Advancing Health Podcast

00:00:00:19 - 00:00:25:16
Tom Haederle
In recent years, and especially since the pandemic, we've been paying a lot more attention to the mental and physical well-being of the nation's caregivers. Many hospitals and health systems have put wellbeing initiatives in place, designed to shore up and support their workforces who give so much to their patients every day. It's a trend that's time has come. But implementing programs to make a difference across very large organizations is a particular challenge.

00:00:25:18 - 00:00:40:28
Tom Haederle
Stay with us and hear how one very large organization has tackled it successfully.

00:00:41:01 - 00:01:14:00
Tom Haederle
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. With 45,000 employees serving patients in more than 70 care locations across the five boroughs of New York City, New York City Health + Hospitals is the largest municipal health care delivery system in the United States. Helping Healers Heal is the name of its peer-to-peer network that supports its vast workforce, helping doctors, nurses, and care teams across all of its service lines stay healthy and operating at peak performance.

00:01:14:03 - 00:01:29:12
Tom Haederle
In this podcast, Jeremy Segall, who oversees the initiative, says his approach to looking out for the well-being of so many employees is guided by a simple philosophy. In his words, "we can no longer split who we are personally from who we are professionally."

00:01:29:14 - 00:01:49:22
Elisa Arespacochaga
Thanks, Tom. I’m Elisa Arespacochaga, AHA vice president of Clinical Affairs and workforce, and I'm excited to be joined today by Jeremy Segall, assistant vice president and system chief wellness officer at New York City Health + Hospitals. And today, we're talking about his work in wellbeing and how he's used his background to really lead wellbeing across a very broad, very diverse system.

00:01:49:24 - 00:01:55:21
Elisa Arespacochaga
So, Jeremy, just to get started, tell me a little bit about yourself and your role at New York City Health + Hospitals.

00:01:55:24 - 00:02:12:22
Jeremy Segall
Well, first and foremost, thank you so much for for having me. Truly, it's a pleasure and privilege to be here to share not only my personal story as the inaugural systems chief finance officer at NYC Health + Hospitals, but to also talk about NYC Health + Hospitals wellbeing journey. And it definitely has been one, to say the least

00:02:12:28 - 00:02:43:17
Jeremy Segall
as I became the system chief wellness officer in practically March of 2020. My name is Jeremy Segall. I am the assistant vice president and system chief wellness officer, but I actually oversee the human experience continuum. For those that are not familiar with the terminology, I oversee, really the broad spectrum of how we not only care for the workforce, wellbeing and wellness initiatives for the system, the teams and the individuals that, kindly work for our system but also oversee employee engagement.

00:02:43:19 - 00:03:10:03
Jeremy Segall
But I also oversee patient, resident and community experience as well. My journey started at NYC Health + Hospitals a little over 14 years ago. I'm a licensed creative arts therapist by trade. I was working psychiatric inpatient service for many years, and, slowly but surely found myself in performance improvement, for behavioral transformation. When district was coming down the line, to really match and meet some of the state needs for behavioral health services.

00:03:10:10 - 00:03:31:27
Jeremy Segall
And with my experience in performance improvement, they actually brought me over to be one of the first directors of performance improvement over an entire facility. This was Kings County, in East Flatbush, Brooklyn. And so I did performance improvement for many years there before I was again promoted to central office now, about almost eight years ago, to oversee performance improvement for the entire acute care service line.

00:03:32:00 - 00:03:52:25
Jeremy Segall
So all 11 hospitals - was overseeing quality improvement programing there. That actually led me into wellness. As our newest administration came in a little over six years ago. With it, ad this was brought over by Dr. Mitchell Katz, our current president and CEO. and then Dr. Eric Wei, our senior vice president, over the office of quality, safety and system chief quality officer.

00:03:53:03 - 00:04:16:16
Jeremy Segall
They brought with them helping healers heal from L.A. County, USC, which is the second largest public health care system. And we see NYC Health + Hospitals as the largest municipal public health care delivery system in the nation. And they had already started a second victim response initiative there. One of the first top down initiatives, because they wanted to put emphasis back on the most important asset, which was the people, so that we could take care of them so that they could then take care of the system.

00:04:16:23 - 00:04:39:20
Jeremy Segall
And because I have a behavioral background and am a licensed clinician and still practice clinically four nights a week, and because I was doing system transformation and change management through performance improvements, they thought I was the perfect person to co-lead, this project at first. And it really began to, to evolve over time. As the pandemic was upon us,

00:04:39:22 - 00:05:07:17
Jeremy Segall
it was February, and I was practicing clinically. And that week, all nine of the patients had started to talk about Covid 19 in their individual sessions. And so I came back to Eric and I said, hey, I think we should probably start talking a little bit more, in our psychological and emotional debrief process, which is known as Helping Healers Heal, brand term for our wellness program, also known as H3 debrief, which is a non-clinical intervention.

00:05:07:17 - 00:05:25:08
Jeremy Segall
It's about empathetic listening, compassionate caregiving for the caregivers. But just a way for us to talk more about what's the experience that they're having so that we can also share resources. So, I start to say, should we be having some system debriefs around this? We all knew that we were preparing for emergency management  - was already on top of it.

00:05:25:10 - 00:05:45:13
Jeremy Segall
And then a few weeks later, stay at home orders. And so I became the central critical response lead as part of our emergency management command center, for the entire public health care delivery system spanning all five boroughs, all care settings and service lines. So that's how I was unofficially brought into the role. And then officially, position was created.

00:05:45:13 - 00:05:47:03
Jeremy Segall
And here I am today.

00:05:47:05 - 00:06:08:13
Elisa Arespacochaga
Wow. So two comments that immediately come to mind. You clearly get more hours in the day than the average person or something. Given your, expansive role. But timing is really everything. You certainly landed with both feet very much in the deep end. You mentioned a few things that are part of your program and part of the wellbeing effort you've been leading.

00:06:08:15 - 00:06:16:05
Elisa Arespacochaga
As you were sort of talking at, you grew with it. You created it as you were going. But can you tell me a little bit about what it encompasses now?

00:06:16:07 - 00:06:39:18
Jeremy Segall
Yeah, absolutely. I think we were flying the plane as we were building it, as cliche as that sounds, for many, many years, specifically at the onset of the pandemic. But we were really, really, lucky, if you will, to have the foundational elements of the Helping Healers Heal program already established as of 2018. From 2018 to now, it has really evolved and transformed over time.

00:06:39:20 - 00:06:58:06
Jeremy Segall
And so, as I mentioned, it first came to the system as a second victim response initiative. It was based off of Dr. Susan Scott 4U team. So pretty much like a rapid response team. If there was ever a sentinel event or an adverse patient, outcome or experience, we would wraparound support services for individuals and teams. And that took off.

00:06:58:12 - 00:07:24:01
Jeremy Segall
We built 18 Helping Healers Heal teams across all service lines, training up helping initial leads, what we call peer support champions. Anyone could get involved because it was a peer support network is peer-to-peers, you know, really listening to each other and providing guidance and support. And so over time, from 2018 to 2019 further evolved into something that was a little bit more inclusive of just the general experience of the health care workers.

00:07:24:01 - 00:07:54:13
Jeremy Segall
So we started to talk more about general compassion fatigue and burnout and vicarious traumatization. And we started to change the nomenclature to not just be around risk or error as second victimization, sometimes, you know, is more connected with. You know, there's a story here. Obviously I have a quality assurance and improvement background. So as I was really looking at a lot of the trends of what debriefs were about, and all we do is document quality assurance data in terms of how long are the debriefs, what were they requested on behalf of? Things of that nature?

00:07:54:16 - 00:08:14:03
Jeremy Segall
We're never actually documenting what specifically's going on or who we're speaking with, so on and so forth. And there was a story that came up that a debrief was requested on a labor and delivery unit at one of our facilities, and that had nothing to do with patient care, or a shoulder dysplasia or maternal child loss or scary event that shook the staff.

00:08:14:04 - 00:08:41:15
Jeremy Segall
It was actually about a nurse that had worked there for over 20 years that, unfortunately was diagnosed with terminal stage 4 cancer, and that it was her last shift. And the staff knew that after her last shift, they would most likely never see her again. And so they wanted a group debrief to just talk through their experience. And that was the moment the light went off for myself and our HB3 steering team, for the system, which was we can no longer split who we are personally from who we are professionally.

00:08:41:17 - 00:09:03:17
Jeremy Segall
And whatever happens in and around our life, our experience affects how we care for patients. And we have to be able to care for ourselves in those moments. And so that's really what helped us further evolve it. And then boom, the pandemic was upon us. And of course, we had to then really shift gears to be about critical and crisis response, universal individualized traumatization.

00:09:03:22 - 00:09:18:11
Jeremy Segall
And so for the first two years of the pandemic, we were really focusing on that, as well as stress on the continuum that we learned from the US Department of Defense that was supporting us, throughout that very uncertain time. And then it was around late 2022, that we said we can no longer be about firefighting.

00:09:18:11 - 00:09:37:18
Jeremy Segall
We can no longer just be about crisis, right? Wellbeing cannot just be about when the pot is boiling over and it's too late. It has to be something that we can get in front of. And so that's where we started to say, let's let's be proactive here. Let's be preventative and let's start thinking about wellness holistically. Because wellness is not just about mental health.

00:09:37:18 - 00:09:51:23
Jeremy Segall
And I'm a licensed psychotherapist in the state of New York, right. Mental health is very important, but it is not all of wellbeing. And we don't have the medicalized wellbeing, nor should we.

Jeremy Segall
So we decided to create that holistic, proactive, preventative model. And we created an alignment to the eight dimensions of wellbeing. And now there's many more dimensions that are being published upon.

00:09:55:22 - 00:10:19:16
Jeremy Segall
But we really choose to focus on emotional, environmental, intellectual, financial, occupational, physiological, social and spiritual well-being. And aligning free, or subsidized as well as confidential private programing for all workforce members to be able to, you know, feel taken care of and to be supported. So the program is really evolved into that. And our interventions also really evolved.

00:10:19:16 - 00:10:41:12
Jeremy Segall
So while we first started helping in this field to be about emotional and psychological support debriefing, - nonclinical again, led by peers - we then changed our approach. We knew that people couldn't get off the floors for the pandemic. So we started proactive unit-based wellness rounds to collect the temperature, to share resources knowing that the two biggest barriers to wellbeing is number one, stigmatization.

00:10:41:12 - 00:11:01:25
Jeremy Segall
And number two, not knowing what's available. And so those proactive wellness rounds, we've done over 40,000 since 2020, has really made a difference in terms of how people access support services. And then that's what also gave birth to our wellness rooms, as well as many other, approaches to wellness events. So some people don't like to talk about their wellbeing.

00:11:01:25 - 00:11:22:18
Jeremy Segall
Some people need to process and express it non-verbally. So as a licensed creative arts therapist myself, and having the largest complement of licensed creative arts therapist in the nation working for a public system, having psychologists and social workers, arts and medicine programing, we started to put together wellness events, using the healing mediums of art practice for support, for staff.

00:11:22:20 - 00:11:44:00
Jeremy Segall
And so that really was incredibly, successful. It's actually the highest rated intervention that the workforce enjoys. And we've done almost 6,000 wellness events since 2020. And then we also obviously had a training approach change and how we could really create pedestrian approaches, if you will, to understanding how to be and feel well and how to spot when someone is not.

00:11:44:06 - 00:11:55:25
Jeremy Segall
And then, of course, now we're doing, tailored retreats for both engagement well-being. So I could talk for hours just on that alone. But one thing I do have to say is it is available to all because we have to have equity and well-being.

00:11:55:27 - 00:12:18:09
Elisa Arespacochaga
Oh, absolutely. And I love the idea that, you really took your own background and brought it to the breadth of resources that you're offering, because each person is going to be different, is going to need different things. And really creating that space for everyone to be able to express themselves as works best, I love that. So let me pick up on that idea.

00:12:18:11 - 00:12:40:27
Elisa Arespacochaga
I mean, you really you grew up in patient safety and quality and improvement, and you've integrated that into your wellbeing program, marrying to the quality and patient safety structure of the organization. Because among other things, and I know when we talked earlier, you mentioned this, you're doing this on grant funding, shoestring and, a wing and a prayer, largely.

00:12:40:27 - 00:12:42:19
Jeremy Segall
A zero operating dollar budget.

00:12:42:22 - 00:12:56:17
Elisa Arespacochaga
Absolutely. So can you talk a little bit about how you've made those connections to be able to offer this across 11 hospitals and really tie it to the work of performance improvement across the system?

00:12:56:20 - 00:13:17:12
Jeremy Segall
Yeah, absolutely. So just a few things about NYC Health + Hospitals. It has 11 acute care hospitals. We have five post-acute long term nursing care facilities. We have what's called Gotham Health, which is our ambulatory care for UHC network, of over 13 large diagnostic centers and up to 70 satellite clinics. We oversee emergency medical practices. We have correctional services

00:13:17:12 - 00:13:40:26
Jeremy Segall
so overseeing the jail systems, health and well-being programing for persons in custody. We have community care and home health services. We have urgent virtual express care as well as in-person express care. And, we also have a central office service line. So all of our well-being programing has to, because that's the right thing to do across all service lines, all departments, all disciplines and all tours.

00:13:40:26 - 00:13:59:21
Jeremy Segall
So it's not just hospitals. And so, you know, you can't really have quality, you can't have patient safety if you don't have wellness. I mean that's the preceptor for all things. So at NYC Health + Hospitals our business case is: the healthier you are, the more engaged you are. The more engaged you are, the higher the quality and safe patient care we deliver.

00:13:59:21 - 00:14:26:08
Jeremy Segall
And then we'll meet the needs and satisfy our, our patient residency populations' expectations. And so, you know, the business case is in terms of health and well-being, if we see, hear  honor, recognize and respect our workforce and also destigmatize utilization of services and also provide time and encouragement to utilize those services, the healthier the staff will be, hopefully both inside and outside of work.

00:14:26:11 - 00:14:42:02
Jeremy Segall
When they are healthy, then they can be more engaged. And often people think employer engagement is about, oh, did they go above and beyond the call of duty? Engagement is: do you remember why you fell in love with health care in the first place? Do you remember why you chose NYC Health + Hospitals or just the helping professions in the first place?

00:14:42:04 - 00:14:59:01
Jeremy Segall
Are you able to see the difference you make? Do you remember why you like the work that you do through the veil of stress that we experience? There are ample bio-psychosocial, spiritual stressors day in and day out in health care, but an engaged employee is able to cope through those and move through them and see the greater good of what they're doing.

00:14:59:03 - 00:15:15:13
Jeremy Segall
Not only because it aligns with their own mission and purpose within themselves as an individual, but then it aligns the mission, vision, and values of NYC + Hospitals. That's what engages employees. And then we know that an engaged employee is three times more likely to have a near miss or an early catch, which translates to patient safety.

00:15:15:16 - 00:15:52:02
Jeremy Segall
And then of course, the higher quality safe care, the better we're going to support our patient populations that are part of our treatment team as we see it. And then hopefully we're also doing with more compassion, empathy because we're well, which then meets their needs. And then they rate and recommend our services. That's the business case. And that's that beautiful loop reminding us of what the internal I would say, I guess intrinsic, and extrinsic reward systems are of being a health care worker. But in terms of quality and patient safety and how wellness has been integrated, I've always seen that wellness is what establishes psychological safety. And without psychological safety, we

00:15:52:02 - 00:16:17:17
Jeremy Segall
cannot have people that are willing to speak up to say that there was a mistake or there was an error, that they see something and are saying something without fear of punitive practice or retaliation, right? So the more that we could create a culture of compassion, the more that we can create a culture of comfort and the more that staff feel taken care of, they'll want to actually take better care of their team, of the system and take greater pride in the work that they're doing.

00:16:17:21 - 00:16:49:12
Jeremy Segall
So I don't think you can have PDSA cycles. I don't think you can have, you know, test of change and a change management framework without psychological safety and you can't have psychological safety without wellbeing. A large part of the core of patient safety is teamness, cohesion, communication. And you can't necessarily have teams steps, let's say, and a patient safety framework or toolkit if you don't have healthy communication, healthy engagement with team because there's trust and respect and value.

00:16:49:17 - 00:16:57:08
Jeremy Segall
And so wellness really establishes and nurtures that culture. So I actually don't see them very separate from each other.

00:16:57:10 - 00:17:21:21
Elisa Arespacochaga
Couldn't agree more. And having gotten to hear you speak on the work that you've done, that was really the first thing that that really grabbed my attention and intrigued me, because you're one of the few chief wellness officers who isn't coming from the physician ranks, who is coming from that therapy background and really that understanding, that is maybe a little bit different than some of your physician colleagues.

00:17:21:26 - 00:17:31:20
Elisa Arespacochaga
So can you talk just a little bit about how that you've brought that, lens that with which you look at the world, focused on therapy into your work?

00:17:31:23 - 00:17:48:00
Jeremy Segall
You know, it's interesting, when I first became chief wellness officer, everyone kept calling me doctor. And I was like, no, no, no, definitely not a doctor. But I am a drama therapist. And, you know, like, what is drama therapy? And so licensed creative arts therapy obviously is a licensed psychotherapeutic practice that is licensed in the state of New York.

00:17:48:02 - 00:18:12:00
Jeremy Segall
There are five licensed modalities. It is a clinical practice. It is a treatment approach, goals and objectives, just like any other modality, or anything under the umbrella of psychotherapeutic services, CBT, DBT, trademark therapy. The great thing about the arts is when you are creating you are not destroying, and when you're creating, you have opportunities to also heal in that process.

00:18:12:07 - 00:18:30:19
Jeremy Segall
And so I have this lens, of how do we create a safe play space as a drama therapist for us to all get back in touch with who we are as people to express that out and to have that reflected back to us because everything is a mirror. And so, to be honest, I don't necessarily believe that a chief wellness officer has to be a physician.

00:18:30:21 - 00:18:59:02
Jeremy Segall
I believe that anyone with social and emotional intelligence and anyone that has the hope or intention that wellness can thrive in a very challenging environment and can strategically, methodologically approach it, can succeed in this position. So I do believe that we're going to see chief wellness officers, social workers, licensed creative arts therapists, psychologists, nurses, doctors, and other administrators that potentially understand how important it is and have the nature and demeanor that that can really partner well with it.

00:18:59:04 - 00:19:20:09
Jeremy Segall
You know, the thing about chief wellness officers being physicians is: there's a reason for it because we are still losing every single day one doctor to death by suicide. Still, to this day, if you are a female identifying physician you are almost 2.5 times more likely to die than the general populace. If you're a male identifying physician, you're about 1.3 times more likely to die by suicide.

00:19:20:09 - 00:19:44:09
Jeremy Segall
It is an epidemic. For medical school, 3 to 4 hundred doctors are being wiped out a year. And so I understand why chief health officers had to start as physicians and physicians generally have a great overview or oversight and understanding of of health care delivery systems and services. But we never want well-being to be about only providers of care. APP or nurses or whatnot.

00:19:44:16 - 00:20:18:26
Jeremy Segall
You know, the whole thing about, wellness, there needs to be representation in wellbeing spaces and there needs to be equitability in wellness spaces. And I already mentioned that it should be available to all non clinicians and clinicians. It doesn't matter who you are as a health care worker. You deserve that support. And so by coming into this role you know I think why it's worked well thus far is because I have the ability through performance improvements and QI principles that I was practicing and working on in the health care delivery system for many years prior, that I was able to turn vision and strategy into execution.

00:20:18:28 - 00:20:46:25
Jeremy Segall
The key to any successful chief wellness officer is can you have an enterprise service line, sight team, and individual approach to well-being and programing and that you can actually turn that into fruition and something that's tangible, concrete and measurable. So I believe anyone can really be a chief wellness officer as long as they're willing to mitigate and prevent risk and to turn those strategies into something that is understood by the staff, why its so needed and invaluable.

00:20:47:03 - 00:21:14:10
Jeremy Segall
And I would also say, I think being a psychotherapist and how it is helped me as a chief wellness officer, because I don't just sit in an office and create, you know, talks and PowerPoints and strategic plans and put together surveys. I am actually at the sites. I am actually conducting psychotherapeutic support services for the system in non-clinical intervention approaches like those debriefs I mentioned being in the wellness rooms, actually offering support.

00:21:14:10 - 00:21:51:10
Jeremy Segall
Yesterday I did a two hour retreat, for a finance department that was struggling. It's about doing the work, rolling up your sleeves and being with the people to learn from them. And not just through survey responses, but from touch points, actually visibility and transparency. And again, being a psychotherapist, I'm able to sit in discomfort. And anyone that is going to be chief wellness officer has to sit with the turbulence of well-being, in a very uncertain health care climate, whether you're in a public sector or private sector, whether you're a safety net hospital system or not, there's a lot of discomfort that you have to tolerate and be able to support from, a

00:21:51:11 - 00:21:56:24
Jeremy Segall
strategic enterprise level, from a business level, but also from a person to person level.

00:21:56:27 - 00:22:21:17
Elisa Arespacochaga
And it sounds like really you not only walk the walk on the ground with your teams, but very much are thinking about this from the perspective of the entire team supports your entire community. And so, you know, whether it's the person delivering the food or the front desk or the clinician who's providing the care, everyone needs to be in a place where they can support the community they're trying to serve.

00:22:21:17 - 00:22:38:02
Elisa Arespacochaga
So, Jeremy, I can't thank you enough for joining us and for sharing your story and the work that you're doing. And I want to continue to check in with you and see what else you've created. And, you know, built for your community. And as a native New Yorker, I very much appreciate it.

00:22:38:04 - 00:22:43:12
Jeremy Segall
Thank you so much. It honestly is such a pleasure and privilege.

00:22:43:15 - 00:22:51:25
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.

00:00:00:18 - 00:00:39:00
Tom Haederle
With similar missions, psychiatric hospitals and community mental health centers sound like they should be two peas in a pod. But in reality they're often siloed, working independently and not coordinating their efforts to meet patients needs. Butler, a renowned psychiatric hospital in Rhode Island, decided to change the equation - forging a close and cooperative relationship with the Providence Center, a community mental health center, and resulting in patient satisfaction rates that are off the charts.

00:00:39:02 - 00:01:06:03
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. For people experiencing severe and persistent mental illness, the goal is to treat and support them in their communities of choice. That's not necessarily a hospital. By closely coordinating their services and resources, Butler Hospital and the Providence Center are able to accommodate that objective and provide a more seamless continuum of services for patients.

00:01:06:06 - 00:01:29:10
Tom Haederle
In this podcast hosted by Rebecca Chickey, senior director of Behavioral health, Clinical Affairs and Workforce with AHA, Mary Marran, president and CEO of Butler Hospital, describes how the enhanced partnership between two mental health service providers has made a big difference. This podcast was recorded at the American Hospital Association's Annual Membership meeting in Washington, DC.

00:01:29:12 - 00:02:00:04
Rebecca Chickey
Thank you, Tom. And Mary, thank you for joining me today here at the American Hospital Association's 2024 Annual Meeting. So far, it has been just a phenomenal event, and we're going to add to it today with learning about Butler Hospital and its relationship with the Providence Center, a community mental health center. So, if I may, I want to start with asking you to describe what is that relationship between Butler, an internationally renowned psychiatric hospital, and the Providence Center?

00:02:00:07 - 00:02:02:11
Rebecca Chickey
Can you share and what was the journey to get there?

00:02:02:12 - 00:02:26:19
Mary Marran
Sure. Thanks. First, let me thank you for the opportunity to talk about our great work in Rhode Island. And it's an interesting story, quite frankly. The Providence Center joined Care New England, which is our health system that includes Butler Hospital - the psychiatric hospital I ran - about 5 or 6 years ago. At that time, they had their own CEO and president, and we moved them into the corporate shared services structure.

00:02:26:19 - 00:02:49:29
Mary Marran
It was a great way to support the great work of the Providence Center. Along the way, the president resigned, and ultimately I ended up stepping in as an interim to run the Providence Center. We tried to recruit a president for a period of time. We weren't really successful. So we decided for essentially now that I would run both the hospital and the center.

00:02:50:02 - 00:03:13:24
Mary Marran
And boy, what a privilege it's been. Because historically, and I think most people know this and it's not a bad thing, but community mental health centers hospitalization is a failure. The center is about days in the community. It's about supporting people with severe and persistent illness in their communities of choice. So when someone has to go into the hospital, truly that's considered a failure.

00:03:13:26 - 00:03:38:23
Mary Marran
I think what we've learned from the pandemic is there's so much need in our communities for the treatment of behavioral health services and our ability to partner and support each other with the unique services we bring, and combine those in a way that we fill the gaps, quite frankly, we're doing a great job with the transitions of care, particularly for the severe and persistently ill.

00:03:38:25 - 00:03:50:21
Mary Marran
So my ability to run both organizations and really connect the people that do this work, elbow to elbow, really does result in some tremendous outcomes, which I'll be happy to share with you.

00:03:50:23 - 00:04:07:10
Rebecca Chickey
Yeah, you teed that up so nicely because that's exactly where I was going to go next. As you say, there historically has been a silo or a big wall, often between community mental health centers and hospitals and sort of peering over the wall every now and then and going, what are you doing? And are you playing in my sandbox

00:04:07:10 - 00:04:40:11
Rebecca Chickey
sometimes. But more and more, I would say I've seen over the last 15 years or so, hospitals and community mental health centers coming together and specifically to have a full continuum of care because discharging patients from an inpatient setting can also be challenging, and that transition of care is a pain point often. So tell me what you have been able to do in care transitions that has really, I think based on the tone in your voice, strengthened the relationship between Butler and Providence.

00:04:40:14 - 00:05:06:04
Mary Marran
So, many things. But let me start with probably our first, most significant move, which was we've located one of our Act model integrated health home teams. So it's a sort of community treatment. We have a team that actually lives within the hospital, in offices that are, you know, maybe 50 yards from the inpatient units. What I love about this, it was my Providence Center staff who'd named the team.

00:05:06:10 - 00:05:38:13
Mary Marran
It's called Unity. It speaks to that coming in they understood that this is a job we need to do together. And actually, from people who meet the requirements for a sort of community treatment, there's about 300 people now served within that hospital based function. We actually are going to add a second team because the caseloads have increased. What it allows for is really both early identification of individuals who need this intensive community treatment and a warm handoff.

00:05:38:15 - 00:06:13:00
Mary Marran
Our staff can go...I should say my staff at the Providence Center because I have staff at the hospital as well...they can go right to the unit, meet the patient, talk to the patient about what the transition is going to look like, and move the patient right to the community services, keeping in mind that within the health home team, there are peer services, wraparound services that they will then plug in to, increasing the likelihood that the transition to the community will be successful, decreasing the likelihood that a readmission will follow, which is really important to all of us.

00:06:13:03 - 00:06:34:20
Mary Marran
So one example. The other example is we actually have a 24/7 call center at the hospital, and we cover the emergency line for the Providence Center. So if a client has a crisis in the community, they call Butler, we're able to engage the staff at the Providence Center, work first to divert, if possible, safely divert the patient.

00:06:34:20 - 00:06:54:21
Mary Marran
But if the patient needs to come in for any reason, we can get them into the emergency room, admit them if we need to, hold them till morning. Really connect them to the people they know at the Providence Center. Another great example is recently we were really struggling with folks who suffer from addiction. Come to our detox unit.

00:06:54:23 - 00:07:19:03
Mary Marran
Typically it's for alcohol use disorders, but they're our most frequent readmissions, are highest utilized hours. We were having trouble breaking that cycle. And this is what's changed at the hospital, is when we think of these transition issues, we first think about our partners at the Providence Center. What might we do with the Providence Center that can help with these transitions?

00:07:19:03 - 00:07:56:00
Mary Marran
Well, the Providence Center has a network of recovery centers, anchor recovery centers, and they have peers who help us in the EDs. They help us throughout the community. But at Butler, what we asked is, could you potentially bring peers to our unit before we try to discharge and see if we can't make that connection there? So it's only been about six months now, but we're starting to introduce peers on the detox unit to help navigate that transition by someone who has lived experience, which is one of our most powerful tools in the community.

00:07:56:00 - 00:08:26:03
Mary Marran
So that's another great example of the work that we're doing. The Providence Center has a huge challenge with individuals who are discharged from the hospital. We set up intake appointments yet high no show rate. So first intake at the Providence Center and it's not always people who are coming from Butler. The folks coming from Butler now, we do the intake right at Butler with the Unity team. Even if they may not need at level services

00:08:26:03 - 00:08:51:29
Mary Marran
we get them connected. They might need outpatient, they might need something else in the Center. But we're able to tie that handoff so that you do that quickly. You don't give opportunity for that person to leave and, you know, not be able to engage them in whatever service they need. So working with Butler to make sure that anybody coming from Butler, we try to increase the likelihood that they're going to engage and start treatment. Again,

00:08:51:29 - 00:09:17:06
Mary Marran
that unity relationship helps with that. We also work with the social service staff at Butler around individuals that they're sending that aren't necessarily going to go to Unity. And we really try to understand is the appointment time convenient? Transportation, all of those social drivers that might interfere and that tight relationship with Butler. We have a better rate of first appointment show rates.

00:09:17:09 - 00:09:35:29
Mary Marran
We struggle with some of the other hospitals. We're doing things to try to engage some of the other hospitals that refer. But with Butler, because of that tight relationship, we're really able to impact that no-show rate. It was pretty high. It was almost half, and we're overbooking, but still that miss. But it's that collaborative work where we brought that down.

00:09:35:29 - 00:09:43:10
Mary Marran
Now last week it looked like it was down to like 20% no show, which is, believe it or not, a pretty good no show rate for the community.

00:09:43:13 - 00:10:07:06
Rebecca Chickey
And that is incredibly significant. You shared so much. One of the things I want to compliment you on is everything you described seems like it is trying to treat the whole person. We were reminded yesterday in one of the sessions that only 20% of health can be managed or influenced by hospitalization, and that leaves a significant part for those of you who are not the math person, that leaves 80%

00:10:07:06 - 00:10:34:10
Rebecca Chickey
that's influenced by everything else that impact human beings on a daily basis. And so this partnership with the Providence Center helps you be able to better address that 80% and treat what's influencing their health. And it also sounds like, particularly those last two examples, that you provided relationships. The Surgeon General recently, within the last year or so, released a report on loneliness and how loneliness it really is becoming an epidemic

00:10:34:10 - 00:10:54:14
Rebecca Chickey
in many ways. It existed before the pandemic, but the pandemic has influenced it. And bringing those peers from the Providence Center into the detox unit, that allows them to have a relationship. And instead of when they're already going through a transition after discharge, trying to establish that relationship. So how brilliant. Thank you.

00:10:54:17 - 00:11:15:06
Mary Marran
Well, and I think that quickly, the other thing that we've learned as a hospital, we've adopted service design from the Providence Center. We actually have an integrated health, an Act model team that we run at the hospital for the commercially insured who suffer from severe and persistent mental illness. We largely serve the Medicaid population from the mental health center.

00:11:15:06 - 00:11:38:28
Mary Marran
We modeled our service after the Providence Center and a lot of our transitional services with case management. These are lessons we've learned from the Providence Center. Social drivers. If we really want to appreciate social drivers, our community mental health centers have been doing this work forever, understanding that in order to actually get to care, you really need to help the individual with those challenges.

00:11:38:28 - 00:11:49:21
Mary Marran
Housing, transportation, food, insecurities, things that are barriers to care, and our mental health centers - and the one I have the privilege to run - have great expertise in that area.

00:11:49:26 - 00:11:56:07
Rebecca Chickey
Yeah, it's so important. Have you been able to track as a part of this any impact on patient satisfaction?

00:11:56:10 - 00:12:20:07
Mary Marran
In terms of the clients at the Providence Center, the patient satisfaction rates are off the charts. The connection to our staff, and quite frankly, our staff are so tightly tied to each other that experience for our clients is really highly regarded. So, absolutely, for those folks who are working with in transition, we're getting great satisfaction results.

00:12:20:08 - 00:12:21:10
Mary Marran
Yes.

00:12:21:12 - 00:12:22:19
Rebecca Chickey
How about the staff?

00:12:22:22 - 00:12:42:03
Mary Marran
Yeah. So it's interesting more and more. And it's a matter of routine now that when we're trying to solve a problem, I bring the teams from both the Providence Center and Butler together. And so at first you're sort of bumping around the table and it's Butler. It's the Providence Center. But now they do it themselves. They have a question.

00:12:42:06 - 00:12:54:12
Mary Marran
Workforce development. Another area where we're at the hospital mimicking some of the ladders, the professional ladders that we've developed at the Providence Center. And those things now are fluid, which is just wonderful.

00:12:54:14 - 00:13:14:11
Rebecca Chickey
That's so great. I had the opportunity last week to interview a community health worker, and I asked her why she chose that career, and at first she was hesitant. And then I said, well, what do you love about what you do? And she said, working with the people when they contact me and they say, you have a really helped me turn my life around.

00:13:14:13 - 00:13:21:01
Rebecca Chickey
And that's something that is invaluable. And she just got this big beam. So I expect that you see that as well.

00:13:21:01 - 00:13:49:27
Mary Marran
And it's not uncommon for me to receive an email sometimes through a staff member, sometimes directly from a client, from a patient at the hospital. And they're appreciative and delighted with the experience. And some of the best stories you're going to hear are from the folks who feel compelled to tell us about it, which is wonderful. And yes, we share that with our staff, and it's a moment where you can really underline how significant the work is that we're doing in this space in behavioral health.

00:13:49:29 - 00:14:08:24
Rebecca Chickey
So I'm going to ask the question around funding, because we all know that hospitals and health systems are being asked to do more and more with less and less. That's how it feels, particularly given Covid and the financial impact that that had. What have you seen in terms of the financial impact of this collaboration?

00:14:08:27 - 00:14:42:28
Mary Marran
I would say that what we're seeing is recognition that we cannot ignore this behavioral health crisis in front of us. So why forget when we did the podcast about the behavioral health short stay unit that I'm opening - entirely publicly funded. State/federal dollars, $12 million to permit me to open up this unit. The hospital has never seen that, but I believe people really understand that if we don't address this problem, it's going to affect us all in our economy, in the overall health of the population.

00:14:43:00 - 00:15:13:02
Mary Marran
The Providence Center is working right now with the state of Rhode Island, who has given us grant funds for workforce stabilization. So we did receive several million dollars to actually pay our staff market competitive rates, because everybody needs the talents of the folks doing the most difficult work in the community. So investment recognition by the state. Right now, the entire state is working on all of the mental health centers becoming CBHCs, so certified behavioral health clinics.

00:15:13:06 - 00:15:31:00
Mary Marran
And there's been a fair bit of grant funding from the state of Rhode Island to support us through that process. If all goes well, by October 1st, all of the community mental health centers that are licensed in Rhode Island will be CBHCs, and a couple other agencies are being added to that list. So in Rhode Island, could we use more?

00:15:31:02 - 00:15:43:28
Mary Marran
Absolutely. Are we struggling financially through this transition to CBHCs? Yes. But the state is, I think, really trying to do their part in helping us through that transition. We're very fortunate.

00:15:44:01 - 00:15:54:11
Rebecca Chickey
Now that's phenomenal. And it sounds like your state leadership has really gotten behind this and acknowledged the problem and not just talked about it, but actually stepped up and said, here's some funding.

00:15:54:15 - 00:15:59:07
Mary Marran
State and our federal delegation has been really active in helping us through this work.

00:15:59:10 - 00:16:05:19
Rebecca Chickey
That's great. Since we're here in D.C., yes, you may be going to the Hill to thank them or inform them.

00:16:05:20 - 00:16:13:17
Mary Marran
A nice thing about Rhode Island is they come visit us often. You know, we're small, 40 square miles. We do see our delegation. Awesome. And they've been wonderful to us.

00:16:13:19 - 00:16:38:01
Rebecca Chickey
That's phenomenal. So as I'm looking at time and wrapping up, you have shared a number of reasons for hospitals and health systems to be inspired by this community partnership. As you and I have talked about many times, there's not one solution to improving access to care. There's integration. There's reducing the stigma, there's technology, digital solutions. But community partnerships

00:16:38:01 - 00:17:06:04
Rebecca Chickey
I truly feel hit so many sweet spots because we're all caring for the same patients. And if you can coordinate that care across the continuum, particularly for individuals with chronic severe mental illness, it's just common sense. Although my son once said, mom, common sense is not that common anymore, and he has some common sense just by saying that, I'll say. But are there particularly 2 or 3 things you would say to inspire other hospital or health system leaders, too.

00:17:06:07 - 00:17:27:27
Mary Marran
I would say one, it's a great investment in terms of the time we put into these partnerships with our community providers. It quite frankly makes good sense clinically and good sense economically to really support those partnerships. I would also say there's a lot of work for us all to do, and the degree that we can collaborate together to get it done.

00:17:27:29 - 00:17:53:02
Mary Marran
And it's a rewarding process that quite frankly, we have to remind ourselves it's not competitive, it's cooperative. And the more we do that, the more patients we serve, the healthier they're going to be. And again, investment in behavioral health is really an investment in the overall health and well-being of your population. And lastly, there's a lot to learn from our community agencies and providers, health and human services providers like the Providence Center.

00:17:53:08 - 00:18:10:20
Mary Marran
They've been doing the work that we're talking about, being so important. Social drivers, taking care of those things that disrupt care, they know how to do it. We have a lot to learn from our community providers, and we should all lock arms with agencies like the Providence Center. The outcomes are pretty special.

00:18:10:23 - 00:18:33:16
Rebecca Chickey
Mary, thank you so much. Thank you for joining us here today. Really appreciate it. I'll let the listeners know there is a website on AHA.org/behavioral health. And if you scroll down on that page you'll see an icon and the words Community Partnerships. So if you click there you can listen and learn and read about other community partnerships.

00:18:33:23 - 00:18:45:19
Rebecca Chickey
Because this one is unique and each one has their own unique journey. But we can learn from all of them. So please consider taking a look at those resources. And Mary, just keep up the great work.

00:18:45:20 - 00:18:48:21
Mary Marran
Oh thank you. Thanks for the opportunity to talk about it.

00:18:48:23 - 00:18:57:05
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.

00;00;00;19 - 00;00;42;23
Tom Haederle
John Bluford's distinguished career in hospital and health system administration has spanned more than four decades. He's been recognized as one of the most influential people in health care, and served as chair of the American Hospital Association in 2011. He's also the founder of the Bluford Health Care Leadership Institute, a professional development program that introduces talented minority undergraduate scholars to health care administration with the expectation that this pipeline of talent will ultimately help to eliminate health disparities among populations dealing with sustained hardship.

00;00;42;25 - 00;01;08;05
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Joy A. Lewis, senior vice president of Health Equity Strategies with the AHA, Bluford describes how his institute trains promising young talent to assume leadership roles... the impact they've made...and how to deal with pushback in some quarters against DEI efforts in general.

00;01;08;07 - 00;01;14;25
Tom Haederle
This podcast was recorded at the American Hospital Association's Annual Membership Meeting in Washington, DC.

00;01;14;27 - 00;01;19;20
Joy A. Lewis
Good morning John. Thank you so much for joining me today. Is it fine to call you John?

00;01;19;20 - 00;01;21;02
John W. Bluford, MBA
Please do. Good morning to you.

00;01;21;02 - 00;01;46;10
Joy A. Lewis
Because I am sitting with the John Bluford. And this came together rather quickly, so I guess my timing was right. Thank you for carving time out of your busy schedule to join me in conversation today. Today's conversation is a really important one. We want to focus on how might we think about ways to create a diverse talent pool of health care leaders?

00;01;46;12 - 00;02;11;24
Joy A. Lewis
We know how important it is to have a diversity of thought, different perspectives weighing in, making decisions that then lead to better health outcomes for the patients and families and communities that we serve. So currently, you are the president, but also the founder of the Bluford Health Care Leadership Institute, which was established over a decade ago in 2013.

00;02;11;27 - 00;02;33;03
Joy A. Lewis
And your program trains and mentors and prepares early careerists to occupy, to advance through into leadership roles in health care settings. And I guess in addition to how you're spending your time today, we should talk about your tenure. Your career portfolio, which includes...

00;02;33;03 - 00;02;33;12
John W. Bluford, MBA
It's been a long one.

00;02;33;12 - 00;02;36;09
Joy A. Lewis
I know! Spans over 50 years.

00;02;36;12 - 00;02;40;03
John W. Bluford, MBA
Oh, just about...not quite over 50, but we're getting there.

00;02;40;04 - 00;03;15;15
Joy A. Lewis
Okay. I want to be like you when I grow up. So, former president and CEO, president emeritus of Truman Medical Centers in Kansas City, Missouri. Prior to that, CEO of Hennepin County Medical Center in Minneapolis, Minnesota. So let's start there. Can you walk our listeners through your journey and I guess leading into this question around what were some of the conditions that you observed, you witnessed inside hospitals and health systems that you led?

00;03;15;21 - 00;03;24;25
Joy A. Lewis
And also, as a former chair of the AHA's Board of Trustees, that led you to create the Bluford Health Care Leadership Institute.

00;03;24;27 - 00;03;56;02
John W. Bluford, MBA
Thank you very much, Joy. It's a great lead in. And I would start by saying that these 45 plus years in the business have always been in urban settings. Large tertiary teaching hospitals that dealt with underserved patient populations. So that has been my story from day one. As an epidemiologist for the Center for Disease Control and the areas of Saint Louis, Missouri.

00;03;56;04 - 00;04;30;17
John W. Bluford, MBA
Pruitt-Igoe housing project, which is the first federally funded housing project in the country. And that is kind of where my orientation comes from. More recently as a CEO -and I've been retired for ten years -but I'll say recently as a CEO of two major academe training centers, I discovered that there was not a pipeline of diverse talent coming through graduate school programs for hospital administration.

00;04;30;19 - 00;05;13;20
John W. Bluford, MBA
How do I know that? Because I was a preceptor for several programs across the country between the late 80s and 90s, and I consistently got very talented scholars to come to my institution to fulfill their requirements for graduate school. But none of them were diverse candidates because they weren't in the pipeline. And the genesis of the program that's in place right now is a request that I made to the Hennepin County Board of Commissioners to give me some funding to go to Morehouse College and recruit an undergraduate student to come to Minneapolis and work with me for the summer.

00;05;13;25 - 00;05;14;20
Joy A. Lewis
Just one.

00;05;14;22 - 00;05;16;28
John W. Bluford, MBA
Just one. You got to start somewhere.

00;05;16;29 - 00;05;17;11
Joy A. Lewis
Yeah.

00;05;17;14 - 00;06;01;01
John W. Bluford, MBA
Right. And that one student stayed with me for two years while I was at Hennepin, followed me to Kansas City, Missouri, and ended up working for me for 17 years. So that project was very successful in one respect, but not a lot of players. Secondarily, because of the success of that one student and my love for doing that kind of work and mentoring, I did the same thing when I got to Kansas City, Missouri, and that has led me to go to primarily HBCUs, Fisk University, Spelman College, Morehouse, Florida A&M University, North Carolina, and A&T and Hampton University,

00;06;01;01 - 00;06;01;27
John W. Bluford, MBA
more recently.

00;06;01;28 - 00;06;03;20
Joy A. Lewis
Not Howard, my alma mater.

00;06;03;22 - 00;06;05;10
John W. Bluford, MBA
But it will be there next year.

00;06;05;11 - 00;06;06;11
Joy A. Lewis
Okay.

00;06;06;13 - 00;06;35;01
John W. Bluford, MBA
And solicit and recruit some very, very, very talented and smart scholars and convince them that health care is a good career path for them and go for it. That's one reason for the BHLI,  and the other is a wonderful experience that I had in the early 80s as a participant in Harvard University's mid-career programs. I was 31 years old at the time.

00;06;35;04 - 00;06;51;22
John W. Bluford, MBA
And that experience just exposed me to how the sausage is really made in health care. And I wanted to expose these young people to that type of experience. I could go on and on, but that gives you a little bit of the seeding of the Bluford Health Care Leadership Institute.

00;06;51;24 - 00;07;25;26
Joy A. Lewis
And again, the early beginnings, rooted in looking at expanding and providing exposure to those from historically underserved, marginalized communities and giving them an opportunity to even consider health care. Absolutely right. So if anyone visits your website for BHLI, they will see the Institute is described as an intense professional development program. Can you share a little bit more? What does that mean?

00;07;25;26 - 00;07;29;00
Joy A. Lewis
What does intense mean in this example?

00;07;29;02 - 00;07;52;21
John W. Bluford, MBA
Intense. It's a two-eek program, seven days a week. Each day, our scholars are picked up by an executive van or bus at seven in the morning, and their day ends 12 hours later, as the last couple of hours of the day, they're working on a case study that they will present to a community audience at the end of the program.

00;07;52;23 - 00;08;17;06
John W. Bluford, MBA
So intense, in my view, means first and foremost, looking for very serious scholars that want to be successful and hopefully in the health care field. The idea is that we are preparing them not for the next level, but the level beyond that. We want leaders, not mid-careerists.

00;08;17;08 - 00;08;27;29
Joy A. Lewis
And we know that there's typically this plateauing that occurs when you get to the midpoint. How do you then move into the more executive senior leadership roles?

00;08;28;02 - 00;08;58;17
John W. Bluford, MBA
So we have a very strong didactic experiential curriculum with leaders from the industry all over the country coming in and sharing their stories, their personal stories. People like Mr. Rick Pollack, for example, or Mr. Wright Lassiter, for example. I think we've had four past chairman of the boards from the AHA. Mindy Estes comes to mind. Kevin Lofton has been a couple of times.

00;08;58;24 - 00;09;34;14
John W. Bluford, MBA
Jeanne Wood has been. So they're get experience and wisdom from the top of the industry. That's number one. Number two, not only didactic and experiential learning, but we really focus on executive presence and what people call soft skills. I don't agree with that terminology. I think they are essential skills. And by that I mean presentation skills, language skills, appearance skills, self-awareness skills.

00;09;34;16 - 00;09;59;26
John W. Bluford, MBA
How to network skills. We drill that into each and every one of these scholars every day and all day. Even though we do have some social activities, but it's not a frat party. You're still on stage. So we have golfing outings, and we've done bowling before, and we go to the performing arts. And we tour a couple of museums in Kansas City, high end.

00;09;59;29 - 00;10;09;06
John W. Bluford, MBA
But we're constantly looking at our scholars and observing our scholars and how they interact with each other and others.

00;10;09;06 - 00;10;09;17
Joy A. Lewis
How they show up.

00;10;09;17 - 00;10;19;24
John W. Bluford, MBA
How they show up. Good point. And we don't grade on the curve. If we catch something that's out of order, we pull them aside and said, you might want to reconsider how you're doing that.

00;10;19;27 - 00;10;21;11
Joy A. Lewis
No partial credit, huh?

00;10;21;11 - 00;10;25;09
John W. Bluford, MBA
No partial credit. And I think that's very enlightening for these students.

00;10;25;11 - 00;10;33;08
Joy A. Lewis
That's helpful. To your point, there's the didactic component, the experiential component. But then there's the: how do you read a room?

00;10;33;11 - 00;10;55;16
John W. Bluford, MBA
Exactly. There are two things that I could have mentioned too: etiquette training, because part of the interview process is often how you perform at dinner or lunch. So we do that and we have speech coaches come in and really help on the presentation skills. So the underlying theme of that, sometimes it's not how much you know, but how well you can communicate what you know.

00;10;55;20 - 00;11;02;22
Joy A. Lewis
That's right. Very comprehensive. I don't know what you do with folks like me who are not morning persons. At seven a.m.?

00;11;02;22 - 00;11;06;09
John W. Bluford, MBA
They get on board real soon or they're left behind.

00;11;06;09 - 00;11;28;03
Joy A. Lewis
They don't have a choice, right? That's right. So a little bit more about, I get the goal here. To your point, it's not mid-career. It's preparing folks for those senior leadership roles. What's been the impact when you look back over the past decade since the inception of this program? Where have your scholars landed? What have they gone on to do?

00;11;28;06 - 00;12;00;08
John W. Bluford, MBA
I'm glad you asked that question. And that's the best question of the interview, because we can talk a lot about what is and what is and what we want to be, but what's the impact is the punch line. And we have been quite successful in our goal. Now remember, the goal is to train culturally sensitive, talented individuals to ultimately impact health care disparities among minority and vulnerable patient populations over the next two generations.

00;12;00;14 - 00;12;01;21
Joy A. Lewis
That's tall order.

00;12;01;23 - 00;12;34;23
John W. Bluford, MBA
That's a tall order. We've got time, and it's going to take time to get it done. And in that regard, in round figures, we've had 150 participants come through the program over the past 11 years, 11 or 12 years. We've had 120 internships that have resulted from those students coming through our program. Now, internships are fully paid summer internships after their two-week didactic experience in Kansas City.

00;12;34;26 - 00;12;51;27
John W. Bluford, MBA
And those internships have been in 50 sites across the country. And the punch line is this: out of 121 students who've actually graduated from undergraduate school, because I interview them as freshmen and sophomores. So they're very young.

00;12;52;00 - 00;12;52;29
Joy A. Lewis
And you're doing the interviews.

00;12;52;29 - 00;13;22;08
John W. Bluford, MBA
And I do the interviews personally. Out of the 121 that have graduated, 100 of them are in health care space today, 83%. And the others are lawyers, and on Wall Street, they're doing well for their own personal careers. But 100 of them are in health care. So just give you an example, and this is a one hour interview in itself where some of these students are and more importantly, what they're doing.

00;13;22;11 - 00;13;49;24
John W. Bluford, MBA
And you can project what they're going to be doing in years to come. But we've got one of our scholars who was in our program in 2014. He is now the surgical specialty clinic director at Henry Ford Hospital. We've got another young lady. She's the pharmacy infusion manager at Emory Hospital's Winship Cancer Center, and she took me through a tour of this new facility.

00;13;50;02 - 00;13;52;29
John W. Bluford, MBA
It is really awesome. And she's in charge. 
00;13;52;29 - 00;13;53;12
Joy A. Lewis
And she's in charge. She's at the helm.

John W. Bluford, MBA
She's at the helm. And we've got another young lady, and I think you're going to meet her at your program in Kansas City later this summer. She's a deputy director for policy and human services for the governor of Kansas, and she's working on access to mental health and Medicaid expansion, which, as you know, is a big issue.

00;14;16;09 - 00;14;30;03
John W. Bluford, MBA
So we've got young people five, six, seven years in their career with no ceiling, doing meaningful and important work with good compensation.

00;14;30;06 - 00;14;35;22
Joy A. Lewis
That's critical. And, well, you started out with them getting paid internships. I noted that.

00;14;35;22 - 00;14;57;16
John W. Bluford, MBA
Absolutley. And they get paid for their two-week tenure in Kansas City as well. It's a $2,000 stipend because we realize while they're there they could have been working their summer jobs. So we want to be competitive to get the best students. And the best students are being paid for their time right now. Let me tell you a little bit about these sites.

00;14;57;18 - 00;15;30;17
John W. Bluford, MBA
I mentioned 120 internships, 50 different sites. The American Hospital Association membership and its leadership has been very valuable connectivity for us because we're placing our students in their institutions. So we've had students at Duke University, Johns Hopkins, Atlantic Health in Morristown, New Jersey, Advocate Atrium have taken a lot of our students. Truman Medical Center's my old stomping ground.

00;15;30;18 - 00;16;03;23
John W. Bluford, MBA
Obviously, it's taking a lot of students University Health and Cleveland, several Blue Cross Blue Shield programs across the country. Saint Luke's Hospital, Dr. Estes' old place, has taken several of our students. Aeon on a long term consultancy..so it just goes to show that networking and the loyalty and concern among my colleagues in the field are paying dividends as well and helping us do this.

00;16;03;23 - 00;16;35;20
Joy A. Lewis
Amazing, amazing impact. So when you started this Leadership Institute again in 2013, the environment was quite different, the external environment. And so what we're looking at right now are some serious - as my CEO Rick Pollack likes to call them - motivated adversaries with deep pockets who are waging a war against anything that smells or looks like diversity, equity, inclusion.

00;16;35;22 - 00;16;55;08
Joy A. Lewis
So again, we're in a very different place today. How are you thinking about the existing world that you're training these young folks to show up in? How are you preparing them to be successful with all the headwinds in the midst of these anti-DEI efforts?

00;16;55;13 - 00;17;47;15
John W. Bluford, MBA
That's a great question, and perhaps one difficult to answer, but it's easy for me. One, we started before these anti-DEI and affirmative action related mentality surfaced and as such very narrowly focused on teaching, mentoring, coaching, and perhaps more importantly, sponsoring the scholars in our program. And that sponsorship, that coaching, that teaching was very specifically directed toward dealing with health care disparities in America, specifically among minorities and underserved patient populations. Rural America, the different pockets that need the support.

00;17;47;17 - 00;18;21;12
John W. Bluford, MBA
And we wanted to make sure they were culturally sensitive to the issues of socioeconomic determinants, etc., which I now favor the public policy determinants of health, and be laser focused on that and eliminating the disparities. So we don't talk a lot about DEI or anything. We talk about disparities, socioeconomic determinants, and how you can position yourself to get in a decision making role to make a difference.

00;18;21;14 - 00;18;33;15
Joy A. Lewis
And the disparities have been there. They have a long tail, to your point, well-documented. So keeping a focus on the elimination, not the reduction, the elimination of those disparities.

00;18;33;15 - 00;18;34;07
John W. Bluford, MBA
Zero.

00;18;34;20 - 00;18;47;29
John W. Bluford, MBA
And we hope that we've given them enough time frame over the next two generations to make a difference. I certainly don't want my grandson's children to experience some of the same disparities.

00;18;48;00 - 00;19;02;05
Joy A. Lewis
Correct, correct. And I like the break down. You've done a really good job of distinguishing between mentoring and sponsorship, for example. Those two tend to get conflated and we know they're very different.

00;19;02;07 - 00;19;27;27
John W. Bluford, MBA
I think many of us who've had the pleasure of serving in this industry were helped quite a bit by someone that was in those positions that we wanted to get to. And it's not unusual for me to pick up the phone and call a colleague of mine and say, you know, Joy Lewis has been in your operation now for four years, and I understand she's doing well.

00;19;27;27 - 00;19;29;24
John W. Bluford, MBA
We want to see some growth in her career.

00;19;29;27 - 00;19;30;11
Joy A. Lewis
Right.

00;19;30;13 - 00;19;31;17
John W. Bluford, MBA
Yes.

00;19;31;19 - 00;19;51;13
Joy A. Lewis
Makes sense. Appreciate that. So we're coming up on time here. But I want to ask. It would be foolish to have someone of your stature sitting here and not solicit some piece of advice from you to these young scholars. What is it that you wish someone had told you?

00;19;51;15 - 00;20;23;20
John W. Bluford, MBA
You know, I've had such a positive journey, and I wish someone would have told me about what an opportunity and blessing it's gonna be to help and serve the community in which I work. It's hard work, but the work is twice rewarding when you see the results. That's a very powerful statement. And I tell everyone, at least in my case: never had a job.

00;20;23;23 - 00;20;42;08
John W. Bluford, MBA
It's always been a mission, not a job. And that's how I've gone about my work. Compensation and those kinds of things have always been secondary. And I tell people all the time, if you're going in it for the money, then do something differently. But if you go in it and do well, get your money.

00;20;42;10 - 00;21;13;09
Joy A. Lewis
That's powerful, John, and very compelling. This notion of you're in it because it's your cause to make lives better at the end of the day. So I can't thank you enough for your continued leadership. You lay the mantle down in terms of CEO-ship roles a decade or so ago, but you continue to add to that almost 50 year legacy that we referenced earlier, really impressive and impactful career that you've had and continue to have for many of us who are in the trenches here.

00;21;13;09 - 00;21;20;00
Joy A. Lewis
So it's great to be in community with you and to have this conversation. And thank you for your time.

00;21;20;05 - 00;21;22;03
John W. Bluford, MBA
Thank you for inviting me.

00;21;22;05 - 00;21;23;20
Joy A. Lewis
Absolutely.

00;21;23;23 - 00;21;32;03
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.

00:00:00:13 - 00:00:24:07
Tom Haederle
Changing demographics and financial pressures pose challenges for hospitals, especially those in rural communities, to maintain obstetric services. In the last five years, more than 300 birthing units across the country have shut down.

00:00:24:09 - 00:01:06:18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Despite today's many challenges, some hospitals are implementing creative strategies to maintain necessary obstetric services for their communities. San Luis Valley Hospital in rural central Colorado is cross-training its clinical staff and partnering with community stakeholders to keep serving their community. Julia Resnick, AHA's director of Strategic Initiatives, recently spoke with Monica Hinds, an RN and director of Emergency Services and Obstetrics and Stephanie Posorske, a certified nurse midwife, about their approach to maternal care for the San Luis Valley community.

00:01:06:20 - 00:01:15:02
Julia Resnick
So, Monica, Stephanie, thank you both so much for joining me. Let's start with some background about each of you and San Luis Valley Health. Monica, I'll start with you.

00:01:15:04 - 00:01:40:14
Monica Hinds, R.N.
I am new to nursing. I've been a nurse for about ten years. This is my second career. and I attribute my nursing drive to OB, actually. When I had my kids, the OB nurses here at San Luis Valley Health were awesome, and I felt like that's what I wanted to give back to the community. So that was a little bit about myself.

00:01:40:16 - 00:01:58:11
Monica Hinds, R.N.
I have been overseeing the OB department for the last 4 to 5 years, I think is when I took over. I was, originally, an emergency room nurse. Became director of the emergency department, and then just sort of, fell into the OB leadership position as well.

00:01:58:14 - 00:02:03:02
Julia Resnick
So can you tell me a just a little bit about the community that is in the Valley?

00:02:03:04 - 00:02:22:28
Monica Hinds, R.N.
Alamosa is the central hub of the Valley. We do service several communities throughout the area, the San Luis Valley. And we are the only location that does labor and delivery. And so everyone does come to us, or they go outside of the valley for their OB needs.

00:02:23:05 - 00:02:26:21
Julia Resnick
Got it. And what kind of pregnancy care does your hospital provide?

00:02:26:23 - 00:02:44:24
Monica Hinds, R.N.
We pretty much do everything. Because even if we cannot manage the patients here, we make sure that we get them to that higher level of care. So we do have the C-sections, we do induce, we do have a local midwife that does deliver outside that we do support as well for her needs.

00:02:44:27 - 00:02:52:06
Julia Resnick
And tell me a little bit about the community stakeholders and partners that you work with, both for prenatal care and postpartum care.

00:02:52:08 - 00:03:11:07
Monica Hinds, R.N.
So we do have valley wide. They are also part of our labor and delivery department. They do manage their own patients. Do their own deliveries, do their postpartum care as well. And then we do have our ObGyn clinic here that, manages our patients for our hospital.

00:03:11:10 - 00:03:24:28
Julia Resnick
So turning to you, Stephanie. I know that there are a lot of challenges faced by rural communities, especially in terms of maternal care. So can you talk about some of the challenges, that expectant and postpartum moms are facing in your community?

00:03:25:00 - 00:03:49:18
Stephanie Posorske
So, interestingly enough, I think that social media has changed this significantly in the last ten years in the sense that everybody knows what's out there, and then what's that availability here? So they're, you know, they want to know, like, can I have an epidural? And yes, they totally can. And being able to meet those needs.

00:03:49:18 - 00:04:19:25
Stephanie Posorske
I think that we do a really good job of finding the niches that are really important. For example, women really worry about being able to have a lactation consultation. And while we don't have a specific lactation counselor, that that's just what they do. I'm our hospital's lactation counselor, on top of being a certified nurse midwife, so that we can still meet those needs without, you know, having to expend our resources.

00:04:19:27 - 00:04:41:08
Julia Resnick
Got it. And, you know, every day we're hearing about more OB units closing down unlimited access in rural communities. But you all are some of the rare ones who are managing to keep yours up and running and serving your community. So can you tell me about what strategies you're implementing that's able to keep your maternity unit open and thriving?

00:04:41:11 - 00:05:05:18
Monica Hinds, R.N.
We are seeing a decrease in, deliveries per year as well. And to be able to make our department managable as far as financial, we've really had to think outside of the box on what we're going to put on that unit. So we have expanded our unit to that surge overflow unit. We have implemented pediatric patients on part of our unit.

00:05:05:21 - 00:05:26:00
Monica Hinds, R.N.
We do some post-surgicals that are not Ob-Gyn related on our unit. So we really have grown our OB nurses into well-rounded nurses that do everything. And so we give them a lot of credit for the knowledge that they've had to obtain over these last few years just to be able to care for our patients in our community.

00:05:26:03 - 00:05:29:02
Julia Resnick
That's really wonderful. Stephanie, anything else you want to add?

00:05:29:04 - 00:05:57:03
Stephanie Posorske
Yeah, I think that there has come a lot of flexibility and changing our expectations of what works for people, and that that's what like all these units that have been able to stay open have had to do...is that we've had to become more flexible as an employee, but also the employer has had to become more flexible on what meeting the needs of everybody's situation so that we can keep this resource available.

00:05:57:05 - 00:06:17:14
Julia Resnick
That's great and wonderful that you're all willing to be so adaptable as you're trying to make your way through this. So besides clinical services, we know that a lot of rural women are also experiencing challenges around behavioral health, such as substance use, and other issues related to social determinants of health. So how are you addressing those issues in your community

00:06:17:16 - 00:06:20:29
Julia Resnick
especially for pregnant and postpartum women?

00:06:21:01 - 00:06:44:19
Stephanie Posorske
I think I can answer that. So I prescribe Suboxone, which is for people that use opiates. And on top of that, like being a great resource for people that use opiates so that they can hopefully get off opiates, it also opens the door for all avenues of people knowing that we're open to doing that and what we can do to help.

00:06:44:21 - 00:07:08:00
Stephanie Posorske
I think we really want to get out there this idea of like, we want you to come in, we want you to get care. Despite all of these challenges, whether it's for behavioral health or because you use some substance, we want to be the doors are open because this is an opportunity for us to capture people that are using

00:07:08:03 - 00:07:20:18
Stephanie Posorske
and it's when they're going to be most motivated to make a change in their lives. And so keeping that door wide open is the best way to do that and hopefully is working.

00:07:20:21 - 00:07:22:17
Julia Resnick
Monica, anything you want to add?

00:07:22:19 - 00:07:48:27
Monica Hinds, R.N.
So I would really like to add we do depression screening on all of our patients - no matter if they're observation patients or inpatients, postpartum in the middle of their pregnancy - just so we can try to catch these patients early enough to be able to give them the resources that they need. We have also really focused on our social determinants and making sure that we're asking those hard questions of patients, you know, do they need some help with housing?

00:07:48:27 - 00:08:06:16
Monica Hinds, R.N.
Do they need transportation? Is food a difficulty for them at this point in time? And we have great care coordination that actually will follow up on all of those patients prior to them being discharged to make sure that they're providing them the resources in the community that they need.

00:08:06:18 - 00:08:29:09
Julia Resnick
And yeah, I think you're both really getting at this idea that, like, these are sensitive questions and sensitive topics for people and keeping that door open so that they feel comfortable coming to you and asking for the support they need is just so crucial. So we always love stories that can really bring this to life. Do you have any stories from your hospital or patient stories, that can help bring to life the work you're doing?

00:08:29:12 - 00:09:02:03
Stephanie Posorske
I have a patient. She's had a baby already. Her and her partner have had times where they've used either fentanyl or opiates. And that door has stayed open to them, despite their not always being as compliant as we would like them to be. But they continue to come see us. Another provider in my clinic sees her husband so that we are both taking care of both of them and their substance use.

00:09:02:05 - 00:09:25:18
Stephanie Posorske
It's just lovely for them, like to have their baby, and for us to be continuing to work on this medical problem that they have. And it's not black and white and it's not it's not super easy. But every time they bring that little baby in and that they're still together and that they're still coming is exactly why that that door has to stay open.

00:09:25:21 - 00:09:34:08
Julia Resnick
Absolutely. And clearly the motivation is there. Yeah. And it's wonderful that you embrace them. Monica, any stories from your world?

00:09:34:10 - 00:09:58:00
Monica Hinds, R.N.
I don't have any specific patients. I mean, we do see when those those patients come in that have that substance use and and we're able to, you know, get them the resources that they need and be able to get them reunited with their baby, even if they aren't able to leave with them at discharge. But to be able to help them get that custody back.

00:09:58:02 - 00:10:06:07
Monica Hinds, R.N.
We see it, you know, not daily, but we see it a lot. It warms our heart that we can help those patients get back with their babies.

00:10:06:09 - 00:10:17:15
Julia Resnick
That is wonderful. So for other rural hospitals that are considering different creative avenues for providing maternal care, what advice do you have for them? What have you learned along the way?

00:10:17:17 - 00:10:56:10
Monica Hinds, R.N.
I'm going to say that you have to listen to your staff. It's been very difficult making that transition from just being a labor and delivery nurse and moving into other fields. It's definitely a lot easier with the newer nurses that are coming out, because that has expectations set forth on employment. But for those those experienced labor and delivery nurses, taking that time to listen to them, about their concerns and what kind of education that they need to make sure that they feel comfortable in providing the care to patients that they haven't cared for, you know, since nursing school, probably.

00:10:56:12 - 00:11:05:03
Monica Hinds, R.N.
So just stopping and listening to concerns is something that I feel that we can really learn throughout this transition.

00:11:05:05 - 00:11:05:27
Julia Resnick
Stephanie?

00:11:06:00 - 00:11:25:09
Stephanie Posorske
I mean I think that's really important. And like listening to your staff is how we will make changes together and not be like get all that pushback. And just like the adaptability like we talked about, we have to all be adaptable. We had to be adaptable in the sense that we brought these patients to our unit,

00:11:25:12 - 00:11:46:09
Stephanie Posorske
that we sometimes have some med surge patients on our unit. But depending on what's going on on labor and delivery, we have to be able to change that. And I think all of our expectations have changed, and we've all learned to evolve with the situation. And that's the true heart of nursing and medicine is that we have to be able to evolve and change based on the patient.

00:11:46:09 - 00:11:54:15
Stephanie Posorske
But big picture: How we evolve and have adapted and changed for our unit as a whole has been really how this has worked.

00:11:54:18 - 00:12:09:22
Julia Resnick
That is an incredibly powerful message that I think we all need to to take in to the work that we do, that, you know, the world changes and we need to change along with it to make things work. So to wrap up, what's next for you all? And SLVH's is work in maternal health?

00:12:09:25 - 00:12:12:06
Monica Hinds, R.N.
I'll let you go first, Stephanie.

00:12:12:09 - 00:12:35:18
Stephanie Posorske
Well, you know, I mean, Monica knows that I always have all kinds of ideas and some of them work and some of them don't. But we, you know, we all move forward and with our ideas and, you know, like, I'd like it if we had nitrous is an option for our patients. And I think we're totally on the brink of getting that. We want to meet to the need of everybody

00:12:35:21 - 00:12:53:28
Stephanie Posorske
which is a wide variety of people really here. And so finding ways that keep us safe and financially feasible, but also our meetings and needs and make us also feel like maybe we aren't as Podunk as sometimes we think, even.

00:12:54:00 - 00:13:10:08
Monica Hinds, R.N.
Yeah. And I would definitely agree with what Stephanie is saying. We we do try to stay up with the times, but making sure that we are providing that safe environment for our patients and for our staff as well, and giving them those opportunities to continue to learn and grow in the field.

00:13:10:10 - 00:13:27:00
Julia Resnick
Well, it's clear how dedicated you all are to your patients and your community and really making sure that door stays open to them. So I just want to thank you for the great work that you're doing to to support moms in your community and really appreciate your taking the time to talk with us today about your work.

00:13:27:01 - 00:13:28:15
Julia Resnick
Thank you so much.

00:13:28:17 - 00:13:29:24
Stephanie Posorske
Thank you for having us.

00:13:29:26 - 00:13:31:28
Monica Hinds, R.N.
Yeah, thank you for sure.

00:13:32:01 - 00:13:40:12
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.

00:00:00:25 - 00:00:33:19
Tom Haederle
Being a new parent is challenging in the best of circumstances, but it's even harder for expecting and new moms struggling with social and behavioral health needs. And living in a rural community means that the resources available to support new parents may be limited. The first 1,000 days from pregnancy to age two offers a crucial window of opportunity to create brighter, healthier futures.

00:00:33:21 - 00:01:17:00
Tom Haederle
Welcome to Rural, a yearlong series devoted to rural hospitals and health systems in America. I'm Tom Haederle with AHA Communications. St. James Health Care in Butte, Montana, now part of Intermountain Health, is designing care around new moms who need the extra support not just during pregnancy, but during the first two years of the baby's life. At this year's AHA Rural Health Care Leadership Conference, Julia Resnick, director of strategic initiatives at the AHA, spoke with April Ennis Keippel, community health director, Montana/Wyoming Market at Intermountain Health, and Joslin Hubbard, social worker at Intermountain Health at St.James Hospital, about how their first 1,000 Days program provides wraparound services for at risk new moms.

00:01:17:03 - 00:01:25:18
Tom Haederle
They were joined by Lacey Starcevich, a former program participant who shares her powerful journey to build a healthy life for herself and her family.

00:01:25:21 - 00:01:42:25
Julia Resnick
April and Joslin and Lacey, thank you so much for recording this podcast with us. We're here at the AHA Rural Health Care Leadership Conference. I'm really pleased to have all of you. So to kick things off, let's get a little background on your health care system. So can you tell us about Intermountain Health, St.James Hospital, and the community that you serve?

00:01:43:02 - 00:01:44:27
Julia Resnick
April, do you want to kick things off?

00:01:45:00 - 00:02:12:19
April Ennis Keippel
Sure. So we are a part of a large system, Intermountain Health, that includes hospitals in Montana, Colorado, Utah, clinics in Nevada as well. And St. James is located in southwest Montana. It's a community of about 35,000 residents, is a level three emergency department and really provides services for all the surrounding counties, which are primarily rural counties.

00:02:12:21 - 00:02:15:12
Julia Resnick
Anything else you both want to add about the hospital and your community?

00:02:15:12 - 00:02:30:04
Joslin Hubbard
Butte is a really proud community. It has a long history of mining and people are proud to be from Butte. They help each other out. They come together to support one another. And it's just a beautiful place to live.

00:02:30:07 - 00:02:44:00
April Ennis Keippel
And Butte was known as the richest hill on earth at one point and at one time was the largest city between Chicago and San Francisco in its heyday. So rich history in the community.

00:02:44:00 - 00:02:58:01
Julia Resnick
That is quite a history. And I love that piece about community because I think that's really what we're here to talk about. And our focus today is really on maternal health. So, Jocelyn, can you talk at all about the maternal population that you're serving and where your patients come from?

00:02:58:07 - 00:03:23:00
Joslin Hubbard
Yeah. So most of our patients live in Butte or Silver Bow County. We do serve the women from the surrounding counties as well. Our payor mix at our hospital is, you know, around 85% Medicare and Medicaid. And we have women primarily of Caucasian descent. And we serve ages, you know, teen age to later maternal - advanced maternal age, they call it.

00:03:23:01 - 00:03:26:06
Joslin Hubbard
So but just a really great mix of.

00:03:26:09 - 00:03:33:27
Julia Resnick
And even though most of your patient population does identify as white, are there any disparities that you've identified between like different subsections?

00:03:33:29 - 00:03:53:15
April Ennis Keippel
So a lot of the disparities we see in our community health needs assessment are actually related to socioeconomic status. Individuals living in poverty across all health outcomes have poorer outcomes. So anyone 200% or less of the federal poverty level just scores worse on a number of health outcomes.

00:03:53:18 - 00:03:58:29
Joslin Hubbard
April, Do you know what population of our patients fall within that 200% below poverty level?

00:03:59:04 - 00:04:05:24
April Ennis Keippel
The residents, I would say about 20% of overall residents. So one in five are below the poverty level.

00:04:05:27 - 00:04:19:22
Julia Resnick
Got it. And when you're thinking about these new parents in your community, are there any particular challenges that you've been seeing them experience? I know you touched on their socioeconomic status of needs, but in terms of behavioral health and how those challenges are impacting them.

00:04:19:24 - 00:04:46:18
Joslin Hubbard
So we have limited resources for our behavioral health and substance use. So those definitely impact our patients' access to care. When we're talking our socioeconomic struggles, it's even transportation to those appointments. It's housing, working with women and families. It's hard to talk about getting to appointments when they're not sure where they're going to live, you know, or stay that night or how they're going to get to that appointment.

00:04:46:21 - 00:04:53:07
Joslin Hubbard
You know, we have to take in all of that into consideration when we're dealing with people with substance and mental health needs.

00:04:53:10 - 00:05:01:00
Julia Resnick
Absolutely. So we're really here to talk about the Meadowlark Initiative. So can you talk to our listeners about what that is?

00:05:01:03 - 00:05:28:08
April Ennis Keippel
I can maybe start and then you can fill in as needed. So the Meadowlark Initiative is funded through the Montana Health Care Foundation. And it's really focused on providing intensive case management to the most at-risk patients prenatal and then following through til the second year of life. So, really helping to guide and support both prenatally and then also postnatal.

00:05:28:10 - 00:05:30:07
April Ennis Keippel
What else would you add, Jocelyn?

00:05:30:09 - 00:06:05:15
Joslin Hubbard
Yeah, so the initiative initially was funded by the Montana Health Care Foundation, but St.James has continued that, recognizing the need and the importance of this work. And so our program was the first 1,000 Days, which is from conception to age two, recognizing that it is the most critical and crucial time in human development. And when the brain develops, you know, it's just really using that care coordination piece to kind of bridge the gaps between those services, whether it's housing, food issues, transportation, mental health, substance use and the clinic or the hospital and how to connect patients when they come in for prenatal care with those outside resources, and then to continue to be

00:06:05:15 - 00:06:12:02
Joslin Hubbard
a resource and a support for them as they not only through their pregnancy, but as they embark on parenthood.

00:06:12:04 - 00:06:22:08
Julia Resnick
That's amazing that you have such a long perspective on it and not just, you know, a specific part of pregnancy or postpartum. So who are you partnering with or coordinating with to bring this all to life.

00:06:22:14 - 00:06:46:16
Joslin Hubbard
In terms of community resources? Yeah, Perfect. Yeah. So we have lots of you know, we partner with all of our resources in the community, whether that's private therapists. We partner with our Southwest Montana Community Health Center to provide mental health services as well as primary care following delivery. You know, our mental health centers and parenting agencies in the community as well.

00:06:46:18 - 00:06:53:24
Julia Resnick
So talk me through it...like someone finds out they're pregnant: how do they get enrolled in the program? Like, what happens next? What does that look like?

00:06:53:26 - 00:07:15:00
Joslin Hubbard
The hope is that they would seek prenatal care and come to an appointment. And at that appointment they would be screened for social determinants of health. So we would be screening for transportation issues, food insecurities, housing, as well as mental health and substance use. We would also be screening the partner or whoever is supportive of that woman in pregnancy.

00:07:15:02 - 00:07:28:25
Joslin Hubbard
So that we can really help the whole unit. And then they would meet with a care coordinator. And that care coordinator then would connect with resources and help identify needs, provide education, and then support throughout the pregnancy.

00:07:28:27 - 00:07:32:27
Julia Resnick
It's wonderful. And are there any stories you can share that can really bring this to life?

00:07:33:04 - 00:07:43:25
Joslin Hubbard
Well, I'm fortunate to have Lacey here today. Lacey was one of our moms in our program, and I think that she can speak to her story better than I could ever.

00:07:43:27 - 00:07:46:05
Julia Resnick
Great. Lacey, over to you.

00:07:46:07 - 00:08:11:12
Lacey St.arcevich
I'm Lacey. I just, on the 22nd of February, recently celebrate five years clean. I originally attended my first prenatal appointment actively using drugs. I was screened and obviously made the requirements for the program. At the time, I was homeless and still using. I left that first prenatal appointment not sure if I was going to get clean or not.

00:08:11:17 - 00:08:26:09
Lacey St.arcevich
Not even sure if I wanted to keep Bradon. That's my son's name. He'll be five in August, actually. So with the help of Jocelyn and the Meadowlark Initiative, I was able to connect with these resources and get help. And today I'm present for my children.

00:08:26:12 - 00:08:32:02
Julia Resnick
That's amazing. I'm just so glad you're here to share your story and that you've been involved in the program since, is that?.. Yes.

00:08:32:03 - 00:08:41:09
Lacey St.arcevich
Yeah. So anything I can do to help? There are just so many mothers out there who are in the same position I am. And it's an unfortunate situation. But with things like this, we can try to lower that number.

00:08:41:12 - 00:08:46:06
Julia Resnick
And I'm sure having contact with you helps them feel less alone and that, you know, there is a light at the end of the tunnel.

00:08:46:12 - 00:08:50:19
Lacey St.arcevich
You know, there's nothing more therapeutic than another addict helping another addict.

00:08:50:21 - 00:09:03:09
Julia Resnick
Wonderful. And I know that, you know, we have a great personal story of the impact of this work, but have you been measuring what the impact is on the women that are in the program? Yes. Yes, we have. Is there anything you can share?

00:09:03:11 - 00:09:06:28
April Ennis Keippel
If I look at my notes...I don't know off the top of my head.

00:09:07:00 - 00:09:31:28
Joslin Hubbard
We have found that women who participate in this program are more likely to have consistent prenatal care. They're more likely to take their child home at delivery. And that means from a lower involvement of the Child Protective Services Removals, women have better health outcomes to higher birth weights, lower complications, less hospital stays that are involved in the care as well.

00:09:32:01 - 00:09:44:24
Joslin Hubbard
And a lot of that's probably attributed to the more consistent prenatal care, as well as changing a lot of their lifestyle and ensuring that they have the food and resources that they need,  as well as you know, hopefully not using substances.

00:09:44:26 - 00:10:01:19
Julia Resnick
So to wrap us up, I love your words of advice for other rural hospitals that are really thinking about what they can do to improve their maternal and child health outcomes. What have you learned along the way that you can share with them? And Lacey, you'll have a slightly different version of that question.

00:10:01:22 - 00:10:30:04
Joslin Hubbard
You know, when we're dealing with rural, it's hard to find people to fill spots, right? And I think the most important thing is that we realize that this is just has to be someone who cares and who understands the community and the resources out there and who can show understanding and love and kindness to patients. There's not a magic wand. This is hard work, but it's, you know, it's done in partnerships and relationships that are built not only with the patient but with the community.

00:10:30:07 - 00:10:40:10
Joslin Hubbard
And, you know, just really taking time, stepping back, understanding what the needs of your community are and, you know, just addressing it one day at a time.

00:10:40:13 - 00:10:41:21
April Ennis Keippel
Well said.

00:10:41:23 - 00:10:43:26
Julia Resnick
Very well said, April.

00:10:43:28 - 00:11:10:09
April Ennis Keippel
I don't know if I could really add anything more to that. I think it just in looking at having a connector and a go-to person, I think is probably the most important thing so that there's a single point of contact that can help move forward any of the needs and make connections. And I'm not sure that that always would need to be a particular type of training to do that work.

00:11:10:10 - 00:11:22:25
April Ennis Keippel
So I think in a rural community you could customize it to really fit what you have available. But the key piece would be just to have that single person who can really help be the connector.

00:11:22:27 - 00:11:41:11
Julia Resnick
That human connection piece really just came out strongly in both of your answers. And Lacey, from being on the participant side of this and, you know, having been one of the moms in the program, what do you wish that hospitals knew about working with new moms who might need additional social or emotional support?

00:11:41:13 - 00:11:59:16
Lacey St.arcevich
We just need, you know, a setting that's not judgmental. We do not have a village. And programs like this help us create that village, and that sets us up for success. They help me create my family. They help not only me get clean and deliver a healthy baby, but my husband followed ensued because they provided us the resource to be able to do that.

00:11:59:19 - 00:12:00:22
Julia Resnick
It's wonderful.

00:12:00:25 - 00:12:16:03
Joslin Hubbard
I just wanted to call out Lacey. You know, not only does she have Bradon, but she now has a two year-old, Parker. She's married, has bought her own home, and is a role model for other women in our community and just so proud of where she is.

00:12:16:06 - 00:12:20:06
Julia Resnick
I'm so glad we can lift up your story and share it with the world.

00:12:20:09 - 00:12:21:03
Lacey St.arcevich
Thank you.

00:12:21:05 - 00:12:30:07
Julia Resnick
So, Lacey, Joslyn, April, thank you so much for joining this podcast. I look forward to seeing your presentation later today. And just congratulations on the fantastic work you're doing.

00:12:30:09 - 00:12:30:22
Joslin Hubbard
Thank you.

00:12:30:28 - 00:12:31:27
Lacey St.arcevich
Thank you.

00:12:32:00 - 00:12:40:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and read us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.