Advancing Health Podcast

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.

00;00;00;26 - 00;00;32;23
Tom Haederle
Where will tomorrow's health care workforce come from? How can we recruit and encourage young people today to pursue careers in this critically important field? These questions face every hospital and health system in the country and are particularly challenging for rural care providers. Big challenges demand innovative solutions and one health care provider in rural Missouri has really stepped up to the plate.

00;00;32;25 - 00;01;05;12
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Signing bonuses and tuition payments are familiar tools many health care employers use when recruiting young people for current and future workforce needs. Hannibal Regional Health Care System offers those things, too. But as we hear in this podcast recorded at the AHA's 2024 Rural Health Care Leadership Conference, Hannibal does much more, such as offering apprenticeships that provide on the job training for people with no health care experience.

00;01;05;14 - 00;01;27;27
Elisa Arespacochaga
I’m Elisa Arespacochaga, AHA's vice president for clinical affairs and workforce. And today, really excited to be joined by Susan Wathen, vice president, Human Resources, Hannibal Regional Health Care System in Hannibal, Missouri, and getting a chance to talk to her about recruiting and encouraging the next generation of the health care workforce. So, Susan, first, thanks for all the work you've done, and tell me a little bit about yourself and your role.

00;01;27;29 - 00;01;50;09
Susan Wathen
Hannibal Regional is an independent health care system located in northeast corner of Missouri. My role is vice president of Human Resources, which means all of the HR functions roll up to me. Training or development, physician recruitment, employee health. And we have a child care center that has to report somewhere. So that is mine as well. You know, I'm part of the senior leadership team.

00;01;50;11 - 00;01;58;13
Susan Wathen
And for an independent health care system, being a part of that team means that we need to be very nimble and collaborative as well. And so that's a bit about my role.

00;01;58;16 - 00;02;27;22
Elisa Arespacochaga
It sounds like you've got a number of hats in your closet to fill. So like all hospital and health systems, you're facing recruitment challenges and not only recruitment challenges for today, but really thinking about the next generation of the health care workforce, which is even harder to do in a rural area. Can you share some of the great programs that you've got underway, both with your local educational system, your high schools, and then some of the opportunities you're putting together going forward?

00;02;27;25 - 00;02;49;13
Susan Wathen
Sure. So we're doing a lot of the same things most of the listeners are doing. We are offering sign-on bonuses for hard to recruit positions such as nursing and radiology positions. We are paying for students' tuition. We're paying tuition for nursing students in exchange for coming to work force after graduation. You know, a certain level of commitment post-graduation.

00;02;49;15 - 00;03;13;09
Susan Wathen
We're paying tuition for some hard to fill radiology positions. We are an official patient care tech apprenticeship program. So for those that have absolutely no health care experience but are interested and maybe even potentially down the road becoming a nurse, they can come in without any health care experience and go through our on the job training to become a patient care tech.

00;03;13;11 - 00;03;31;25
Susan Wathen
And in the state of Missouri, that's just essentially an unlicensed CNA. So they're paid on the job. They're able to work full time in that role afterwards. If at some point they decide they want to go into nursing and further their education, we can help pay their tuition to do that as well. And we have partnerships with the local nursing schools.

00;03;31;28 - 00;04;14;00
Susan Wathen
We have no cap on our tuition payments for one of the local universities there in Hannibal for their nursing programs, and we get a number of nurses for them. And then we have a little bit of a unique program called Work and Learn, where someone in any sort of university or community college, any accredited post-graduate level education...and they don't have to be going into health care. But if they will work in some of our frontline positions, such as dietary, EVS, phlebotomist and even some pharmacy tech one positions depending on how many hours they work each quarter, then we pay them a stipend for their going to school and work in those frontline jobs.

00;04;14;02 - 00;04;38;21
Susan Wathen
So again, those are pretty similar to what a lot of places are doing. One of my favorite unique programs to help fill some non-clinical positions is what we call the BEST program. It's basic employment skills training. It's a partnership with our local high school, and it is for seniors in high school who have disabilities. They're either physically disabled or they're challenged.

00;04;38;27 - 00;05;05;06
Susan Wathen
And honestly, for these students, their families plan for them before this program came to existence was probably going to be going on disability after they graduated high school if they graduated high school. So this is our eighth year for that program, and it places these seniors in internship roles on our campus. They learn soft skills, but then they are in positions such as environmental services and dietary materials management.

00;05;05;13 - 00;05;25;08
Susan Wathen
And then we have that child care center. And so we've actually this year had our first intern in that child care center. We have been able to recruit and retain seven of those throughout the past years. And I'm sure we'll probably have the opportunity to recruit and retain 1 or 2 of those this year as well. So that's been, for the frontline non-clinical

00;05;25;08 - 00;05;31;01
Susan Wathen
that's probably one of my favorite programs. It's just been life-changing for those high school students and their families.

00;05;31;07 - 00;05;51;28
Elisa Arespacochaga
It gives them such a great opportunity to understand health care and be able to, you know, find a role that makes sense for them. That's wonderful. Let me ask and we'll get to your rural residency program that your personal mission to get done. But work like this doesn't exist in a vacuum. Obviously, you talked about a number of partnerships that you have already in place.

00;05;52;00 - 00;05;55;07
Elisa Arespacochaga
How did you build some of those and how do you sustain them now?

00;05;55;09 - 00;06;20;18
Susan Wathen
That's a great question. Relationships are key, and I think if you talk to anyone in rural health care, you're talking about rural areas. Those people have to have relationships to trust you. And so it's relationships internal but external as well. It's with the school districts. It's with the chamber. It's with your local governments. It's really building those partnerships and maintaining those relationships.

00;06;20;20 - 00;06;32;04
Susan Wathen
You know, we're taking care of those same people in our health care system. And so they often will get to see both sides of that. But it's a lot about the relationships, any place in rural health care.

00;06;32;06 - 00;06;40;11
Elisa Arespacochaga
I know you have on your plate building a rural residency, but you're not building that from nothing. You've got a program already in place. Can you tell me a little bit about where you're going with that work?

00;06;40;15 - 00;07;01;22
Susan Wathen
Sure. So this is the eighth year that we have had third and fourth year medical students doing their clinical rotations at Hannibal Regional. We're a formal training site for the University of Missouri out of Columbia, Missouri, and for A.T. Still University out of Kirksville, Missouri. And we'll have some one off clinical rotations for people that maybe are in other medical schools across the country but have ties to the area.

00;07;01;24 - 00;07;18;11
Susan Wathen
But those third and fourth year medical students do all of their third year rotations with us and then a number of their fourth year. And that has really been good for the physicians. I think our physicians were a little gun shy at first. It was change. It was new. It looked like it was going to be a lot of work for them.

00;07;18;14 - 00;07;37;14
Susan Wathen
But what they have found is that these students really compliment the work they do. And the students keep these physicians very sharp. You know, the students are being trained. They're asking questions that sometimes cause the physicians to have to go look something up. So then just organically, our next step is to bring residents into the setting.

00;07;37;17 - 00;07;57;04
Elisa Arespacochaga
That's awesome. So as you're, you know, based on your experience in building all these programs and your deep HR background, what's some advice you'd give for those who are saying from, you know, are in clinical departments or other departments, they're trying to figure out how to approach you - HR - and say, I want to build a program. What's your advice to them?

00;07;57;06 - 00;08;26;02
Susan Wathen
I'm going to go back to relationships. You know, we have a little over 1,600 team members. I can't say now like I could when I started working there, that I really know everyone, I know their names. But I work hard to know people and build relationships with them. I think keeping that open door, doing rounding in all of the locations and areas so they at least see who we are gives them the opportunity to feel comfortable coming, instead of just going from the HR perspective, instead of just going in some place

00;08;26;02 - 00;08;34;20
Susan Wathen
when you're coming in with bad news, come in with good news and build those relationships. I think that's true for any leader in rural health care.

00;08;34;22 - 00;08;45;26
Elisa Arespacochaga
And I guess the flip side of that is all the folks listening should know that they can go talk to their HR folks, and especially when they've got a good point, you know, a plan to try something new.

00;08;46;01 - 00;09;08;25
Susan Wathen
Right. Well, and I think with all of these programs we've talked about, it is not just HR. This crosses, it breaks down the silos, and it really crosses a lot of different areas in rural health care settings. Nursing is involved in many of these and nursing education. If our chief medical officer weren't on board for having medical students or residents, these programs wouldn't be going. Operations is impacted

00;09;08;25 - 00;09;14;21
Susan Wathen
when we bring these interns on site and we need a classroom. It is not just HR.

00;09;14;24 - 00;09;19;00
Elisa Arespacochaga
I'm glad you're leading the charge for Hannibal. And thank you so much for joining me today.

00;09;19;05 - 00;09;20;28
Susan Wathen
Yeah. Thank you Elisa.

00;09;21;01 - 00;09;29;12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:22:43:15 - 00:22:51:25
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.