currently in my doctoral program for health sciences and clinical leadership.

I am so blessed to have worked at Bradley for eight years. I started my career on the adolescent unit as a behavioral health specialist and now I get to work on a higher level to really bring together some of my passions, like patient care and staff development. So I really appreciate you having me on today. 

Greg Fritz, MD: Well, that's great and welcome. We're glad to have you here. Today we're going to dedicate our time to understanding the role motivation plays in the mental health of kids. We talk a lot about meeting kids where they are, and I'd like to start off with understanding the context in which we will discuss motivation. Can you help us with that?

Morgan Lindberg, M.Ed, LMHCA: Sure. Sounds like an easy question, but motivation, it's really the driving force behind why someone does what they do, a kid's behavior. It encourages them to engage in activities and it also helps people push through those challenges. And I like to think of motivation in two parts, right?

So we have intrinsic motivation that comes from within a person. So something that a kid's engaging in because they find it enjoyable. An example is an example from my past, a kid plays basketball because they love it. It makes them happy. Right. And then you have extrinsic motivation. So that's driven by external forces, external rewards, external consequences. An example of that is a kid plays basketball because their parent gets them a donut on the way home every week. Right? So that's an extrinsic motivation. 

And at Bradley, we talk about all the time meeting kids where they are at and broken down, that really means treating each person that you come across as an individual, right? Figuring out what drives each person, each child, along with what, what might be a barrier to that motivation. And most importantly, we want to foster and create an environment that helps with growth. 

Tanuja Gandhi, MD: So how do you motivate a child? For example, some kids seem unmotivated. What do you do then, and what might be happening beneath the surface? How do you figure that out?

Morgan Lindberg, M.Ed, LMHCA: That is a really great question, and I think it's a balance of a few different things, right? It's a balance of praise and encouragement. It's a balance of support, and it's a balance of understanding. It's really important to consistently work on the relationship behind what you're trying to do, right? If you have a strong rapport and a strong relationship, you can really help find what's going to be intrinsically motivating for a kid. So what are they going to do because they enjoy it? 

We also want, as adults, we want to model motivation. We want to use positive reinforcement. And lastly, and this is really important, we want to make things achievable for a kid. So you mentioned Dr. Gandhi, why might a kid seem unmotivated? And one of the reasons is to my last point, if a kid deems a task as unachievable, a lot of times they take the approach of why even try? 

Because if I can't achieve it, why am I going to try? Why am I going to waste my time and everybody else's time? Other things that might play a part, fear of failure. That's something I think we can all relate to. Adults, kids, feelings of stress, and maybe a lack of interest could be another reason.  

Tanuja Gandhi, MD: What do you think we can do to identify what motivates an individual child?  

Morgan Lindberg, M.Ed, LMHCA: That I think is where the heart and the meat of the work really is, right? It's understanding what motivates someone, that's extremely important to shaping behavior. So to start, it's all about learning the kid, knowing the kid, figuring out what gets them excited, looking at what activities they want to do, they want to engage in voluntarily. Sometimes kids, adults are deemed lazy because they might just seem unmotivated. Right. But building that environment of trust and rapport can really eventually get kids involved in that conversation of what motivates you. 

If they're able to come to you and say, Hey, listen, this is what I want, this is what I need to be motivated. We're really creating that environment of growth. And honestly, sometimes it's just really trial and error. I can't tell you how many times I've thought something was going to be so motivating for a kid, and I went into it like, I got this, and let me tell you, I did not have it.

It was not motivating for them. Right. So I could verbally praise a kid and think that they're going to love this, it's motivating, and then they go spend an hour in their room because that's not motivating for them. Right. They might be embarrassed. They might just, that, that didn't work for that kid.

And being able to kind of take that failure, quote unquote on the chin, regroup, model, and then do something different that's going to be motivating for them and find what's going to be motivating.

Greg Fritz, MD: It sounds like that's somewhat of an intuitive skill that some people have more so than others. 

Morgan Lindberg, M.Ed, LMHCA: Sometimes. Yes. And I think that one of the biggest pieces again, is, I mean, it's just like, it's like parenting. It's like staff development. It's doing what you say you're going to do. That follow through, showing up. Right. I feel like a huge chunk of parenting, a huge chunk of working with kids is being there when you say you're going to be there. Showing up, when you say you're going to show up.

Tanuja Gandhi, MD: Being consistent.

Morgan Lindberg, M.Ed, LMHCA: Being consistent, following through on the things that you say you're going to do. That really lays a foundation for that environment of trust to then build on, okay, now let's work on the motivation and what can we do to get you to be successful? 

Tanuja Gandhi, MD: So I, think one thing we can say for sure at this point is that not every solution works for every child.

Morgan Lindberg, M.Ed, LMHCA: Correct. It is, it is not a one size fits all kind of approach. Alright, so I can give you an example. So we've taken care of a patient that for some reason I was motivating, spending time with me was motivating for them. It could have been because I was a shiny and new face. It could have, could have been because I have the ability to take them off unit. But we set the parameters that for this kid to spend time with me for 20 minutes to play football, they would have to have eight hours of safety.

Tanuja Gandhi, MD: That's very smart.

Morgan Lindberg, M.Ed, LMHCA: Eight hours of safety. Right? Something we found out, eight hours seemed to be unachievable in this kid's mind. And if something's unachievable, like we talked about; why am I going to try? Right? So we lessened that. We lessened that to four hours of safety, four hours of safety, and going to groups and then they get to throw the football with me for 20 minutes.

And we really followed through with that. We held this kid to expectations and when they met that four hours, we would show up when we said we were going to. So we really built that trust, that continued consistency like you had spoken about Tanuja.  

Greg Fritz, MD: So you mentioned praise a minute ago. And it sounds like you've given a lot of thought to types of praise and the use of praise. Tell us about how your thinking goes there.  

Morgan Lindberg, M.Ed, LMHCA: I think praise is one of the most powerful change agents in behavior, if it's done effectively, right? And there are a few different types of praise. We have verbal praise, which is exactly like it sounds. It's recognizing verbally that someone's done a really good job.

We also have nonverbal praise, right? Which again, is exactly like it sounds. It might be for people who don't love the spotlight, something even as simple as a high five or a smile can go a long way. And then we have tangible praise. That's for those people who enjoy small rewards that are actually tangible, think stickers. Or for me, a really good cup of coffee if I've done a good job that day.

Tanuja Gandhi, MD: Oh that would work.

Morgan Lindberg, M.Ed, LMHCA: Is rewarding for me. Absolutely. It's going to really motivate me to do more of what I just did. I like to think of it like the ideal that people that we care about, we want to find out their love language, right? When we are working with kids, we want to find out their motivation language, their praise language, what is going to be helpful for this kid,  

Greg Fritz, MD: And how do you do that?

Morgan Lindberg, M.Ed, LMHCA: It's a multi-step process where we build that environment of trust. Again, we continue to show up when we're supposed to, trial and error. What works, what doesn't, and we know our kids. We know what they enjoy to do and what's going to be motivating for them, whether that be sports or stickers or art, or even just a little bit of a conversation.  

Tanuja Gandhi, MD: So it seems like we want to know what works for every child in that moment and identifying what the need is at that time. I'm imagining when you're trying to use praise, we might also make mistakes. Do you have any examples or ideas if mistakes adults commonly make when trying to praise kids?

Morgan Lindberg, M.Ed, LMHCA: Absolutely. So we are not perfect, right? And I think sometimes it's easy to fall into some not so great habits with praise. Empty praise. Right? Those are those statements like, oh, this is perfect. This is the best art piece I've ever seen. And it kids know they have a really good sense,

Greg Fritz, MD: Right.

Morgan Lindberg, M.Ed, LMHCA: Of when we're not being genuine. And that might fall short. If we're trying to praise in an empty way, they're going to know it, so it might not affect the way that we want it to. Another trap is non-specific praise. So if I say Tanuja, good job. And you do so many things well, that you don't know what specifically I'm talking about.

Tanuja Gandhi, MD: I want to have the best painting ever.

Morgan Lindberg, M.Ed, LMHCA: The best painting ever, right? But you might not know what I'm talking about. If I use really general, non-specific, Hey, you were good today. Or Nice job. In order for praise to be effective, it should be really specific, based on what we want to see more of, and it should be as close to immediately after the behavior as possible.

Last thing that I see a lot is only praising outcomes. And as we know, like I just said, life is not perfect. Right? And sometimes we need to praise the effort and not only the good outcomes. So how hard someone is trying. 

Tanuja Gandhi, MD: It's not all about winning or being right. Sometimes kids make mistakes.

Morgan Lindberg, M.Ed, LMHCA: Which was a hard skill for me to learn as an athlete. It's not always about winning, but sometimes, making mistakes, kind of reframing that into a learning opportunity.

Tanuja Gandhi, MD: Yeah. So I know a lot of the work you do at Bradley Hospital is with our staff who take care of children and families every day. On our podcast, our audience is mainly parents and caregivers. So would you be able to describe some strategies that would be appropriate for parents and caregivers to use that you probably teach staff on the unit?

Morgan Lindberg, M.Ed, LMHCA: To be honest, Tanuja I think that a lot of the same principles apply. So again, we're creating that safe and trusting environment where kids can feel comfortable to come and ask for help. We are using validation, which I have to say is the most difficult skill that I teach, but it is such an important skill to learn. It's not about cheerleading someone or agreeing with the behaviors. You don't even have to agree with behaviors or feelings, but it's letting a kid know that you see them and that their feelings make sense to them.

Right? So a kid's really worried for an exam. They're really, really stressed out. Some parents might say, you better study. You better open those books. Or they might say, you're too smart to get anything below a B. Right? And parents might think that that's being effective and motivating, but it might just be raising the stress, right?

So you can always start with validation of saying, I can see how stressed out you are right now. I can see how well you want to do on this exam. I'm telling you, if it is done effectively, you can just hear the,whew, and it's almost like a kid okay, I'm seen and then we move into problem solving. Then we can move into the, let's crack the books together, let's see what we can do next.

But validation is a huge first step. And then again, modeling motivation as adults, admitting when we make mistakes, leading by examples and changing our strategies when we need to. Modeling flexibility.

Tanuja Gandhi, MD: Mm-hmm.

Greg Fritz, MD: It's important to note that the motivation isn't always about difficult tasks I think. Sometimes it's about helping kids ask for help, getting them motivated and confident enough to do that. So what are some of the signs that a child may need some encouragement along these lines?  

Morgan Lindberg, M.Ed, LMHCA: I think some of the signs that a kid might need encouragement to ask for help are when you really have those noticeable changes in a kid's behavior. When a kid's really frustrated, the increase in frustration or avoidance of activities that they might have liked before. When there's an increase of emotional outbursts, maybe a loss of confidence. And then those physical complaints of I have headache, I have a stomach ache, and now I know if you have teenagers, you're going through this list and you're going check, check, check. Right?

This is where we can really rely on that relationship that I talk to, knowing the kid, empowering them to ask for help, and now how can we do that? Right? We can model ourselves. Letting kids know adults are not perfect. We need help too sometimes. Praising the help seeking behavior. I really appreciate that you came to me and asked me for help.

Reframing, asking for help as a strength and then again mistakes; looking at those as a learning opportunity. My whole life, it was either you win or you lose. I've tried to reframe that into, you either win or you learn.  

Tanuja Gandhi, MD: Both of these are such excellent points.

Greg Fritz, MD: Thank you, Morgan. That was outstanding. Very good discussion. One of the top takeaways I have from our discussion today is that reflecting on what it means to meet kids where they are, that's so essential. That's, it sounds like a simple point, but it's so powerful and it's just a great reminder that puts almost any situation into a useful perspective.

Tanuja Gandhi, MD: I agree. I think many times as parents, caregivers and just individuals in general, when you see a child in need or in distress, our first response is to try and fix it. Yes. Or to try and, say the things that we might think are the right words, use the right approach.

And what I'm learning today, from you is what's effective is taking a step back and thinking what's effective for that kid in that moment. And then knowing sometimes we might fail and you learn strategies that are effective and then you do better together.  

Morgan Lindberg, M.Ed, LMHCA: Absolutely. And I think, when we create these environments where kids feel safe to ask us for help, we're not just building their confidence, but we're teaching them that growth success. Really important things come from just starting with the courage to reach out to someone.  

Tanuja Gandhi, MD: Thank you again, Morgan. This was really helpful and I hope our listeners find it helpful too. To all of you listening to our podcast, thank you for joining us. If you enjoyed our podcast, please check out our full podcast library at bradleyhospital.org/podcast.

Thank you again, until next time.