Advancing Health Podcast

00;00;00;24 - 00;00;30;24
Tom Haederle
Many health care providers have an equally important caregiving job at home. They’re moms, dads, and parents to young children. As the health care field continues to experience workforce shortage issues, hospitals need to ask themselves, what will it take to prevent burnout and keep new parents, and especially moms in the health care workforce?

00;00;30;26 - 00;00;53;01
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this final episode of the award winning series Beyond Birth, we're exploring how health care organizations can better support new parents to enable them to thrive at work and at home.

00;00;54;19 - 00;01;25;18
Michelle Yu
So prior to having kids, I was super invested in my career. And it's not to say that I'm not invested now. I think it's more so that it really defined me and I loved it. I loved my clients. I loved my career. It was a lot of fun. And in hindsight, I realized that my self-worth was very much enmeshed with myself as a professional.

00;01;25;20 - 00;01;38;20
Michelle Yu
That was my value that I brought to the world, and without it, I really wasn't sure what value I had. Now that I can look back and reflect, I was really trying to operate in the exact same way as I did before.

00;01;43;13 - 00;02;06;17
Yara  Mikhaeil-Demo, M.D.
Before becoming a mom, I was very into my career, right. Like I would stay until 9:00, 10:00 p.m. I didn't really have. I mean, I was married, but running home was not my top priority. Writing that paper or seeing the next patient was really my top priority. And then suddenly, like, I had drop off times and pick up times at daycare, and I had sick days and I had to navigate all of that.

00;02;06;20 - 00;02;20;03
Yara  Mikhaeil-Demo, M.D.
And that's when I was like, this is not just a me problem. This is every working woman in general, all parents, to be honest with you. Because a lot of times now, the dads are also the primary childcare provider.

00;02;20;05 - 00;02;42;24
Julia Resnick
There are 24 million working moms in the United States. You just heard from two of them, Michelle Yu and Dr. Yara Mikhaeil-Demo. Both are professionals in the health care field and moms of young children. Dr. Mikhaeil-Demo is an assistant professor of neurology at Northwestern's Feinberg School of Medicine, as well as a physician well-being coach. Michelle is the co-founder and CEO of Josie.

00;02;42;27 - 00;03;07;26
Julia Resnick
They guide new parents in making the transition into working parenthood through mental health support and other services. I'm Julia Resnick, director of strategic initiatives at the American Hospital Association. In this final episode of the Beyond Birth series, we'll be exploring how health care organizations can support new parents in their workforce. Health care field is experiencing an ongoing provider shortage that is projected to only get worse.

00;03;07;28 - 00;03;39;17
Julia Resnick
The Bureau of Labor Statistics projects that the country will face a shortage of nearly 338,000 nurses and 140,000 physicians in almost all specialties by the year 2036. And while female medical students outnumber their male peers, they are leaving medicine at a higher rate, particularly after having kids. Adding to that, eight in ten health care workers are women. Fostering a sustainable healthcare workforce necessarily has to include addressing the needs of moms and parents. During May

00;03;39;18 - 00;04;01;24
Julia Resnick
we observe both Women's Health Month and Mother's Day, so we're recognizing the dual provider roles played by many people in the health care field. Their medical professionals and parents will be discussing what it takes to create an environment where new parents can do what they love at home and at work. Michelle and Yara, who you heard from at the top, both have intense health care careers.

00;04;01;26 - 00;04;08;27
Julia Resnick
I asked them what it was like going back to work after becoming a parent. Hear what Michelle had to say about her return to work.

00;04;08;29 - 00;04;34;16
Michelle Yu
When I was transitioning back to my big career after baby, I faced a lot of mental emotional challenges and also career related challenges. A lot of questions around, you know, how do I view myself now as a professional and what are my goals? And how do people view me? Did that change at all, and if so, how do I navigate that?

00;04;34;19 - 00;04;57;21
Michelle Yu
And I just had a hard time kind of finding my stride in working motherhood. And I asked other parents. I started to ask other parents if they felt the same, because this is something that I never talk to others about before. And I quickly realized that I was not alone. And that's when I decided to also start doing some research about just becoming a working parent

00;04;57;21 - 00;05;27;12
Michelle Yu
today, and I quickly found that it has shifted a lot in just the last few decades. There's everything from more dual income households. There's more women in the workforce than ever. There's changing family structures, single parent households, blended families, multiracial families. People are also delaying having children, until they are further along in their careers. So what that means is they're going back to these really big roles after baby, and that could be a lot of pressure.

00;05;27;14 - 00;05;56;24
Michelle Yu
One of the things that stood out to me the most is there was a 2019 University of Michigan study, and it found that 4 in 10 female physicians will either scale back or leave their careers entirely within six years of residency. That is really shocking, considering how much time is invested in becoming a physician. And there's also been a few more studies that I've seen, particularly on nurses, especially around, retention for those with children under the age of five.

00;05;56;26 - 00;06;18;18
Michelle Yu
I think that speaks to health equity issues as well. And so I love how some of your prior guests have said that health equity is so important in the perinatal period, and you can't have health equity without a diverse health care workforce, and you can't have a health care workforce that's diverse without women.

00;06;18;21 - 00;06;36;12
Julia Resnick
Yara has had to navigate her new life as a physician mom. And with that comes a multitude of questions. How do you navigate the pressures? What about the time commitments of medicine, all while being a new parent? She certainly isn't alone in facing those challenges and shared her experience with me.

00;06;36;14 - 00;06;56;09
Yara  Mikhaeil-Demo, M.D.
So how do we make coming back to work easy? How do we make that transition easier so that we don't feel like we're alone or isolated? I think there's a lot of isolation that comes with coming back to work, struggling with a newborn, and trying to function at the same level that you had before. Without just slowing down and noticing the difference.

00;06;56;11 - 00;07;23;15
Yara  Mikhaeil-Demo, M.D.
I think that the biggest thing is community. Having group programs for women who are parents, I think is huge. I've led two different, group, of women physicians. and just sharing the experience, sharing the struggle, normalizing it, realizing that we're not alone is huge. One thing that I did was one of the groups was we wrote mission statements about our roles as moms and our roles as physicians.

00;07;23;18 - 00;07;40;10
Yara  Mikhaeil-Demo, M.D.
And every time we have that mom guilt, we can go back to the mission statement and be like, overall, I am meeting my mission statement. If I was five minutes late to pick up, it's not a big deal, right? But trying to take a step back, see the big picture rather than focusing on the small things that we're not doing.

00;07;40;12 - 00;08;03;19
Yara  Mikhaeil-Demo, M.D.
So I think just having that group dynamic where people can come together and share is important, but then also having some guidelines and policies in place to account for that. So my biggest stressor, for example, was childcare. Like unexpected sickness or school closures or things like that. How do you have a policy that allows for, you know, things like that when you have a last minute cancellation?

00;08;03;22 - 00;08;20;16
Yara  Mikhaeil-Demo, M.D.
How do you allow for promotions not to be affected by maternity leave, or by the time that you spend pumping, for example, when you come back? How do you account for that when it comes to productivity? There's a lot of things that systems can do to help parents, especially new parents.

00;08;20;18 - 00;08;34;29
Julia Resnick
So now that we understand the pressures that moms in health careers are facing, what can healthcare organizations do to support their team members that are new parents? Yara and Michelle proposed some minor changes that would make a huge impact on working out.

00;08;35;01 - 00;08;56;29
Yara  Mikhaeil-Demo, M.D.
I think there is a huge push now and understanding of how many new parents struggle. there are support groups that are on system that account for productive for leaves, that block time for parents, for a woman that choose to pump and things like that. Just keeping in mind parents when making decisions. Simple things as meeting times, right?

00;08;56;29 - 00;09;30;03
Yara  Mikhaeil-Demo, M.D.
Like sometimes we have 7:30 meetings or 5:00 p.m. or 6:00 p.m. meetings. And if you have to pick up your, you know, your child, having a virtual option really makes a big difference, right? Like you're still involved but can also able to pick up your child. Or noticing the need for community and providing space for that. We have a program called Ignite where right now I'm leading a woman physician group where we meet once a month and is sponsored by the hospital, and we pay for our meal and we get to talk about our struggles and how are we approaching our days and how can we get better.

00;09;30;06 - 00;09;46;04
Yara  Mikhaeil-Demo, M.D.
So just I think creating that community and encouraging it and also making decisions with the struggles in mind. I think most leaders want to make a different, but just taking the parents voice in consideration when making decisions will be really helpful.

00;09;46;07 - 00;10;13;10
Michelle Yu
Community is just key here. And also just the small things like the meeting times. Yara I hear that all the time. The other thing I will say is I actually recently spoke with a physician executive at UC Davis Health, and this person pointed out to me that there was a study by physician moms group that found nearly 40% of physician moms returning from leave will experience exclusion from administrative decision making or important projects.

00;10;13;12 - 00;10;47;26
Michelle Yu
So I think the other thing here to note is manager and supervisor awareness and training to ensure that they play, because they play such an important role in that individual's overall experience, and making sure that they're equipped to support them. So particularly for clinicians who may have responsibilities outside of direct patient care, you know, having a manager proactively reorients you back to work and take the care to re-onboard you after the return from leave.

00;10;47;28 - 00;11;05;26
Michelle Yu
And also being able to proactively invite you back into those meetings where those decisions are being made. And it's one thing to have you say like, oh, can I go back to this meeting? They're not in my calendar anymore. Versus someone actually saying, hey, we really missed you during these meetings and you bring such an important voice to the table.

00;11;05;29 - 00;11;26;24
Michelle Yu
I'm going to ask that you come back and we'd love to have you join us or something like that. You know, that just that tone that approach is so different. And then on the clinical side of things, I interviewed a few clinicians recently about their struggles and their return to work and something that, especially in primary care, happens is that you're missing this window of time to see your patients when you come back.

00;11;27;02 - 00;12;01;26
Michelle Yu
Sometimes you're taking on their emotions as well, on top of your own emotion, emotions, and your mental and hormonal changes. One primary care physician said that she experienced from her patients, abandonment issues, where they felt they were abandoned by them during that maternity leave. And so just making sure that your workforce is aware of any mental health supports or emotional supports and helping them maybe on-ramp back in a more measured way, so that they can kind of take that on, more slowly.

00;12;01;26 - 00;12;27;08
Michelle Yu
could be really, really helpful. And there's also, policies around blocking time. However, that being said, that doesn't necessarily account for some of the cultural aspects of that actually happening. I.e., is the pumping room actually close enough for me to get to so I can pump in the break time that I have. And as my team and my supervisor support me in taking that time off.

00;12;27;12 - 00;12;49;08
Michelle Yu
1 in 3 physician moms actually face discrimination when it comes to breastfeeding and pregnancy. So again, being able to train your supervisors to know that this is protected time. And then it's important to the organization that you all feel that way. That's part of your values as an organization is so important. And then being able to actually get there and use those spaces is also important.

00;12;49;11 - 00;13;05;10
Julia Resnick
Cultural changes around returning to work after pregnancy need to be ingrained across health care organizations, and new parents should feel empowered to ask for what they need to feel supported. Yara and Michelle shared stories from their own lives of what this looks like in action.

00;13;05;12 - 00;13;20;14
Yara  Mikhaeil-Demo, M.D.
I would say I was lucky when I came back, I think was my second child. My biggest stress was pumping like Michelle was saying. Where am I going to pump? How am I going to pump? And thankfully my my team was like, okay, we're going to block like you tell us what times you want to block and we'll block it.

00;13;20;14 - 00;13;41;21
Yara  Mikhaeil-Demo, M.D.
And I wasn't asked or expected to like make up the time or, or place anything like that. I've heard stories of clinicians being asked to stay extra later or come earlier to make up for the time that they blocked in clinic, which I think is just too much to add to a new parent. so I think this has been really helpful.

00;13;41;22 - 00;13;59;18
Yara  Mikhaeil-Demo, M.D.
I've heard a lot of women now being empowered to really ask for what they need when they come back. Whether it is, like Michelle was saying, graduated duties and you're not, you know, on call your first week in back or you're not on a full panel your first week back. but more and more parents are actually becoming more empowered to ask for what they need to make it work.

00;13;59;21 - 00;14;27;22
Michelle Yu
And I would say there's a lot of organizations outside of health care that I think health systems can learn from in terms of small and actually low hanging fruit, ways to support working parents that don't require significant amounts of investment. One of those things, like I said earlier, we just work with a company, a financial services company, in training their managers on just understanding what are some of the challenges new parents go through when they have a new baby.

00;14;27;25 - 00;14;52;29
Michelle Yu
What are some biases to watch out for. What are some things you can say to show your support. And what are some things maybe you shouldn't say. to someone who may be going through that. That was something that they had. Once they can record it, they can share it with others in the organization. And it's small things like that that I think really signal that you care and that you really want to see a cultural shift.

00;14;53;02 - 00;15;15;02
Michelle Yu
My husband actually works for a bio-tech company, here out in D.C., and they actually have parking spots, for pregnant women, that are a little bit closer to the building, to support them. They also have an on care daycare facility that is has just been such a lifesaver for so many of the team members there.

00;15;15;02 - 00;15;28;01
Julia Resnick
Much like working moms, health care organizations have lots of priorities to juggle. So Michelle and Yara each offered a simple action hospitals can take to change the culture to better support new parents.

00;15;28;03 - 00;15;49;23
Yara  Mikhaeil-Demo, M.D.
I think having a committee of parents to brainstorm ideas that are relevant to that organization would be helpful because I think every organization is unique and different, and academic is different than private practice and different than community practice. But having that be part of their mission, like we're going to include parents, we are going to have a committee, their voice will be heard.

00;15;49;26 - 00;15;51;21
Yara  Mikhaeil-Demo, M.D.
I think that will be helpful.

00;15;51;23 - 00;16;17;02
Michelle Yu
This is really hard to pick one thing, but if I had to choose one thing, I think it would go back to that supervisor manager training component and being able to support them and equip them with understanding how to be more empathetic to this population and how to show your support for this population, how to get creative and solutioning with this population.

00;16;17;02 - 00;16;33;29
Michelle Yu
How to navigate all the tricky scenarios that come with it is one thing that I think a lot of health systems, who probably already invest in a lot of training, to just leverage what you already have and do something in this particular area.

00;16;34;01 - 00;16;55;22
Julia Resnick
A big thank you to Michelle Yu and Yara Mikhaeil-Demo for sharing your expertise and passion for supporting working moms. Your work is paving the way for future moms and parents in health care. We appreciate your dedication to making it better for everyone. This is our last episode of Beyond Birth, but don't worry, we'll continue to cover important topics in maternal health.

00;16;55;25 - 00;17;13;06
Julia Resnick
You can listen to all of our previous Beyond Birth podcasts on the Advancing Health Channel wherever you get your podcasts. And for more resources on maternal health visit www.aha.org/betterhhealth formothersandbabies.

00;17;13;08 - 00;17;21;19
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;28 - 00;00;27;14
Tom Haederle
Ask any hospital leader to name the biggest challenges facing their organization, and their answers are pretty much the same, regardless of size. But for rural care providers, the workforce and financial issues found everywhere are harder to solve, and they're looking to their boards of trustees for help.

00;00;27;17 - 00;00;49;21
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Join us for this brief but on-point discussion of the role board members can play in helping their hospitals and health systems navigate today's pressing problems, and how the AHA's resources and educational materials can assist board members in turn.

00;00;49;23 - 00;01;12;28
Sue-Ellen Wagner
I'm Sue Ellen Wagner, vice president of trustee engagement and strategy for the American Hospital Association. I'm here at the AHA Rural Conference in Orlando, Florida with Barbara Sowada, who's the president of the board of trustees for Memorial Hospital of Sweetwater County in Rock Springs, Wyoming. Barbara, thank you for joining me today.

00;01;13;00 - 00;01;16;14
Barbara Sowada, Ph.D.
Thank you for inviting me. It's a pleasure to be here.

00;01;16;16 - 00;01;23;02
Sue-Ellen Wagner
Barbara, can you highlight the top three challenges that rural hospital boards are experiencing?

00;01;23;05 - 00;01;58;16
Barbara Sowada, Ph.D.
Obviously, workforce stability, including physician recruitment. That is difficult in rural areas. The financial challenges Medicare and Medicaid do not cover the cost of care right now. And then the commercials are, what should I say,  providing their own challenges with pre-authorization and denials. The other part with the commercials is we're just starting to experience in Wyoming narrow networks through Medicare Advantage.

00;01;58;18 - 00;02;18;00
Sue-Ellen Wagner
Thank you for citing those challenges that we've heard at the conference a lot about the financial and the workforce challenges. So given the challenges that you just talked about, rural hospitals do serve a tremendous value to their communities, and trustees represent these communities. So can you expand a little bit more on that?

00;02;18;02 - 00;02;49;06
Barbara Sowada, Ph.D.
Yeah, the challenges, as you know, the no mission, no margin or no margin, no mission. One of the tricks anymore is to find that balance between what is affordable and what are the community's needs. One of the things that I forgot to mention, but is a challenge nationwide, is behavioral health. And again, in rural areas that I don't know whether it's worse in some areas of the country

00;02;49;06 - 00;02;57;03
Barbara Sowada, Ph.D.
yes, mental health is more challenging than in the urban areas. And again, it's a dearth of resources.

00;02;57;05 - 00;03;15;00
Sue-Ellen Wagner
Absolutely. Yeah. We hear a lot about the behavioral health challenges. My colleague Rebecca Chickey spearheads the behavioral health issues for AHA And we do a lot of collaboration with her. So what can AHA trustee services do to help boards, specifically the rural boards?

00;03;15;02 - 00;03;46;01
Barbara Sowada, Ph.D.
I think the things that you are doing right now, the continuing education...the newsletters...you have a fabulous webinar archival board, the education is fabulous. What was really fun today, is one of the AHA - and I cannot remember her name - employees is working with our hospital to become critical access. So your resources are widespread and greatly appreciated.

00;03;46;07 - 00;04;11;11
Sue-Ellen Wagner
Oh that's good to hear. We aim to help our members. Our website is trustees with an "S" trustees.aha.org. As Barbara mentioned, we do have a wealth of information, including some boardroom briefs, which are 2 or 3 pagers, which also includes some questions that board members can ask about specific issues. We do have a brief on behavioral health, so I encourage folks to listen to that.

00;04;11;14 - 00;04;25;27
Sue-Ellen Wagner
As Barbara mentioned, we do have some great recorded webinars on quality and some other issues. Anything else you want to talk about, Barbara? Maybe something at the rural conference that you learned about or heard about that could be helpful to our listeners?

00;04;25;29 - 00;05;01;19
Barbara Sowada, Ph.D.
One of the things that really delighted me and surprised me are there are several presentations on, I would say, building relationships, having more civil conversations, the need to repair community relationships, sometimes even relationships within an organization. That is part of the focus of this week's conference is truly delightful, and I actually encourage you to do more of that, whether it's written or webinars or what have you, because that communication is just key.

00;05;01;22 - 00;05;11;09
Sue-Ellen Wagner
Well, for folks who weren't able to join us at the conference, hopefully they'll visit our website and utilize some of our podcast and webinars. Thank you for being with us today, Barbara.

00;05;11;11 - 00;05;15;09
Barbara Sowada, Ph.D.
Oh, thank you, Sue Ellen. This is delightful and I love the conference.

00;05;15;12 - 00;05;17;24
Sue-Ellen Wagner
Great. Thank you.

00;05;17;26 - 00;05;26;06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;26 - 00;00;39;09
Tom Haederle
Despite the fact that half of all mental health issues begin before age 14, most parents don't talk to their kids about this growing public health issue. It isn't easy, and many well-intentioned parents don't quite know how to do it or where to start. As we observe May as Mental Health Awareness Month, and this week as Children's Mental Health Week, Florida-based AdventHealth for Children has created a suite of tools and resources to help parents and their kids open the door to these difficult but necessary conversations.

00;00;39;11 - 00;01;02;09
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. During and since the pandemic, AdventHealth for Children has noted an alarming rise in the number of children coming into the E.R. with mental health issues. In response, it has created "Be a Mindleader," a preventive campaign targeted to parents who have kids ages 8 to 12.

00;01;02;12 - 00;01;29;02
Tom Haederle
The goal of the Be a Mindleader campaign is to get curated, expert information into the hands of kids, parents, caregivers, coaches, mentors, and teachers and help facilitate life changing conversations about mental health issues between children, teens and the adults in their lives. In this podcast hosted by Jordan Steiger, senior program manager of Clinical Affairs and Workforce with AHA; she is joined by two experts to explore how the Be a Mindleader

00;01;29;02 - 00;01;43;15
Tom Haederle
campaign is leading the way to improving adolescent mental health. Jaeann Ashton is marketing director for Women's and Children's with AdventHealth. And Jessica Galo is director of Specialty Care with AdventHealth for Children.

00;01;43;17 - 00;02;05;12
Jordan Steiger
Jaeann and Jessica, thank you so much for joining us today at the AHA to tell us more about your work at AdventHealth for Children. We know that it is Mental Health Month, and we also know that is Children's Mental Health Week. So we'd really like to shed some light on the great work that our members are doing around helping kids and their families, you know, be the mentally healthiest that they can be.

00;02;05;12 - 00;02;07;00
Jordan Steiger
So thank you for being here.

00;02;07;02 - 00;02;08;19
Jaeann Ashton
Thank you so much for being here.

00;02;08;22 - 00;02;15;14
Jordan Steiger
So as we get started, tell our listeners a little bit more about AdventHealth for children and the community that you serve.

00;02;15;17 - 00;02;42;03
Jessica Galo
Absolutely. AdventHealth is a nationwide health system. We have over 52 hospitals across nine states, and we care for about 7 million patients a year. We have about 90,000 team members throughout the system. And our headquarters and the Children's Hospital AdventHealth for Children are located in Orlando, Florida. We've been a part of the Central Florida community for over 100 years, since 1908.

00;02;42;05 - 00;03;07;16
Jessica Galo
We are a faith-based, not-for-profit with a mission to extend the healing ministry of Christ and deliver whole person care. And we serve a very diverse community here in Central Florida with lots of families that have young children. Our children's hospital is a nationally recognized children's hospital, and has a network of pediatric care facilities. And we have over 250 pediatricians and specialists throughout central Florida.

00;03;07;18 - 00;03;30;16
Jordan Steiger
Wow, Jessica. Thank you. I'm sure a lot of our members can, you know, hear parts of themselves in their own systems, in hospitals in the description that you just gave. So I think that really sets the stage nicely for the work that you're doing. So, Jaeann, you know, we know that at AdventHealth, you've been really focused on developing new programs and ways to connect with the community around the mental health of the children that you serve.

00;03;30;18 - 00;03;35;19
Jordan Steiger
So what inspired you to implement this new program that you have called Be a Mindleader?

00;03;35;21 - 00;03;57;10
Jaeann Ashton
Well, we were seeing an alarming number of kids and teens coming to our E.R. with mental health issues. We were seeing anxiety, depression, self-harm, suicidal ideation, and we knew we need to do something about it, like Jessica just  mentioned. We are all about whole person care. And that includes not just your physical health, but your mental health as well.

00;03;57;13 - 00;04;18;06
Jaeann Ashton
We know that half of all mental health illnesses begin before the age of 14. And so this campaign is really targeted to parents who have kids ages 8 to 12. We're trying to be preventative. We're trying to stop the problem before it happens. And we know that most parents don't talk to their kids about mental health. I grew up not talking with my parents about mental health.

00;04;18;06 - 00;04;30;16
Jaeann Ashton
So as a parent now, it's not something that I'm really well equipped to do. And so these resources and tools are meant to help those parents have those conversations so that the epidemic doesn't continue.

00;04;30;18 - 00;04;48;07
Jordan Steiger
I think you bring up a really good point that, there's been some cultural shifts in the way we talk about mental health. And, you know, even from when I was, a child, we didn't talk about mental health in the same way as kids want to do now and are more open to doing now. So I think it's great that you're kind of seeing that change and adapting to it.

00;04;48;10 - 00;04;53;07
Jordan Steiger
I'm sure people are wondering, what is a mind leader and where did you come up with that phrase?

00;04;53;10 - 00;05;14;00
Jaeann Ashton
Yeah, a mind leader is someone who speaks up. They talk about that they're having a bad day or that that something happened, or they just don't feel right. And they also make it safe for other people to speak up about it, too. You know, I mentioned that our target audience is that younger population. And so "MindLeader" is a play off of line leader.

00;05;14;00 - 00;05;22;27
Jaeann Ashton
So, a lot of kids want to be the line leader at school, or on the playground. And so that was the initial inspiration for the word.

00;05;22;29 - 00;05;35;29
Jordan Steiger
I love that. I think that is such a patient-focused way to kind of approach this and make it understandable for an 8 to 12 year old, you know, to say, I do want to be at the front of the line. I do want to be the one talking about mental health. And I just think that's so creative.

00;05;36;01 - 00;05;46;06
Jordan Steiger
I know that this is an initiative that takes, you know, a lot of different people from across your hospital to make happen. So tell us a little bit about who is involved in making it work.

00;05;46;09 - 00;06;13;00
Jessica Galo
We obviously have to have our clinicians involved, our experts. So we have teams of psychiatrists, psychologists, licensed social workers and nurses. We have mental health care coordinators and mental health navigators, that are all a part of the program. So really, we lean into our clinical expertise, of course. But then also what was really important was having our hospital administrators and our hospital leaders be supportive.

00;06;13;05 - 00;06;44;03
Jessica Galo
And we collaborate really closely with our marketing team, our communications, social media and internal and external agencies to create the campaign. We relied on local news and radio stations who provided in-kind and pro-bono support for this initiative, and we recruited our mental health ambassadors who are community members, who have seen some of our marketing, campaign or social media posts and have actually reached out to us and said, hey, we want to be a part of this.

00;06;44;10 - 00;07;03;20
Jessica Galo
And so we record those posts with them and allow them to speak their mind and speak about what inspires them to be mind leaders and encourages other people to join us as well. And then, of course, we couldn't do it without our community partners. We received some grant funding from a local charity, the Doctor Phillips Charity.

00;07;03;22 - 00;07;25;05
Jessica Galo
United Way is a really big partner with us in this as well. And we have an advisory board full of our government stakeholders and our local stakeholders. Our other hospital systems in the area, who all provide input and guidance to us on what we should be doing with the campaign and our mental health programing.

00;07;25;07 - 00;07;50;02
Jordan Steiger
I love what you've done with this program because it's not just a hospital program. I mean, obviously your clinicians and administrators and leaders have a huge role in this, but you've really taken, I think, the best from your community and come together and said, this is a problem that we need to all work together to solve. So I think that other, you know, hospital leaders listening to this can maybe get some inspiration from you about how to work with others in their community.

00;07;50;02 - 00;08;08;10
Jordan Steiger
That's really, really great to hear. One thing though, we know about, you know, talking about mental health, that there's a lot of stigma sometimes. We talked about that a little bit already, just with families maybe not knowing how to start those conversations. How do you think this initiative has helped make those conversations a little easier?

00;08;08;13 - 00;08;27;25
Jaeann Ashton
Well, we've had a tremendous response since launching a year ago. We have had people reach out to us via social media. We've had employees reach out to us when they've seen us. Parents as well as kids saying, oh my gosh, I love what you're doing. I want to be a part of it. And so Jessica mentioned our ambassadors earlier.

00;08;28;02 - 00;08;59;27
Jaeann Ashton
Those have all been grown organically by kiddos or their parents reaching out to us and saying, I struggled with this and I want to help other people. So we know just from that that it's resonating. But we actually just conducted a research study. Since we're at our one year, we wanted to see how the launch went and what the data showed was that people were more likely to start conversations with their children and with their families about mental health after seeing the message, after reading about it, hearing about it, following us on social.

00;09;00;06 - 00;09;16;07
Jaeann Ashton
So we know that it's working. This is a long term effort. This is not a short term effort, right? We know that this isn't all going to be fixed overnight. So we're in this for the long haul. Our partners are in this for the long haul which we're really excited about. We're also seeing patients to our practice.

00;09;16;07 - 00;09;33;06
Jaeann Ashton
You know the campaign is not really meant to drive volume to our practice, but we're seeing people reach out and get the help that they need if they need it. So all of those things working together just make us thrilled to know that we're moving in the right direction.

00;09;33;08 - 00;09;55;17
Jordan Steiger
It really sounds like it. It sounds like you've made a lot of headway just in one year, you know, getting people into care if they need it or helping people avoid care if they don't, you know? So I think that that is just a fantastic outcome. Jessica, you mentioned working with community partners and you mentioned, like, the heart of Florida United Way and a few other people, maybe that you got some funding from for this, this project.

00;09;55;17 - 00;10;01;03
Jordan Steiger
And I'm wondering how working with community partners has really helped to move this program forward.

00;10;01;05 - 00;10;24;01
Jessica Galo
Yeah. So the community relationships are a key component of what we are doing. When we first started thinking about what we wanted our mental health program to look like, we took a survey and really looked into what was already existing in the community. And, you know, there were already some crisis centers and some intensive care programs that were already out there and available.

00;10;24;01 - 00;10;52;11
Jessica Galo
And we realized that obviously, there's always a need for more of those programs. But you know what really aligned with our mission and our vision of providing that whole person care is really focusing on that preventative and that early intervention phasing. So that's why we work with our local school systems and our early learning centers, and why it was really important for us to get that feedback from those key stakeholders that are in kids lives.

00;10;52;14 - 00;11;15;02
Jessica Galo
Also, at the same time, we were creating our programing in our campaign, the United Way and our local county had conducted a need survey to determine what the needs around mental health were. And, it was determined that reducing stigma was a very important component for our community. And that's where the United Way really, got involved.

00;11;15;05 - 00;11;46;14
Jessica Galo
They partnered with us. So we launched our children's focused initiative first. But now we're working with them on the trans-creation of the stigma reduction campaign into Spanish and eventually into Haitian Creole. So they identified that those communities were underserved and there were gaps in mental health services. And, you know, since they're already a frontline partner, answering our hotline calls, the 211 and 988, and they're well respected and well known

00;11;46;16 - 00;11;50;06
Jessica Galo
in our community. It just really made sense for us to work with them.

00;11;50;08 - 00;12;08;29
Jordan Steiger
That makes a lot of sense. And I think, you know, bringing in the strengths of those other organizations and saying, here is an underserved population. Here's what we can do to help serve them better, I think is something so powerful. I love that you're turning your content into different languages that represent the people in your community. So I think that's really cool to hear.

00;12;09;01 - 00;12;27;08
Jordan Steiger
I'm wondering, I know, Jaeann, you talked a little bit about some of the positive outcomes that you've seen from surveys and, you know, your data and everything from the first year, but do you have maybe a positive patient or family story that you could share with us, or any other kind of things that demonstrate how positive this has been for the community?

00;12;27;10 - 00;12;53;21
Jaeann Ashton
We have lots of stories. We have had parents who struggled to know what to do for their child. They knew something was wrong, but they didn't know what. And they found us. And they found our physicians and our therapists and were able to turn the situation around. One girl that I'm thinking of, I mean, she was sleeping over 14 hours a day.

00;12;53;22 - 00;13;17;03
Jaeann Ashton
She wasn't eating, and she didn't know what was wrong. There wasn't something physically wrong, but there was obviously something mentally wrong. And so her mom was just...was struggling to know how to help her. And the transformation that she has had, it's truly life changing. She's in a completely different space now. She's back at school and she's thriving.

00;13;17;03 - 00;13;38;08
Jaeann Ashton
And so those stories just, like, warm your heart. But we've heard that in lots of different scenarios, in lots of different ways. And not everybody needs clinical care. Sometimes it's just they need to talk to somebody, or they just they just need to be heard. And so there's sometimes extremes where there is that clinical care needed, but not always.

00;13;38;10 - 00;13;48;14
Jaeann Ashton
And that's the beauty of this program is that there are lots of different options and different ways for people to get help if they even need help. Sometimes it's just as simple as having a conversation.

00;13;48;17 - 00;14;06;27
Jordan Steiger
Exactly. And I think that's why this program is so powerful, because it really reaches every child in whatever phase they're in, kind of, with their mental health. So I think you've done some really incredible work that others can really learn from. If somebody wants to learn more about Be a Mindleader, is there a place that they can go to get more information?

00;14;07;00 - 00;14;32;11
Jaeann Ashton
Absolutely. www.BeAMindleader.com is our website. As Jessica mentioned, we will have a Spanish version later this month very soon. But BeAMindleader.com has a lot of resources that are downloadable. Whether it's conversation starters, there's also blogs, there's videos. You can connect with our mental health navigator there. There is also social channels. So hashtag be a mind leader.

00;14;32;13 - 00;14;36;19
Jaeann Ashton
And we have Facebook, YouTube and Instagram where we're posting content daily.

00;14;36;22 - 00;14;42;29
Jordan Steiger
Awesome. I'm sure you will get some new visitors after listening to this podcast on your social channels and website.

00;14;43;01 - 00;14;59;23
Jaeann Ashton
We welcome that and people have also reached out about how to do this. How did you partner? Where did you start? And so we're happy to help. We think that mental health is so important and not just in our community. We know it's resonating everywhere. And so we're happy to help.

00;14;59;25 - 00;15;16;19
Jordan Steiger
I'm sure people will be very appreciative of that. And I'm sure you will be getting some outreach, from other members of AHA. So thank you so much to both of you for spending time with us today, sharing a little bit more about your work. And thank you for the work that you do for all of the children in your community.

00;15;16;21 - 00;15;23;14
Jessica Galo
Thank you so much. Thank you for having us. And thank you for putting a spotlight on mental health and Be a Mindleader.

00;15;23;16 - 00;15;31;28
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;24 - 00;00;21;29
Tom Haederle
There are a host of medical and or psychological issues that can come with pregnancy and giving birth. For most new or expecting moms who may need some extra help, standard perinatal treatment programs will usually fit the bill. But not for everyone. An often overlooked aspect of pregnancy and motherhood is that some new mothers do better with intensive outpatient perinatal care,

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

00;00;34;00 - 00;01;04;09
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Illinois based Ascension Alexian Brothers Behavioral Health Hospital is among a small number of caregivers who specialize in providing intensive outpatient perinatal care. They create unique treatment programs for patients, which could include medication management, sleep therapy, substance abuse issues, family counseling, and strategies to deal with a host of other issues that new moms may be struggling with.

00;01;04;12 - 00;01;26;20
Tom Haederle
In this podcast, Rebecca Chickey, senior director of Behavioral Health with AHA, speaks with two behavioral health experts associated with the Ascension Alexian Brothers Behavioral Health Hospital program, who share its formula for success. Doctor Xiaohong Yu is medical service director for the Perinatal Intensive Outpatient program, and Kimberly McCue is its clinical coordinator.

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

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

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

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

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

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

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

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

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

00;05;23;05 - 00;05;42;27
Kimberly McCue
The two members of our team that really make things work are our perinatal mental health nurses. Each of them worked in labor and delivery for over 25 years. They had a full career in labor and delivery, and they came to us with all of that knowledge, all of that training, all of that certification. And then they went the extra mile

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

00;06;06;19 - 00;06;08;25
Kimberly McCue
I'll let you, Dr. Yu, jump in.

00;06;08;28 - 00;06;40;09
Xiaohong Yu, M.D.
Thank you Kim. And thank you, Rebecca. It's my honor to be here today. Yeah I agree with Kim that our program is staffed by multiple disciplinary team. Including psychologists like me and also psychologists, social workers and nurses and, other mental professionals, including like chaplain, specialist and also a nutritionist. We also have lactation consultant to work together.

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

00;07;18;06 - 00;07;48;21
Rebecca Chickey
That's exceptional. So just to summarize, I think I heard a couple of key words. One, multidisciplinary treatment team. Two, meeting the patient or individual where they are. Three, it's not just treating that individual. It's treating the family, the infant, the settings. Bringing in and addressing the perhaps unique challenges of, home life that often impact the mental well-being of all of us.

00;07;48;22 - 00;07;50;06
Rebecca Chickey
Would that be correct?

00;07;50;09 - 00;08;14;24
Kimberly McCue
Absolutely. That's correct. one of the most important parts of our treatment is to treat the entire family, to treat the the dynamic between mother and baby, mother and her partner. Oftentimes there's other children, so incorporated with our treatment we do family sessions. We have to support partners. We have to support whoever the system is that helps mom out.

00;08;14;24 - 00;08;32;29
Kimberly McCue
And oftentimes that might be her mom, a mother in law, a sister. We bring everyone into the treatment, and we have found over the years that that helps get mom back to her baseline quicker. It helps her to feel surrounded and supported in ways that she's just not asking for help.

00;08;33;01 - 00;08;48;20
Rebecca Chickey
That's wonderful. So let me back up a bit. Please share with me your journey to create this program. What were the first couple of steps? Was hospital or health system leadership involved? How did you get it off the ground?

00;08;48;22 - 00;09;24;27
Xiaohong Yu, M.D.
My journey and interest in helping create this program actually started in May 2015. It's around my birthday, actually. One of our leading psychologists - his name is Dr. Saper - he introduced me to one of the coordinators, Mrs. Lita Samanas, who is also coordinator for, Postpartum Support International. It's the organization for, you know, support in guiding women and families through the pregnancy and postpartum mental health conditions.

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

00;09;53;21 - 00;10;17;00
Xiaohong Yu, M.D.
And then we came with, very, very great group, including Dr. Kim McCreary. And the nurses. So far, it's been great, rewarding experience to help women with mental health issues during the perinatal period.

00;10;17;02 - 00;10;46;05
Kimberly McCue
It's a great question, Rebecca. It was quite a journey. Our goals were to build on the great programing at Alexian Behavioral Health Hospital. There's a number of specialized programs there. Women were being screened during pregnancy and postpartum, and they were being referred to more general adult IOP programing. The feedback was it's good treatment, but I feel like a fish out of water because my needs are so different than the rest of the patient population.

00;10;46;08 - 00;11;13;04
Kimberly McCue
And so to Dr. Yu's point,  Samanas - who has been in the perinatal field for years - had asked the administration if this is something that we can start looking at. The administration at Alexian and the rest of our leadership was incredibly supportive, and they sort of put us out on a mission to see what are the unique needs of this population.

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

00;11;35;09 - 00;12;08;09
Kimberly McCue
So we were looking to see how we can overcome the barriers that moms face, including very simple things like parking, bringing baby with them, strollers, car seats, diaper bags, all of these things. And how do we create a space in the hospital that allows moms to be comfortable with their babies and still receiving mental health? And we've always taken the approach of and, and we literally meet almost daily during, you know, program time:

00;12;08;12 - 00;12;13;26
Kimberly McCue
What worked for us, what do we need to change? And that has been consistent for the last eight years.

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

00;12;43;03 - 00;12;50;17
Rebecca Chickey
We all know, we're continually challenged. So how are you able to support and sustain these kinds of programs?

00;12;50;19 - 00;13;17;20
Kimberly McCue
Ascension Illinois maintains one of the largest and most comprehensive behavioral health services in the Midwest. And we're just very thankful to receive philanthropic support for our services and have worked hard to ensure that our patients have access to the very best care. And, you know, Doctor, you had mentioned the pandemic. We had to switch to telehealth medicine. That was meeting the needs of our moms during the most difficult time bringing the therapy into their homes.

00;13;17;22 - 00;13;40;12
Kimberly McCue
And then when we returned back to in-person, you know, we're back in the hospital, but now we have both. We continue to have a virtual version of our program so that we could treat moms across the entire state of Illinois. But we're also able to overcome some barriers that moms might have to coming in person, like they have older children, they don't have transportation.

00;13;40;15 - 00;13;54;24
Kimberly McCue
Some of these moms that we're treating are in a sandwich generation where they're also caring for a parent. So we are meeting all of their needs. We are just trying to overcome any barriers that a mom would have to treatment.

00;13;54;26 - 00;14;20;26
Rebecca Chickey
Well, it's interesting you bring up philanthropy. I've been in the field of behavioral health now since the mid-80s, dare I admit. And I would say in the 80s and the 90s that wasn't something that you often saw foundations or individual families giving to. Specifically to mental health, psychiatric or substance use disorder programs. But that has changed.

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

00;15;05;04 - 00;15;22;04
Rebecca Chickey
I'm a little biased, but definitely to the better. So I'm going to shift this just a little bit, looking at time. If you had to pick, could you name maybe two key elements? I've heard a couple, funding, leadership support, but maybe beyond that.

00;15;22;07 - 00;15;50;10
Kimberly McCue
I would have to say, focusing on the unique needs of the population. From how the space is created that they program in, making sure that literally, the room itself is meeting the needs of the moms. So, having all the baby supplies, having, you know, the seating, the lighting, everything, to meet the unique needs of having babies in the milieu.

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

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

00;16;36;13 - 00;17;07;29
Xiaohong Yu, M.D.
Sometimes we use our extra time. You know, even after work, we text each other, provide service for the patient. When patient is imagined situation, we're able to provide service for them as well. So, yeah, that's very key for our team. And, another thing is, you know, I just want to say there is a door open from our team, from our perinatal IOP program.

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

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

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

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

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

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

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

00:00:00:21 - 00:00:29:04
Tom Haederle
Health equity - the drive to eliminate disparities in health and health outcomes, regardless of ZIP code - is a major goal across the U.S. health care system today. That's why hospitals and health systems are paying more attention than ever to tackling the social determinants of health that play such a large role in individual and community health outcomes.

00:00:29:06 - 00:01:03:05
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this month's Leadership Dialog series podcast, Dr. Joanne Conroy, CEO and president of Dartmouth Health and the 2024 Board Chair of the American Hospital Association, explores with Lynn Todman, vice president of health equity and community partnerships with Corewell Health in Michigan, how care providers can work with partners to reach out to community members and reinforce strong health habits such as scheduling screenings and making doctor's appointments, among others.

00:01:03:08 - 00:01:18:09
Tom Haederle
As Todman notes, fantastic clinical work is great, but at the end of the day, people go home to their neighborhoods and that's where they spend most of their time. As she says, we have to make sure those environments support the wonderful clinical outcomes we're trying to generate.

00:01:18:11 - 00:01:43:04
Joanne M. Conroy, M.D.
I'm Joanne Conroy, CEO and president of Dartmouth Health, and I'm currently the chair of the American Hospital Association Board. I'm really looking forward to our conversation today as we talk about health equity. It is an imperative for hospitals and health systems to fully commit to not only building a diverse workforce, but to actually create a culture that promotes equitable care for all.

00:01:43:06 - 00:02:17:15
Joanne M. Conroy, M.D.
Hospitals and health systems have an important role in creating a culture that confronts disparities in health outcomes, by addressing the social and political drivers that can hinder an individual's ability to access or achieve optimal health. We know that these are issues that cross all geographies, although they're usually exacerbated in rural communities. At Dartmouth Health, we firmly believe that the diversity of our patients, people, and communities show our strength.

00:02:17:18 - 00:02:55:24
Joanne M. Conroy, M.D.
And it's something we're actively working towards to support and celebrate. And nationally, the American Hospital Association is certainly active through the Institute of Diversity and Health Equity in helping hospitals and health systems make impactful and sustainable change that increase equity and inclusion, and will build community partnerships that will improve access to equitable care. You know, I often say that some of these complex problems are so difficult, no one institution, no matter how well resourced or how well organized, can solve them alone.

00:02:55:24 - 00:03:26:09
Joanne M. Conroy, M.D.
And we absolutely we need our community partners. That's why I am thrilled to have as a guest today, Dr. Lynn Todman. Dr. Todman is vice president of health equity and community partnerships at Corewell Health. Corewell Health is an integrated nonprofit health system that's headquartered in Michigan, with a team of more than 65,000 dedicated professionals caring for patients at 21 hospitals and more than 300 outpatient and post-acute care facilities.

00:03:26:12 - 00:03:57:20
Joanne M. Conroy, M.D.
We're lucky to have Dr. Todman with us, as she's able to draw from many interdisciplinary as well as professional perspectives in her role. She has a background in urban planning, and has spent her career committed to addressing the needs of marginalized and disadvantaged communities, working to address the social and underlying structural determinants of health and wellness. So, Lynn, I'm sure I missed a lot, but I really want to kind of jump into our discussion.

00:03:57:25 - 00:04:12:03
Joanne M. Conroy, M.D.
And the first question is, tell us a little bit about yourself. How did you get to Corewell Health and how did you find your passion in diversity, equity and community partnerships?

00:04:12:06 - 00:04:36:22
Lynn Todman
Thank you, Joanne, for that. A little bit about myself. So I was born and raised in Chicago and come from a family...my father was a physician, and grew up in a setting where I was able to see disparate experiences every day. I went to a school on the north side of the city, but I lived on the south side of the city because of the segregation in the city.

00:04:36:25 - 00:05:11:20
Lynn Todman
It was apparent to me from a very young age that different groups had different access to quality housing and food and education. So my interest in this goes back to my childhood. And yes, I am an urban planner by training. My work has historically been in the field of community development. And so for a few decades I did work on education, public safety, housing, the natural environment, all those things that today we call the social determinants of health.

00:05:11:22 - 00:05:34:02
Lynn Todman
And how I got to this space? Probably in the mid early 2000s, 2003 or so, I went to work with the group of mental health professionals in Chicago. And my role there as a social scientist was to help the clinicians and mental health professionals understand this notion that emotional health and well-being is constructed by what we have to navigate every day.

00:05:34:05 - 00:05:56:06
Lynn Todman
It's socially constructed, in other words. And so that, you know, their role wasn't simply to make a person feel better about being poor, but actually do something about their poverty. So I spent about eight and a half years doing that with mental health professionals. And then in about 2014, I came into health care to do that with clinicians in the hospital setting.

00:05:56:06 - 00:06:11:24
Lynn Todman
So that's what I do - is to round out our collective understanding on what drives health with a more robust appreciation for these social factors that play a role in shaping health outcomes, including health inequities.

00:06:11:27 - 00:06:41:01
Joanne M. Conroy, M.D.
That is really fascinating. The dean of the School of Public Health at Boston University used to talk about what poverty does to an individual. It creates almost an inability sometimes to focus affects their judgment, because when you're worried about do you pay your rent or do you pay for food, there are some incredibly difficult decisions that when people are living in poverty, they're having to deal with.

00:06:41:01 - 00:07:12:19
Joanne M. Conroy, M.D.
And we don't always appreciate the behavioral health impact of people that are constantly making those decisions. Yes. So let's shift and talk a little bit about your role at Corewell. Health equity and community partnerships. That seems like a lot of landscape to cover. So talk a little bit about the, you know, the relation between those two areas because they are different, but they do share a lot of the same real estate.

00:07:12:21 - 00:07:40:06
Lynn Todman
Yeah. So I think certainly in public health historically for, you know, probably 100 years now, we've understood that a lot of what determines our health outcomes has to do with the environment we're in every day. And in the last 15 or 20 years, that way of thinking has found its way into health care. So we know we can do fantastic clinical work and generate really wonderful clinical outcomes.

00:07:40:08 - 00:08:10:02
Lynn Todman
But people go home, they go back to their neighborhoods, they go back to their houses, they go back to the places of worship or work or school. And that's where they spend most of their time. And so we have to make sure that those environments support the wonderful clinical outcomes that we're trying to generate, and that these environments enable people to adhere to medical advice, or guidance and suggestions around eating or exercising or stress reduction, whatever.

00:08:10:05 - 00:08:39:03
Lynn Todman
So we don't have the levers for that in health care. But our community partners do. They know where the landmines are. They know who the key stakeholders are. They know the agendas. They're much more able to navigate that space than we are sitting inside the health care system. So in order to sustain clinical improvements, if we close, disparity gaps need to sustain the closure of those gaps.

00:08:39:06 - 00:08:57:26
Lynn Todman
We have to make sure that the communities that people go back to, you know, that are health promoting and health sustaining. We can't do that as health care. We have to work with people in the community settings to actually create those environments to sustain the great clinical outcomes that we're working to achieve in health care. So that's essentially it.

00:08:57:29 - 00:09:03:20
Lynn Todman
You know, we have to have those partnerships to do the work that we're actually not equipped to do ourselves.

00:09:03:22 - 00:09:26:27
Joanne M. Conroy, M.D.
You know, it is interesting, though, that at some level, some leaders and organizations think we do have all the answers. And I had a really great conversation with somebody that ran a homeless shelter here, a really big one. And she said, you guys don't understand homelessness. You just don't understand it. She goes, we do homelessness. She said, you need to work with us.

00:09:26:28 - 00:09:58:12
Joanne M. Conroy, M.D.
And I'm like, oh yeah, she's actually was so correct because we think we know. But unless you're really living in the environment and understanding the issues that your clients are facing every single day, you don't really get it. So talk a little bit more about community stakeholders, like how do you draw them in? Because every health system probably enters into some of these conversations with the "we have the solution for you."

00:09:58:16 - 00:10:07:27
Joanne M. Conroy, M.D.
It's like the IRS, we're here to help you. And and sometimes we're not very helpful! How do you create those partnerships that are really productive?

00:10:07:29 - 00:10:36:08
Lynn Todman
Yeah. So it takes a long time. Because there's a lot of trust building that has to happen to developing meaningful, authentic and productive relationships. The other thing that has to happen that's a little bit difficult for large organizations is there needs to be a shift in the balance of power. and so as a large organization, we have lots of people, we have lots of resources.

00:10:36:10 - 00:11:04:16
Lynn Todman
There's financial resources, human resources. And we have to be very careful as we engage with organizations that don't have the people that don't have the resources. Because we're not going to get the best out of those relationships if people feel...the word that comes to mind is overwhelmed. But it's not so much overwhelmed but overpowered in the relationship and feel that their voice isn't going to hold as much weight and much gravitas as the organization's.

00:11:04:16 - 00:11:32:03
Lynn Todman
So I would say, if you ask me how you do it: One is really work hard to be trustworthy, like earn the trust of community partners and then kind of check our power and recognize that we're often the biggest employer, we have the most resources, and we have to be very self-aware when we engage in these relationships. Because it's very easy to put ourselves in a position where the two stakeholders don't want to work with us.

00:11:32:05 - 00:11:49:22
Joanne M. Conroy, M.D.
Go into detail and describe maybe one of the partnerships that actually, had a real impact on health equity. So you can change the names to protect the innocent. But talk about something that you would consider real success.

00:11:49:24 - 00:12:09:20
Lynn Todman
When I first started doing the work with the health care system, I wanted to work with the local barbershops in town in a low wealth African-American community for a number of reasons. Men are late to get care. They don't answer the questions in our community health needs assessment. I really didn't know, kind of like where their heads were.

00:12:09:20 - 00:12:31:09
Lynn Todman
So I wanted to work with local barbershops. As an African-American, I went into this barbershop thinking, oh, I'm going to be trusted. They're going to, you know, they're going to embrace me and we're going to have this wonderful partnership. And it didn't turn out that way. And in fact, the barber and the owner said that he was risking his reputation just talking to me because I represented the health care system.

00:12:31:11 - 00:12:57:12
Lynn Todman
So then I had to kind of pull back there. And I had to reframe my ask, like, what can I do for you? What can I do for you? As opposed to, here's what I have for you. Here's what big health care system has for you. So once I reframed that question and became more humble and checked my own power, he told me what I could do for him.

00:12:57:12 - 00:13:22:18
Lynn Todman
And we ended up having nurses onsite doing blood pressure checks, stroke education. Even taught the barbers how to identify somebody who was having a stroke, which actually caught two strokes in the years subsequent to the training. But it also meant that I had to do things like I had to go get my haircut at the barber shop and sit in his chair and develop that relationship over time.

00:13:22:24 - 00:13:53:09
Lynn Todman
That was ten years ago, and we still have a great relationship. But that's a good example of a relationship with a community partner that could have gone south, where I had to step back, check my power, do the things that needed to be done to earn his trust. And then we were able to do some really meaningful things with the men in the barber shop, they engaged with the health care system in many instances, proactively. They they decided to go get a PCP.

00:13:53:09 - 00:14:00:14
Lynn Todman
They felt more empowered and, trust people to go get a PCP, for instance. So that's one example.

00:14:00:17 - 00:14:31:23
Joanne M. Conroy, M.D.
That's a great example. And, you know, when I was at the Association of American Medical Colleges, we brought blood pressure cuffs into the facility, Know Your Numbers week, and actually took them to the mail room. And we found some really high blood pressures there. But, you know, it's interesting, though, the men in the mailroom didn't want to continue taking their blood pressure because they felt like if it was high, they'd done something wrong.

00:14:31:25 - 00:14:51:28
Joanne M. Conroy, M.D.
I never thought about that. So we had to teach them to take each other's blood pressure. So we were totally out of the loop, and they could understand when their blood pressure got high that they would say, well, after I have two cups of coffee, my blood pressure goes up about ten. And I was like, wow, what a breakthrough.

00:14:51:28 - 00:15:30:14
Joanne M. Conroy, M.D.
Almost teaching them how to really embrace their health. I think investing in health equity, awareness of disparities, and working with community partners can be transformative to organizations. I mean, think back ten years ago, I don't think we thought about it very much. And yet now I realize that a town 12 miles away, you know, people are going to have a life span that's 15 years shorter than the town that's much more affluent in the same region.

00:15:30:17 - 00:15:48:17
Joanne M. Conroy, M.D.
You know, by just talking about it, we've kind of really elevated the awareness that wasn't there ten years ago. So talk a little bit about how this investment and how the visibility of disparities and access to care has changed Core- well.

00:15:48:19 - 00:16:12:18
Lynn Todman
Well, in many ways. So first of all, there's a workforce doing this work...a bigger workforce doing this work than there was ten years ago. There's somebody like myself and my peers across the organization that are doing it. The data. We're collecting and analyzing data in a very different way to what we were doing ten years ago. Certainly in the way we're thinking about hiring

00:16:12:18 - 00:16:39:00
Lynn Todman
maybe, is different from the way we we were doing ten years ago. Even something is, you know, our mission and vision and values are reflective of this emerged commitment to health equity. So there are many, many ways in which the emergence of a broader understanding of disparities and inequities have changed the way our health care system works.

00:16:39:02 - 00:17:06:03
Lynn Todman
H.R., data, vision, mission, even the way we're thinking about our programs, care management processes, a lot of internal processes are being reevaluated for their impact on disparities. Do they close them? Do they open them? Reevaluation of clinical algorithms, that kind of thing wasn't happening ten years ago. - looking at race based, algorithms and identifying whether they're helpful or not.

00:17:06:03 - 00:17:19:06
Lynn Todman
So it's innumerable the ways and that even as I listen to, you know, your question, I realize, oh my gosh, it's actually starting to be somewhat pervasive in the organization.

00:17:19:08 - 00:17:20:27
Joanne M. Conroy, M.D.
It's part of your fabric now.

00:17:20:27 - 00:17:25:04
Lynn Todman
Yes. It's it's it's becoming part of the fabric just the way we do business.

00:17:25:06 - 00:18:02:04
Joanne M. Conroy, M.D.
Yeah. Well, that that's awesome. I would say that is actually when you start to see that what you're doing actually becomes sustainable. And that's very fulfilling. Lynn, thank you for joining me today. Your insights and your expertise are really greatly valued. And you and I are both going to be at the AHA's Accelerating Health Equity Conference this next month, May 7th and May 8th in Kansas City, where attendees can learn from experts in the field and dive much deeper into these topics that we have just scratched the surface on today.

00:18:02:06 - 00:18:23:03
Joanne M. Conroy, M.D.
To register or learn more, you can visit www.equity conference.aha.org. I want to thank you again, Lynn. And for our viewers I'll be back next month for another leadership dialog discussion. So have a wonderful day. And again, thank you so much, Lynn for sharing your expertise.

00:18:23:05 - 00:18:31:16
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.