Advancing Health Podcast

00:00:01:04 - 00:00:31:25
Tom Haederle
Welcome to Advancing Health. An increasing number of hospitals today are part of a larger health system. How can the big systems support the mission of their local member hospitals, while avoiding a one size fits all approach that may not work for everyone? As we recognize Community Health Improvement Week, we learn more about Michigan-based Corewell Health's approach, from tactical support to collaborative community partnerships that helps each hospital or health system be the best it can be.

00:00:31:27 - 00:00:54:23
Andrew Jager
My name is Andrew Jager at the AHA. Today, it's my pleasure to be joined by two colleagues from Corewell Health in Michigan. With me we have Dr. Corey Smith and Vanessa Briggs. Today, as part of Community Health Improvement Week, we're going to talk a little bit about the role of a health system in supporting hospitals to maintain a really robust process in identifying and understanding the health needs of the local communities that they serve.

00:00:54:26 - 00:01:09:14
Andrew Jager
Now, I'd like to turn to our guest to hear a little bit about how you see the role of health systems like Corewell Health in supporting local hospital offers to identify, understand and to address community health needs. Starting with Vanessa, how do you see the role of Corewell in this?

00:01:09:17 - 00:01:45:24
Vanessa Briggs
That's a really great question. And some of the lessons I think, that we've learned here at Corewell Health. It really does take a collaborative process. And that really requires diverse voices and perspectives and lived experiences, because that engagement process is really critical, because we think about -when we do CHNA - as an ecosystem. And an ecosystem model that can be replicated across all three regions, given the spanned and reach that Corewell Health has within Michigan.

00:01:45:27 - 00:02:29:05
Vanessa Briggs
And so our CHNA ecosystem is made up of public health partners, health and human service organizations, community based organizations, as well as community advocates. And we also include our Corewell Health local community board representatives and health professionals that have local but yet regional specific insight into the needs that are happening and needed within community. And so when we work alongside all of those individuals, when we call our ecosystem, it really allows us to deliver programs and work alongside our community to engage throughout the entire process for the CHNA.

00:02:29:07 - 00:02:40:04
Andrew Jager
I love that, Vanessa, really taking that ecosystem approach and then intentionally bringing in those local community voices to create that strong effort. Corey, what would you add to Vanessa's response?

00:02:40:06 - 00:03:03:02
Corey Smith, Ph.D.
Well, the one thing I would add is, for a health system like Corewell Health, it can be sometimes easy to think, given our size, that we are kind of the main actor in a space. Right? And I think it's important, especially at the regional level, at the local level, to remember the kind of the legacy and positionality that some of these local hospitals have in their communities and that they are a part of the fabric.

00:03:03:02 - 00:03:30:00
Corey Smith, Ph.D.
Right. And so I think in some of our regions, and one of the things that we're trying to lift up as best practice is to be conduct doing the needs assessment process as part of a collective, right, a collective group in collaboration with public health departments, with local organizations, with school districts and other stakeholders that have some interest and where it's relevant for them to be aware of and participating in the process of defining community health needs,

00:03:30:00 - 00:03:30:18
Corey Smith, Ph.D.
right?

00:03:30:20 - 00:03:55:13
Andrew Jager
Yeah, I love that sort of intentionality of recognizing the true complexity across the communities, the legacy, different perspectives, and the intentionality of bringing all those together in a process is great. So moving on to that process, I guess I'd ask Vanessa, you know, from the system level, what would you say are some of the most important resources or tools that that you can use to support that local priority identification?

00:03:55:15 - 00:04:22:08
Vanessa Briggs
Yeah. At Corewell we firmly believe that technical support to help prioritize and help our local hospitals and stakeholders. It really has to align all focus areas effectively. And so having that technical support that Corey's team actually provides for my team in healthier communities is critical to the success. And that's a huge resource that's beneficial to us.

00:04:22:10 - 00:04:28:18
Vanessa Briggs
And I'm sure Corey has some other examples that that he would like to share in terms of some resources as well.

00:04:28:21 - 00:04:44:24
Andrew Jager
Yeah, I'd love to hear Corey's thoughts, especially around, you know, what do you think about when you try to balance standardization across the hospitals in your health system and data collection, reporting, etc., with the flexibility that local teams really need to to get at those needs and address them in a local way?

00:04:44:26 - 00:05:16:09
Corey Smith, Ph.D.
Yeah, it's one of the main tensions that we wrestle with, right? And it can be enticing to want to go with standardizing across systems. Right. It's simpler. You know you can feel like you're focusing, but when you bring it to local stakeholders, it can feel misaligned with what they actually need and what they experience. So, you know, I think stepping back from the actual process of identifying the needs rather than bringing forth a standard set of here are the needs that we're going to identify at each hospital across our system.

00:05:16:11 - 00:05:52:24
Corey Smith, Ph.D.
We try to frame it as here is our broad theory of change for how we think we can address health needs across the Corewell Health service area, right? We think we need to have a balanced approach to investing in, initiatives that are going to create change at lots of different levels. And so rather than saying this is exactly, you know, the condition or the need that you need to work towards trying to offer a way to work rather than a how to work, I think is a critical part of what we try to bring into both the CHNA, the community health assessment needs process, but also the development of the strategies and response to that

00:05:52:24 - 00:06:17:18
Corey Smith, Ph.D.
process. So I think that's part of the way we balance that tension. And then we've thought a lot about, you know, what is a system's sort of backbone look like for local teams doing this work. And what kind of technical support can we bring to the table, whether it's, you know, in the in the form of how to create better surveys, whether it's in the form of bringing forth access to publicly available data sets that look more at community need.

00:06:17:21 - 00:06:41:15
Corey Smith, Ph.D.
Mining census data. Mining other forms of information that, you know, the communities themselves, they may have the capacity, but not the time necessarily to do that work. And even more recently, what tools are available from a technology standpoint site now that even boost the efficiency of accessing that kind of information even more, right? There are tools now that, you know, make that an even simpler process.

00:06:41:15 - 00:06:49:23
Corey Smith, Ph.D.
And then how do we make that data more publicly available to people to use as part of the CHNA process or in their own work? Right?

00:06:49:25 - 00:07:09:10
Andrew Jager
Those are such good examples of kind of how you think about balancing that tension, as you mentioned, between kind of having a standard set of measures and having things resonate with the local communities that you serve. You talked about, I think, Vanessa, there are three regions across Michigan that you serve. So I wonder, you know, from a practical level, what does this work look like?

00:07:09:10 - 00:07:14:24
Andrew Jager
Could you share how it plays out, maybe, in one of the initiatives from 1 or 2 of those regions?

00:07:14:27 - 00:07:47:06
Vanessa Briggs
So the way that we like to approach our work is we sort of like to say we use a system wide approach and we're developing what we're calling program portfolios that allows us to encapsulate programs that healthier communities can deliver at a regional level. This approach gives us a system wide strategy, but it gives us local context within the regions across east, west and south by addressing the needs that we have identified within our 21 hospitals.

00:07:47:08 - 00:08:28:13
Vanessa Briggs
And so examples of those programs, it ranges from doing school based clinics on the east side of the state, where we're actually providing primary care in the school for our students, as well as for residents in community. And the west side of the state, we have a school nursing program that allows us to have a different model, but yet still in the schools, providing training for the school administrative staff, providing basic care for our students in the schools, and helping them manage their chronic diseases whether it's asthma or diabetes.

00:08:28:15 - 00:08:54:09
Vanessa Briggs
So that's why we're able to sort of customize our approaches, but yet still have, if you will, a collection of programs in a portfolio that addresses the needs of children, adolescents in a school environment. And so that's a good way and a good example to show how you can have a system wide strategy, but yet still keep it very, very local based off of the needs that are in community,

00:08:54:17 - 00:09:33:28
Vanessa Briggs
the partnerships that we have in community. Because we know, as I mentioned, it takes an ecosystem to do this work. And so Corewell has deep relationships with other nonprofits within organizations to help us execute programs, whether it's prevention programs, chronic disease management programs, and even coalition building and doing what we like to call collective impact work. And so it's a variety of programs and interventions that are derived from our implementation plans and, as you know, come from the priorities that are identified in our community health needs assessments.

00:09:34:00 - 00:10:00:26
Andrew Jager
Such a powerful example, I think, of the ways that you're thinking about understanding what are the local assets of your communities and then partnering to address those needs in a way that that is really having an impact across the state. So thank you for that work. Corey, one of the questions I frequently get, and I imagine maybe you hear something like this too, is, you know, how do we show the impact of the work that we're having, you know, both through metrics as well as through sharing the stories of the work across our community.

00:10:00:26 - 00:10:13:00
Andrew Jager
So how do you share your work in a way that that gets people excited about the work you're doing, brings in partners, and also that can help to develop a system wide culture of learning, adaptation and continuous improvement?

00:10:13:02 - 00:10:36:26
Corey Smith, Ph.D.
Definitely a question that I get. You know, my background is in evaluation. And so this is something I've been thinking a lot about. Corewell Health for the time I've been here - and, and I think the question that's been sitting in my head for five years has fundamentally been, how do we evaluate at scale, you know, have three regions, with, you know, over 100 individual initiatives.

00:10:36:28 - 00:11:02:08
Corey Smith, Ph.D.
How do you think about evaluating at scale? Right. You want to have evaluation where it makes sense, but you also have limited resources. And so what we've been doing is working to establish a systematic way of making choices with our regional leadership about where to invest, evaluation resources based on local priorities. Right. So really trying to define first where do we need to do this evaluative work.

00:11:02:08 - 00:11:24:21
Corey Smith, Ph.D.
Where do we feel it's most important for us to either generate learning or evidence of impact. And then through that designing, evaluation and monitoring processes that are really going to help us hone in on the indicators that are going to be useful for tracking our progress over time, but also the critical outcomes that our stakeholders have helped us develop,

00:11:24:23 - 00:12:03:13
Corey Smith, Ph.D.
that our regional leadership has decided are most important. And then it's just a technical task, right? Then it's designing methodologies, whether they're quantitative and qualitative, whether they're optimally mixed. You know, the application of both is most often the best way to answer the evaluative questions that you may be trying to answer. The last thing I'll say about that is, you know, we really have been working to try and establish a set of regional sort of priority indicators that can serve as a guidepost where they're not going to be right the first time, and they're going to have to get better over time in terms of their relevance to local needs, but really trying to

00:12:03:13 - 00:12:15:21
Corey Smith, Ph.D.
establish what are some of our, you know, our north stars, our guideposts that we can organize around as we try to make decisions about what to do, and where to invest some of our resources.

00:12:15:23 - 00:12:29:22
Andrew Jager
Really well said. Any last words? I mean, a lot of the listeners are health system leaders. So what do you think they need to know about supporting a process that's locally led and owned with the system level resources?

00:12:29:24 - 00:12:58:04
Vanessa Briggs
The way that I sort of think about it is it really is important to have a system wide strategy, as I mentioned, whether or not it's in the interventions and creating portfolios to allow you to house like programs, or whether it's having Corey's team do evaluation, provide technical assistance across the entire system in doing our community health needs assessment.

00:12:58:06 - 00:13:39:14
Vanessa Briggs
But what's most important and critical is that that system wide strategy still needs to have and allow for adaptability and customization based off of local context. While we can move to centralize and provide benefits from economies of scale within a system wide approach, we can't lose sight that the relevance and the effectiveness of addressing unique needs at a local level or regional level is still critically important, because that's when you're able to address the needs that have been identified within community.

00:13:39:17 - 00:14:01:26
Vanessa Briggs
And I think that that's what's most important. We can have system wide strategies but that local context is what really matters, because then we know we're moving the needle to address health disparities, access to care, partnering with organizations, addressing transportation, food access.

00:14:01:28 - 00:14:24:17
Andrew Jager
Thank you so much for encapsulating the important work that hospitals do across the country every day to support the communities and to help people be as healthy as they can be. Well, thank you to each person listening for the work that you do to support health and resilience in your communities. Community Health Improvement Week is really about recognizing the important work that you do every day on behalf of America's hospitals and health systems, and more importantly, the communities that we all serve.

00:14:24:19 - 00:14:38:06
Andrew Jager
Special thanks to Vanessa and Corey for sharing your thoughts and expertise, for the great work that you're doing at Corewell for Michigan communities. Be well. And until next time, this is Andrew Jager from the wishing you all a very happy Community Health Improvement Week.

00:14:38:09 - 00:14:46:20
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:02 - 00:00:16:21
Tom Haederle
Welcome to Advancing Health. Coming up in today's podcast, we hear how SSM health is taking a whole team approach to combat workplace violence. And it's working.

00:00:16:24 - 00:00:39:29
Jordan Steiger
Hi everyone. My name is Jordan Steiger. I am a senior program manager on the Clinical Affairs and Workforce team at the American Hospital Association. I'm joined today by Todd Miller, who is the vice president of security, and Amy Wilson, who is a chief nurse executive at SSM Health, to talk about how they're making their hospitals safer for everyone, including patients, their families and the health care workforce.

00:00:40:01 - 00:00:50:21
Jordan Steiger
So to get us started, I'd love for all of our listeners to learn a little bit more about SSM health and also about the roles that you're playing within your organization. So, Amy why don't we start with you?

00:00:50:23 - 00:01:19:13
Amy Wilson, R.N.
So thank you, Jordan, and thank you for having us here today to talk about this really important topic. SSM Health is a fully integrated health care network, located in the Midwest. We’re across four states. We have 23 acute care facilities, a post acute network, and approximately 500 ambulatory care site settings across those states. My role at SSM Health as chief nurse executive, and also I'm responsible for our clinical workforce.

00:01:19:15 - 00:01:34:26
Todd Miller
And hi Jordan, I’ll introduce myself. Todd Miller, VP of security with SSM obviously. My role is really just overseeing the physical security program, security technology, as well as just all the programmatic elements that make up our department systemwide.

00:01:34:28 - 00:02:01:06
Jordan Steiger
That's great. So two really important perspectives here. I mean, somebody overseeing the clinical workforce and especially that nursing perspective, and then also the security perspective. And one thing as I was learning a little bit more about the work that you all do at a system health that I was just so impressed by is the way that you bring every single person in your workforce together to tackle the issue of workplace violence, because I think we all know on this call that it can't be just one person or one group.

00:02:01:08 - 00:02:07:11
Jordan Steiger
It can't just be security or nursing or administrators working on this. It has to be everyone together.

00:02:07:14 - 00:02:30:29
Amy Wilson, R.N.
Absolutely Jordan and I would tell you, I think that is the magic at SSM Health is the fact that we have taken a fully integrated approach to thinking about safety, security and workplace violence prevention. In many organizations and in organizations I've been in, in the past, this has really been the role of security or the role of facilities, and we don't actually have that perspective at SSM Health.

00:02:30:29 - 00:03:00:24
Amy Wilson, R.N.
And I think that is the reason, the number one reason actually, for why you're seeing some of our successful results is because we really think about the whole team, what the role is of that team and how they interact together. And one of the things that I'm most proud of, especially as as we think about the clinical work team, is that our clinical work team believes that our security team is an integral part of that team and helps us take great care of our patients and our families and our communities every single day.

00:03:00:27 - 00:03:22:17
Todd Miller
I want to add on to that, Amy. When Amy joined the organization, within two weeks or so, I said, Amy, I would love some time to sit down and go over the security program. You remember we met and it was it was awesome to see an executive at her level engaged. And what is security doing? How are you supporting our clinical staff?

00:03:22:19 - 00:03:54:27
Todd Miller
And probably the most important sentence that really rung with me was how can I support you and your team? And again, it was it was just that comforting feeling that there was understanding about what we do there. There's understanding we are part of the patient care team to some degree. And then again, that high level of support from the top down in the programs, what we're doing, in that ultimate goal of lowering workplace violence. Right from the start, it was a good, strong relationship, reinforced at the highest level, which we appreciated.

00:03:54:29 - 00:04:16:12
Jordan Steiger
That's great. That leadership by in piece is so, so important, as I think all of us know. Let's take a step back even because I'm hearing that there's this commitment across the organization to lowering the incidence of workplace violence. And I don't think we need to explain to anybody on this podcast that health care workers are far more likely at this point to experience violence than the everyman.

00:04:16:12 - 00:04:30:27
Jordan Steiger
right. And that trend seems to be increasing. That's not what we want to be seeing. So what were you seeing within your organization at SSM Health that led you to start developing some of these programs and, you know, getting that leadership buy in for it?

00:04:30:29 - 00:04:49:24
Todd Miller
When I first joined SSM which is actually ten years ago, I remember when there was a workplace violence incident, let's just say a nurse got assaulted. It was a big deal. It still is a big deal., but it would I would say it was more of a rare occurrence, that got of a lot of focus. And even within my first year, I was starting to notice that.

00:04:49:24 - 00:05:17:27
Todd Miller
So again, around 2015, you started to notice more incidents, higher volume, and the sentiment just from the nursing staff was something was changing. Whether it was at huddles or just informal conversations. Something was changing. And then you started to hear about it nationally. And the trend kept growing and growing. And then my peers in health care security industry, there was that conversation happening in forums through our trade organizations where something was changing.

00:05:18:00 - 00:05:37:17
Todd Miller
It was about, I would say, 2017, 2018 when really the focus started to grow and grow and grow, to say we have to be more proactive and not as reactive. So what are we doing to get ahead of that curve of just the the assault in general? How are we looking at our data? How are we working with our nursing staff?

00:05:37:19 - 00:05:57:16
Todd Miller
That was really for me. The start of it was around then, and I can probably speak for a lot of my health care security peers. That's about the point where the curve started going up almost exponentially, where we knew there was an epidemic across the US and then globally as well as far as health care workers.

00:05:57:18 - 00:06:23:09
Amy Wilson, R.N.
Yeah, and I would add to that, Jordan, I wasn't here during that time, but I would say that my frame of reference around the time frame is, is similar. About that same time, I was in a different organization, rounding in the ED one day and one of my most strong charge nurses was visibly upset about something. I was surprised to see this, pulled him off to the side, said, hey, tell me about what's going on.

00:06:23:09 - 00:06:55:27
Amy Wilson, R.N.
Seems like it might be a rough day. And it wasn't one thing that had happened that day. It was really the weight of the world on his shoulders with him saying, Amy, something's different than it used to be. We used to have all of our patients and families come into our emergency rooms, and no matter who they were or what they might have been involved in outside the walls of the hospital, once they walked over that threshold, there was this respect for the fact that the doctors and the nurses are caring for them in a very important time, in a very vulnerable time.

00:06:55:27 - 00:07:17:21
Amy Wilson, R.N.
And there was just total respect. And he said, we're seeing that change and we're seeing people come in and demand things or verbally escalate or be disrespectful. And it's it's really hard to see. And then I think if you fast forward to what we all experienced in the pandemic, we start to see this happening across the society.

00:07:17:23 - 00:07:51:12
Amy Wilson, R.N.
And unfortunately for us in health care, what's happening outside the walls of all of our facilities and our ambulatory care settings, as well as our hospitals and acute care settings, is being brought across the threshold now into that. And so all of the turmoil that we feel as a society, all of the kind of polarization that we feel, the lack of empathy and understanding other people's perspectives and just a little bit of respect for each other and humanity now gets brought into the facilities, into our hospitals, our health care settings.

00:07:51:14 - 00:08:15:14
Amy Wilson, R.N.
And now we are dealing with all of that burden at a very vulnerable time in people's lives, because in health care, we're dealing with everything from birth to death and everything in between. It's one of the most stressful times people ever have in their life. And so you couple that with what's been happening in our society, and we just see this escalating violence on the inside of our walls too.

00:08:15:17 - 00:08:24:02
Amy Wilson, R.N.
And so as leaders, we would be amiss if we did not address that differently than we thought about this a few years ago.

00:08:24:04 - 00:08:43:21
Todd Miller
I'll tack on that Amy. A common thread that we've noticed in our health care security teams is the external risk has now been brought internal. And that's the change. It used to be a sacred space and we're losing that. Churches, schools, hospitals. There's a change. And unfortunately we've had to adapt to that.

00:08:43:23 - 00:09:13:19
Jordan Steiger
It does seem like those places that seemed untouchable. Now we are seeing more violence, and it's not a trend that we certainly want to see. We know that, it's affecting, you know, the well-being of our our health care workforce, our patients, our families. This is something that's not beneficial to anybody right? So I'm hearing from both of you as you're starting to talk about what you're doing at SSM Health, that there isn't just one solution or set of activities that you can just implement and everything's going to be fine.

00:09:13:22 - 00:09:33:04
Jordan Steiger
It seems like you are using a lot of, just layered approaches, lots of different things. You know, it's not just physical security. It's not just de-escalation training. It's thinking about this problem holistically. So could you tell us a little bit about some of the activities you have that are helping your team members and your patients and families stay safe?

00:09:33:07 - 00:09:58:28
Amy Wilson, R.N.
One of the most important things we're doing around thinking about the entire team and thinking about security as part of a team member is team training, so those teams are trained together. They practice together. They're in simulation together, and they are simulating real live events so that when something happens, not if something happens, but when it happens that they know how to respond together as a team.

00:09:59:01 - 00:10:34:04
Amy Wilson, R.N.
And we've invested a lot of time and resources into finding the right tools to train with, the right settings to train with and providing the time and the space for training. And I think that has been instrumental in part of our success. We have a really wonderful partner right now and our de-escalation training, and we are seeing results that I've never seen before with our care teams and our security teams telling us that they feel 93% more capable of dealing with the violent situation than they have ever felt before.

00:10:34:04 - 00:11:06:21
Amy Wilson, R.N.
And I think those results are astronomical. And we're doing that by not just thinking about de-escalation training, which has been kind of the historical view of the world in the health care setting. It's what happens when de-escalation doesn't work. How do you stay safe? What do you do? What happens if this escalates to physical violence and is actually talking about protecting themselves and their team members and keeping themselves safe, and also integrating into that, this concept of trauma informed care.

00:11:06:24 - 00:11:29:25
Amy Wilson, R.N.
So the trauma that the person who is escalating might be experiencing and and if you're thinking about that, what could be happening and also your own trauma in the situation and thinking about what how that is impacting your reaction to the situation. And so that as well as a concept called heart math, is also an integral part and is really about self-regulation,

00:11:29:25 - 00:11:56:16
Amy Wilson, R.N.
in order to be able to hopefully de-escalate. But then also acknowledging that every situation will not be de-escalated and could turn into a violent situation. And what do you actually do if it if it does become violent? And I think for a long time we've been afraid as clinicians to have that conversation. You know, we always thought that we had a magic wand and we were going to de-escalate everything and everyone and everybody was going to be okay.

00:11:56:19 - 00:12:14:15
Amy Wilson, R.N.
And we now know that that may not happen. And in some circumstances it will not happen. And so we train for when that happens. What do you do as well. And what we're hearing from our team members is that makes them feel safer and well equipped. When the situation happens.

00:12:14:17 - 00:12:38:03
Todd Miller
If we back up even before we chose that, that the partner we have for our de-escalation program, really evaluating what was of value in the de-escalation programs and for us, even how it's delivered to me, was one of the more important aspects of that vetting process for all these de-escalation programs. They all have value and their you know, apples to gala apples, they're similar enough

00:12:38:03 - 00:12:58:09
Todd Miller
right. And I think when we were looking at that and saying, well, our old program that we were using really focused more on the intensity model, the idea that on January 1st you have an eight hour training, congratulations, you know, how to de-escalate somebody. Great. And then the incident happens on December 31st. Are you going to remember those physical intervention skills?

00:12:58:09 - 00:13:21:21
Todd Miller
Are you going to remember all those are of de-escalation skills. Maybe that's not realistic. And saying, okay, so what are we going to do to change? And moving more towards that consistency model of more training, smaller increments, more touch bases throughout the year. And even just that change to me is showing value because people are remembering it, instead of having to sit there and go, what did I do?

00:13:21:24 - 00:13:41:26
Todd Miller
And we all know in a time of panic and a time of crisis, actually dealing with somebody in crisis, you're kind of reverting back to fight, flight or freeze. And sometimes the think, the critical thinking, especially when dealing with our patients. So that to me was a big advantage in how we were moving forward with the program we have now.

00:13:41:29 - 00:13:45:12
Todd Miller
And really how we're delivering that education to be retained.

00:13:45:15 - 00:14:09:27
Jordan Steiger
So many things that you both just said resonate. I think this move of the month or, you know, remember this verbal de-escalation tactic. You know, having that repetitive kind of education I think is so important. You know, I'm a social worker by background. I've worked in the hospital, and I can say that that would have been very helpful to know and, you know, to train with the interdisciplinary team, because that's how you're responding to incidents when they happen.

00:14:09:27 - 00:14:21:24
Jordan Steiger
It's not just the nurses that are responding or just the social workers. It's everybody coming together and you have to know how to work together. So I think these are practices that I think a lot of different organizations could try to implement.

00:14:21:27 - 00:14:41:15
Amy Wilson, R.N.
And Jordan, you referenced earlier, kind of our multi-pronged approach. But then if you even start to peel back the layers of the onion more, you start to see in our system many other things that we're doing. And I think Todd's approach to physical security of our buildings and what that looks like has been instrumental.

00:14:41:17 - 00:15:05:20
Todd Miller
Yeah. New start. And you look at just historically and base like foundational level, no pun intended, but the construction of our buildings and how they were built, our hospitals are built for convenience, not security. We want to make sure the non ambulatory patients park close, walk directly in. So if you look and this isn't just a SSM issue, this is across the United States even globally.

00:15:05:22 - 00:15:30:13
Todd Miller
That's how we were building and designing our hospitals which made sense at the time. We're all now dealing with what we call sins of the architectural past and saying, well, now we have these open environments, these open campuses, numerous ingress points. How do we site harden these now while still making it convenient. You know, what are we doing to relook at how we're designing and reevaluating, how we are having people come into our buildings?

00:15:30:16 - 00:15:52:18
Todd Miller
And that has been one of the hardest challenges, just from a physical security perspective. If you think about even how a bank is designed and you walk into any bank across the United States, there's certain standards you see immediately. The desk height, the glass, how they talk to you. The way the doors and entrances are designed. Those standards have been in place for decades and decades, if not a century or more.

00:15:52:20 - 00:16:13:04
Todd Miller
Now hospitals are having to think the same way and saying, how are we designing our buildings? Or if we do a renovation, how are we incorporating what kind of a nerdy security term, crime prevention through environmental design? How are we designing our facilities to reduce crime, without even doing anything, other than just how it's built, and how that can lower the risk for violence?

00:16:13:04 - 00:16:36:01
Todd Miller
Because it does. Now we're looking at we're going to redesign it. And when that person enters, and what is the process now that we're going to employ to keep our staff safe. And we know through our trade organization, International Association of Security and Safety, they’re guidelines and standards. So when they say, those are management, weapons detection is now a standard to hold ourselves to,

00:16:36:03 - 00:17:05:11
Todd Miller
that's a big change from where it was ten years ago, 15 years ago. And so we're now we're having to rethink about how our patients and visitors are coming in, even our staff, how are they entering the building and what are those security controls, that can make our staff safer. I will say, when we started doing these renovations and redesigning some of our entrances, especially in the high risk departments and with our emergency departments especially. It’s staggering what we've turned up.

00:17:05:13 - 00:17:27:13
Todd Miller
And let's just be honest about it. Anybody that employs weapons detection, there's kind of a shock that happens when you say, oh my, look at all the things that we're preventing coming in, and it doesn't have to go straight to firearms or knives. It can be a screwdriver, it can be a can of mace, you name it, anything that can be used as a weapon against our staff.

00:17:27:16 - 00:17:34:08
Todd Miller
So some of those successes have been game changing for us as an organization. And again, in all transparency, we're not done.

00:17:34:10 - 00:17:53:00
Jordan Steiger
Absolutely. And, Todd, I won't be, totally surprised if you get some outreach after this podcast because you both just shared some incredible advice and insight. Thank you both so much for being here with us today. We really appreciate you sharing the work that you're doing, and we look forward to hearing about more of your success.

00:17:53:02 - 00:18:01:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:04 - 00:00:30:12
Tom Haederle
Welcome to Advancing Health. Community health workers play a vital role in bridging the gap between health care systems and the communities they serve. As we celebrate the upcoming 2025’s Community Health Improvement Week, June 9th through June 13th, we learn more in today's podcast about how the team at Duke University's partnership with Community health workers led to stronger communities and measurable improvements in heart health outcomes.

00:00:30:14 - 00:00:55:24
Chris DeRienzo, M.D.
Hello again. I am Dr. Chris DeRienzo, the chief physician at the American Hospital Association. On this week's podcast, we are celebrating CHI week and that stands for Community Health Improvement Week. And we could not have two better guests joining our podcast today to celebrate CHI week and talk about the wonderful work that they do, right in my home of North Carolina around their community health needs assessment.

00:00:55:26 - 00:01:18:21
Chris DeRienzo, M.D.
Joining me today is Anna Tharakan. She is the lead project manager on the Closing the Gap on Hypertension Disparities work at Duke. And Bradi Granger, who is a professor in the Duke University School of Nursing and a co-pi for that same project. Thank you both for joining us on the podcast today. I am so excited to get to welcome you here.

00:01:18:24 - 00:01:19:19
Anna Tharakan
Hi. Happy to be here.

00:01:20:05 - 00:01:21:27
Bradi Granger, Ph.D.
Thanks for having us today.

00:01:21:29 - 00:01:45:09
Chris DeRienzo, M.D.
Well, let's jump right in. You know, the community health needs assessments is a really broad overview of both the assets and the needs within a community. I have known the community here in Durham, North Carolina, for nearly 25 years. When I started medical school in the early 2000’s. But I'm really curious, you know, Duke Health has excelled in doing its CHNAs for a long time.

00:01:45:14 - 00:01:52:17
Chris DeRienzo, M.D.
Talk to us about how do you approach this CHNA, and what kinds of things have you uncovered? Anna, we'll start with you.

00:01:52:19 - 00:02:21:20
Anna Tharakan
It's kind of kind of setting up what a hypertension is present within our community. We see that despite the proven interventions that are currently present, over 50% of patients that are diagnosed with hypertension kind of have their condition controlled. And kind of specifically within Durham, we see that there's a prevalence of hypertension of almost 42%. So I think for us, as are kind of really some baseline statistics of really motivating us to kind of get out into the neighborhood and communities and reduce these hypertension disparities and improve overall population health.

00:02:21:22 - 00:02:48:02
Anna Tharakan
So kind of our approach was taking a quality improvement intervention to target these hypertension disparities via a telephone outreach program. So we partnered with the local FQHC or Federally Qualified Health Center and students based out of Duke Health to kind of deliver this telephone outreach. We applied these functions essentially through student ambassadors, which were these students that conducted a structured telephone outreach to kind of help reach patients where they are.

00:02:48:03 - 00:03:11:06
Anna Tharakan
So over a series of three to four phone calls directly work with our patient cohort, which was around 300 patients, to help identify hypertension education. What are ways that we can help kind of work within their lifestyles to maybe attach hypertension care? We distributed free blood pressure cuffs. We helped them create Smart goals and accountability partners. And then lastly also conducted a social needs assessment.

00:03:11:08 - 00:03:16:24
Anna Tharakan
Which is really just trying to identify what are other things that are kind of getting in the way of your hypertension and health.

00:03:16:26 - 00:03:34:02
Chris DeRienzo, M.D.
Let's pause there for a second because wow! I mean, the level of depth that you all are able to go to, is, is truly impressive. But bring this up, you know, to the 30,000ft view level for a moment, because I don't know how many of our listeners are familiar with the Durham community and specifically the role that Duke plays in that community.

00:03:34:03 - 00:03:46:05
Chris DeRienzo, M.D.
So can you give the just sort of the brief snapshot of when you're talking about, you know, over 40% of the Durham population? How many people are we really talking about? And when you're saying going into the community, what does that look like?

00:03:46:07 - 00:04:24:03
Bradi Granger, Ph.D.
I can pitch in here. Durham has about 300,000 people and roughly, as Anna pointed out, we have a prevalence of hypertension of about 42 to 48% of the people in this county have, hypertension. About half of those are uncontrolled or unaware. And so the third issue, I would say in Durham County, is the disparity in care that we've seen and the prevalence. That the higher prevalence in the higher mortality and comorbidity that is associated with this, chronic illness in the black population, which that statistic is true throughout the South.

00:04:24:09 - 00:04:53:03
Bradi Granger, Ph.D.
And so we have a high proportion of minorities and underserved patients in Durham County. And we tend to focus on these first, as the risk in this group is much higher than the risk in the average population overall. So, given that we started there, the clinics and the specific areas in the community where we could be most effective in improving overall health for the community were those underserved, like safety net clinics.

00:04:53:03 - 00:05:25:25
Bradi Granger, Ph.D.
And so across the county, we have our Federally Qualified Health Center, which Anna mentioned and our, my co-pi, Dr. Holly Biola, is there leading the effort there. And we've also worked together with the Duke Safety Net Clinic, the Duke Outpatient Clinic, as well as our broader population health clinics in the county. So though the work began at Lincoln, our Federally Qualified Health Center, we have reached out to try and scale the project across other areas in the community that represent underserved populations.

00:05:25:27 - 00:05:48:07
Chris DeRienzo, M.D.
Thank you so much for sharing that. You know, I moved to North Carolina 25 years ago, and in the other places I've lived, I never really had the level of appreciation that I have now for just how different a place like Durham County can look when you drive like eight minutes from the downtown core, because Durham, you know, with 300,000 people, there's definitely a downtown core and there's some high rises.

00:05:48:07 - 00:06:12:23
Chris DeRienzo, M.D.
And I mean, it's not, you know, like New York City is downtown, but it's definitely an inner city environment. But eight minutes away, you are in farm country. And so when you're talking about reaching a community, that you are going from a very urban feel to a very rural feel quite quickly. And so I know that community health workers have played a huge role in how you all have addressed this work through the project around hypertension.

00:06:12:26 - 00:06:21:25
Chris DeRienzo, M.D.
Tell us a little bit more about the role that you all are finding community health workers playing and amplifying community outreach.

00:06:21:27 - 00:06:49:29
Bradi Granger, Ph.D.
We have a cohort of community health workers. The intent for that workforce is to really expand and extend the work that's done in a clinic, during a clinic visit, with a primary care provider. The fact is that many of our people in the underserved area, especially, have so many social determinants, which Anna can expand on. That it's hard to fit the care that's needed within that short window of time of the visit.

00:06:50:02 - 00:07:13:05
Bradi Granger, Ph.D.
So this project has served to really engage health professions students like Anna as patient navigators, to partner with these community health workers and literally give everyone more time to be able to provide the care, at the community level, that we want to do. So Anna can expand on exactly what that looks like.

00:07:13:07 - 00:07:34:09
Anna Tharakan
I think kind of as she pointed out, there was this huge, not gap that necessarily we realized, but kind of this, this system that patients weren't necessarily kind of getting the full time that they needed to just with the limitations of the system. And so I think what really community health workers, and in our case students, were able to really fill that gap was kind of being able to take that time with patients when they had it.

00:07:34:11 - 00:08:00:12
Anna Tharakan
Our first call with patients and students made was just sitting down with them being like, are you interested in kind of learning more about what hypertension means or how we can kind of implement some lifestyle changes, and can we do that on your time? I think that was just a really big portion of whether it was people that were working two to three jobs and only had availability at 8 p.m. or 9 p.m.. I think that was kind of the really great gap that students could kind of fill is kind of making sure outside clinic hours, where can we sit in and really impact and make a change?

00:08:00:15 - 00:08:27:26
Anna Tharakan
And then on top of that, really kind of making it really personalized with that education that we gave them,. Learning about the different things that they were kind of experiencing. What kind of struggles were specifically relevant to their lives, whether that was I'm struggling or trying to get groceries when I have to make sure to pick up my kids from preschool, or whether it's I'm taking care of two of my parents that are, kind of based in the hospital and kind of making sure that we were able to insert little pieces of advice where I was, hey, like how about we try to get 30 minutes, you know, walk to your parent's house instead

00:08:27:26 - 00:08:39:21
Anna Tharakan
of necessarily being able to drive there and really kind of instill small changes that they can make. And really be their personal cheerleader and kind of instill in these small changes that can really make such a big difference in their blood pressure and hypertension.

00:08:39:23 - 00:08:56:27
Chris DeRienzo, M.D.
I love that. Wouldn't we all benefit from having a personal cheerleader, especially when fighting, you know, a condition like hypertension, which is so seemingly innocuous because it's just a number on a machine. But we know that, that years and years and years of high blood pressure take its toll on nearly every organ system in the body.

00:08:57:00 - 00:09:14:28
Chris DeRienzo, M.D.
And again, being good project leads, I imagine you all are measuring countless kinds of metrics through this work. What is one measurable impact that you can tell us about through this engagement of a community health workers and really extending their reach, and not only into patients homes, but into community based settings as well.

00:09:15:00 - 00:09:34:05
Anna Tharakan
I think the big one was just the impact that we had on their blood pressure. And then also just self-management. I think within our intervention this past year, we saw a average drop in the systolic blood pressure of those that participated of over 15mg mercury, which is just a really huge kind of drop when considering, this intervention that took place.

00:09:34:08 - 00:09:53:13
Speaker 3
I think another big one was this idea of self-monitoring, kind of bringing the power to the patient, kind of being able to track with the free blood pressure cuffs that they were able to be provided, as well as the social needs assessment. Was kind of really putting that power of health back in their hands and showing that community health intervention lead can produce really meaningful clinical outcomes.

00:09:53:15 - 00:09:56:03
Chris DeRienzo, M.D.
Spectacular. Bradi, anything you would add?

00:09:56:05 - 00:10:29:04
Bradi Granger, Ph.D.
The one thing I would add to that is the idea of the system integration that this project brings. Whereby, to your point, hypertension really is a chronic illness, that the long term outcome is what we're after, reduction in stroke, reduction in chronic kidney disease and reduction in cardiovascular events. But those things happen so far from, you know, today's single measurement or even a couple of years worth of measurements of high blood pressure in an office visit, which is often mistakenly elevated anyway.

00:10:29:12 - 00:11:00:04
Bradi Granger, Ph.D.
So our real achievement, I feel like in addition to what Anna said about bringing the power to the patient to set their goals and really be able to be aware and to be responsible for changes and improvements in their health. We also really are trying to effectively connect a patient to the primary care provider team, including the community health worker and the community business organizations that help us serve patients outside of the formal system of health care delivery.

00:11:00:07 - 00:11:50:05
Bradi Granger, Ph.D.
These groups provide food, transportation, assistance with housing insecurity and all the things that are real barriers for patients managing long term, hypertension. So solving for those things and tracking it as we have, and making sure there's a closed loop on the referrals that happen, allows us to really measure the impact of this kind of project on some of our really important community outcomes, but also the policy implications for this project. Which we're working on now with our North Carolina Department of Health and Human Services, and trying to make sure that the opportunity for us to expand healthy opportunities. Pilots from our Medicaid expansion initiative, trying to make sure that we have the evidence and

00:11:50:05 - 00:11:56:27
Bradi Granger, Ph.D.
the measurable outcomes to support new policies for expansion of those kinds of efforts in the community.

00:11:57:00 - 00:12:29:11
Chris DeRienzo, M.D.
Well, you all have certainly covered the waterfront. I mean, clearly, it takes, it takes a team. And you've been able to connect not just the acute care clinical team, but the patient's family, community teams, all together in this web in supporting patients. I'm curious, we've only got a minute or two left. If you had to give one piece of advice for health care team members, in a community right now listening to this podcast who are just coming away from hearing your story and saying, I got to go do this tomorrow, what would your one piece of guidance be,

00:12:29:13 - 00:12:31:27
Chris DeRienzo, M.D.
as they're preparing to take their first step?

00:12:31:29 - 00:12:42:29
Bradi Granger, Ph.D.
Our guidance would be communicate with your primary health care provider and let them know you're interested in joining our team as a patient expert in the hypertension management program.

00:12:43:01 - 00:12:51:07
Chris DeRienzo, M.D.
Outstanding. Anna, what if you were giving advice to a hospital who was hearing the story and they said, I want to be just like this project that they're doing at Duke?

00:12:51:07 - 00:13:06:29
Anna Tharakan
I think it's just showing that it's possible to kind of get an intervention like this off the ground, and it really can can make a real big difference in patients lives. And so kind of putting a focus on community health workers and kind of connecting back that primary care doctor as Dr. Granger said is a really important component.

00:13:07:01 - 00:13:25:09
Chris DeRienzo, M.D.
You all have done tremendous work. Obviously connecting all the way back to the community health needs assessment. What it lifts it up, how you connect that to a project building in the the approach that brings community health workers into the fold and then obviously bringing patients and family members into the fold with you. We could not wish you more luck in the work that you're doing.

00:13:25:09 - 00:13:33:22
Chris DeRienzo, M.D.
And again, couldn't think of a better story to tell this week during CHI week in 2025. Any closing thoughts before we say goodbye?

00:13:33:25 - 00:13:41:14
Bradi Granger, Ph.D.
I think thanks for your support and for the dissemination of efforts like this and the impact it has on our community. Thank you.

00:13:41:16 - 00:13:45:04
Chris DeRienzo, M.D.
I couldn't say it better myself. Thank you both so much.

00:13:45:07 - 00:13:53:17
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:06 - 00:00:22:12
Tom Haederle
Welcome to Advancing Health. In today's podcast, we learn how West Virginia University Medicine involves the entire clinical team: primary care physicians, virtual social workers and others to get children and young people the care they need before a psychiatrist is required.

00:00:22:15 - 00:00:53:12
Jordan Steiger
My name is Jordan Steiger, and I am senior program manager for clinical affairs and workforce at AHA. I'm really excited to be joined today by Dr. Adrienne Coopey from West Virginia University Medicine. Dr. Coopey is a child and adolescent psychiatrist who is extremely passionate about integrating physical and behavioral health services, which is, we know, something we love to talk about at AHA. And she is especially interested in doing this in areas of West Virginia where children and their families faced challenges in accessing behavioral health services.

00:00:53:14 - 00:01:14:17
Jordan Steiger
She and her team are doing lots of great work, not only to improve the outcomes for these children and their families, but also really trying to support the health care workforce, and clinicians who are developing behavioral health programs and delivering services maybe for whom behavioral health is not their specialty area. So, Dr. Coopey, thank you so much for being with us today.

00:01:14:20 - 00:01:15:29
Adrienne Coopey, D.O.
Thank you.

00:01:16:01 - 00:01:21:12
Jordan Steiger
So to get us started, please tell us just a little bit about you and your role at WVU.

00:01:21:14 - 00:01:52:13
Adrienne Coopey, D.O.
Thank you, Jordan, for that lovely introduction. I think the biggest thing is I'm really fortunate to have the support of West Virginia University to do this work, because I really enjoy it and it doesn't always pay well, right? Reimbursement can be an issue. So, I am currently a fully virtual faculty member in the Department of Behavioral Medicine and Psychiatry, and my role there at WVU is primarily in teaching psychiatry residents and the child and adolescent psychiatry fellows.

00:01:52:15 - 00:02:33:11
Adrienne Coopey, D.O.
So they can join the workforce, and help take care of our people. So teaching is a big role in my work, and it has been all along, which I didn't really catch on to. But, through integrated behavioral health, I've really done a lot of teaching all along. I think most of my, early career has been in-patient child and adolescent psychiatry, emergency departments,  doing consult liaison work in medicine and pediatrics, and then the integrated behavioral health work was just kind of like natural development that kind of happened, which is medical overlap, behavioral health

00:02:33:13 - 00:02:53:25
Adrienne Coopey, D.O.
in a lot of the work that I was doing. And I got really lucky. The hospital that I was working in supported me to implement, integrated behavioral health into primary care. Now, I've been at WVU for two years, and really I was hired to implement behavioral health integration.

00:02:53:28 - 00:03:12:21
Jordan Steiger
I love that WVU has made this investment in behavioral health integration. I think that speaks so, so much to the system and the priorities. And I love that you are completely virtual. I know we'll talk about that a little bit more later and how that helps you in your role. But I'd like to go back to, you know, you are a child and adolescent psychiatrist.

00:03:12:22 - 00:03:36:18
Jordan Steiger
You've practiced for a long time in this role. I know you're really passionate about the care that you provide. We know that there are not enough of you out there in the workforce right now. There are just not enough people going into psychiatry, and especially child and adolescent psychiatry. What does this mean for patients? What does this mean for the short term and long term outcomes for these kids when they can't see a psychiatrist?

00:03:36:20 - 00:04:02:19
Adrienne Coopey, D.O.
Right. So all of that is true. We are not able to produce enough child and adolescent psychiatrists to see every kid who needs help. But I would argue we don't need to. You know, our primary care providers are really seeing the kids who need behavioral health intervention. They're seeing them first, right? They're identifying their needs pretty early, right.

00:04:02:20 - 00:04:34:23
Adrienne Coopey, D.O.
We have made it important for screening tools to be implemented for depression and anxiety. So our primary care providers are seeing these kids right off the bat. If we can support our primary care providers to intervene early, we may not need as many child psychiatrists as we feel we do at this point. Treating behavioral health though, is so different than, say, treating strep throat, right?

00:04:34:25 - 00:04:57:04
Adrienne Coopey, D.O.
We don't have that one test that gives us that one answer and know that one antibiotic is going to be helpful. And so that can make it a little more difficult to just do. And that, is where I get to be a part of sort of distilling all the I've learned to support the primary care providers.

00:04:57:11 - 00:05:21:27
Jordan Steiger
So what I'm hearing you say, I think, is that we need to maybe shift our mindset around this a little bit. Not every child needs to be seeing a psychiatrist. And that early intervention piece is really important. And I know that that's something that WVU medicine is really investing a lot of time and resources in right now. So could you tell us a little bit about the work you're doing to empower that early intervention and get kids the care that they need?

00:05:21:29 - 00:05:46:12
Adrienne Coopey, D.O.
Yes. We have implemented three different programs already in behavioral health integration. That has been very exciting for me. One that I have continued today and it is a direct education with a primary care provider. I have a pediatrician that I work with in an area of West Virginia that has no behavioral health services as far as child and adolescent psychiatry is concerned.

00:05:46:15 - 00:06:12:13
Adrienne Coopey, D.O.
She primarily sees children with behavioral health needs. And I talk to her a couple times a week about patients. And we help implement those screening tools in a way that makes it easier for her to care for kids. I give her recommendations, but really, she's doing all the work. And often I am just saying, yeah, that sounds like a really good idea.

00:06:12:13 - 00:06:46:28
Adrienne Coopey, D.O.
And that has gotten a lot of children seen earlier and getting the care in their communities that they would otherwise have to travel pretty far for. Another program is primarily supported through our population health department. Really cool. It is a fully virtual collaborative care model. In general, the collaborative care model parks a social worker in a primary care office who then is the liaison between the patient, the primary care provider, and the specialist,

00:06:46:28 - 00:07:13:27
Adrienne Coopey, D.O.
the child and adolescent psychiatrist. I've worked in that model, it's super fun. It's great to have that collaboration with everybody in that team model. This model is completely virtual. The primary care provider can be in any setting. The social worker is calling the patient using the medical record to communicate. And I have direct conversations with the social worker.

00:07:13:29 - 00:07:45:06
Adrienne Coopey, D.O.
What that gives us is an opportunity to see patients in various practices that can be geographically quite separated. That was one of the difficulties with rural collaborative care is that the social worker may not have enough volume in one practice to really support their position. And so this really negates that issue. The third thing that we're doing that's super fun is, we call it E-consultation.

00:07:45:12 - 00:08:11:09
Adrienne Coopey, D.O.
It is an interprofessional consultation. So the primary care provider puts in an order and a question about a patient. It comes to me or one of our child psychiatrists electronically. We review the chart, review the question and send back an answer. This can be really great. Because we can give it an answer pretty quickly, and we can bill for it so it can support itself.

00:08:11:12 - 00:08:36:16
Adrienne Coopey, D.O.
The primary care provider and this child psychiatrist, are part of any kind of billings and review generation, so that can be helpful in supporting the program. That can give those patients who may not be appropriate for a collaborative care model, a more immediate answer before they can get to a child psychiatrist in specialty care.

00:08:36:18 - 00:09:07:01
Jordan Steiger
Wow, so many things you've mentioned I would love to just dive deeper and deeper into. I think that I mean, the thread I hear among all of these programs though, is the willingness to embrace that virtual care and the willingness to connect across a very large state with a lot of rural communities. You know, I think being a big anchor system in a state like West Virginia, there is such an opportunity maybe for other, you know, states similar to West Virginia, to kind of model off of the work that you are doing.

00:09:07:04 - 00:09:29:22
Jordan Steiger
One of the things you mentioned at the beginning, you know, talking about your different implementations is, you know, how you work one on one with this primary care physician in a rural community in West Virginia. I love this. I think this is such a smart way to just spread that knowledge and help - like you said - just bring that access to care to communities where it wouldn't maybe be.

00:09:29:24 - 00:09:51:18
Jordan Steiger
You alluded to this at the beginning too, but we know that behavioral health provision, you know, for services, is a little different sometimes than primary care. So how can other child and adolescent psychiatrists model kind of the work that you're doing and empower other primary care clinicians to be more confident in treating children with behavioral health needs?

00:09:51:20 - 00:10:23:15
Adrienne Coopey, D.O.
Great question. And this has taken time to develop for myself. Getting little bits of information about someone and formulating a diagnosis and plan can be really difficult and a little scary. So learning the ways that primary care providers can communicate with you in the same language. So sometimes our primary care providers and our psychiatrist are speaking different languages.

00:10:23:17 - 00:10:57:09
Adrienne Coopey, D.O.
One way that we can speak the same language and get the same information is if by using screening tools. And we are using screening tools in primary care a lot, right? We're using the PHQ. We're using the Gad seven and the scared for anxiety. We're using the Vanderbilt for ADHD. We're doing that. And that can be a great way to get the information that you need and communicate it with each other, primary care and psychiatry and follow the care. So we can use those to help support diagnosis.

00:10:57:11 - 00:11:17:18
Adrienne Coopey, D.O.
We can use those to help follow the care and see if we're getting better. Because one thing about psychiatry in general is that our responses aren't always immediate and they're not big. You don't go from sore throat to no sore throat, right? You have incremental improvement.

00:11:17:21 - 00:11:47:05
Jordan Steiger
Absolutely. And just making it objective, like you said, it's not like you have sore throat and no sore throat. It could be a lot of time, a lot of different interventions, a lot of different experimentation with lots of different things to get that person to that right care plan in psychiatry. So I think that that's a great takeaway message for our listeners is just figuring out what is that shared language and how can we come to kind of the middle and understanding each other between psychiatry and primary care

00:11:47:05 - 00:11:59:15
Jordan Steiger
so I love that. As we start to close, what advice would you have for other health systems who are looking to integrate behavioral health into their other models of care?

00:11:59:17 - 00:12:28:24
Adrienne Coopey, D.O.
Support it. I am super grateful to WVU for supporting my work. I am grateful to other hospitals that I've worked at for supporting behavioral health integration. It doesn't always pay upfront, but the improvements on the end in quality of life, hospital visits, hospitalizations and other needs are significant. So that prevention piece is really powerful.

00:12:28:26 - 00:12:34:16
Jordan Steiger
I absolutely agree. Thank you so much. Is there anything else you'd like to add?

00:12:34:18 - 00:12:57:24
Adrienne Coopey, D.O.
Thank you for having me. I really appreciate this. It is something I've been doing in the background for quite some time, and I know that individually, each primary care provider I work with is grateful their patients are getting what they need, and they are also grateful for this program. But I don't always get to talk about it.

00:12:57:27 - 00:13:06:12
Adrienne Coopey, D.O.
Because behavioral health can be something that we don't talk about a lot. So I really appreciate that you've given us this time and spotlight to do it.

00:13:06:15 - 00:13:17:23
Jordan Steiger
We are so happy to do so. I love talking about behavioral health and getting to help other people share their stories. So, we are really excited to keep following your work and see what comes next.

00:13:17:25 - 00:13:19:10
Adrienne Coopey, D.O.
Thank you.

00:13:19:13 - 00:13:27:24
Tom Haederle
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