Rebecca Egger: Co-Founder & CEO of Little Otter

Episode 691

On this episode of The Kara Goldin Show, we’re joined by Rebecca Egger, Co-Founder and CEO of Little Otter—a fast-growing digital mental health platform built specifically for children and families. Created alongside her mother, internationally renowned child psychiatrist, Dr. Helen Egger, Rebecca has combined cutting-edge technology with clinical expertise to reimagine mental health care for ages 0–18.
In our conversation, Rebecca shares what led her to build a platform rooted in empathy and accessibility. We dive into what makes Little Otter different, how it’s changing the landscape of pediatric mental health, and why whole-family care is the future. Rebecca also opens up about the challenges of launching during the pandemic, co-founding a business with her mom, and the misunderstood realities of childhood mental health.
If you're curious about building mission-driven companies, scaling in health tech, or creating impact in underserved spaces, you’ll love this conversation. Now on The Kara Goldin Show.

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Transcript

Kara Goldin 0:00
I am unwilling to give up that I will start over from scratch as many times as it takes to get where I want to be. I want to be you. Just want to make sure you will get knocked down. But just make sure you don’t get knocked out, knocked out. So your only choice should be go focus on what you can control. Control. Hi everyone, and welcome to the Kara Goldin show. Join me each week for inspiring conversations with some of the world’s greatest leaders. We’ll talk with founders, entrepreneurs, CEOs and really, some of the most interesting people of our time. Can’t wait to get started. Let’s go. Let’s go. Hi everyone, and welcome back to the Kara Goldin show. Super excited to have my next guest here today. We have Rebecca Egger, who is the co founder and CEO of Little Otter. And if you don’t know what Little Otter is, you are going to be super excited to find out such such a brilliant idea, and also so needed. It’s a digital mental health company delivering expert evidence based care for children and their families. And Rebecca’s journey is anything but ordinary, leading to creating a platform that makes it easier for families to get the mental health care that they need when they need it most, and she launched it during the pandemic, another pandemic, baby and Little Otter is already helping 1000s of families across the US, redefining what care looks like from ages zero to 18. I can’t wait to dig into Rebecca’s journey and how she scaled this amazing, amazing platform and company, while keeping empathy at the centers. Rebecca, welcome to the show.

Rebecca Egger 1:50
Thank you so much for having me. I’m so excited to be here. I’m super,

Kara Goldin 1:54
super excited. And you are now living in one of my favorite states, North Carolina. Love, love, love. So let’s start with the basics. For people who are not familiar with Little Otter, can you share what it is and give us a picture of what you’re building? Yeah. I

Rebecca Egger 2:12
mean, your summary was actually exceptional. So thank you for that. We’re building a mental health platform for young children, older kiddos, and then caregivers. We really want to be the Family Mental Health Home that helps you understand, should I worry about my child’s behavior? Is this normal or not? And then also the location where you go if you need help. So if that’s therapy for your kid, if it’s parent training for you and your partner, or couples therapy or psychiatry and medication management, we match you to the right services that are appropriate for your family at the right time. Amazing.

Kara Goldin 2:51
So you launched Little Otter during a mental health crisis for the world and definitely for families. What made you confident that this was the moment that you needed to go all in? Yeah,

Rebecca Egger 3:06
you know, it’s so interesting, because this is actually Little Otter. Is something that we had been kind of batting around me and my co founder, who happens to be my mom and our chief medical and scientific officer for many years, because I had seen her incredible career, and the amount of kids and families that were getting help have not changed. Families have been in a crisis before the pandemic, and continue to be in a crisis now, but it has become more apparent, and they’re also dealing with slightly different issues. And so I really think the pandemic just gave us the confidence that virtual therapy was going to be accepted. We always knew that we had to have a virtual first offering, because the type of care that we are providing is so specialized that it was going to be required that we had virtual care. Because what I say, and like, no shade to any states, okay, we’ll use the state I live in North Carolina, but it’s like, we’re not going to convince every single early childhood and childhood mental health specialist to move to North Carolina, and we want to make sure that families across the US all have access to quality care. And I think it was really the pandemic that helped everyone understand, yes, this is a huge market. There’s a real opportunity there, and this could actually provide better care.

Kara Goldin 4:22
I love that you started this company with your mother, and we’re actually recording this just the day after Mother’s Day. So how did she inspire you overall to kind of launch into what you were doing even before starting your company. But, I mean, it’s pretty unique. I guess I started hint with my husband. Everybody always said, Oh, wow. How do you work with your husband? But working with your mom, I think it’s, it’s, it’s super special.

Rebecca Egger 4:56
It is really special, right?

Kara Goldin 4:58
And obviously. Actually, you know, you continuing kind of the good work that your mom had, some of the good work that your mom had been working on. Obviously, she did a lot of lot more than that, but I but I think it’s just really inspiring. So can you talk a little bit about that? I

Rebecca Egger 5:16
think there’s a few parts to this. The first is, I’m able to be a CEO today because of who my mom was, because she is a psychiatrist, because she identified and supported me with my ADHD and anxiety as a young kiddo, and I got the help that I needed and the support. And that’s not true for everyone. So I think partially it’s, you know, and I think a lot of people who start healthcare companies or mission driven companies have that same tug of, how do I make this, you know, what I got, accessible to everyone, or how do I change this experience? So that’s one, and then the second is that I was just always obsessed with my mom’s research and her career and her work. I always just thought it was so fascinating, and it was actually my work at the Chan Zuckerberg Initiative that ended up making me want to take that jump, because I was working with incredible scientists there who I all love and adore, and they were all men. I was like all of them have these partners and institutions that are helping them to get their research more visible. And my mom’s work could impact millions and millions of children and families lives, but she needs that business partner to make that possible. And I think once I started realizing I could be that person, is when we decided to make this step. And honestly, I think her research and her work, it’s her life’s work is still so much her baby, in a lot of ways too, that I think she needed to work with someone she deeply trusted, who felt like was going to honor that and take care of that, which made the partnership kind of really easy at the beginning.

Kara Goldin 6:53
That’s incredible. So you touched on your initiative, or some of the initiatives that you had worked on at the Chan Zuckerberg Institute. CZI, you also had incredible experience at Palantir, and I’d love to hear how those experiences kind of helped you to think I need to just go do this now.

Rebecca Egger 7:16
Yeah, I mean, I What was really amazing at my, you know, time at Palantir is that I got to see so many different types of problems, because a lot of it was kind of jumping with different clients working on, you know, their biggest needs. I mean, it was pretty much consulting and, you know, building products in a consulting framework. And that was such great learning for me, because it just helps you be able to flex really quickly. And what are the patterns that I see, what are ways that I can address this, what can be done, etc. And that was the biggest takeaway that I took away from Palantir. And also, I mean, a lot has been written about this, but their philosophy was very much like, there are no blockers in your way, you know, like get stuff done, do the cold emails, reach out, work hard to make, you know, get what you need. And so I think I brought a lot of that into CZI then, which really helped us spin up this infectious disease program there, which was also kind of taking something from zero to one. So I had a lot of confidence that I could do a zero to one project, but it was really hard for me to be like, what’s going to be the thing that’s going to make me want to take that step? I mean, you know, you built something, and it’s so, it’s, it’s such, I would always say is, like doing a startup is completely irrational. There’s no rational bit about it, because you could stay at a much safer position. You have to really get over that rational part of your brain to make that leap. And so I rationally knew I could kind of do the zero to one, but the irrational part was, what is something that I feel driven enough to do that, I will be willing to give up, you know, a really great job and more kind of traditional pathway,

Kara Goldin 9:13
yeah, definitely, it’s I’ve met so many people over The years where they think, Okay, I’m going to just go start something because maybe they’re more established company that they’re working at isn’t interested in working on this kind of niche that that they’re working on, but it’s so much harder imagine. So I love your description that you know you have to be a little crazy to be able to jump off and just say, I’m going to go do this. It’s a lot of fun, but it’s a whole lot of work, for sure, and it’s, you know, trust, I think you you mentioned that with with having your mom, I think that that is, is so. Key, and especially somebody working with somebody who maybe has different skill sets, but also you just trust their opinion, trust that they’re capable, yeah, all of all of those things. So, so, so, so key. So Little Otter, so, so unique, and focusing on whole family care. Why was that so important, and how does that actually work? Can you take us through the process when somebody signs on to Little Otter, and what should they hope for? So

Rebecca Egger 10:33
when someone first signs up for Little Otter, they take what’s called our family mental health checkup, which is free online. I’ll say anyone can take it. You don’t have to get care from us. Just go to the website, you know, walk through the questions. It takes a couple of minutes, and it asks developmentally sensitive questions about your kids mental health, and then also your own mental health as a parent and your family relationships. And so a core principle of early childhood mental health, which my mom is an expert in, is this idea of dyadic care. You know, you’re not just looking at the child. You have to also bring in the parent. And I always use the example of, you know, I don’t know if you know CBT is like a very traditional therapy if you get a six year old or seven year old to do CBT, but the parents are arguing every single night, that’s not going to help the outcome in the family. You have to look at it holistically. So we’ve taken that principle and applied it all the way through older childhood as well. So when you come to Little Otter, you take the family mental health checkup, and you’ll get a full report on your family’s mental health so immediately you can see, should I worry? And then what could I do, including resources, things that we have on our website, etc, on like activities that you could do with your kiddo, even if things are norm, normal or not. And then, if you want to sign up for services, you then convert into Little Otter, create your account, have an initial call where you’re going to walk through that family mental health checkup with one of our clinicians, and they’re going to match you to a clinician that’s going to start providing services. Most families have a full diagnostic assessment, so we’ll actually get a do a diagnosis, and from there, that’s how we develop a treatment program. But your care starts, you know, the minute that you first start interacting with a clinician at little adder, and then during care, you have access to what we call as our care done. So you can message your clinician, you get resources between appointments, and then we repeat that family mental health checkup every three months to make sure things are going okay. But we have a really strong philosophy at Little Otter of like kids and families should get back to functioning. The goal is not to have someone in therapy infinitely, obviously, if you want to stay engaged or do checkup appointments, but the goal is to get the family functioning as quickly as possible.

Kara Goldin 13:05
So what is the average age of a child who is coming into Little Otters? Well, parent first, but, but what is the age of the individual? I guess that people are most concerned about

Rebecca Egger 13:20
it’s around eight years old. It’s usually our average age kiddo. But I will say we see many, many kids under the age of two. We see very young kids. And I’ll also tell you the stat that always like, blows people away. But our average age of suicide ideation at Little Otter is 10. And the youngest kid we’ve seen as five Wow. And about a third of our kids coming into Little Otter have suicide ideation, and we’re very well prepared for that. And so it’s something about, you know, this is not just about preventative care. This is really about children who are suffering now and families who are suffering, and how do we identify and support them as soon as possible?

Kara Goldin 14:01
So what’s been the most surprising insight? I mean, that that you just said it was incredibly surprising, but observing children and families engaging with digital therapy, I guess what’s been the most surprising?

Rebecca Egger 14:16
I mean, I think the most surprising has been how sick the kids are that are coming to us. I think when we initially launched this company, we were kind of thinking we were going to do more the preventative mild to maybe slightly moderate families who were like, I want to, you know, be proactive about my kids mental health. But there is such a huge gap in services that we very quickly realized that when families are coming to us, they are often in crisis. And so we really and I mean, we discovered that right after we launched, and so we’ve made sure to build an entire model that supports those appointments. And I think also something that shouldn’t be that surprising, that we’ve just been able. To validate is that virtual care really works, and in a lot of ways, it can be better than in person care and really works with mixed families. When you have parents in different locations, when you you know are looking at a kid and you’re looking at a really anxious kid, and having them in their home is a lot easier than trying to get them to go to a doctor’s office around town, you know. And so I think just the the outcomes backing up our belief was really exciting. So

Kara Goldin 15:31
biggest mistakes the healthcare industry keeps making when it comes to especially pediatric mental health. I

Rebecca Egger 15:39
mean, I think not focusing on the parents as well, and not looking at the caregivers or the entire family unit. I think the just assuming the full responsibility, you know, on the kiddo or the individual. I’ll tell a story about this, because I think this is such a great example of a mom that I was talking to recently. She had her second kid, and she her older was having some some problems, and so she went to the therapist, and the therapist told the mom, so this is the kids. Therapist told the mom, look, you’re you’ve really been struggling. Because she has, she just had a new baby, and your anxiety is making your older kid anxious, so I would just make sure not to be anxious around him, to which she said, I’m never going to do again. Thank you, because she felt so blamed, and she’s trying to keep it in and she doesn’t know what to do. And you know, she wants to obviously help both of her children. And what we’re trying to change a Little Otter is have the conversation to say, okay, instead of you need to hide your anxiety from your older child. Great, you are anxious. Let us support you first and foremost, because getting you better as a parent and a mom is going to impact everyone in your family. But let’s put you now at the center, and it’ll trickle down and pack the rest of the family. I think that kind of perspective is something that us as an entire society has to start thinking about differently.

Kara Goldin 17:13
Yeah, definitely. Well, I love that you’re focusing on the whole family, and I feel like so often you hear that people are focusing on the whole family, but they don’t really have a business model that is helping the entire family. So can you talk a little bit about the business model, a bit, and I guess the profit and the pain, so to speak. But when you look at all these, all the different aspects of of, really, the core of of what you’re going for, you are focusing on, on the entire family. And how do you, how do you generate a business off of that?

Rebecca Egger 17:57
Well, I think that goes back to your earlier question of like, what do people need to know about the industry? And I’ll try to explain this as simply as possible, but basic reimbursement rates for an insurance like, I don’t know if you’ve tried to get therapy, but most therapists don’t want to take insurance, and it’s not because they’re evil. It is because insurance companies historically have not valued mental health care, and it has been seen as this bonus extra part of health care, kind of like dentistry or something else. But even worse, and so reimbursement rates are really, really, really low, and so on average, an hour of a therapist’s time through insurance is usually like $50 per hour, where, if you pay out of pocket, you could get up to $200 per hour. And these are master’s level clinicians. So the reason I’m sharing that is reimbursement rates are really untenable to drive a quality mental health care business. And then the other problem is that kids are not very expensive to insurance companies, even very sick ones, there’s not that many of them. Mostly kids are really, really healthy, even though we know that kids with mental health care end up in the ER, it leads to future physical health and mental health and very high costs. But that’s really interesting when you start to think about it in terms of the whole family, because parents are expensive and parents with mental health disorders do cost insurers more money than a kiddo, so we partner with insurance companies to figure out, how do we get high enough reimbursement rates that we can get our health care covered for families? So we do some cash pay like any family can sign up and pay out of pocket for our services, but really our business model is working with insurance companies to figure out, how do we get our reimbursement covered, and then prove to the insurance companies that caring about Child and Family Mental health is going to lead to better outcomes.

Kara Goldin 19:57
What do you think the future looks like? For that. Do you think it gets better? Do you think so many people, obviously are talking not to get political, but so many people are talking about all the, you know, changes in the world, and especially when it comes back to people that are just trying to progress. What do you think the future holds for mental health? Yeah, consumers ability to to actually get it covered.

Rebecca Egger 20:27
Well, I think I’m gonna answer that in a few ways. The one is to everyone listening. Consumers have a lot more power than you realize, and that’s when I want to continue to like emphasize and I’ve continued to learn you can demand more from your insurance companies, from your employers, and make a really big difference if you say, No, I deserve quality care because they want happy consumers. And also you can pay with your dollars and start to say, I will get this out of pocket. But you know, be loud about what you’re not getting reimbursed. So I actually feel very positive on that front, because I think the move towards consumer healthcare is actually very great for the average consumer, because it’s cutting out all of the different layers of bureaucracy and pathways that make it so hard to access quality care. Consumers can say, No, this is what I deserve and I demand this. You know, I don’t know, it’s like, the first time you walk into one medical you’re like, Oh, this is what I could be getting. Like, of course, you know. And I think that’s that’s really powerful, and why, from the beginning, we wanted to have a product that spoke to consumers. But I think larger in the market, I actually am very positive about the state of mental health care, because I think during the pandemic, there was a flock to access over quality, and folks are realizing that that doesn’t work. The outcomes are not improving. The amount of people who are getting care is not improving, and the insurance companies are still paying a lot of money without being able to see that their population is getting better. And I really think there is a reckoning in the space of, how do we make mental health and I don’t know if it’s all for positive reasons, but I think where it’s going is positive. Of we actually care about quality, and need to know what works and why. And then I do think that there is more focus on family, for better or worse, there’s a lot of talk about it, and we’ll see if things deliver. But I’m gonna try to stay positive with the areas that I can feel like I have some control over

Kara Goldin 22:42
so what have you learned about building trust in a space that’s deeply emotional and highly personal? It’s, it’s tough. I mean, it’s, you’re in a very tough space and and I’d love to hear, yeah, you describe that.

Rebecca Egger 22:59
And then on top of that, I’ll add we have two levels of trust we need to build, because we have to build trust with our families, and then we also have to build trust with clinicians who are hiring. And so we really have two markets and two groups of consumers that we need to make sure that our brand is resonating with. I think there’s a reason we’re named Little Otter. I wanted something that felt approachable. We wanted to use illustrations. We wanted it to feel fun and not silly but not overly serious, to make sure that it felt like a welcoming environment for everyone, and then I think it’s just a lot of communication, both with your consumers, with your internal team, etc, and being able to say the hard things out loud has always kind of been our our stance. But I think that, like honestly, the fun and approachability is what’s setting brands apart right now.

Kara Goldin 24:03
How have most people found out about Little Otters?

Rebecca Egger 24:08
So we do some direct to consumer marketing, I think a lot, through Google organic word of mouth, and then, you know, we do some with our insurance partners and pediatricians. But, you know, I would love us to be synonymous with like your family mental health, home, your place that you go if you need answers about your family’s mental health, as you’re going to first stop shop for all of your needs. And some of that might be delivered by Little Otter, and maybe some in the future, it’s delivered by partners or somebody else. But instead of having families kind of search in all these different locations, I want them to come to us first.

Kara Goldin 24:48
So Mental Health Tech is super hot right now. There’s a lot of companies in this space not necessarily serving the entire family as you are, but quality very. Raise wildly. And you know, I think most consumers don’t know where to start. What would you say are the non negotiables for somebody coming in knowing that they need help navigating this very, very hard, very emotional challenge that they’re up against? But what are some of the non negotiables that you’d say, what it when it comes to care?

Rebecca Egger 25:25
I love I love that question, because I do a lot of that and something that I also, when I founded this company, and I’m not gonna name any names, I talked to a lot of CEOs, not just of pediatric mental health companies. And I would ask them, Where do you send your family, and if they didn’t stay their own company, I’d be like, What are you doing? And honestly, that is the very first step of all of these things. Is if you see the executives or CEOs of a company, if they are not using that service, the quality is not there because they think that there’s somewhere that they can get better care. And if you know that those leaders are standing by their product and services and would send their own children, that’s a good measure of quality. I think also seeing if there’s a doctor or clinician on leadership is incredibly important. You know, is there someone making the decisions who can, who is putting their license on the line and saying that this is good care? And then lastly, looking at the outcome data with a curious eye, which is how many families were actually or individuals were surveyed. What does this mean? Is it just improvement, or is it clinical outcomes? Do they have white papers? Have they published other research, like, what is is this marketing speak, or is it clinical? Those are the things that really differentiate the companies in the space.

Kara Goldin 27:01
So last question, what does success look like for Little Otters? I don’t know how many years it is when you gain that success, but how will you know Little Otter is really changing the system overall. I will

Rebecca Egger 27:18
believe that we have succeeded when people don’t act amazed when I tell them that one in five kids under 14 have an impairing mental health disorder. You know, when people start recognizing that this is normal, can be identified and can be treated, I feel like we have been have succeeded in our mission to create awareness and move the entire space forward.

Kara Goldin 27:40
I love it. Well, Rebecca, thank you so much for joining us, and what you and your team are doing at Little Otter is just amazing. I mean, the platform is terrific, and it’s really a lifeline, not just for the individual, but also for families, as you challenged many other people in this industry to step up and do that as well, just by building the platform that you have with Little Otters. For those listening, be sure to check out Little Otter, and we will have all the relevant info in the show notes as well. And as always, if you enjoyed this episode, don’t forget to subscribe. Leave a review and share it, and thank you again. Rebecca, thank you so much everyone for tuning in until next time. Thank you so much. Thank you. Thanks again for listening to the Kara Goldin show. If you would please give us a review and feel free to share this podcast with others who would benefit. And of course, feel free to subscribe so you don’t miss a single episode of our podcast, just a reminder that I can be found on all platforms at Kara Goldin, I would love to hear from you, too. So feel free to DM me, and if you want to hear more about my journey, I hope you will have a listen or pick up a copy of my Wall Street Journal, best selling book, undaunted, where I share more about my journey, including founding and building hint we are here every Monday, Wednesday and Friday. Thanks for listening, and goodbye for now. You.

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