Little Otter: How a Mother-Daughter Team Is Uniquely Positioned to Revolutionize the Country’s Approach to Youth Mental Health

When Helen Egger’s 13-year-old son faced a startling change in his physical and mental well-being, she had the training and the experience to know what was happening. An epidemiologist, researcher, child psychiatrist, and parent of four, she had developed the first structured diagnostic interview for assessing mental health symptoms and disorders in children aged two to six.

And yet she still had to fight until her son received an accurate diagnosis.

“My kid is alive because I was his mother, because I was a doctor, and because I knew who he was,” said Egger.

For years after that experience, Egger mulled over how to create a practice where parents were partners in their children’s health care journeys, not just bystanders being fed diagnoses and care management plans. In 2021, she and her daughter, Rebecca Egger, a former Palantir engineer and expert in technology and product development, launched Little Otter, an online mental health practice that provides care for the entire family.

In less than four years, Little Otter’s whole-family approach, which integrates technology to create a “hyper-personalized” care plan and then to measure the results of that plan’s success, has helped more than 25,000 families. Engage sat down with Helen and Rebecca Egger to discuss how their model differs from other digital mental health platforms and how it can be scaled to revolutionize the country’s approach to childhood well-being.   

Not Just Another Digital Mental Health Firm

In December 2021, just months after the Eggers launched Little Otter, U.S. Surgeon General Vivek Murthy issued a 53-page report that warned of a “devastating” decline in youth mental health. Two months earlier, a statement from the American Academy of Pediatrics and others had declared “a national emergency” in youth mental health.

The Eggers knew there was a demand for innovative digital mental health services, but they also knew “virtual” came with baggage. Namely, tele-mental health providers often focus on a single disorder or only treat mild cases, and, rarely, if ever, do providers actually meet parents.

“Our goal was never to create a clinic in the clouds,” said Helen. “I’m an early childhood mental health specialist. At zero to six years old, you do not think of the child as separate from the parents or caregivers. But the truth is, no person should be thought of separately from their family.”

Helen said she and Rebecca founded Little Otter with the “whole-family clinical model already fully formed.” The whole-family approach acknowledges a child’s mental health cannot be isolated from the family and, recognizing this fact, integrates parents and caregivers into a child’s therapy sessions. Indeed, as Helen envisioned all those years ago, parents do not take a back seat to practitioners.

“We really believe that parents are the experts of their kiddos,” Rebecca said.

The company differentiates itself in two other important ways as well. First, its care leads integrate Little Otter care with a child’s school and daycare, medical providers, and even speech, occupational, and physical therapists. A team forms around each child. Second, all of Little Otter’s psychiatrists, therapists, and parenting specialists are company employees.

“Most digital health providers are just marketplaces for people who are in practice,” explained Helen. “We are not that. We hire the right people, we train them, and we have incredibly rigorous quality control. That’s the only way you provide quality care in this field.”

This model allows for greater coordination and transparency in treatment. Little Otter families all have access to tailored care plans, assessment results, progress reports, and clinician notes in the Little Otter app. And it works.

Most individuals who begin counseling or therapy last two visits. Little Otter families attend an average of 25 sessions, though they begin to see results within the first several. According to the company’s measurements, within 12 sessions, 80 percent of children show clinically significant improvements, three-quarters of parents report measurable reductions in anxiety and depression, and 61 percent of families report a significant reduction in stress.

Little Otter: Improving Care Access and Provider Accountability

According to the American Psychiatric Association’s latest annual mental health poll, 83 percent of Americans say untreated mental health challenges negatively affect families. Nearly two-thirds, 65 percent, said they negatively affect the country’s economy.

Still, more than half of adults with a mental illness, 54.7 percent, never get the care they need according to Mental Health America’s State of Mental Health in America 2024 report. The number of children who do not is probably much greater. Many of these families simply do not have access to care. Other parents are afraid they will be blamed by providers or family for their children’s mental health challenges. 

Little Otter aims to improve access, reduce stigma, and ultimately address the mental health challenges that not only impact family well-being for generations but diminish productivity at work, increase overall health care costs, and drive higher usage of government safety net programs.

“I hear from parents who ask, ‘Where was this when I was a child?’” said Rebecca. “They wish their parents had support and that their families had been able to talk about these things. The whole-family approach really is interrupting challenges that have been festering for generations. It’s showing there is hope. You can get better, and it’s not hard if you have the right care.”

For Little Otter, a key part of enhancing care access is to work with health insurers to help them understand why providing full coverage for family mental health services will benefit their company’s business models.

“Payers are looking at who is costing them the most money,” explained Rebecca. “Our health system is not structured for prevention and early intervention. It’s structured for the five-alarm fire despite the fact that the evidence is 100 percent clear that if you invest in mental health, particularly for children six and under, you establish a foundation for lifelong physical health, productivity as a citizen, and educational attainment.”

Because Little Otter measures its results, it has convinced several health insurers to cover the cost of their whole-family care. State lawmakers have been integral to changing insurers’ behaviors, advocating for payers in their state to not only fully cover mental health care for children, but for adults as well. Some states, like Oklahoma (see following page) are going even further, working to create programs to screen children before they go to school so caregivers and teachers can work to address challenges before they arise in the classroom.

Helen says it is not only health insurers who need to change behavior, though. Only 19 percent of psychiatrists, 13 percent of master’s-level therapists, and 11 percent of psychologists provide measurement-based care.

“Those numbers are appalling,” said Helen. “The field of mental health needs to be accountable for its outcomes. If you just talk about access, you’re only paying for time and not only for outcomes. That’s why we built our platform to measure at every part of the care journey for every member of the family.”

Seventy percent of U.S. counties lack a single child psychiatrist in their community, according to a study published in Pediatrics by McBain et al. “New York City doesn’t need us. Palo Alto doesn’t need us,” said Rebecca. “Children in those cities are more likely to have access to people like my mom. But children in more rural communities, they do need us.”

The dream, Helen and Rebecca said, would be for every school district and every pediatrician’s office to use Little Otter’s diagnostic model to determine whether a young person needs intervention, and for insurers to cover needed care before a five-alarm fire erupts.

“It’s not okay that every child doesn’t have what my child did,” concluded Helen.

With Little Otter, more children soon may.

Kerrie Rushton is a freelance writer and owner of Groundwork Communications based in Bethesda, MD.