Advancing Health Podcast

00:00:00:15 - 00:00:24:23
Tom Haederle
In 2022, more than 49,000 Americans took their own lives. Beyond the tragic loss of someone who might have been saved by seeking help in time, suicide has a domino effect, leaving devastated families and communities in its wake. Suicide happens across every sector of society and there are resources available to help. But for farmers in rural areas, accessing those resources is especially difficult.

00:00:24:26 - 00:00:39:10
Tom Haederle
That's why Farmer Angel Network in central Wisconsin has stepped up to help.

00:00:39:12 - 00:01:07:26
Tom Haederle
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Farmer Angel Network is a support group founded to tackle suicide prevention, as well as assist loved ones who are coping with it after the fact and steer them to resources that can help. In today's podcast, hosted by Jordan Steiger, senior program manager of clinical affairs and workforce with AHA, we learn more about the group's important work and how area hospitals are contributing to the effort.

00:01:07:28 - 00:01:22:14
Tom Haederle
Jordan's guests are Brenda Statz, cofounder of Farmer Angel Network, Carey Craker, who handles marketing and volunteer services at Reedsburg Area Medical Center, and Christy Updike, transformation program manager with Sauk Prairie Healthcare.

00:01:22:16 - 00:01:45:12
Jordan Steiger
Brenda, Christy and Carey, thank you so much for joining us today on the Advancing Health podcast. We know that it is Suicide Prevention Month. We really want to shed light on the work that our members and our communities across the country are doing to bring some awareness about the issue of suicide, and I think the work that all of you are doing in your community in Wisconsin is really exceptional.

00:01:45:15 - 00:01:57:27
Jordan Steiger
So, Brenda, I'd like to start with you as one of the founders of the Farmer Angel Network. Could you please just tell us more about what the Farmer Angel Network is and what inspired you to start this initiative in your community?

00:01:57:29 - 00:02:16:21
Brenda Statz
We are just a group of people that started out at our church. I had lost my husband to suicide, maybe six years ago coming in October. And we started a support group of people to come in through our church. The president of the men's club, who was a friend of my husband's, wanted to do something.

00:02:16:21 - 00:02:38:05
Brenda Statz
And so he said, I just want to call people together to come in and talk, and that's how it started. And so the ladies of the church did a soup and sandwich luncheon, and we did it from noon to two, because that's when farmers usually come in to eat. And we put it out to Pam Jahnke on Channel 3 News and said, hey, we're having this gathering at Saint Peter's Church in Loganville.

00:02:38:07 - 00:03:04:05
Brenda Statz
Anyone who wants to come and talk or just needs someone to listen, or just wants to find out what's, you know, if something's going on in their life that they want some help with, they should show up. A lot of events we go to, we show up, and our main goal is to provide resources to the rural communities. Because when I went through it with my husband, everybody afterwards said, well, you could have gone here, you could have gone checked into this.

00:03:04:07 - 00:03:30:00
Brenda Statz
I didn't know any of that existed. And so I thought, this is some way that we can help other people and other families. And that was another big key to me was, for me, was to support the families, supporting those going through the crisis because they're already in trauma also. And that trickles down to the kids, all the way down, because it is a domino effect that affects everyone.

00:03:30:02 - 00:04:00:21
Brenda Statz
And so we try to bring resources to everyone to support the whole family. So, if the person does have to go into a treatment facility, by the time they come home, we can have the families supported. Because, like on a farm especially, somebody still has got to do the work whether you're there or not. And so if that person, like when my husband would go, that fell on me and my sons to do the cropping and get everything done while he was in the hospital. And the guilt that they have of not being there. But yet, they can't function where they're at.

00:04:00:21 - 00:04:18:18
Brenda Statz
So, that's what I always told them. You need to go where you can get help because we can't help you here on the farm. So that's your job now, to go get help. And so then he would agree to go, and we would take care of what needed to be done on the farm. But sometimes that can cause a lot of resentment to the other farm members

00:04:18:18 - 00:04:48:03
Brenda Statz
if it goes on for a long amount of time, because everybody gets tired; everybody gets stressed out. And if you don't teach them how to handle that stress, by the time that person comes home, they might be in a good place. Everybody at home is not, and that can just spiral out again. So, if we try to get everybody on a good place before they come home or whatever the situation they have going. That is our biggest goal that we have is just to bring resources, so people realize they are not alone.

00:04:48:06 - 00:05:16:23
Jordan Steiger
You've brought up so many important topics, I think within suicide prevention and just that introduction of the work that you do. I think, you know, surrounding the family and making sure that other people are empowered to take care of themselves as they're taking care for their family member that might be struggling. But one of the things that you really brought up, that I think maybe people in urban areas don't know as much, is just that stress that farmers face and those risk factors that come up for farmers and their families.

00:05:16:25 - 00:05:25:21
Jordan Steiger
So, I'm wondering if you could expand on that a little bit and just tell us about some of the unique things that farmers and farming communities face when it comes to mental health.

00:05:25:24 - 00:05:46:24
Brenda Statz
Stress is one of the number one things, but the biggest stressors they have is the weather. We can't change the weather. YouÕve got hay to make, youÕve got corn to plant. Everything relies on good weather or it's too dry. Last year we had a drought. I mean, we had half the crop or less because it wouldn't grow once you put the seed in the ground.

00:05:46:26 - 00:06:07:15
Brenda Statz
The other stressor we have is markets, totally out of our control. We have to take the price that is offered unless you work for a contract[BM1]. You know, there's ways that you can do that. But there's a lot of farmers that don't have access to that or just don't understand how to use the systems. And then other stress too, is just, having time to yourself. Time away,

00:06:07:15 - 00:06:30:18
Brenda Statz
time to get away from the farm, trying to relax somewhere. Because when you live where your job is, you never are off the clock. When you live in town, you work your job, you go home. When you're on a farm, you're at your job all the time, and you can never walk away. And so you have to teach people how to take time for themselves.

00:06:30:20 - 00:06:33:00
Christy Updike
I would add to that, if that's okay.

00:06:33:08 - 00:06:35:20
Jordan Steiger
Yeah, absolutely. Jump in, Christy.

00:06:35:23 - 00:07:05:29
Christy Updike
Couple additional things, are the transitions in farming. So many are family farms, and that transition to younger generations or having to sell or get out of farming are huge stressors and crisis moments for many people. That's a big risk factor that they're going through that. Another is access to guns or deadly weapons. So that is a standard part of living on a farm.

00:07:06:01 - 00:07:34:02
Christy Updike
It is a tool that we have to utilize. And unfortunately, that can be a risk factor in the farming. And the last one is isolation. So much of what farming is with the animals and the fields, and we don't have as many opportunities for fellowship. And that's one thing that Farmer Angel does, is to help bring farmers together to help address that isolation.

00:07:37:06 - 00:07:55:17
Jordan Steiger
I'm really glad you brought up isolation, because I was just going to ask Brenda about that. That was the first word that came to my mind when she was describing, you know, putting together this, this meal and, kind of fellowship at the church, you know, is just having that opportunity to come together, we know, is so important for mental health.

00:07:55:19 - 00:08:20:19
Jordan Steiger
It sounds like that's something that doesn't naturally always happen for people in farming communities. So, I think that, again, underscores the importance of the work that you guys are doing. So, I'd like to transition now and talk to our hospital leaders a little bit about how this actually works within the community. So, Christy and Carey, both of you represent two different hospitals, who work together as part of the Farmer Angel Network.

00:08:20:21 - 00:08:37:17
Jordan Steiger
I love to see when hospitals kind of come together for a common cause, and work across the organization to do something good for the community. So, I'd love for you to explain the role that hospitals play in this greater kind of network of work and the types of services that you provide.

00:08:37:19 - 00:09:07:24
Christy Updike
Sure, I'll start off with that and then Carey can jump in. To start with, Carey and I are both part of farming families as well. So, we have our professional roles and represent our organizations, but then also have our personal roles in being part of farming. And many of the people that we serve in both of our hospital service areas are either farmers, farm families or farm workers.

00:09:07:24 - 00:09:37:06
Christy Updike
They're part of that agricultural community. So, what we do as hospital partners with Farmer Angel Network is to offer our own resources as a part of our professional roles, to help the network coordinate the activities to achieve their mission. So, for example, in my role, I serve on board for the network and bring in the resources we have from the hospital. Whatever

00:09:37:06 - 00:10:18:26
Christy Updike
that might be, my time, the tools and resources, other experts. We also are able to support with expenses or resources like materials and printing materials, which Reedsburg Area Medical Center has done, as well as Sauk Prairie Healthcare. And we cohost and comarket our events. We have also trained our health care providers. So, with the collaboration with Farmer Angel Network, we've brought in different trainings for suicide prevention and for caring for farmers.

00:10:18:28 - 00:10:50:21
Christy Updike
And then we offered a continuing medical education collaborative with our entire county. So, all health care providers and behavioral health care providers in our county that are working toward suicide prevention on how they can best understand the farmers they care for, and practical strategies to help with suicide prevention, mental health care. So, I think with that, Carey can jump in as well.

00:10:50:23 - 00:11:26:19
Carey Craker
Sure. Just to expand a little bit on what Christy said. We help get the resources out there to our rural communities. As with any support group, you have times when things don't get better or when things escalate beyond what our group can help with. Reedsburg has both emergency services for crisis that's available 24/7 and a dedicated and growing behavioral health team thatÕs comprised of people from the rural community who understand rural living, farmers and rancher perspective.

00:11:26:21 - 00:11:51:09
Jordan Steiger
One thing that you both just brought up was that kind of cultural awareness around, you know, making sure that your providers and your behavioral health providers are aware of some of these things that we're talking about, you know, that could really affect farming communities. I'm a licensed, clinician myself. I'm a social worker, and I can tell you I did not learn in social work school how to care for these types of communities.

00:11:51:09 - 00:12:17:18
Jordan Steiger
And I think it's something that is really important to understand if you're going to be in that situation. So, I think that offering the CME credit, like you mentioned, offering that training at lots of different like lengths and, you know, over different times, I think is really probably very effective for, for you. Carey, I'm wondering if you have any advice for other rural hospital leaders who might say, like, wow, this program and this work is incredible.

00:12:17:18 - 00:12:20:24
Jordan Steiger
I want to start this in my community. What would you tell them?

00:12:20:27 - 00:12:48:04
Carey Craker
I think the biggest thing is going off of what we call our community needs health assessment. It's done nationwide and for the last, I don't know how many years, mental health has been at the top of the list. And so between us, Sauk Prairie Healthcare and the other hospitals in the area, it's the top of our conversation whenever we're looking at what do we need to do to help the community?

00:12:48:08 - 00:13:03:05
Carey Craker
So, the biggest thing, I think, would be, you know, to come together. We're not standing alone where hospitals in small communities who need to band together to help this mental health need.

00:13:03:08 - 00:13:32:17
Jordan Steiger
I think that's great advice. Again, just, you know, we're not in silos. I guess that's kind of a farming pun. I didn't mean that, but we should be working together. Not even just with other hospitals, but, you know, other community organizations, other groups across your, you know, your county, your region. I think that you guys have really done a great job of not staying just within the hospital or staying within a church or staying within these small entities, but really coming together.

00:13:32:20 - 00:13:49:14
Jordan Steiger
As we wrap up, I'd like to just turn it back to Brenda. I want to thank you for starting this and having the courage and the foresight to say that this is something that your community needed and using the loss that you endured to help other people. I think itÕs a really beautiful thing.

00:13:49:16 - 00:14:10:03
Brenda Statz
When it comes to this, like we are a network and that's why we are called the Farmer Angel Network. I always say, if one of us doesn't know something, we might know somebody who does. So, we all work together to get to the end result, which is to help the family or to help those that are struggling. And there is a lot of training. I've done mental health, first aid responder and safe talk training.

00:14:10:06 - 00:14:29:05
Brenda Statz
And that's what we've done with the hospitals. And the one thing I give them as advice is when a farmer finally decides to come in, don't just brush them off because it's going to take 15 minutes before they finally come forward with why they're there, because it takes a lot [BM2]for them to leave the farm because they've got 100 things to do.

00:14:29:05 - 00:14:44:06
Brenda Statz
So, they have to be in a really bad place before they will come in. And I said, they're going to walk in your office and they're going to talk about the dog, the weather and everything else. And then when you'll say, well, I guess our 15 minutes is up, and then they'll say, wait a minute, I've been struggling with this.

00:14:44:06 - 00:15:22:17
Brenda Statz
It takes time for them to gain your trust because a person with mental health, like with my husband, it takes a long time before you can trust someone to tell them that they're struggling with something like this, because farmers are fixers and they try to fix it themselves, and they wait so long to go in. But once they get in and they get the right tools or medication or whatever they need to help them navigate what they've got going on in their life, they do respond that much better once they've let it out, that they need help. And we just need to just, really, just listen because sometimes they just want to be heard.

00:15:22:19 - 00:15:39:12
Jordan Steiger
Sometimes just a very easy conversation to say, hey, I'm not doing okay. It's just the gateway that you need. I think everyone listening to this is going to be able to take something away, and we really appreciate the work that you're doing on behalf of all of our hospitals and all of the people that you serve. So, thank you.

00:15:39:16 - 00:15:40:21
Christy Updike/Brenda Statz overlapping 
Thank you. Thank you.

00:15:40:24 - 00:15:42:16
Carey Craker
Thank you, Jordan.

00:15:42:18 - 00:15:50:29
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:17 - 00:00:36:13
Tom Haederle
Hospitals and health systems across the nation are working hard to advance equity of care to all patients and to spread lessons learned and progress towards diversity, inclusion and health equity. The American Hospital Association's Carolyn Boone Lewis Equity of Care Award was created to honor the most outstanding examples of such work. The 2024 award was split among three health systems who are helping to chart the path forward for everyone.

00:00:36:16 - 00:01:04:22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In today's podcast, Jackie Hunter, vice president of Health Equity Strategies with the AHA explores the winning strategies of this year's three Carolyn Boone Lewis Equity of Care Award honorees. Their discussion was recorded at the AHA's Leadership Summit in San Diego. Her guests are Dr. Clint Merritt, chief physician executive with Augusta Health,

00:01:04:26 - 00:01:32:09
Tom Haederle
recognized for its progress in dismantling structural barriers in their care delivery system and the communities they serve. Rosangely Cruz-Rojas, vice president and chief diversity and equity officer for Mainline Health, honored for creating strategies to influence equity in the surrounding community ecosystem. And Juana Slade, chief diversity officer with AnMed, distinguished for demonstrated excellence in advancing health equity in rural or small communities.

00:01:32:12 - 00:01:50:27
Jacqueline Hunter
Congratulations again on being recognized as the 2024 Equity of Care Award winners. This is a huge honor, and I am sure that comes with a lot of excitement for your organization and community. Clint, can you share with me what it means for your organization to win this award in your respective category?

00:01:51:00 - 00:02:15:18
Clint Merritt, M.D.
Sure. Thank you for being here. We feel incredibly honored. Augusta Health is a community, nonprofit health system in the Shenandoah Valley in Virginia. We earned the emerging category in the Carolyn Boone Lewis Equity Care Award, and that fits that we're on a journey. We've had many different projects that fit into the health equity body of work, which means we've engaged a lot of people in the organization and a lot of community partners.

00:02:15:18 - 00:02:22:21
Clint Merritt, M.D.
And so winning this award, it tells us that we're on the right track. It gives us a lot of energy. So we're incredibly honored.

00:02:22:24 - 00:02:26:22
Jacqueline Hunter
Great. Thank you. And I ask the same question to Rosangely, what about you?

00:02:26:24 - 00:02:49:19
Rosangely Cruz-Rojas
This is extremely exciting for us. We've been working on issues of health equity for about 13 years now, and it has been a period of going through a lot of learning, you know, doing the steps that you have to do in order to be able to understand what you need to do in terms of your work clinically, internally and some of the work we do in the community.

00:02:49:22 - 00:03:14:05
Rosangely Cruz-Rojas
And so going through that whole health equity transformation assessment, the HETA, two years ago, getting some of the information back, help us really organize some of the efforts. And we went into putting the application as a way to show and demonstrate the efforts we found in so many areas, and it was just simply amazing to get the reward back of being awarded the winners.

00:03:14:12 - 00:03:18:17
Rosangely Cruz-Rojas
We are in the category of transforming, which is for health care systems.

00:03:18:19 - 00:03:20:27
Jacqueline Hunter
Great. Thank you. And Juana, what about you?

00:03:21:00 - 00:03:39:03
Juana Slade
We're just incredibly proud. It's a long time coming. We've been at the work since 2001, and I think that this was an opportunity for us during that time to take a pause and establish the infrastructure that many systems around the country are really struggling now to try to get into place.

00:03:39:03 - 00:04:03:13
Juana Slade
But we had the time and the opportunity to engage internally across our system, but we also had the opportunity to establish relationships which are paying back benefits tenfold, because we have the trust of the community to be involved in the work. And that's not to mean that we're perfect, but we certainly don't have an issue with looking for our imperfections and then addressing them.

00:04:03:13 - 00:04:15:02
Juana Slade
And we've got both clinical and non-clinical partners leading the work. And it's just not only personally rewarding and gratifying, but it's gratifying for those individuals who've been working for so long.

00:04:15:04 - 00:04:27:01
Jacqueline Hunter
Great. Thank you. And Julie, you had referenced the Health Equity Roadmap. How was your experience with the Health Equity Roadmap thus far, and how does align with your organization's current strategic plan?

00:04:27:03 - 00:04:53:19 Rosangely Cruz-Rojas
So, and I said two years, I think it was really three, because we were part of the first wave of early adopters. That was 2021. We initially did it as a way to understand the different areas or pockets or levers where we needed to invest efforts and do work and help us really identify where we have opportunities, where we were more mature, what areas we needed to do better or integrate better with the rest of the work we were doing.

00:04:53:21 - 00:05:22:15
Rosangely Cruz-Rojas
It really ultimately became a way of us developing our own internal maturity model. In fact, we were just finishing our strategic plan for DREI. We call it DREI because we add respect, and in doing so, we went through the health equity transformation assessment, identify where we had priorities and prioritize in our strategic plan, those areas where we wanted to do additional efforts to continue to move to the next level.

00:05:22:17 - 00:05:30:24
Rosangely Cruz-Rojas
So it has become part of our maturity model, alongside with our community needs assessment and some other factors that we use.

00:05:31:00 - 00:05:35:24
Jacqueline Hunter
Great. Juana, how have your organization incorporated the HETA within your strategic plan?

00:05:35:26 - 00:05:52:16
Juana Slade
Absolutely. We, of course, completed the HETA as we had to do and as we were required to do as a part of the process. But actually, for us, it began about 15 years ago as a part of some work within the South Carolina Hospital Association under what we call the Health Coordinating Council.

00:05:52:24 - 00:06:19:18
Juana Slade
So the terminology was somewhat different, but the objective was quite the same. We wanted to identify those individuals, both inside our organizations across South Carolina hospitals, but we also wanted to make sure that those hospitals were identifying community partners, public health partners, business partners, and then bringing all of those resources to the table and then looking for ways to improve health outcomes for everyone.

00:06:19:21 - 00:06:44:24
Juana Slade
In 2017 AnMed replicated that approach for ourselves. So internally, we tried to do what we were helping the state to do. We came together. We brought individuals from across disciplines, from across the community, from our governance leaders. We wanted to make sure that everybody who could impact health being provided through AnMed was at the table to look for some solutions, and we took action.

00:06:45:00 - 00:07:11:12
Juana Slade
Dr. Michael Seemuller is our chief quality officer and he makes it his responsibility to make sure that we are re-stratifying quality measures across the organization. We have a director of patient care quality who was has the responsibility to do that at the bedside. And then of course, my primary responsibility is to make sure that we've got the cultural and linguistic competence inside the organization to do what's necessary.

00:07:11:13 - 00:07:30:26
Juana Slade
So, as I said, it's been a part of our character, the culture of the organization for a very long time. I know that for me, the most important part - we were talking about this the other day - the most important thing is to have this work embedded in our strategic plan. Because it doesn't matter if I think it's important,

00:07:31:01 - 00:07:39:27
Juana Slade
what matters is our governance leaders, our administrative leaders, operational leaders are holding themselves and us accountable for patient outcomes.

00:07:40:04 - 00:07:43:15
Jacqueline Hunter
And Clint, what is your experience been with the Health Equity Roadmap thus far?

00:07:43:19 - 00:08:10:19
Clint Merritt, M.D.
Yeah, we completed the health equity roadmap in 2022, and it came at a really good time for us because through Covid we had built a lot of community programing very organically, not only around Covid safety and vaccines, but a lot of work with housing and homelessness and food insecurity work with the Latino community. And we realized in completing the health equity roadmap, we engaged many of the leaders across the organization and the clinical teams to do the assessment.

00:08:10:20 - 00:08:33:20
Clint Merritt, M.D.
How are we doing? And we found there are some things we were strong at. Our community partners were incredibly strong, and our data and analytics were also quite strong. But then we had a lot of work to do, and it's very helpful to see sort of a structured framework to recognize we need a continuous building curriculum for team members to understand how they engage in reducing health disparities and care for the community.

00:08:33:22 - 00:09:05:17
Clint Merritt, M.D.
We need a governance structure engagement that defines how each of our committees and our boards have a role in advancing health equity for the community, and this helped us craft all that structure. And we put it together in a strategic plan in 2023, using a lot of the ideas and framework that came out of the roadmap. We also recast the organization's mission, which we had not done in a couple decades, and it was a mission statement that really leaned into inclusivity and diversity.

00:09:05:20 - 00:09:09:22
Clint Merritt, M.D.
to strengthen in the health and well-being of all people in our communities, it's been very meaningful.

00:09:09:25 - 00:09:22:15
Jacqueline Hunter
Great. And some of you have hit on this as well... but Clint, if you can elaborate on anything that you may not have referenced in regards to innovative strategies, that kind of came from the implementation of the HETA - Health Equity Roadmap.

00:09:22:17 - 00:09:49:06
Clint Merritt, M.D.
Yeah, we've been using data at the neighborhood level to understand where our opportunities lie, who we're not reaching. The health equity roadmap is also about those partnerships and listening well. So we are taking neighborhood level data on mental health, on addiction, on diabetes, and then meeting with neighborhood partners to share "here's what we're seeing." And then lead with listening at that point.

00:09:49:06 - 00:10:06:14
Clint Merritt, M.D.
And it's helping us craft tailored interventions for particular pockets in our community with engaged partners and that kind of approach of very tailored care for health equity seems to come through the Health Equity Roadmap. It's a philosophy that you see in that framework.

00:10:06:17 - 00:10:13:02
Jacqueline Hunter
Anyone else want to add anything additional in regards to any innovative strategies that you have implemented? Juana or Rosangely?

00:10:13:09 - 00:10:45:18
Rosangely Cruz-Rojas
One thing we, because of having the roadmap and understanding the areas where we have opportunities that we've been trying to communicate more clearly is what I call the 3P's of DREA. And the 3P's meaning people, patients, population, population as code for community. And we have a lot of work in all these different areas that until recently were reporting or being developed through different areas of the organization.

00:10:45:18 - 00:11:09:18
Rosangely Cruz-Rojas
So now with all of us being combined, we have an opportunity to say if an ERG employee resource group, or a DEI council is working on a particular area we can tie that back better to our community space and the more we want to do with our community partners. But also in any health equity initiative that we have been working through.

00:11:09:20 - 00:11:45:12
Rosangely Cruz-Rojas
An example just recently, our African-American and black African-American ERG was consulted for some issues and questions we have around providing palliative care consults for the African-American population. And they were able to not only give us recommendations, but also tell us where to go to get additional information and additional feedback on our processes internally. So we are seeing now this combined effort of the 3P's of the work we do in it internally to really accelerate the work we are doing in the health equity space.

00:11:45:18 - 00:11:47:20
Jacqueline Hunter
Great. Thank you Juana, anything to add?

00:11:47:22 - 00:12:07:15
Juana Slade
Well, character, this is sacred work. And that work has been embedded in our organization. And because of our long standing character, we've been able to provide the backbone for our Anderson County Safety Net Council. And one of the tenants is about making sure that we're looking for partners beyond the four walls of our systems.

00:12:07:22 - 00:12:30:21
Juana Slade
We are a founding member of a group in South Carolina that I mentioned earlier, called the Alliance for a Healthier South Carolina and our intent is to bring together people around the state who have similar purpose, whose missions are similar, but to convene those conversations to be at the table for those conversations certainly does take character, and one that I'm particularly proud of -

00:12:30:23 - 00:12:54:28
Juana Slade
we're in a partnership with the Urban League of the Upstate of South Carolina to co-host the Black Men in White Coats Youth Summit to provide outreach, education and field exploration for underrepresented populations. That had not been done in our state. And it certainly had not been done in Anderson County. So we're really proud of that. And then we look for opportunities to bring local dollars together.

00:12:54:28 - 00:13:18:21
Juana Slade
So our foundation, in partnership with the United Way of Anderson County is conducting, for the last few years, a joint fundraising effort to make sure that we're looking at people who are food insecure and those individuals who have opportunities for not only to receive or take a handout of food, but to understand how to prepare that food, and better yet, perhaps how to grow their own.

00:13:18:23 - 00:13:28:25
Juana Slade
So we think that because of the character, the longstanding character of our work, our voice is a trusted voice. We are not new to the conversation of DEI.

00:13:28:27 - 00:13:43:13
Jacqueline Hunter
So as we get ready to wrap it with our last question for you, if you can maybe name one thing and how does your organization, as we look ahead, how does your organization plan to continue to use AHA’s Health Equity Roadmap and advancing its mission of promoting health equity in your respective communities?

00:13:43:13 - 00:13:45:01
Jacqueline Hunter
So I will start with Juana.

00:13:45:03 - 00:14:09:18
Juana Slade
This is one of the levers is about community engagement and thinking organically, thinking outside of the box. Well, in 2020, at the height of Covid 19, the credibility of our organization allowed us to come together with several individuals, leaders from across the community and launch a program that replicates the work of the Equal Justice Initiative in Alabama.

00:14:09:18 - 00:14:36:29
Juana Slade
And we identified the five known victims of racial terror lynching. Now, what does that have to do with the work that we are doing as it relates to health equity? Well, it helps to know how we got here. And so understanding that there are reasons that people are reluctant to engage and to seek counsel and support from health systems, and why people may be reluctant to seek care from individuals who may not look like them or live like them.

00:14:37:06 - 00:14:56:27
Juana Slade
This kind of bold conversation in a community like Anderson has allowed us to expand the meaning of beloved community. And quite honestly, we think that having this conversation, acknowledging that there are founded reasons and the reluctance is going to eventually allow us to provide better care.

00:14:57:00 - 00:14:59:24
Jacqueline Hunter
Great. And Rosangely what about at Mainline Health?

00:14:59:26 - 00:15:28:13
Rosangely Cruz-Rojas
So we plan to continue using the framework both as part of our maturity model, but also as a way to measure our progress to many of the strategic initiatives that we have in place. I come from measurement. I used to direct the Department of Analytics and Process Improvement on the quality, safety and equity before. I'm very strong and really ensuring that over time, the only way you know that you're moving forward is by measuring.

00:15:28:20 - 00:15:59:01
Rosangely Cruz-Rojas
And so using a model like this help us understand where we still have gaps, where we have opportunities to continue to grow. Part of what I've been able to benefit as I examine that framework is that you see in the roadmap, if you were to mature and do more work in your community collaborations or, you know, engage your employee base resources, you have clear steps that some other organizations have done, and they are now documented that you could use that information to grow. For us,

00:15:59:02 - 00:16:23:09
Rosangely Cruz-Rojas
one opportunity that is in the horizon and we're going to be working on this year, is to continue to capacitate, provide capacity for our ERGs and the councils to do work that moves the bar around the strategic imperatives, particularly around these issues of health equity. I hear from some of the members of our organization and that they would like to be part of the solutions, work with us.

00:16:23:09 - 00:16:33:29
Rosangely Cruz-Rojas
So, while providing capacity and getting, you know, training for them to do process improvement, to be part of the initiatives, we probably will be able to scale up more of the work we are doing.

00:16:34:01 - 00:16:37:06
Jacqueline Hunter
Great. And Clint, will you bring us home, what's happening at Augusta Health?

00:16:37:06 - 00:17:02:08
Clint Merritt, M.D.
Thank you. As I think about the next few years in health equity work at Augusta Health, there's a few challenge areas that I think the roadmap gives us some guidance for. One is in the work with community partners who are really the experts on social drivers of health. How do we share data? How do we measure our impact in a way that helps all of our organizations set goals and move forward?

00:17:02:11 - 00:17:23:27
Clint Merritt, M.D.
I see a lot of meetings that focus around that, and that's sort of fits within the roadmap nicely. Related to that, showing impact, is making sure we continue to draw the connections of health equity work to value-based care models so that we have growing funding behind this work. And that looks so many creative ways right now

00:17:23:27 - 00:17:44:15
Clint Merritt, M.D.
so it's an exciting space. And then last at Augusta Health, we're continuing to lean into teaching the next generation of health care workers. We do a lot of education in nursing and pharmacy and therapy, and we just launched our first internal medicine residency program, first GME work three weeks ago. And these young folks coming out, they are very drawn to health equity work.

00:17:44:16 - 00:17:54:08
Clint Merritt, M.D.
It is in their passion. It's wonderful. And I believe they're going to help us be even better at that work with time and that's an exciting part of the work for the next few years for us.

00:17:54:10 - 00:18:13:29
Jacqueline Hunter
Great. Thank you. So thank you all for your time today and for sharing with us innovative, impactful initiatives your team has implemented to advance health equity. We appreciate your dedication to this vital work, and we look forward to seeing you continue the positive impact of your leadership. Thank you so much. As I close, thank you all for listening.

00:18:14:03 - 00:18:25:16
Jacqueline Hunter
For additional information from the Institute of Diversity and Health Equity, please visit our website at IFDHE.aha.org. Thank you very much.

00:18:25:18 - 00:18:33:22
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:18 - 00:00:27:22
Tom Haederle
Tuesday, August 8th, 2023 is a date that Hawaii residents and all of America will never forget. The fire was the deadliest in the U.S. in the past hundred years. And one year later, even as the recovery goes on, caregivers and first responders are reflecting on what was learned.

00:00:27:25 - 00:00:58:11
Tom Haederle
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In today's podcast hosted by Ben Wise, senior program manager of operations for AHA Funded Partnerships, we hear from those who were on the scene as the historic fires scorched the beautiful island of Maui last year. Hilton Raethel, president and CEO of the Health Care Association of Hawaii, describes how the tragedy unfolded and what health care providers did right and perhaps would do differently next time.

00:00:58:14 - 00:01:11:01
Tom Haederle
The local health care system and larger community have largely overcome immense adversity in the wake of the wildfire. But, as Raethel notes, "we'll be dealing with the consequences of this disaster for many, many years."

00:01:11:03 - 00:01:29:20
Ben Wise
Hilton, thank you so much for being here today for this important conversation. I was wondering, just to start, if you could take me back to a little over a year ago, early August of 2023, and tell me, when did you first hear about the fires and when did you fully grasp the severity of them, and even what were your initial thoughts regarding the hospitals and health systems in the area?

00:01:29:22 - 00:01:55:06
Hilton R. Raethel
We first heard about the fires on the morning of August 8th, which was a Tuesday of last year. And like in many places, fires occur. And so you just track them. We heard later that morning that the fires, at least the Lahaina fire was contained and the Kula fire was burning. But the Kula fire is more of a what we call upcountry, more rural.

00:01:55:08 - 00:02:20:23
Hilton R. Raethel
And the Lahaina fire was in some brush and some grass. However, later in the afternoon, we heard that the fires had flared up again. We did not know, however, at least on Oahu, which is the main island here, because Lahaina was on Maui, a separate island. We did not know until very early the next morning, just on Oahu, at least the severity of the fires.

00:02:20:25 - 00:02:53:03
Hilton R. Raethel
I started getting texts about 2:00 in the morning on the 9th. We started to realize very early that morning just how significant the fires had been. What we did not know until later that morning, which was the 9th, around 9 or 10:00 o'clock, that people had actually died. Because we were talking to...I was talking, for example, the evening before and early the morning to the governor who was on vacation with his family on the East Coast.

00:02:53:05 - 00:03:18:23
Hilton R. Raethel
And at that point in time, we knew there'd been some damage but we were not aware of deaths. So we did not become aware, at least on Oahu, we did not become aware of the deaths until early the next morning. What we didn't know is that over 90 people had died that prior evening and overnight. So it was a very, very challenging situation.

00:03:18:26 - 00:03:44:12
Hilton R. Raethel
Part of the problem was that the landlines were down - because of the fires, because it destroyed most of Lahaina -the landlines were down, the cellular towers were down. And so communication and the people on the ground, the emergency services, fire, police, they were focused just on taking care of the community, trying to put out the fires, trying to protect, get people to hospitals, for example.

00:03:44:14 - 00:04:12:22
Hilton R. Raethel
They were focused on what was right in front of them. There was a breakdown in communication between the people on the ground in Lahaina, which is on the west side of Maui, and even the county, Maui County and the state, the governor's office, the emergency management office. So that communication did not start to build until Wednesday the 9th.

00:04:12:28 - 00:04:41:19
Hilton R. Raethel
So over 2,200 structures were damaged or destroyed in Lahaina, 85% of which were residential. And in Kula, the upcountry, there were about 700 acres destroyed and burnt. And there was about 19 homes destroyed. About 8,000 residents were displaced. And this has been described as the deadliest fire in the U.S. in the past 100 years.

00:04:41:25 - 00:04:57:09
Ben Wise
And the logistical and operational and geographical aspects aside, the immediate health impacts must have also been profound. What stood out to you or stands out to you in terms of the challenges faced by those communities, especially in Lahaina and Kula?

00:04:57:11 - 00:05:20:15
Hilton R. Raethel
Fortunately, we have a very good health care system in Hawaii. We have one primary hospital on Maui called Maui Memorial and a couple of critical access hospitals. A lot of tertiary services are provided on Oahu. It's a small state. We only have 1.4 million people in the entire state. So, for example, we only have one level for NICU.

00:05:20:18 - 00:05:44:27
Hilton R. Raethel
We only have one major trauma center. We only have one major burn center in the state. The burn center is a hospital called Straub, which is on Oahu. So there were 82 people admitted to hospital in the first couple of days. Seventy-one of those went to Maui Memorial, the hospital on Maui, and 11 were flown over to Oahu.

00:05:45:00 - 00:06:14:01
Hilton R. Raethel
The majority of those ended up in the burn unit. Now we only have a four-bed burn unit at Straub. This was the largest number of burns that we've ever had in that hospital. So the burn unit expanded into the critical care unit at the hospital so that we could accommodate all these burn patients. Fortunately, we have a great team of doctors and nurses who were able to take care of those 11 patients.

00:06:14:02 - 00:06:37:08
Hilton R. Raethel
Unfortunately, we did lose one of those after a few days because of the extent of the burns. We also had almost 700 outpatient visits in the week after the fire. There were two phases of outpatient visits. Apart from the inpatient, you know, people who had significant injuries. The outpatient visits, you know, it's a lot of outpatient, you know, minor burns,

00:06:37:08 - 00:07:06:20
Hilton R. Raethel
just smoke inhalation, things like that. Cuts, bruises. So there was this initial wave in the first 24 to 48 hours. What we discovered is that when the shock of this whole trauma of this disaster set in, some people two, three, four days later - once the adrenaline had settled down, once they'd sort of...you know, taken a little bit of stock of what was happening, they realized, oh, I've got a burn or, you know, my feet are burned or I've got a bad cut.

00:07:06:20 - 00:07:30:25
Hilton R. Raethel
And so we had this initial wave of visits to the hospitals and then that second wave a few days later. Fortunately, there were no nursing homes or hospitals in this area, either in Lahaina or Kula. And so we did not have any major structures that were damaged or even burned or damaged. There were three physician clinics that were destroyed.

00:07:30:27 - 00:07:48:11
Hilton R. Raethel
There were pharmacies that were destroyed or damaged or shuttered because of the lack of staff, and there were many houses and businesses that were damaged or destroyed. So our immediate concern was ensuring that all of those inpatients, all of those outpatients, were being taken care of.

00:07:48:13 - 00:08:07:11
Ben Wise
That's a really interesting thing to reflect on in thinking about those immense response efforts and needs that you're describing. I'm curious as to, what you and your team at the Health Care Association of Hawaii were doing to kind of step in to support these health care workers and the patients and even the broader community during these critical early moments.

00:08:07:14 - 00:08:30:21
Hilton R. Raethel
A fire like this, when a town, most of a town burns, it means that houses burn, cars burn. People didn't have transport, for example, because all their cars were literally destroyed. But, you know, burned to the ground. So everything in the house was burned. Licenses, passports, medications, you know, baby formula, diapers, toothbrushes. You know, all of those things were destroyed.

00:08:30:22 - 00:08:59:18
Hilton R. Raethel
Many people only had the clothes that they were wearing. So, and then we had the landlines and the cellular towers were down. We had health care workers who lost homes, lost all their possessions, and they were sleeping in the hospital or the long term care facility taking care of patients. They had lost everything, but they went to work. They took care of patients and then were sleeping in the hospital because they, like that literally did not have a place to sleep.

00:08:59:21 - 00:09:23:07
Hilton R. Raethel
So there were two sets of emergency services. We have an emergency services team funded through the hospital preparedness program, the national federal program. We had our team on the ground within 24 hours of the fire. So the fires happened on the evening of Tuesday afternoon and evening of Tuesday and overnight. We had a team on the ground Wednesday morning.

00:09:23:10 - 00:09:57:03
Hilton R. Raethel
They were embedded with state and county officials. We were working with...one of the challenges we had was medications. Again, people lost medications. Everything was destroyed. So we had about 8,000 people in what we call congregate shelters, which is stadiums, high schools, you know, things like that. And we had teams of people come in from primarily from Kaiser and our Blue Cross Blue Shield plan, talking to these individuals to say, you know, what sort of medications do you need?

00:09:57:06 - 00:10:23:20
Hilton R. Raethel
And the challenge was that we have all these people, thousands of people literally in these different shelters that were trying to survive. We would do the rounds. The nurses or the doctors would do the rounds in the morning and saying, you know, what sort of medication do you need? Those orders would get sent to a pharmacy, which was on a different part of the island, and then the medications would be brought back in the afternoon.

00:10:23:22 - 00:10:49:03
Hilton R. Raethel
The problem is, many of the people who were there in the morning, were maybe not there in the afternoon or moved to another shelter or were with friends. We set up the system very quickly, for example, for vital medications, which are critical for individuals. But we had for the first few days about an 80% return rate because the people in the afternoon were not there in the morning and we couldn't track them down.

00:10:49:03 - 00:11:15:21
Hilton R. Raethel
So we're having to send medications back. We worked to coordinate volunteers. There were so many volunteers. We were getting, again, all of these basic supplies, basically setting up a free store next to these congregate shelters where people could just go and get all of these basic supplies, including, again, things like a toothbrush, toothpaste, clothes, anything that they needed.

00:11:15:23 - 00:11:41:24
Hilton R. Raethel
We had dialysis patients. Again, they'd lost their transport. They didn't have their homes, so were having to shuffle around. Dialysis is obviously a critical service. We were having to arrange transport for patients to get from these congregate shelters, these large shelters where they're sleeping on cots on the floor of these stadiums. They had to still get to dialysis.

00:11:41:24 - 00:11:54:18
Hilton R. Raethel
So there were many, many details that our teams, along with state and county officials, worked with to address the immediate needs of these individuals.

00:11:54:24 - 00:12:09:02
Ben Wise
And it sounds like there's a theme of a lot of collaborative work happening here. I was wondering, you can maybe speak a little bit to, what those collaborations were and how they kind of helped aid across sectors to the recovery response that was going on.

00:12:09:04 - 00:12:40:11
Hilton R. Raethel
Well, collaboration is incredibly critical. Disasters, by definition, are chaotic. You know, every disaster is different, and it takes days and even weeks to build systems. You know, it depends on what's destroyed, where people are, how people are being moved around. We're incredibly fortunate in Hawaii that because we live on these islands out in the middle of the Pacific, five hours from the West Coast, people have to rely on each other.

00:12:40:11 - 00:13:09:13
Hilton R. Raethel
They're used to working with each other. So we're very fortunate that we as a health care association, have very close working relationships with the governor, who happens to be a physician. We work very closely with the lieutenant governor, with the Hawaii Emergency Management Agency, and we work very closely with the counties as well. And so, because we know who these people are, we have these relationships, we have email addresses, we have phone numbers.

00:13:09:16 - 00:13:31:07
Hilton R. Raethel
We were able to put teams of people together very, very quickly to help coordinate this in all of this chaos. And if you don't have those relationships set up, if you don't have that level of trust, then it's much harder. If you're calling someone up and say, look, you know, we need to deal with dialysis. We need to deal with medications.

00:13:31:07 - 00:13:48:21
Hilton R. Raethel
We need to deal with whatever it is. If you don't have that level of trust built up, it's going to take a while for people to say, well, what do I want to work with you? We even had payers, for example, Kaiser and Blue Cross, Blue Shield of Hawaii. They stepped up tremendously and they had their pharmacists, for example.

00:13:48:23 - 00:14:12:28
Hilton R. Raethel
They had their behavioral health specialists working with us, coordinating with us. So the whole community came together. And I'm not saying it was all perfect. You know, it was a very, very chaotic situation. But we were able to build these systems, bring in mobile clinics, make sure people got dialysis, make sure people got medications and build those systems in a very short period of time.

00:14:13:00 - 00:14:31:13
Ben Wise
That's so interesting and also encouraging to hear that collaborative work happening. And I suppose now thinking not necessarily in those immediate moments, but here we are a year later, I was thinking maybe just tell me about some of the long term challenges that of that have come from this. And, in recovering from the wildfires and any lessons learned.

00:14:31:15 - 00:14:55:29
Hilton R. Raethel
So one of the things that was really critical was emergency proclamations. And again, we have, a very close working relationship with the governor and the attorney general. And it was really critical that we get these emergency proclamations in place, and we're still operating under emergency proclamations to this day. We are currently on our 16th emergency proclamation in the state of Hawaii.

00:14:55:29 - 00:15:33:09
Hilton R. Raethel
An emergency proclamation can only be in effect for a maximum of 60 days. So we've had a whole series of emergency proclamations. And some of those things, for example, is being able to bring in staff from the mainland. And if you are, if you're a doctor or a nurse or behavioral health therapist, for example, and if they are from the mainland and they have a valid state license on the mainland, but they're not licensed in Hawaii, the emergency proclamation allows them to work in Hawaii without getting a state license, because it takes a while to apply for a state license.

00:15:33:11 - 00:16:01:23
Hilton R. Raethel
So we're very fortunate to have that. We don't have enough behavioral health therapists. There's a huge amount of trauma that goes on when a community gets destroyed. We were short of behavioral health therapists, but you have your health professionals even before this disaster and the need just went up dramatically. So again, one of the emergency proclamations, we have a waiver so that people could do telehealth, for example, consults.

00:16:01:25 - 00:16:25:02
Hilton R. Raethel
Now, normally you need to do an in-person visit before you can establish a relationship and do a telehealth visit. So that was waived, for example. The ability of being in-state to prescribe narcotics, that was waived as well. So again, we had this series of waivers that helped us and are helping us to this day to help take care of the community.

00:16:25:05 - 00:16:34:07
Ben Wise
Tell me about the community a little bit. What's special about it and what makes it, resilient in the face of something is as big and disastrous as these fires.

00:16:34:09 - 00:17:01:26
Hilton R. Raethel
We have this concept in Hawaii called Ohana, which is family. And there is a very, very strong sense of family, of community. And this has been incredibly challenging, again, to have literally thousands of people displaced. Just over 12 months later, the rebuilding has started. We've had incredible support from FEMA, and we've had incredible support from the Corps of Engineers as well.

00:17:01:28 - 00:17:32:28
Hilton R. Raethel
President Biden has been here. We've had members of our congressional delegation been out to visit...all the way from the president, through congressional delegation, through FEMA, for the local community has been incredible. There are a lot of long term effects from a disaster like this. A survey was done recently by the University of Hawaii, and 46% of the Maui residents had reported that their health a decline in the past year.

00:17:32:29 - 00:18:00:08
Hilton R. Raethel
We're going to be dealing with the consequences of this disaster for many, many years. It's a multi-year recovery and we are working very hard to rebuild. It's just some houses have started to be rebuilt. Some of the businesses have reopened. There are people who have left either Maui or left the state because of these fires, because I don't know how long it was going to take to rebuild their  community.

00:18:00:10 - 00:18:12:25
Hilton R. Raethel
However, many people, the majority of people in the community do want to rebuild their community. They do want to stay living in that area. And those rebuilding efforts are starting right now.

00:18:12:27 - 00:18:29:01
Ben Wise
And out of such difficult circumstances, I just really want to express gratitude for everything that you and HAH and all the health care professionals in the area have done. And thank you for taking this time to speak with us today and really appreciate all that you do.

00:18:29:03 - 00:18:30:19
Hilton R. Raethel
You're very welcome.

00:18:30:21 - 00:18:39:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:18 - 00:00:29:05
Tom Haederle
Behavioral health specialists are in short supply pretty much everywhere. But health care leaders are finding out that knocking down the traditional walls between physical and mental health care not only benefits patients, but also helps with the recruitment and retention of the behavioral health specialists that so many providers and patients need more of.

00:00:29:07 - 00:01:00:28
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. These days, integrating physical and behavioral health care is increasingly a seamless part of the overall care experience, what health professionals call a "warm handoff" between physical and behavioral health providers for those patients who need both. This integration is good for patients and is also a significant factor in keeping many health care workers, both in physical and behavioral health, engaged and much happier in their jobs.

00:01:01:00 - 00:01:20:23
Tom Haederle
In today's podcast hosted by the AHA's Rebecca Chickey, senior director of Behavioral Health Services, we hear from Stacey Ouellette, director of Behavioral Health Integration with Maine Behavioral Health Care, on her organization's experience with the positive impact integrated care has had on workplace productivity and satisfaction.

00:01:20:25 - 00:01:49:13
Rebecca Chickey
Thank you Tom. Indeed, it is an honor to be here with Stacey today from Maine Health and Maine Behavioral Health. We are going to discuss the value of integration. I know you've heard this from me before, but she's here with us today specifically to talk about how integrated physical and behavioral health care can improve workforce productivity and perhaps even more important, worker satisfaction.

00:01:49:15 - 00:02:20:12
Rebecca Chickey
We all know that hospitals and health systems have been struggling to recruit and retain qualified workers across a variety of clinical areas, but in behavioral health, that was a challenge even prior to the COVID pandemic. So, Stacey, can you share with the listeners what are some of the specifics that you've experienced around the challenges of recruiting and retaining health care workers in behavioral health?

00:02:20:14 - 00:02:46:29
Stacey Ouellette
Yeah, absolutely so it's always been a little bit of a challenge. The work pool is not that deep really. But definitely with the pandemic it worsened. It wasn't uncommon for us as a program in Maine Behavioral Health Care to have a few positions vacant at a time. But when the pandemic hit, it jumped up quickly to around 20, we're a program of about 100,

00:02:46:29 - 00:03:16:23
Stacey Ouellette
so put that into context there. But it was a shock really, having that many positions to recruit for. And the challenge was there just weren't many applicants out there. And the ones that were out there, you know, that we interviewed, were really looking for that work-life balance. So as a program, we needed to at the time consider how we were, you know, bringing people in and providing them with this sort of work-life balance so that we could keep them right?

00:03:16:24 - 00:03:45:29
Stacey Ouellette
Retention is key. Some of those vacancies were due to growth, not because everybody was leaving. So the demand grew at the same time. And so we needed to, continuously work on recruitment so that we could have the adequate staffing to support the needs and the practices. In terms of the retention piece, really trying to lean in to integrated care can offer people in the role.

00:03:46:01 - 00:04:11:12
Stacey Ouellette
I'll often hear, you know, having access to the primary care provider, it just makes the job better. It makes it easier because you can really coordinate that care. And it's the care team working together for the sake of the patient. Having the role integrated into their primary care and or specialty care practices that we're in can definitely make a difference in terms of that satisfaction with the work.

00:04:11:14 - 00:04:39:12
Rebecca Chickey
So if I may, integration in primary care is something that I think has really caught on across the United States. While it is not in every community or every county, it is something that we're seeing grow each and every day, thankfully, because as we know, particularly early on in an individual struggling with a psychiatric or substance use disorder, often they're seeking care from their primary care physician first.

00:04:39:14 - 00:05:03:02
Rebecca Chickey
So it's very important that that primary care office have access to behavioral health clinicians so that they, too, can be more excited about their job each and every day, as well as feel more comfortable in providing the holistic care that the patient needs. But I'm wondering, you mentioned specialty care. I hear a little bit about this across the country.

00:05:03:04 - 00:05:15:08
Rebecca Chickey
Would you mind sharing what specialties you have gone into? Sometimes people consider pediatrics as a specialty, while others define it as primary care. So what does that mean for Maine Health?

00:05:15:10 - 00:05:45:04
Stacey Ouellette
For us currently, yes, we are in all of the pediatric practices. We are also in practices such as neurology, cardiology, weight management programs, aka bariatrics, pain management programs. So a lot of the diabetes and endocrinology, a lot of the specialties, where patients get their care outside of the primary care home, we're starting to integrate into as well.

00:05:45:05 - 00:06:19:28
Stacey Ouellette
Women's health is another one that we're in. And so it's just it's the same, just that we're integrated into these specialties, providing that support there. Similar to that of primary care you mentioned, you know, you alluded to the patients and trusting their provider. Right? So when the provider identifies or the patient identifies a concern or a need and they're able to do a handoff, a warm handoff with the behavioral health clinician right there on site, it just gains access to care, right?

00:06:19:28 - 00:06:35:29
Stacey Ouellette
And that trust is there because the provider recommended it and usually patients trust their providers. So by us entering some of these specialty practices we're also to be able to support the patients there at those sites as well.

00:06:36:01 - 00:06:56:28
Rebecca Chickey
I'm going to add a little bit of a personal story here because, phrase that you said a "warm handoff" has a really strong meaning for me. My older son, who is now doing incredibly well and in fact is going diving in Bali in October - not that I'm nervous about that at all - but, nonetheless, he's doing much better.

00:06:56:28 - 00:07:20:06
Rebecca Chickey
But he suffered a major depressive episode while he was in undergraduate school. And, you know, he was screened and diagnosed with depression. The handoff was to send a 19 year-old male in college an email with the contact information for two therapists that they wished him the best of luck to see if he could get an appointment.

00:07:20:08 - 00:07:59:02
Rebecca Chickey
That is the opposite of a warm hand off just for those of you wondering. I have a great depth and appreciation for the true value and importance of a warm handoff. Meeting the next person, knowing that you are, not just being put on hold per se. So what I'm hearing, if I can summarize to date: there are a number of important success factors related to integrating physical and behavioral health as it relates to recruiting and retaining qualified health care workers, particularly in the behavioral health field, but also in other specialty areas.

00:07:59:04 - 00:08:26:20
Rebecca Chickey
I think you alluded to this, that, primary care physicians or the clinicians in many of the specialties that you mentioned: cardiology, neurology, women's health. I don't want to assume so I'm going to ask you to validate this: Have you also heard from those clinicians who are not trained in behavioral health that is something that they value that has added value and, improve their satisfaction, in their day-to-day work.

00:08:26:22 - 00:08:50:10
Stacey Ouellette
We as a program, do a provider satisfaction survey every year to 18 months to get some feedback on how things are going. And that is one of the questions that we ask overall, you know, their satisfaction as well as does having an integrated clinician in their practice help make their job easier? And unanimously, all pretty much agree with that,

00:08:50:10 - 00:09:02:28
Stacey Ouellette
strongly agree with that concept that having an integrated clinician in the setting helps make their jobs easier, but also just it helps support them, right? And managing the complexities of the patients.

00:09:03:00 - 00:09:43:01
Rebecca Chickey
For the listeners, I'm going to read a statistic, related to the real challenges and struggles for all health care workers in terms of recruitment and retention. Since 2020, one in five health care workers have quit their jobs. And surveys suggest that up to 47% of health care workers not just behavioral health, but health care workers in general, because this integrated care impacts not just behavioral health care workers, but even more so the other clinicians who often struggle because they may not have recent training in how to diagnose or screen for anxiety disorder or bipolar disorder.

00:09:43:04 - 00:10:23:18
Rebecca Chickey
But 47% of health care workers plan to leave their positions by 2025. And we all know that the recruitment costs, the turnover costs, are significant and often that leads to other sort of hidden cost. And that is the domino effect, when one person leaves an organization, then several others may follow. So just emphasizing not only is this important for each individual who's happier, more satisfied in the work that they do every day, but this can have a positive impact on the bottom line of hospitals and health systems across the country.

00:10:23:21 - 00:10:45:21
Rebecca Chickey
I'm going to put you on the spot here a little bit, Stacey, and ask you to personalize this. I mean, we've seen a lot of studies, for instance, the University of Michigan's Behavioral Health Workforce Research Center, you know, they've come out and they've said, when we've done this research, it's, you know, increased employee productivity. It's stabilized primary care physicians workloads.

00:10:45:28 - 00:11:16:03
Rebecca Chickey
It better allows them to refer patients more effectively and in a timely fashion. But sometimes research seems so impersonal when the listeners are sitting here thinking, could I really do this at my organization? Can you share just a story or two about how you have seen this play out? I know you've talked generally, but how if you, you know, maybe a personal story of how this has impacted, or maybe quotes that you've heard from clinicians at Maine Health.

00:11:16:06 - 00:11:40:27
Stacey Ouellette
One quote that always will stay with me is from that provider satisfaction survey, where one provider, said, this is better than Christmas morning, having behavioral health in our practice because they have access to that support. You know, we've worked to make ourselves available and accessible to support the primary care or specialty care teams and managing the complexity of the patients.

00:11:41:00 - 00:12:04:23
Stacey Ouellette
They're in the moment. And so when we're able to respond, when a patient presents with a concern...we hear time and time again, that just helps them to feel confident, right? The medical providers to feel confident like they know how to respond. Their response might be let's get the behavioral health clinician and get them connected to you so that they can they can help us out.

00:12:04:25 - 00:12:26:02
Stacey Ouellette
I have personally been working, when I worked in one practice was pulled in this will stick with me for probably a very long time, but I was pulled in for a warm handoff. Patient was suicidal, and together the medical provider and I had a conversation with the patient. I did some assessing. We made a safety plan. Patient.

0:12:26:09 - 00:12:54:05
Stacey Ouellette
I provided some education, some validation as to why this person was feeling this way and together as a team, patient included in that team, we all felt good about next steps, and patient left with a plan and came back and continued some treatment. And I think like those examples just demonstrate how having integrated behavioral health in the practices can help improve productivity of the whole care team, right?

00:12:54:10 - 00:13:24:03
Stacey Ouellette
Can help improve confidence and competence in the work that we do. And to the patient, it hopefully helps with patient satisfaction, right? Like it improves their confidence. Like this team's got me, right? They they're all wrapped around. They're working together. They all are on the same page. So those types of examples just demonstrate how integrating behavioral health can have an impact on multiple individuals and outcomes.

0:13:24:05 - 00:13:48:25
Rebecca Chickey
That's phenomenal. Thank you. And thank you for making it personal to you as well. Truly meaningful. Well, as we begin to look towards the end of our podcast here, I'm going to ask two questions. One is thinking back over the last several years as you built out this integrated care system, what are a couple of the things that you think made this successful?

:13:48:28 - 00:14:05:10
Rebecca Chickey
Where do I start? You know, what do I what are the two anchors that I need to have in place in order to replicate what Maine Health has done? What would you say, to the listeners? And the other one is, do you have a call to action for the listeners?

00:14:05:12 - 00:14:38:17
Stacey Ouellette
Use a team, right? So identifying perhaps a provider champion to help support the initiation of this, have leadership on board, which requires perhaps educating, informing of how integrated behavioral health care can be useful for the organization. Give them resources and studies that have demonstrated utility of the role within the primary care settings. It is a whole team approach. It is the medical champion.

00:14:38:17 - 00:15:10:01
Stacey Ouellette
It's behavioral health. It's your billing and finance folks at the table and being flexible, really being willing to try things and adjust. Doing perhaps like a PDSA cycle, so that you can learn and grow and adjust. I would say use resources out there. There's a lot of great people doing this work across the country. The Collaborative Family Health Care Association, CFHA is one group that I, belong to, and they have helped me tremendously

00:15:10:01 - 00:15:29:15
Stacey Ouellette
just as a collective group. They help with questions, they help provide guidance. There's a lot of people out there doing this, so you're not alone. Use your resources. Connect to people, ask questions. People doing this usually really love to share and help others because we believe in it.

00:15:29:17 - 00:16:09:01
Rebecca Chickey
I will add on, you added, you may have to educate, and one of the reasons we're doing this podcast is to continue to draw attention to an issue brief that we released, the AHA released last fall. Basically, the short version of the title is "Integration - The Time is Now." It's only four pages. It has almost 30 references of evidence-based research, showing the multiple ways in which integrating physical and behavioral health can provide value in a multitude of ways, just as you have shared many of them with us here today.

00:16:09:01 - 00:16:30:03
Rebecca Chickey
So I would point to that as an educational resource and an easy read. Four pages. Most of us can do that, and, you know, skim that in a minute. So thank you so much, Stacey, for, again, as I started for your willingness to share your time and expertise, you are doing champions work. We greatly appreciate it.

00:16:30:05 - 00:16:36:17
Rebecca Chickey
I know our listeners do too. You've just inspired someone to start on this journey. So thank you.

00:16:36:19 - 00:16:38:05
Stacey Ouellette
Thank you.

00:16:38:07 - 00:16:46:16
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:25 - 00:00:28:07
Tom Haederle
Welcome to Advancing Health's new limited podcast series, "Caring for Our Kids." The American Hospital Association's Julia Resnick will speak with hospital leaders and clinicians, as well as children and their families, to explore how pediatric hospitals are designing care to meet the needs of their communities.

00:00:28:09 - 00:00:47:27
Tom Haederle
We're glad you can join us for this Advancing Health podcast. I'm Tom Haederle with AHA Communications. Today's episode of "Caring for Our Kids" focuses on how Texas Children's Hospital's pioneering pediatric cancer survivorship program continues the post-treatment care.

00:00:48:00 - 00:01:03:08
Vaughn McCullum
It's a strange experience, especially for a kid because we don't know what happened, and it changed my perspective on a lot of things like how crazy life really is, how stuff could just happen out of nowhere.

00:01:03:10 - 00:01:31:06
Julia Resnick
That was Vaughn. He's in high school. He's a video gamer and a basketball player. He's also a pediatric cancer survivor. We'll hear from Vaughn and his mom later in this episode. Welcome to "Caring for Our Kids," a new limited podcast series from Advancing Health. I'm Julia Resnick, director of strategic initiatives at the American Hospital Association. We'll be exploring how pediatric hospitals are designing care to meet the needs of the children and families they serve.

00:01:31:08 - 00:01:56:18
Julia Resnick
This episode is personal for me. When I was 20 years old, an otherwise healthy college sophomore, I was stunned to be diagnosed with acute myeloid leukemia. And I was lucky in every way. I had access to best in class medical care, insurance to cover my treatment, ongoing support and love from a wide circle of family and friends. And a cancer that responded to treatment exactly like it was supposed to.

00:01:56:21 - 00:02:17:20
Julia Resnick
I emerged on the other end, cancer free, with minimal side effects and ready to take back my life. I work in health care because I want everyone to have the opportunity to live their healthiest life possible. Because if we don't have our health, our quality of life suffers. Merely surviving isn't enough.

00:02:17:22 - 00:02:41:13
Julia Resnick
Just a few decades ago, the survival rate for pediatric cancer was only 10%. So the focus of treatment was to create the best chance for survival. Over the past 40 years, medical advances have caused the survival rate to skyrocket. Now, 85% of childhood cancer patients survive. Yet many kids that survive childhood cancers have long-term effects and side effects,

00:02:41:15 - 00:03:10:06
Julia Resnick
from either the cancer or the treatment. A cancer diagnosis and subsequent treatment can be traumatic and isolating for both the kid and their parents. So part of helping pediatric cancer survivors to thrive is holistic, comprehensive survivorship care. For this episode of "Caring for Our Kids," I spoke with Texas Children's Hospital's Dr. ZoAnn Dreyer, professor and pediatric cancer survivorship and clinical director of the Long-Term Survivor Program.

00:03:10:08 - 00:03:28:26
Julia Resnick
I also spoke with 15-year-old Vaughn McCullum and his mom. Vaughn is a cancer survivor and participant in Texas Children's cancer survivorship programs. To set the scene, let's start with Dr. Dreyer. She has spent the bulk of her career at Texas Children's and gave me some background on the hospital and the children it serves.

00:03:28:28 - 00:03:59:05
ZoAnn E. Dreyer, M.D.
So we're actually the largest children's hospital in the country, and we are very proud of the fact that when the founders broke ground, the mission statement was to take care of all children, regardless of the environment to which they were born. And what that means is you could come here for treatment, whether you've got insurance or you don't, whether you're employed or you're not, you might be living at a homeless shelter, or you might be a member of the richest family in Houston, or the richest family in the U.S.

00:03:59:07 - 00:04:20:12
ZoAnn E. Dreyer, M.D.
All of those patients, all of those families will get identical care. And I think that's probably one of the things that makes me most proud of this institution. Now, it's grown tremendously since I came as an intern. We have buildings everywhere. We now are able to staff the hospital 24/7 with attending physicians in every single specialty.

00:04:20:14 - 00:04:40:17
ZoAnn E. Dreyer, M.D.
And that's been probably in the last maybe 5 to 10 years. So pretty much everything you could want is here. Of course, Texas is huge. So we have many families that come from several hours away. We also have a fair number of patients that are international patients that come here for therapies that we may have, that may not be available elsewhere.

00:04:40:19 - 00:04:52:10
Julia Resnick
As a seasoned pediatric oncologist, Dr. Dreyer has seen firsthand how the field has evolved. I asked her to share what changes she has seen in pediatric cancer care and survival over the years.

00:04:52:13 - 00:05:21:24
ZoAnn E. Dreyer, M.D.
Overall childhood cancer cure rates right now are 80%. When you compare and include both those that have the toughest outlooks and those that are much easier to treat for the most part, like leukemia patients. In the leukemia world, acute lymphoid leukemia, the most common cancer that we see, the cure rates now range from 90 to 95. And in a new study, we had one study where the cure rate was 98%, which is phenomenal.

00:05:21:27 - 00:05:43:27
ZoAnn E. Dreyer, M.D.
When I started in oncology, cure rates were of course not as good as they are now, but kids would finish therapy and we'd say follow them for a year or two. And then in 1988, the founder of our cancer center, Dr. Fernbach, who's also one of the fathers of pediatric oncology, came to me one day and said, we need to start a survivor program.

00:05:44:00 - 00:06:07:10
ZoAnn E. Dreyer, M.D.
Well, interestingly, almost no place had survivor programs then. And in today's world you can have a whole career in survivorship. In those days, you could not. So we started off and I think our first year we saw 100 patients. And then we developed a program through these years to a very sophisticated program that we now see 1,000 to 1,500 patients.

00:06:07:13 - 00:06:17:28
Julia Resnick
Let's meet Vaughn, one of Dr. Dryer's patients from Texas Children's Hospital. Vaughn was seven years old when he got his diagnosis. He told me what he remembers from that time.

00:06:18:00 - 00:06:43:10
Vaughn McCullum
Well, as a younger kid, I didn't really know what was going on, you know? Once I got to the hospital, I was like...I thought it was like, just like another headache or something. I was seven, still learning multiplication. I was diagnosed in 2016, medulloblastoma. I had the brain surgery and I was inpatient, re-learning how to talk

00:06:43:13 - 00:06:54:17
Vaughn McCullum
and walk for about 40 days and 40 nights. Then I got transferred outpatient, and I was in and out of the hospital for about two and a half years.

00:06:54:19 - 00:07:07:18
Julia Resnick
Vaughn has been cancer free for eight years now and is officially a survivor. That makes him eligible for Texas Children's Survivorship Program. Dr. Dreyer spoke to me about why programs like this are so important for kids like Vaughn.

00:07:07:20 - 00:07:26:07
ZoAnn E. Dreyer, M.D.
So to us in pediatrics for our program, if you've had cancer, whether it was your first time, your second time or third time, but you've been off therapy for two years, then you're eligible to come to our survivor clinic. If it's their first visit, they're very excited to be there because that's kind of a milestone. When they get there

00:07:26:08 - 00:07:47:19
ZoAnn E. Dreyer, M.D.
of course, we welcome them. Our director is there to welcome them. We've already extracted all their information, so we have a very good sense of who they are, what their needs are going to be, what their family situation is. But then they kind of start off like new patients from a survivor perspective, because it's a whole exhaustive evaluation with them about signs and symptoms

00:07:47:19 - 00:08:06:27
ZoAnn E. Dreyer, M.D.
they may be having, worries and concerns they may be having. We get lab work generally after the visit in case we need to add things that we hadn't thought of after we talk to them. We try to schedule on the same day any studies they may need like an echocardiogram or lung function testing. So it's a long day. As an important part of that

00:08:06:27 - 00:08:23:29
ZoAnn E. Dreyer, M.D.
every survivor sees our social worker support team, which is terrific. Financial counselors as needed, especially for those that may not have good coverage. And we work to get them into a program that will help to cover, give them health care coverage, not just to come here, but in general. We have a little thing that we give a survivor every year.

00:08:24:00 - 00:08:52:23
ZoAnn E. Dreyer, M.D.
They get a little specialty bear, and we have an incredible program that was developed here called the Passport for Care, which is an internet-based tool that is linked to the Children's Oncology Group, our a major research group which developed a huge set of guidelines. So that if you know, Mary had leukemia when she was five and now she's 15, and I know what therapy she had because I've already put that into the computer, I can click the mouse about five times and up will pop all the guidelines.

00:08:52:23 - 00:09:12:08
ZoAnn E. Dreyer, M.D.
It would say at this point she may need her heart looked at, she made need her lungs checked and so on and so forth. So the surveillance is really sort of organ-system dependent on the therapy that the children had. Some of our therapies can affect your lungs. Some can affect your heart. Radiation, of course, can increase your risk for secondary cancers and affect your heart and a number of things you're learning.

00:09:12:10 - 00:09:31:27
ZoAnn E. Dreyer, M.D.
We certainly off and on will pick up new problems. Our survivors don't just come once a year for their survivor checkup, but they're in constant contact with us. One of the most important parts of what we do is a psychosocial support. And in fact, we've just completed a review of the last year of our patients' mental health assessments.

00:09:31:29 - 00:09:57:04
ZoAnn E. Dreyer, M.D.
And we have a very dedicated social work program here, are very engaged. And about a third of our survivors identified a significant mental health need. And I personally think that that's probably the most important part of the program. How often do we find a significant organ system issue? Small percent of patients. How often do we find significant mental health issues?

00:09:57:07 - 00:09:59:16
ZoAnn E. Dreyer, M.D.
A lot of patients.

00:09:59:19 - 00:10:07:27
Julia Resnick
Let's go back to my conversation with Vaughn and his mom. While he is cancer free, his diagnosis and the side effects are still part of his life.

00:10:07:29 - 00:10:31:22
Vaughn McCullum
Well, yeah, the side effect. I have some scarring. It was like, you know, my stomach. I forget what where it is, but sometimes I have problems going to the bathroom, so I'd have to stay home from school one or two days. The hair, it's pretty thin now. Which I used to be like all of them, like in front of my face because I didn't know how to have it.

00:10:31:24 - 00:10:48:00
Vaughn McCullum
Then I got a haircut. Since I had a lot of hair and it was all long, it looked like I didn't have that much. But now that it's shortened and it's hair all over, people don't really know it anymore. People just see me as a normal kid.

00:10:48:02 - 00:11:26:06
Megan McCullum
Vaughn’s case was he was always the kid...that it was the, wow, we never saw that coming, or the we never have seen this happen. And so it was a lot of firsts for him, especially the way and the quality of life that he has now in comparison to the unfortunate that a lot of other kids that have had the medulloblastoma, brain cancer, the surgery, the brain radiation, the spine and, you know, the chemotherapies that he's in A-B honor roll, that he's in a college prep school, that he's running and doing all of these things is not the normal.

00:11:26:08 - 00:11:47:06
Megan McCullum
And so just to always as a physician, to keep that in mind, I remember when he was, something that stands out to me was one of your physical therapy appointments and he wasn't walking yet. And his physical therapist, he wanted to climb this rock wall. She was like, you can't do that. Like there was mats, but she's like, yeah, we're not going to do that just yet.

00:11:47:06 - 00:12:10:07
Megan McCullum
She was very nice. And Vaughn looks at her and says, no, I'm going to do it. And he crawls over and she says, Vaughn, not yet. And he still proceeds. And I said, go ahead, Vaughn, climb the wall. So he starts climbing. And it was small, but he climbs and he hits the little bell, and then he falls, and he looked at her and goes, I told you I could do it.

00:12:10:09 - 00:12:19:16
Megan McCullum
And I just believe that it's that mentality, and it's that drive that has really just got him where he's at now.

00:12:19:18 - 00:12:33:00
Julia Resnick
Other kids might not know what Vaughn has been through, but cancer is part of his and his family's story. Texas Children's partners with the Periwinkle Foundation to create a supportive community around kids with cancer and their families.

00:12:33:02 - 00:13:04:12
ZoAnn E. Dreyer, M.D.
So the Periwinkle Foundation started in 1983, and it started as a weeklong camp for patients on therapy and off therapy. And it's grown over the years to so many different camps and so many support programs and a huge arts and medicine program. And then about five years ago, probably, they formally created a Periwinkle long-term survivor program. And that program, they have socials once a month for any of our survivors 18 and above.

00:13:04:13 - 00:13:41:07
ZoAnn E. Dreyer, M.D.
I think our oldest one that goes to that is about probably 45 now. And I actually did a survey with the survivors, and the impact on them was tremendous. On their well-being, their relationships with family, just about six or seven different categories. Of the respondents, 80% – every category - was exceptionally impactful, if not 100%. So I think what that does is bring them together in a safe environment where they don't have to explain who they are, what they had, what it was like to be a cancer patient, which is what always happens to them when they're out of the community.

00:13:41:10 - 00:13:58:04
ZoAnn E. Dreyer, M.D.
And in fact, one of the kids - and they're young adults - in their comments was, this is my safe place. This is my family. I just saw a little girl that I took care of. She's 15 now. She was six, I think, when I took care of her. And she was so cute. She said all she wanted for her survivor visit was to get to see me.

00:13:58:06 - 00:14:08:13
ZoAnn E. Dreyer, M.D.
But it's not about me. It's about me, her doctor. So it really gives us that sort of full circle, extended family.

00:14:08:15 - 00:14:30:00
Vaughn McCullum
I've been going every year since I was about eight. First, I started off in family camp. It was like hanging out because everyone there knows and they all have their own story, which is all related. I've made many friends at Periwinkle as well, so I talk to them even when I'm not at Periwinkle. And at Periwinkle,

00:14:30:00 - 00:14:33:08
Vaughn McCullum
it's just it's really fun. I love it.

00:14:33:10 - 00:14:42:03
Julia Resnick
As he looks towards his cancer-free future, Vaughn understands that his experience can help other kids as they navigate their own cancer journeys.

00:14:42:06 - 00:14:57:19
Vaughn McCullum
I remember sitting down with my mom. I was asking her, why me? And I remember she told me, why NOT you, as a reason. You can share your story with others.

00:14:57:21 - 00:15:27:18
Julia Resnick
With so many children surviving cancer, it is more important than ever for pediatric hospitals to continue to support their patients and families long after treatment, both their physical and mental health. Texas Children's continues to build on their trailblazing legacy of pediatric cancer survivorship programs for their community and for survivors across the country. Thank you to Dr. ZoAnn Dreyer for dedicating her career to pediatric cancer survivorship and sharing her work with us. And to Vaughn and his mom,

00:15:27:20 - 00:15:41:18
Julia Resnick
we know your family's story of resilience will inspire hope in others. This has been "Caring for Our Kids," an Advancing Health podcast. Stay tuned for future episodes in the series, available wherever you get your podcasts.

00:15:41:21 - 00:15:50:02
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.