Supporting Intensive Outpatient Perinatal Care

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Tom Haederle
There are a host of medical and or psychological issues that can come with pregnancy and giving birth. For most new or expecting moms who may need some extra help, standard perinatal treatment programs will usually fit the bill. But not for everyone. An often overlooked aspect of pregnancy and motherhood is that some new mothers do better with intensive outpatient perinatal care,

00;00;22;07 - 00;00;33;28
Tom Haederle
an elevated level of support.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Illinois based Ascension Alexian Brothers Behavioral Health Hospital is among a small number of caregivers who specialize in providing intensive outpatient perinatal care. They create unique treatment programs for patients, which could include medication management, sleep therapy, substance abuse issues, family counseling, and strategies to deal with a host of other issues that new moms may be struggling with.

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Tom Haederle
In this podcast, Rebecca Chickey, senior director of Behavioral Health with AHA, speaks with two behavioral health experts associated with the Ascension Alexian Brothers Behavioral Health Hospital program, who share its formula for success. Doctor Xiaohong Yu is medical service director for the Perinatal Intensive Outpatient program, and Kimberly McCue is its clinical coordinator.

00;01;26;23 - 00;01;56;02
Rebecca Chickey
It is my honor to speak today to Dr. Yu, the medical service director of the Perinatal Intensive Outpatient Program at Ascension Alexian Brothers Behavioral Health, as well as Dr. Kim Kim McCue clinical coordinator of the Perinatal Intensive Outpatient Program. It is a delight to have these two experts here today to speak to this incredibly important and often overlooked aspect of pregnancy and motherhood.

00;01;56;05 - 00;02;30;27
Rebecca Chickey
Ascension Alexian Brothers Behavioral Health has developed an exceptional program for perinatal care. I'm going to take just a moment to define briefly intensive outpatient, because some people may say, what is that? And how does it differ from outpatient? This is a very broad definition, so do not expect this to be on Wikipedia. But the real difference is when you go to outpatient therapy, often it's a 1 hour or 45 minute session and you may go to outpatient therapy once a week, sometimes twice or three times a week.

00;02;31;00 - 00;02;57;01
Rebecca Chickey
Intensive outpatient is just that. It is building on that. It is often two to three hours, sometimes four. Although when you get to four, you're often speaking about, a partial program for a different podcast. So, it is an acknowledgment, a program that's been designed to realize that 45 minutes or an hour, for some individuals in need of treatment is just not enough.

00;02;57;01 - 00;03;20;18
Rebecca Chickey
And often, as is the case in this program as you'll hear, when families are brought in that often adds to the need for and the value of IOP, which is the acronym that you can now add to your nomenclature. So, Dr. Yu, Dr. McCue: I'm going to start off with a pretty basic question, building on my definition of intensive outpatient.

00;03;20;20 - 00;03;33;20
Rebecca Chickey
What is the Ascension Alexian Brothers Behavioral Health Perinatal Intensive Outpatient Program? So tell our listeners not only what it is, but who does it serve? How is it staffed?

00;03;33;22 - 00;04;00;13
Kimberly McCue
This is a program that has a very unique curriculum that is aimed at meeting the needs of pregnant and postpartum patients, not just to assess behavioral health and support them in that way, but it's also medication management. It's focused on parenting efficacy. Sleep hygiene, nutrition. And it's very unique in that we're allowed to have babies in the milieu.

00;04;00;16 - 00;04;26;06
Kimberly McCue
So moms are encouraged to bring their babies with them to programing. And it is really designed to be all encompassing and have a very comprehensive curriculum. But moms feel more at home when every other patient in the room is in the same boat they are. Right? And it is - if I can brag on our staff for a bit - the the dream team.

00;04;26;10 - 00;04;53;27
Kimberly McCue
So it starts with Dr. Yu. She has such unique training in that she is uniquely trained to medically treat, psychiatrically treat pregnant and postpartum moms. When they're postpartum, they are often breastfeeding. So we have to take lactation into consideration. But she is also a board certified sleep specialist. And I think at no other time in a woman's life is she more sleep deprived than during pregnancy and postpartum when she brings the infant home.

00;04;54;00 - 00;05;23;02
Kimberly McCue
We are really aimed at meeting all the needs of moms and then, the rest of our staff all has unique perinatal training. But many of them have additional training in OCD and chemical addiction medicine and, you know, eating disorders in family care and family therapy and all that plays into creating unique treatment plans for individuals. While it is group therapy, each individual needs to be met where they're at.

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Kimberly McCue
The two members of our team that really make things work are our perinatal mental health nurses. Each of them worked in labor and delivery for over 25 years. They had a full career in labor and delivery, and they came to us with all of that knowledge, all of that training, all of that certification. And then they went the extra mile

00;05;42;27 - 00;06;06;17
Kimberly McCue
and were trained in perinatal mental health. So they allow our team to collaborate with other providers. OB is maternal fetal medicine pediatricians. And they work so closely with Dr. Yu screening the patients daily for where they're at with their medications, side effects, what else is going on with them in terms of pregnancy and just women's health after giving birth.

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Kimberly McCue
I'll let you, Dr. Yu, jump in.

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Xiaohong Yu, M.D.
Thank you Kim. And thank you, Rebecca. It's my honor to be here today. Yeah I agree with Kim that our program is staffed by multiple disciplinary team. Including psychologists like me and also psychologists, social workers and nurses and, other mental professionals, including like chaplain, specialist and also a nutritionist. We also have lactation consultant to work together.

00;06;40;11 - 00;07;18;05
Xiaohong Yu, M.D.
So we provide comprehensive assessments and sometimes design individualized treatment plans. Intensive outpatient program means intensive, right? But it's not like inpatient, not like an E.R. setting. We treat patients in outpatient and let patient connect with outside better. So make sure them feel comfortable in the treatment settings, not here just intensive, but, also provide very comfortable care and provide a lot of support.

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Rebecca Chickey
That's exceptional. So just to summarize, I think I heard a couple of key words. One, multidisciplinary treatment team. Two, meeting the patient or individual where they are. Three, it's not just treating that individual. It's treating the family, the infant, the settings. Bringing in and addressing the perhaps unique challenges of, home life that often impact the mental well-being of all of us.

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Rebecca Chickey
Would that be correct?

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Kimberly McCue
Absolutely. That's correct. one of the most important parts of our treatment is to treat the entire family, to treat the the dynamic between mother and baby, mother and her partner. Oftentimes there's other children, so incorporated with our treatment we do family sessions. We have to support partners. We have to support whoever the system is that helps mom out.

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Kimberly McCue
And oftentimes that might be her mom, a mother in law, a sister. We bring everyone into the treatment, and we have found over the years that that helps get mom back to her baseline quicker. It helps her to feel surrounded and supported in ways that she's just not asking for help.

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Rebecca Chickey
That's wonderful. So let me back up a bit. Please share with me your journey to create this program. What were the first couple of steps? Was hospital or health system leadership involved? How did you get it off the ground?

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Xiaohong Yu, M.D.
My journey and interest in helping create this program actually started in May 2015. It's around my birthday, actually. One of our leading psychologists - his name is Dr. Saper - he introduced me to one of the coordinators, Mrs. Lita Samanas, who is also coordinator for, Postpartum Support International. It's the organization for, you know, support in guiding women and families through the pregnancy and postpartum mental health conditions.

00;09;24;29 - 00;09;53;21
Xiaohong Yu, M.D.
So they ask me, hey, do you have interest in helping women? Also, sometimes postpartum. The vital signs or one of the critical complaints is sleep problem, right? Sleep deprivation or lack of enough sleep or, you know, sometimes miserable because taking care of themselves and the baby. I said, sure, of course. So in 2015, I started to be interested in this program.

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Xiaohong Yu, M.D.
And then we came with, very, very great group, including Dr. Kim McCreary. And the nurses. So far, it's been great, rewarding experience to help women with mental health issues during the perinatal period.

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Kimberly McCue
It's a great question, Rebecca. It was quite a journey. Our goals were to build on the great programing at Alexian Behavioral Health Hospital. There's a number of specialized programs there. Women were being screened during pregnancy and postpartum, and they were being referred to more general adult IOP programing. The feedback was it's good treatment, but I feel like a fish out of water because my needs are so different than the rest of the patient population.

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Kimberly McCue
And so to Dr. Yu's point,  Samanas - who has been in the perinatal field for years - had asked the administration if this is something that we can start looking at. The administration at Alexian and the rest of our leadership was incredibly supportive, and they sort of put us out on a mission to see what are the unique needs of this population.

00;11;13;04 - 00;11;35;06
Kimberly McCue
How do we get a program like this off the ground? The perinatal mental health field is growing. But eight years ago, nine years ago, it was very small. And so we talked to our colleagues across the nation. Really, we were the first to launch in Illinois. And we are at this point, I think, the only still running at this level of care and intensive outpatient level of care.

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Kimberly McCue
So we were looking to see how we can overcome the barriers that moms face, including very simple things like parking, bringing baby with them, strollers, car seats, diaper bags, all of these things. And how do we create a space in the hospital that allows moms to be comfortable with their babies and still receiving mental health? And we've always taken the approach of and, and we literally meet almost daily during, you know, program time:

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Kimberly McCue
What worked for us, what do we need to change? And that has been consistent for the last eight years.

00;12;13;28 - 00;12;42;27
Rebecca Chickey
So leadership has definitely been involved. They've been supportive not only both physically reaching out, checking touching base with you, but also providing resources. You know, some of the listeners are wondering, okay, how are they financing this? Because the health care system landscape is continually challenged to do more with less. I see a lots of nods for those of you who are just listening in on this.

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Rebecca Chickey
We all know, we're continually challenged. So how are you able to support and sustain these kinds of programs?

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Kimberly McCue
Ascension Illinois maintains one of the largest and most comprehensive behavioral health services in the Midwest. And we're just very thankful to receive philanthropic support for our services and have worked hard to ensure that our patients have access to the very best care. And, you know, Doctor, you had mentioned the pandemic. We had to switch to telehealth medicine. That was meeting the needs of our moms during the most difficult time bringing the therapy into their homes.

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Kimberly McCue
And then when we returned back to in-person, you know, we're back in the hospital, but now we have both. We continue to have a virtual version of our program so that we could treat moms across the entire state of Illinois. But we're also able to overcome some barriers that moms might have to coming in person, like they have older children, they don't have transportation.

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Kimberly McCue
Some of these moms that we're treating are in a sandwich generation where they're also caring for a parent. So we are meeting all of their needs. We are just trying to overcome any barriers that a mom would have to treatment.

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Rebecca Chickey
Well, it's interesting you bring up philanthropy. I've been in the field of behavioral health now since the mid-80s, dare I admit. And I would say in the 80s and the 90s that wasn't something that you often saw foundations or individual families giving to. Specifically to mental health, psychiatric or substance use disorder programs. But that has changed.

00;14;20;29 - 00;15;05;02
Rebecca Chickey
Nationwide Children's, which is a pediatric hospital in Columbus, Ohio; Big Lots donated $50 million to Nationwide a few years back to to support the creation of a child and adolescent psychiatric hospital treatment center and research center. So for those of you who are listening, note that they said, you know, philanthropy has been a strong factor in supporting the work that they're doing. AQd the attitude of philanthropists around giving to psychiatric and substance use disorder treatment programs has definitely shifted, to the better.

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Rebecca Chickey
I'm a little biased, but definitely to the better. So I'm going to shift this just a little bit, looking at time. If you had to pick, could you name maybe two key elements? I've heard a couple, funding, leadership support, but maybe beyond that.

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Kimberly McCue
I would have to say, focusing on the unique needs of the population. From how the space is created that they program in, making sure that literally, the room itself is meeting the needs of the moms. So, having all the baby supplies, having, you know, the seating, the lighting, everything, to meet the unique needs of having babies in the milieu.

00;15;50;13 - 00;16;03;23
Kimberly McCue
I would say the individualized treatment plans. This is group therapy, but we are meeting every single patient where they're at and creating a treatment plan that is meeting each patient's needs.

00;16;03;26 - 00;16;36;11
Xiaohong Yu, M.D.
The key point for me, I think you know, the awareness, right? About perinatal mental health condition is very important, too. We try to provide the best service with multidisciplinary team to the patient who is in need. And also, we have all of the staff members in that team have passion to help the woman who is in need of the help.

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Xiaohong Yu, M.D.
Sometimes we use our extra time. You know, even after work, we text each other, provide service for the patient. When patient is imagined situation, we're able to provide service for them as well. So, yeah, that's very key for our team. And, another thing is, you know, I just want to say there is a door open from our team, from our perinatal IOP program.

00;17;08;01 - 00;17;17;08
Xiaohong Yu, M.D.
If you need help, please knock on the door or please just reach out to us and we're there for you and available for you.

00;17;17;11 - 00;17;40;22
Rebecca Chickey
Thank you so much. It's clear that there is a need for programs like this. Not everyone needs intensive outpatient. And you said that at the beginning, but there are many who do, and there are many who are not seeking help. So reducing the stigma, I agree, is very important. I'll point the listeners to a resource on AHA's webpage.

00;17;40;25 - 00;18;09;13
Rebecca Chickey
It's called People Matter, Words Matter. It's a series of posters pointing out words or phrases that do nothing but accelerate and reinforce stigma around mental health and substance use disorders, and providing alternative words and phrases that you can use that decrease the stigma and normalize seeking care. One of those posters is around maternal mental health so I wanted to connect the listeners with that.

00;18;09;13 - 00;18;35;12
Rebecca Chickey
We also have a webpage where you can find other resources related to maternal mental health. So that can be accessed at AHA.org/behavioralhealth because this podcast is incredibly important. Thank you so much for your time, for sharing that you're treating the whole person, that looking at the full continuum of care that is needed.

00;18;35;12 - 00;19;03;29
Rebecca Chickey
And when I say that not just inpatient, outpatient IOP, but the continuum in terms of during pregnancy, post pregnancy and even months after delivery that you need to look and treat the whole person. So I thank you so much for: One, creating the program and doing that, but for being willing to share of your time and expertise and inspiring others to do the same.

00;19;04;02 - 00;19;05;22
Rebecca Chickey
Thank you so much.

00;19;05;25 - 00;19;14;06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.