Advancing Health Podcast

00:00:01:27 - 00:00:24:23
Tom Haederle
Welcome to Advancing Health. Tending to the overall well-being of a patient often has emotional and spiritual dimensions as well as medical. In today's podcast, we hear from two experts about how chaplains are helping people of all backgrounds in the health care setting as part of an interdisciplinary team, making sure care is focused on the whole person.

00:00:24:26 - 00:00:50:06
Elisa Arespacochaga
I'm Elisa Arespacochaga, vice president of clinical affairs and workforce at the AHA. Today, I'm joined by Jason Lesandrini, AVP of Ethics, Advanced Care Planning, Spiritual Health and Language Access Services at Wellstar Health System; and Kelsey White, assistant professor and chaplaincy faculty researcher in the Department of Patient Counseling at Virginia Commonwealth University. And this is a discussion I've been looking forward to for a little while.

00:00:50:06 - 00:01:09:27
Elisa Arespacochaga
We're here to really discuss how they have worked to integrate chaplains into well-being programs in health care, and really make those connections across both their research and their organization. So to start off, Kelsey, why don't you start, just tell us a little bit about the work that you do and who you are.

00:01:09:29 - 00:01:33:07
Kelsey White, Ph.D.
Yeah. Thanks for having me. I'm a professor primarily these days. But my career started out as a board certified chaplain working in outpatient, a very large outpatient center as well as oncology. Fell in love with chaplaincy to the extent that I wanted to figure out how to do research about it. And from there I went to do a Ph.D. and really focus on expanding the research and the integration of chaplains in my efforts.

00:01:33:09 - 00:01:37:27
Elisa Arespacochaga
And I'm guessing that's how you got to meet Jason. Jason, can you tell us a little bit about your work?

00:01:37:29 - 00:02:08:20
Jason Lesandrini. Ph.D.
Thank you. Thank you both for being with me today. So, like you said, I work at Wellstar Health System, which is a large integrated health care system in Georgia. I've been here for about ten years and really my focus on the work I was doing originally when I came was on ethics. That's where my background is. I'm a Ph.D. in healthcare ethics from Duquesne and spent a number of years at another local system doing ethics work and as I got here to Wellstar noticed there was a need, sort of in conversations with the executives to really take spiritual health as a team and have an executive representative.

00:02:08:20 - 00:02:12:23
Jason Lesandrini. Ph.D.
And so I've been doing that eight years now is what we're going on. So I'm really excited for it.

00:02:12:26 - 00:02:24:11
Elisa Arespacochaga
Kelsey, just to level set with our audience. Can you describe a little bit the role of a chaplain within a health care organization? I think everyone may have a little bit of an idea, but not fully understand what that role means today.

00:02:24:13 - 00:02:49:15
Kelsey White, Ph.D.
Yeah, absolutely. So to kind of step back, they aren't just the folks that go in and pray, but really they're members of the interdisciplinary team who really help make sure that the health care that we provide is focused on a whole person. So they typically have a graduate level of education, clinical training, over a year of clinical training typically, board certification or certified eligible.

00:02:49:17 - 00:03:28:08
Kelsey White, Ph.D.
And then they have this expertise to attend to individuals emotional, spiritual and that interpersonal well-being. So they are trained typically to talk to all people, whether it be staff or patients or family members, about spirituality, but not just what we think of as this like religious type of topic when it comes to spirituality. But spirituality really encompasses the way we make meaning of the world around us, how we find purpose and connection, and then to deal with kind of the tough things that happen in our life that make us ask why?

00:03:28:10 - 00:03:36:07
Kelsey White, Ph.D.
And so chaplains are trained to really have those tough questions, but also to really support folks in really difficult situations.

00:03:36:09 - 00:03:57:24
Elisa Arespacochaga
As I usually say, one of the challenges and opportunities in health care is that we are with people at what may be some of the most difficult moments in their lives, and so being able to not only support their physical health and their mental health, but their emotional health and their ability to connect with them and support them as they wrestle with some of those questions I think is key.

00:03:57:27 - 00:04:21:16
Kelsey White, Ph.D.
Yeah. And I also add like because of the extensive training they've had, they're equipped to work with people from all different backgrounds and regardless of faith tradition. And I think they're really touching on these like core existential topics that are just part of everyone's natural being and that when those things are out of whack, they can end up impacting one's health, too.

00:04:21:18 - 00:04:34:09
Elisa Arespacochaga
Jason, how are you actually incorporating this amazing set of skills and resources and humans in your organization into well-being initiatives? And, you know, Kelsey, I'm sure you have ideas as well.

00:04:34:11 - 00:04:59:13
Jason Lesandrini. Ph.D.
Yeah. So it's a great question. Kelsey definitely has a lot to share about this as being a chaplain, not being a chaplain, but leading chaplains. I get to see the great work that they do. And I think here in my own organization, we have a program called CARES. It's an acronym that basically it's a sort of a response system that when sort of some type of critical incident happens, our chaplains are available 24 hours a day, seven days a week, 365 days out of the year.

00:04:59:15 - 00:05:22:24
Jason Lesandrini. Ph.D.
No holidays, no breaks, no nothing. They are there to respond. The chaplain is the first person who gets that call. And the beautiful thing about our chaplaincy program is that our virtual care providers are on the ground, right? We're not in a telecenter responding to our team. We're actually on the ground and can be with another person, which we think is really important to, sort of, staff's overall well-being.

00:05:22:24 - 00:05:41:16
Jason Lesandrini. Ph.D.
Now, how you get in touch with them, of course, is electronically, but it's that physical presence that we think is important. You know, to Kelsey's point earlier about how do you care for this person? We care for them in the moment with them and to be by their side. And so our team, this is one big thing that we've been pushing as our team is there for others when they need them during those critical times.

00:05:41:19 - 00:06:18:02
Kelsey White, Ph.D.
At VCU we do a whole lot of different things. I like to think about them in kind of two buckets. So we've got like chaplain efforts that really focus on in real time reducing stress levels, helping manage distressing situations whether it be debriefing or giving them a moment of respite. So some people have heard of, like tea for the soul or cheek hearts, where chaplains will push them around and offer clinicians these moments to just breathe and to be reminded that they're cared for and that they're supported and that they're not alone.

00:06:18:04 - 00:06:46:12
Kelsey White, Ph.D.
And sometimes that can make a big difference in a busy day. And then there's this other group of ways in which, chaplains, I think can really impact well-being is thinking about a specific way that a chaplain can alter a workflow or a process that really shifts the burden off of other clinicians. So a really concrete example of this is, a program that was actually developed here at VCU called the Family Communication Coordinator.

00:06:46:15 - 00:07:17:23
Kelsey White, Ph.D.
And this intervention is really focused on those individuals that qualify to donate an organ. And so the chaplain comes in and to relieve some of the stress on the nurses and the physicians and the clinical team will facilitate the process between the family and the organ procurement organization. Which really can just, I mean, decrease the stress, decreases role ambiguity and helps kind of minimize all of the things that are that can be exacerbated in those moments.

00:07:17:25 - 00:07:44:01
Elisa Arespacochaga
I think that's so key. One of the challenges we keep seeing broadly in the workforce space is that need to unburden some of our team members from having to do all of the things, and how can we find those roles that and those activities that don't require a physician or a nurse to be doing it, but someone has to be part of the health system and, and be able to provide that support.

00:07:44:01 - 00:07:56:29
Elisa Arespacochaga
So I love the idea of taking advantage of that amazing set of skills and connections and really, bringing them to bear on what has got to be one of the those difficult times.

00:07:57:01 - 00:08:33:03
Kelsey White, Ph.D.
Yeah. And they're actually I talked to some chaplains recently who were part of their organizations efforts to assess for the social determinants of health. And that could be done by a lot of people. There's something about the way in which a chaplain is able to build that trusting relationship that not only helps with a specific process, but it's one less thing that the nurse has to screen for or attend to, but also those chaplains have the skills to get at really sensitive topics for patients and families.

00:08:33:06 - 00:08:47:23
Elisa Arespacochaga
Jason, talk to me a little bit about how you're connecting this great work not only to you make it available to your patients, but to the organization's mission and overall well-being for your team, for those who are doing the caring.

00:08:47:25 - 00:09:11:11
Jason Lesandrini. Ph.D.
Yeah. So here at WellStar, our mission is to enhance the health and well-being of every person we serve. And we're focused on something called People Care, which is about providing care that's unique to whoever. So it's Kelsey care, it's Jason care. It's all of our care. And look, I know this sounds silly, but I can't think of anything more people focused and thinking about how individuals deal with, mind, body and spirit.

00:09:11:13 - 00:09:29:16
Jason Lesandrini. Ph.D.
Right. And thinking about what are those individuals who have expertise in that space, and in some of the spaces that we often forget of to sort of attuned to that. And so while most of our work tends to focus on patients and their families at the bedside, there's also this other side of people care, which is about the people who care for the people care.

00:09:29:19 - 00:09:50:28
Jason Lesandrini. Ph.D.
And so, you know, we need to think a lot broader about this. Kelsey's earlier comments made me think of, you know, something that's really fascinating about working with chaplains. Sometimes it's just about being there. So, yes, the issue might be called up because of, you know, a family or a patient may be having some spiritual distress or something that's going on.

00:09:51:00 - 00:10:10:11
Jason Lesandrini. Ph.D.
But I'll tell you that the beautiful thing is when you just watch it happen, it doesn't have to be anything magical. It's Kelsey as a chaplain coming to my bedside or talking with a patient, a family. And then what do they do? They go out to the nurses station or they see the doctor who's documenting, you know, in the chart or whatever it may be, or the EDS worker and just being with them.

00:10:10:11 - 00:10:27:19
Jason Lesandrini. Ph.D.
I think that means a lot. And so when I think about how we focus on people care here and how we care for the people who care for the people that we care about, you know, that we're trying to tune to. I can't think of anything more connected than sort of the great work that our special care providers do across the entire enterprise.

00:10:27:21 - 00:10:48:22
Elisa Arespacochaga
It's just so heartwarming to see the taking that moment, because, I mean, health care is a hard place to be. It's a hard place to work, but it's one that is so rewarding. And so hearing the opportunity that the chaplains can take to really sort of reground everyone in that work. Kelsey, let me ask you, I've got, sort of two options here.

00:10:48:22 - 00:11:07:19
Elisa Arespacochaga
One share a story of something that surprised you as you've been involving chaplains in this work or -otherwise it may actually be both - advice you'd give to other organizations who are looking to tap into their chaplaincy programs to support well-being. And then, Jason, I'll ask you the same thing.

00:11:07:22 - 00:11:40:07
Kelsey White, Ph.D.
The thing that I think surprises me the most when I have conversations with folks across the country is this level of innovation that chaplains are really living into in these efforts. They recognize the highly specific nature of the stress and distress they see, and can adapt in a way that focuses on their localized contexts. So if there is a certain challenge that is very... perhaps it was a community shooting, right?

00:11:40:11 - 00:12:04:08
Kelsey White, Ph.D.
So the chaplain able to really adapt and address those tensions that are arising right there, and how that affected the clinicians because they're part of the community, too, right? They're not just there at the hospital, but they live there. And then I'd also add just the way in which chaplains care for the employees and the non, like at the outskirts of health care institutions.

00:12:04:08 - 00:12:33:21
Kelsey White, Ph.D.
So there's stories about chaplains caring for security workers, teaching them how to be resilient, teaching them how to cope with intense situations. Or teaching community health workers how to engage in authentic conversation. You know, Jason talked some about just being there. And I really, I would even take it a step further. And there's something about being both physically available and emotionally available that is not unique in our everyday relationships.

00:12:33:23 - 00:13:04:18
Jason Lesandrini. Ph.D.
I think the most surprising thing that I know in the work with chaplains is this misnomer about chaplains coming to pray. So Kelsey talked a lot about this. When I've asked my colleagues across the country about it that's what they tell me, that, you know, well, we call the chaplain to come in and pray. And I just think that selling them short, just really short of the work and scope, you know, we're all trying to work together every day to operate to the fullest extent of our capabilities because everyone in health care needs it.

00:13:04:21 - 00:13:21:24
Jason Lesandrini. Ph.D.
So I think just thinking about chaplains, as folks who come up and pray with people is just way too narrow. They can do that. But man, they can do so much more if we just open the door. You know, I live by this principle about being a helper. I think they're helpers. I think that's what they actually are.

00:13:21:24 - 00:13:44:21
Jason Lesandrini. Ph.D.
And they can help people across the spectrum: the religious, the non-religious, the spiritual, the non-spiritual. My experience has shown me that spiritual care providers are probably some of the best listeners and man, I can tell you this, I need an ear more frequently than I'd like to admit. It's not a judgment, it's not a religious context, it's just a really good listener.

00:13:44:23 - 00:14:04:22
Jason Lesandrini. Ph.D.
Your second point, Elisa, maybe I could just chime in here because I got lots to say. And if people who know me across the country know that I have a hard time being quiet. So I'll say this about advice to other organizations. You know, you'd mentioned that. I think the biggest piece of advice I'd give other folks is please just ask them, that's the biggest piece of advice, is ask them for help.

00:14:04:24 - 00:14:23:10
Jason Lesandrini. Ph.D.
I think that's the biggest problem we have across this country is that spiritual care providers, chaplains, all these folks who sit in this space are not being asked to assist with this work. And wow, if they are, the evidence is just not even you can't doubt it that they can help. But they got to ask. You got to ask them.

00:14:23:10 - 00:14:35:21
Jason Lesandrini. Ph.D.
And we have to, you know, we're doing work on this on the other side is we got to have the chaplains and folks speak up. That's the other piece. You got to speak up. So we need to ask, you got to ask them what's the work that they can do? What can they do? And then hold them accountable for it.

00:14:35:21 - 00:14:45:24
Jason Lesandrini. Ph.D.
Because I think that's part of the value that chaplains can do. The literature is clear, they can help. You got to ask them to do it and then just hold them to it because it will come out, I promise you.

00:14:45:27 - 00:15:10:00
Elisa Arespacochaga
Jason and Kelsey, thank you so much for joining me, sharing a little bit about your world, and hopefully through this podcast, we're sharing with others the opportunity both for chaplains to raise their hands and for those around them to say, hey, you got a moment? Can I bend your ear? Because I think that is something we all need very much to get through health care and to be able to help others.

00:15:10:02 - 00:15:12:01
Elisa Arespacochaga
So thank you again for joining me.

00:15:12:03 - 00:15:13:03
Kelsey White, Ph.D.
Thank you.

00:15:13:06 - 00:15:14:24
Jason Lesandrini. Ph.D.
Thank you.

00:15:14:26 - 00:15:23:07
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:27 - 00:00:24:23
Tom Haederle
Welcome to Advancing Health. Tending to the overall well-being of a patient often has emotional and spiritual dimensions as well as medical. In today's podcast, we hear from two experts about how chaplains are helping people of all backgrounds in the health care setting as part of an interdisciplinary team, making sure care is focused on the whole person.

00:00:24:26 - 00:00:50:06
Elisa Arespacochaga
I'm Elisa Arespacochaga, vice president of clinical affairs and workforce at the AHA. Today, I'm joined by Jason Lesandrini, AVP of Ethics, Advanced Care Planning, Spiritual Health and Language Access Services at Wellstar Health System; and Kelsey White, assistant professor and chaplaincy faculty researcher in the Department of Patient Counseling at Virginia Commonwealth University. And this is a discussion I've been looking forward to for a little while.

00:00:50:06 - 00:01:09:27
Elisa Arespacochaga
We're here to really discuss how they have worked to integrate chaplains into well-being programs in health care, and really make those connections across both their research and their organization. So to start off, Kelsey, why don't you start, just tell us a little bit about the work that you do and who you are.

00:01:09:29 - 00:01:33:07
Kelsey White, Ph.D.
Yeah. Thanks for having me. I'm a professor primarily these days. But my career started out as a board certified chaplain working in outpatient, a very large outpatient center as well as oncology. Fell in love with chaplaincy to the extent that I wanted to figure out how to do research about it. And from there I went to do a Ph.D. and really focus on expanding the research and the integration of chaplains in my efforts.

00:01:33:09 - 00:01:37:27
Elisa Arespacochaga
And I'm guessing that's how you got to meet Jason. Jason, can you tell us a little bit about your work?

00:01:37:29 - 00:02:08:20
Jason Lesandrini. Ph.D.
Thank you. Thank you both for being with me today. So, like you said, I work at Wellstar Health System, which is a large integrated health care system in Georgia. I've been here for about ten years and really my focus on the work I was doing originally when I came was on ethics. That's where my background is. I'm a Ph.D. in healthcare ethics from Duquesne and spent a number of years at another local system doing ethics work and as I got here to Wellstar noticed there was a need, sort of in conversations with the executives to really take spiritual health as a team and have an executive representative.

00:02:08:20 - 00:02:12:23
Jason Lesandrini. Ph.D.
And so I've been doing that eight years now is what we're going on. So I'm really excited for it.

00:02:12:26 - 00:02:24:11
Elisa Arespacochaga
Kelsey, just to level set with our audience. Can you describe a little bit the role of a chaplain within a health care organization? I think everyone may have a little bit of an idea, but not fully understand what that role means today.

00:02:24:13 - 00:02:49:15
Kelsey White, Ph.D.
Yeah, absolutely. So to kind of step back, they aren't just the folks that go in and pray, but really they're members of the interdisciplinary team who really help make sure that the health care that we provide is focused on a whole person. So they typically have a graduate level of education, clinical training, over a year of clinical training typically, board certification or certified eligible.

00:02:49:17 - 00:03:28:08
Kelsey White, Ph.D.
And then they have this expertise to attend to individuals emotional, spiritual and that interpersonal well-being. So they are trained typically to talk to all people, whether it be staff or patients or family members, about spirituality, but not just what we think of as this like religious type of topic when it comes to spirituality. But spirituality really encompasses the way we make meaning of the world around us, how we find purpose and connection, and then to deal with kind of the tough things that happen in our life that make us ask why?

00:03:28:10 - 00:03:36:07
Kelsey White, Ph.D.
And so chaplains are trained to really have those tough questions, but also to really support folks in really difficult situations.

00:03:36:09 - 00:03:57:24
Elisa Arespacochaga
As I usually say, one of the challenges and opportunities in health care is that we are with people at what may be some of the most difficult moments in their lives, and so being able to not only support their physical health and their mental health, but their emotional health and their ability to connect with them and support them as they wrestle with some of those questions I think is key.

00:03:57:27 - 00:04:21:16
Kelsey White, Ph.D.
Yeah. And I also add like because of the extensive training they've had, they're equipped to work with people from all different backgrounds and regardless of faith tradition. And I think they're really touching on these like core existential topics that are just part of everyone's natural being and that when those things are out of whack, they can end up impacting one's health, too.

00:04:21:18 - 00:04:34:09
Elisa Arespacochaga
Jason, how are you actually incorporating this amazing set of skills and resources and humans in your organization into well-being initiatives? And, you know, Kelsey, I'm sure you have ideas as well.

00:04:34:11 - 00:04:59:13
Jason Lesandrini. Ph.D.
Yeah. So it's a great question. Kelsey definitely has a lot to share about this as being a chaplain, not being a chaplain, but leading chaplains. I get to see the great work that they do. And I think here in my own organization, we have a program called CARES. It's an acronym that basically it's a sort of a response system that when sort of some type of critical incident happens, our chaplains are available 24 hours a day, seven days a week, 365 days out of the year.

00:04:59:15 - 00:05:22:24
Jason Lesandrini. Ph.D.
No holidays, no breaks, no nothing. They are there to respond. The chaplain is the first person who gets that call. And the beautiful thing about our chaplaincy program is that our virtual care providers are on the ground, right? We're not in a telecenter responding to our team. We're actually on the ground and can be with another person, which we think is really important to, sort of, staff's overall well-being.

00:05:22:24 - 00:05:41:16
Jason Lesandrini. Ph.D.
Now, how you get in touch with them, of course, is electronically, but it's that physical presence that we think is important. You know, to Kelsey's point earlier about how do you care for this person? We care for them in the moment with them and to be by their side. And so our team, this is one big thing that we've been pushing as our team is there for others when they need them during those critical times.

00:05:41:19 - 00:06:18:02
Kelsey White, Ph.D.
At VCU we do a whole lot of different things. I like to think about them in kind of two buckets. So we've got like chaplain efforts that really focus on in real time reducing stress levels, helping manage distressing situations whether it be debriefing or giving them a moment of respite. So some people have heard of, like tea for the soul or cheek hearts, where chaplains will push them around and offer clinicians these moments to just breathe and to be reminded that they're cared for and that they're supported and that they're not alone.

00:06:18:04 - 00:06:46:12
Kelsey White, Ph.D.
And sometimes that can make a big difference in a busy day. And then there's this other group of ways in which, chaplains, I think can really impact well-being is thinking about a specific way that a chaplain can alter a workflow or a process that really shifts the burden off of other clinicians. So a really concrete example of this is, a program that was actually developed here at VCU called the Family Communication Coordinator.

00:06:46:15 - 00:07:17:23
Kelsey White, Ph.D.
And this intervention is really focused on those individuals that qualify to donate an organ. And so the chaplain comes in and to relieve some of the stress on the nurses and the physicians and the clinical team will facilitate the process between the family and the organ procurement organization. Which really can just, I mean, decrease the stress, decreases role ambiguity and helps kind of minimize all of the things that are that can be exacerbated in those moments.

00:07:17:25 - 00:07:44:01
Elisa Arespacochaga
I think that's so key. One of the challenges we keep seeing broadly in the workforce space is that need to unburden some of our team members from having to do all of the things, and how can we find those roles that and those activities that don't require a physician or a nurse to be doing it, but someone has to be part of the health system and, and be able to provide that support.

00:07:44:01 - 00:07:56:29
Elisa Arespacochaga
So I love the idea of taking advantage of that amazing set of skills and connections and really, bringing them to bear on what has got to be one of the those difficult times.

00:07:57:01 - 00:08:33:03
Kelsey White, Ph.D.
Yeah. And they're actually I talked to some chaplains recently who were part of their organizations efforts to assess for the social determinants of health. And that could be done by a lot of people. There's something about the way in which a chaplain is able to build that trusting relationship that not only helps with a specific process, but it's one less thing that the nurse has to screen for or attend to, but also those chaplains have the skills to get at really sensitive topics for patients and families.

00:08:33:06 - 00:08:47:23
Elisa Arespacochaga
Jason, talk to me a little bit about how you're connecting this great work not only to you make it available to your patients, but to the organization's mission and overall well-being for your team, for those who are doing the caring.

00:08:47:25 - 00:09:11:11
Jason Lesandrini. Ph.D.
Yeah. So here at WellStar, our mission is to enhance the health and well-being of every person we serve. And we're focused on something called People Care, which is about providing care that's unique to whoever. So it's Kelsey care, it's Jason care. It's all of our care. And look, I know this sounds silly, but I can't think of anything more people focused and thinking about how individuals deal with, mind, body and spirit.

00:09:11:13 - 00:09:29:16
Jason Lesandrini. Ph.D.
Right. And thinking about what are those individuals who have expertise in that space, and in some of the spaces that we often forget of to sort of attuned to that. And so while most of our work tends to focus on patients and their families at the bedside, there's also this other side of people care, which is about the people who care for the people care.

00:09:29:19 - 00:09:50:28
Jason Lesandrini. Ph.D.
And so, you know, we need to think a lot broader about this. Kelsey's earlier comments made me think of, you know, something that's really fascinating about working with chaplains. Sometimes it's just about being there. So, yes, the issue might be called up because of, you know, a family or a patient may be having some spiritual distress or something that's going on.

00:09:51:00 - 00:10:10:11
Jason Lesandrini. Ph.D.
But I'll tell you that the beautiful thing is when you just watch it happen, it doesn't have to be anything magical. It's Kelsey as a chaplain coming to my bedside or talking with a patient, a family. And then what do they do? They go out to the nurses station or they see the doctor who's documenting, you know, in the chart or whatever it may be, or the EDS worker and just being with them.

00:10:10:11 - 00:10:27:19
Jason Lesandrini. Ph.D.
I think that means a lot. And so when I think about how we focus on people care here and how we care for the people who care for the people that we care about, you know, that we're trying to tune to. I can't think of anything more connected than sort of the great work that our special care providers do across the entire enterprise.

00:10:27:21 - 00:10:48:22
Elisa Arespacochaga
It's just so heartwarming to see the taking that moment, because, I mean, health care is a hard place to be. It's a hard place to work, but it's one that is so rewarding. And so hearing the opportunity that the chaplains can take to really sort of reground everyone in that work. Kelsey, let me ask you, I've got, sort of two options here.

00:10:48:22 - 00:11:07:19
Elisa Arespacochaga
One share a story of something that surprised you as you've been involving chaplains in this work or -otherwise it may actually be both - advice you'd give to other organizations who are looking to tap into their chaplaincy programs to support well-being. And then, Jason, I'll ask you the same thing.

00:11:07:22 - 00:11:40:07
Kelsey White, Ph.D.
The thing that I think surprises me the most when I have conversations with folks across the country is this level of innovation that chaplains are really living into in these efforts. They recognize the highly specific nature of the stress and distress they see, and can adapt in a way that focuses on their localized contexts. So if there is a certain challenge that is very... perhaps it was a community shooting, right?

00:11:40:11 - 00:12:04:08
Kelsey White, Ph.D.
So the chaplain able to really adapt and address those tensions that are arising right there, and how that affected the clinicians because they're part of the community, too, right? They're not just there at the hospital, but they live there. And then I'd also add just the way in which chaplains care for the employees and the non, like at the outskirts of health care institutions.

00:12:04:08 - 00:12:33:21
Kelsey White, Ph.D.
So there's stories about chaplains caring for security workers, teaching them how to be resilient, teaching them how to cope with intense situations. Or teaching community health workers how to engage in authentic conversation. You know, Jason talked some about just being there. And I really, I would even take it a step further. And there's something about being both physically available and emotionally available that is not unique in our everyday relationships.

00:12:33:23 - 00:13:04:18
Jason Lesandrini. Ph.D.
I think the most surprising thing that I know in the work with chaplains is this misnomer about chaplains coming to pray. So Kelsey talked a lot about this. When I've asked my colleagues across the country about it that's what they tell me, that, you know, well, we call the chaplain to come in and pray. And I just think that selling them short, just really short of the work and scope, you know, we're all trying to work together every day to operate to the fullest extent of our capabilities because everyone in health care needs it.

00:13:04:21 - 00:13:21:24
Jason Lesandrini. Ph.D.
So I think just thinking about chaplains, as folks who come up and pray with people is just way too narrow. They can do that. But man, they can do so much more if we just open the door. You know, I live by this principle about being a helper. I think they're helpers. I think that's what they actually are.

00:13:21:24 - 00:13:44:21
Jason Lesandrini. Ph.D.
And they can help people across the spectrum: the religious, the non-religious, the spiritual, the non-spiritual. My experience has shown me that spiritual care providers are probably some of the best listeners and man, I can tell you this, I need an ear more frequently than I'd like to admit. It's not a judgment, it's not a religious context, it's just a really good listener.

00:13:44:23 - 00:14:04:22
Jason Lesandrini. Ph.D.
Your second point, Elisa, maybe I could just chime in here because I got lots to say. And if people who know me across the country know that I have a hard time being quiet. So I'll say this about advice to other organizations. You know, you'd mentioned that. I think the biggest piece of advice I'd give other folks is please just ask them, that's the biggest piece of advice, is ask them for help.

00:14:04:24 - 00:14:23:10
Jason Lesandrini. Ph.D.
I think that's the biggest problem we have across this country is that spiritual care providers, chaplains, all these folks who sit in this space are not being asked to assist with this work. And wow, if they are, the evidence is just not even you can't doubt it that they can help. But they got to ask. You got to ask them.

00:14:23:10 - 00:14:35:21
Jason Lesandrini. Ph.D.
And we have to, you know, we're doing work on this on the other side is we got to have the chaplains and folks speak up. That's the other piece. You got to speak up. So we need to ask, you got to ask them what's the work that they can do? What can they do? And then hold them accountable for it.

00:14:35:21 - 00:14:45:24
Jason Lesandrini. Ph.D.
Because I think that's part of the value that chaplains can do. The literature is clear, they can help. You got to ask them to do it and then just hold them to it because it will come out, I promise you.

00:14:45:27 - 00:15:10:00
Elisa Arespacochaga
Jason and Kelsey, thank you so much for joining me, sharing a little bit about your world, and hopefully through this podcast, we're sharing with others the opportunity both for chaplains to raise their hands and for those around them to say, hey, you got a moment? Can I bend your ear? Because I think that is something we all need very much to get through health care and to be able to help others.

00:15:10:02 - 00:15:12:01
Elisa Arespacochaga
So thank you again for joining me.

00:15:12:03 - 00:15:13:03
Kelsey White, Ph.D.
Thank you.

00:15:13:06 - 00:15:14:24
Jason Lesandrini. Ph.D.
Thank you.

00:15:14:26 - 00:15:23:07
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:02 - 00:00:27:03
Tom Haederle
Welcome to Advancing Health. Experts say mental health issues and substance use disorders in people over age 65 is underreported, under-diagnosed and deserves much more attention than it gets. In today's podcast, we learn more about how the brand new Henry Ford Behavioral Health Hospital created a designated unit dedicated to older adults to help focus on their behavioral health needs.

00:00:27:05 - 00:00:55:24
Rebecca Chickey
Hello, my name is Rebecca Chickey and I am the senior director of behavioral health for the American Hospital Association. And it's my honor to be joined today by Dr. Zaira Khalid, who is the senior staff geriatric psychiatrist at Henry Ford Behavioral Health Hospital, which is located in West Bloomfield, Michigan. Today, our discussion is entitled Improving Behavioral Health for Older Adults: Lessons from Henry Ford Health.

00:00:55:26 - 00:01:25:08
Rebecca Chickey
Thank you so much for being here with us today. What I'd like the listeners to learn and hear first from you is what is the situation? What's the prevalence of psychiatric, or substance use disorders in individuals who are 65 and older? And what are the perhaps unique circumstances that older adults may experience that may drive conditions such as depression or anxiety?

00:01:25:10 - 00:01:50:15
Zaira Khalid, MD
Rebecca, thank you for having me. Thank you for shedding light on this very, very important topic that I think doesn't get enough attention and should be getting much much more attention just because of the need that there is. So in terms of mental health and substance use disorder treatment, it is definitely underreported and underdiagnosed in our elderly patients.

00:01:50:17 - 00:02:25:15
Zaira Khalid, MD
Having said that, the numbers are still very high. So, patients who we look at that may be, let's say admitted to the hospital with medical concerns and have medical comorbidities. Their prevalence of having psychiatric disorders is going to be anywhere between 40 to 50%. That's very, very high. Substance use disorders in the elderly...I believe the last time I saw a good study was in 2022. Eleven in 60 adults, older adults, had a substance use problem.

00:02:25:17 - 00:02:55:00
Zaira Khalid, MD
And that's only those that are being diagnosed. You know, I can tell you from personal experience, it's a lot higher than that. We just don't recognize it. So a lot of our elderly are struggling, not getting the help they need, not seeking the help they need due to various factors. But what leads them to where they are with their mental health and where they are with their psychiatric health are that they're a unique population, they go through stressors that the majority of the other population doesn't.

00:02:55:02 - 00:03:20:23
Zaira Khalid, MD
They're at a stage in life where they are losing their loved ones around them. They're losing their friends that they've had their entire life. They are retiring from their jobs, which is what gave them meaning in their life. Their kids are moved out of the home, busy with their lives. That was a huge part of their life that gave them meaning - parenting, raising their kids.

00:03:20:25 - 00:03:54:29
Zaira Khalid, MD
They're now sometimes, most of the time, having to give up their homes, and they're moving into assisted living or nursing homes. And it's a completely different environment, completely different level of independence. They're not driving anymore. So all of those things put together, I think, would be stressful for any one of us. And once you add on medical problems like not being able to walk as well, having diabetes, possibly a stroke, it just leads to sort of a concoction of items that's going to lead to poor outcomes

00:03:54:29 - 00:03:56:18
Zaira Khalid, MD
if not intervened.

00:03:56:21 - 00:04:23:18
Rebecca Chickey
Absolutely. I saw my own mother go through this, and now my husband's parents have done exactly what you've described. They've moved into an assisted living facility. My father in law is now 94 and wheelchair bound. And my mother in law is younger and still active. And so there's also that sort of strain. Luckily, they do still have friends that are their age that are in that same living facility

00:04:23:19 - 00:04:31:00
Rebecca Chickey
so that's helping offset. But, but it doesn't eliminate all the other challenges that you described.

00:04:31:02 - 00:04:34:27
Zaira Khalid, MD
Yeah. Social isolation is very real and very dangerous.

00:04:34:29 - 00:04:54:22
Rebecca Chickey
Absolutely. So tell me, in the design and the development of the new Henry Ford Behavioral Health Hospital, what did you do to better meet and accommodate the needs of the older adult population? Both perhaps from a physical design, but, additionally, from a treatment design. What's your approach?

00:04:54:25 - 00:05:20:29
Zaira Khalid, MD
Well, we wanted to make sure we had a designated spot and a separate unit, a physically separate unit that was dedicated to older adults so we could focus on the design being different and accommodate all their needs. Simple things like having handrails on the walls in the hallways so that they were able to hold them and walk, which, you know, is not something that you commonly see in an inpatient psychiatric hospital.

00:05:21:01 - 00:05:48:14
Zaira Khalid, MD
Having a courtyard outside that allows for more relaxation. It's surrounded by trees. There's benches, sunlight. Which is very different than some of the other courtyards we may have for a younger population where they we want them to be a little bit more active. So they've got basketball hoops and such. Things like having call lights. So, a psychiatric hospital, generally we don't have call lights because it can be a safety measure.

00:05:48:17 - 00:06:06:25
Zaira Khalid, MD
We don't want to have a lot of cords and strings. But for our geriatric unit, we wanted to make sure we have those in case there's a fall while they're using the restroom. We have more bathrooms on this unit that are ADA accessible and have shower chairs so they're able to sit and take a shower with handheld showers so they don't have to stand for too long.

00:06:07:02 - 00:06:29:17
Zaira Khalid, MD
Those would be kind of some of the design, major design elements that we've tapped into account. And the other was really having staff that has been trained and experienced in dealing with this population and knows what to look for. And it's not just about the treatment they get here, but also what we set them up with once they leave here and staff that has the knowledge of that.

00:06:29:17 - 00:06:51:19
Zaira Khalid, MD
So how do we set them up with resources that is going to keep them involved in the community, keep them active? And how do we give them tools that they can learn here and continue to utilize outside of here? So that's a social worker that is well versed in some of the resources we have here. The PACE program, which is designed for the elderly, day programs for the elderly.

00:06:51:21 - 00:07:18:22
Zaira Khalid, MD
We've got activity therapy that is used to doing activities that, you know, may be designed for those with less cognitive reserve, and sometimes it may just be as simple as musical instruments because that's the cognitive capacity we have. We had exercise equipment that some of the activity therapists can bring on to the unit and teach them how to do exercises, just, you know, sitting in the dayroom.

00:07:18:25 - 00:07:36:13
Zaira Khalid, MD
It's something that they can translate into their own living rooms when they get discharged. So we really wanted to make sure that the staff is able to identify those needs in these patients and help them teach some of the skills that they can also translate outside of here, because this is just a week of their life or two weeks of their life.

00:07:36:16 - 00:08:07:02
Rebecca Chickey
I had a thought while you were describing all the talents of the staff that you've recruited and wondering - I'm kind of leading the jury here. Also, staff who care and who look forward to working with individuals who are in perhaps their last decades of life. And it's been my experience working in health care for over 30 years now, that there's often less of a shortage for people to work in the labor and delivery unit.

00:08:07:09 - 00:08:20:28
Rebecca Chickey
They want to see the new life come forward. They want to work with the babies and the new moms. But geriatric care has had its own challenges. So has that been something too, that you've focused in on to find those people with that passion?

00:08:21:00 - 00:08:41:03
Zaira Khalid, MD
100%. So everyone that works on the geriatric unit, the staff that has always voiced that they want to work on the geriatric unit and always has in the past. So our social worker has been in geriatrics for a long time. Our activity therapist has been in geriatrics for a long time. So I mean, I love working with the older adults, it's all I do.

00:08:41:05 - 00:09:00:12
Zaira Khalid, MD
So all of us share that passion and I think that's why we work so well as a team. I think that's why our patients can see that when they're here and getting the care that they want. So for sure, I think passion has a lot to with it. It's not a population that most people choose to work with or want to work with. Something

00:09:00:12 - 00:09:11:17
Zaira Khalid, MD
I've never understood why - I think it's the absolute best population, the sweetest population, and the most rewarding population you could work with. But the passion of the team is definitely there.

00:09:11:20 - 00:09:34:20
Rebecca Chickey
Wonderful. I think another, not to say that that what I'm about to say doesn't exist in individuals who are under the age of 65, but often individuals who are 65 or older may have physical illnesses as well. Their diabetes may have gotten to a certain stage or their congestive heart failure. So how do you integrate physical and behavioral health?

00:09:34:22 - 00:09:59:07
Zaira Khalid, MD
It's a wonderful question. So one of the things that I'm very passionate about is cut down their meds. A huge problem we have in our geriatric population is poly-pharmacy, meaning they see multiple doctors because they need to. And there's a lot of multiple medications being put in. And sometimes they interact. They cause side effects. Then medications are prescribed to counter those side effects.

00:09:59:07 - 00:10:25:25
Zaira Khalid, MD
And this is a population very sensitive to that. So we have a fantastic family medicine team that we work with very closely. They're in-house seven days a week. A wonderful pharmacist who helps us. And we really try to treat the patient as a whole. So for example, let's say someone gets admitted for uncontrolled anxiety and they've also got diabetes.

00:10:25:27 - 00:10:51:27
Zaira Khalid, MD
My first approach is not to go ahead and prescribe them something for anxiety. It's to look at their blood sugars, because we know fluctuations in blood sugars caused anxiety, geriatric or not. It's just it's much more prevalent in geriatrics because they're more sensitive to blood sugar fluctuations. So my first thing is let me work with my family medicine counterpart and let's get these blood sugars under control.

00:10:51:29 - 00:11:13:17
Zaira Khalid, MD
And if we're still seeing the anxiety, then yes, we will intervene with something that is safe, doesn't interfere with their diabetes medicines, their heart medicines, and try to treat those. Working with nutrition, who's here and making sure that these patients have the adequate diet, have the adequate protein levels in order to gain some strength back that they might have lost.

00:11:13:19 - 00:11:21:24
Zaira Khalid, MD
So putting all those teams together and really having that multidisciplinary approach to patient care, I think is what works really well.

00:11:21:27 - 00:11:33:22
Rebecca Chickey
Yeah. Whole person care. Who knew? The brain is connected to the rest of the body. Do you have a story you'd like to share for the listeners? A success story when you've seen this approach be used?

00:11:33:25 - 00:11:55:06
Zaira Khalid, MD
Yes. Actually, the diabetes medication, a story I just example I shared with you was a real life patient. So, I mean, these are all sort of lessons learned, and educating families on how important, you know, managing their blood sugars are. We see this day and night. Another very common thing that I see a lot of times is the sleep.

00:11:55:08 - 00:12:15:20
Zaira Khalid, MD
You know, a lot of our elderly have trouble sleeping. That leads to irritability the next day. That may lead to behaviors like agitation in a nursing home, or they're coming in because they might have hurt someone in a nursing home. And when we really kind of think back and look back into it, one of the biggest things is sleep.

00:12:15:20 - 00:12:36:19
Zaira Khalid, MD
It's not that they are agitated because they have bipolar disorder or they have something else going on. It's sleep and having to target that. And once they've gotten a good night's rest for a few nights, they're a completely different person. And I think we can all relate to that. I mean that nobody does well without sleep, but these patients and their brains are much more sensitive to that.

00:12:36:21 - 00:13:10:18
Rebecca Chickey
Absolutely. So I have a couple more questions before we wrap up. The first is if one of the listeners is thinking about creating such a program as yours in their own organization, whether it's in a freestanding psychiatric hospital like yours, or they're going to try to adapt it inside a general acute care hospital, do you have maybe 2 or 3 things that you think you did as you were planning for this that really provided the successful foundation that you're operating from now?

00:13:10:21 - 00:13:37:06
Zaira Khalid, MD
So I think number one is what you touched on earlier, having staff that is passionate about this population. It is not an easy population. There's a lot of medications, there's a lot of social factors that are involved. I think one of the other key elements is collaborating with your community resources. We can only do so much. They are going back into the community, and they're going to need those resources.

00:13:37:13 - 00:14:06:25
Zaira Khalid, MD
So knowing what those resources are, knowing how to refer patients to those resources is going to be extremely, extremely important. Those are two of the biggest things I think that leads to success when treating geriatric patients. And then having a collaborating counterpart that is going to be medicine, because these patients have significant comorbidities that you're going to need the help of your family medicine colleagues, or your internal medicine colleagues.

00:14:06:27 - 00:14:13:07
Zaira Khalid, MD
I think if you can work together as a team with them, you can really, really help these patients significantly.

00:14:13:09 - 00:14:33:27
Rebecca Chickey
Well, I'm so inspired. If I had the capability to go start one of these programs, I think I would do it right now. But, I don't. Thankfully, we have professionals like you and the wonderful team at Henry Ford Health. My last question to you is, do you have words of inspiration or a call to action that you'd like to share with the listeners of this podcast?

00:14:33:29 - 00:14:56:16
Zaira Khalid, MD
Sure. I think Call to Action, for me, the biggest thing would be check in on your older loved ones, please. I think a lot of them are part of a generation that doesn't talk about mental health. They're from a generation that did not necessarily believe in mental health. And, had the mindset of just keep pushing and it'll get better.

00:14:56:16 - 00:15:22:08
Zaira Khalid, MD
Just keep going and you'll get better. And sometimes it doesn't. Check in on them. Also, please keep a close eye on them for any substance use. We continue to see a rise in substance use in our elderly. It's really leading to a lot of other complications as well. So, you know, I'll give you an example. For example, if a grandmother falls down the stairs, our first instinct is she's old, she tripped and she fell.

00:15:22:10 - 00:15:46:18
Zaira Khalid, MD
We don't ever test her, or very rarely do we test her for alcohol. Was she intoxicated? Is that why she fell? It's not our first thought. So please look at those things. Look at their safety in their home. See if they're involved in the community or if they're spending all their weeks in their apartment. Get them involved volunteering at the library, community center.

00:15:46:25 - 00:15:55:23
Zaira Khalid, MD
Day programs, whatever it may be. Giving them a purpose, giving them a routine can be so, so beneficial for them.

00:15:55:25 - 00:16:06:13
Rebecca Chickey
That's wonderful and exceptional. And thank you so much for your willingness to share your passion, your time, your expertise and to inspire others on this really important journey.

00:16:06:16 - 00:16:14:27
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.

00:00:00:29 - 00:00:23:14
Tom Haederle
Welcome to Advancing Health. The perinatal period is a delicate time for a new mom's mental health. In fact, 1 in 4 moms experiences perinatal depression and anxiety. Coming up, a look into how a leading specialty hospital for women and newborns developed a program that helps prevent perinatal depression.

00:00:23:16 - 00:00:44:29
Julia Resnick
Hi everyone. I'm Julia Resnick, director of strategic initiatives at the American Hospital Association. I am so pleased to be here today to talk with all of you about perinatal depression. I'm joined by two experts from Women & Infants Hospital of Rhode Island. We have Shannon Sullivan, who is the president and chief operating officer, joined by Dr. Caron Zlotnick, who's the director of behavioral medicine research.

00:00:45:01 - 00:00:49:04
Julia Resnick
Shannon, Dr. Zlotnick, so happy to be here with you all today.

00:00:49:06 - 00:00:50:04
Shannon Sullivan
Thank you. Julia.

00:00:50:05 - 00:00:51:12
Caron Zlotnick, Ph.D.
Thank you for having us.

00:00:51:16 - 00:01:02:02
Julia Resnick
So let's dive right in. Shannon, I want to start with you. Can you start with some background on your hospital and your community?

00:01:02:04 - 00:01:37:21
Shannon Sullivan
Sure. Absolutely. So Women & Infants is one of the largest freestanding women's health hospitals in the country, exclusively dedicated to serving women and their families. We do about 8,700 deliveries annually. We have an 82 single bed level, 3 to 4 NICU with about 1,100 discharges annually. We have a comprehend of women's medicine program that includes an inpatient unit, GI, OB medicine, endocrinology, basically anything that cares for women during the course of their lifetime.

00:01:37:24 - 00:01:58:23
Shannon Sullivan
We are also the only OB hospital in the region that is an obstetrical tertiary care hospital. Plus, we have one of the largest NICUs in New England and actually on the East coast. So we care only for women here, only for women and their infants. And we feel really strongly about their care being really high quality.

00:01:58:25 - 00:02:16:09
Julia Resnick
That's amazing. And I love that whole life cycle from when they're young until when they're much older. And for this podcast, we're really focusing on your hospital's pregnancy and postpartum care. So how are you thinking about that whole continuum and making sure that that care extends to women after they give birth?

00:02:16:11 - 00:02:40:10
Shannon Sullivan
You know, I think it's important to note that even though I'm the president and chief operating officer now, my background is I'm a perinatal social worker. I've a master's in social work and I practiced in this setting for about ten years before I got into leadership. And so I can tell you, we're particularly dedicated to the pregnant and postpartum care, especially the mental health needs of women across the state.

00:02:40:13 - 00:03:12:03
Shannon Sullivan
And so, you know, currently, when you look at morbidity and mortality across the United States in the pregnancy and postpartum period, suicide and overdose are climbing higher in that list, and mark two of the top ten reasons that women get sick and die during their pregnancy or one year postpartum. It's a particularly delicate time for women and their families, and that's underscored not just by the data and the research but a lot of the anecdotal stories that you'll hear, you know, across news outlets.

00:03:12:03 - 00:03:38:12
Shannon Sullivan
And so it's incredibly important for us, being that we are a women's hospital, being the types of patients that we care for, that like I said, come from a wide variety of backgrounds. And given what we know about women in their pregnancy and postpartum period and what's happening nationally. And so there are not ever enough resources to care for women during this particularly delicate time during their life.

00:03:38:14 - 00:03:47:26
Shannon Sullivan
And so we've really spent a lot of time in the last 25 years investing both in the research and in the care of women.

00:03:47:28 - 00:04:04:27
Julia Resnick
I think what your hospital is doing is so important because it connects the research in this space with the care. So, Dr. Slotnick, you're an expert in this space. What were you seeing that helped, you know, it was so important for your hospital to do more around postpartum depression care?

00:04:04:29 - 00:04:34:22
Caron Zlotnick, Ph.D.
Well, my expertise and focus is preventing postpartum depression. When I first started at Women & Infants Hospital, which was, many, many moons ago, you know, Women & Infants has a large ObGyn clinic. The majority of their perinatal patients are on Medicaid. And this is a very high risk group of women who are at risk for postpartum depression.

00:04:34:24 - 00:05:01:08
Caron Zlotnick, Ph.D.
When I started at Women & Infants Hospital as a clinical psychologist, I treated many of these perinatal patients with mental health issues. So I heard firsthand the struggles of these patients with mental health issues. You know, we know society  - you could even look on Facebook - tells us that having a baby is the happiest time of your life.

00:05:01:10 - 00:05:20:00
Caron Zlotnick, Ph.D.
And, these patients really experienced a lot of stigma and shame around their mental health issues. You know, that got me thinking that, you know, screening and treatment is very important but prevention is better and more cost effective.

00:05:20:06 - 00:05:23:11
Julia Resnick
So talk to me more about that. What does prevention look like?

00:05:23:13 - 00:05:52:27
Caron Zlotnick, Ph.D.
Well, there's no proven or consistent way to predict who might be at risk for postpartum depression. You know, it's probably more cost effective to offer a prevention intervention like program to prevent postpartum depression to every pregnant woman rather than guess who may benefit from the program. So, the Rose program: Reach out, stay strong,

00:05:52:29 - 00:06:21:29
Caron Zlotnick, Ph.D.
essential for mothers with infants. So the overall aim of ROSE is to reduce suffering and increase joy for as many new mothers with an infant as possible during a time when which can be very stressful and lonely. The Rose program is administered during pregnancy, usually in small groups consisting of four sessions during pregnancy and a postpartum check-in post delivery.

00:06:22:01 - 00:06:54:22
Caron Zlotnick, Ph.D.
The ROSE program tries to focus on those risk factors that fall postpartum depression that are amenable to change. So the session topics focus on improving relationships and support system, effective strategies to communicate, like how to say no, how to ask for help. Very important in the postpartum period. Self-care strategies, ensuring that new moms have me time, that they don't get depleted. And goal setting.

00:06:54:25 - 00:07:27:17
Caron Zlotnick, Ph.D.
We also provide information on different types of stresses that can occur in the postpartum periods, you know, such as baby blues and what is involved with postpartum depression and how to identify it, we try to destigmatize it. It is a common struggle for many postpartum women. You know, 1 in 7 experience full-blown postpartum depression. We tell them how and where to reach out for help.

00:07:27:19 - 00:07:53:28
Caron Zlotnick, Ph.D.
To accompany our sessions, we have a patient workbook, which is available in English and Spanish. We did a very large implementation study in which we had 98 sites across the country, delivering Rose. So some sites delivered Rose virtually, others in person. Now, what is important with delivering Rose is that you don't need mental health expertise.

00:07:54:00 - 00:08:27:17
Caron Zlotnick, Ph.D.
So we had the full spectrum of people delivering Rose: clinic nurses, doulas, medical assistance navigators, community health workers, and actually mental health providers. And the training for those who want to deliver Rose is relatively an easy process. The ROSE website, which is hosted by Women & Infants, has all the training intervention materials. The training videos, as I mentioned before, the patient workbook.

00:08:27:19 - 00:08:38:08
Caron Zlotnick, Ph.D.
And Rose itself is highly scripted. So there's a scripted manual there. We have slides for virtual delivery and all free of cost.

00:08:38:11 - 00:09:01:27
Julia Resnick
That's amazing. And I think just having this publicly available is so hugely important. And also there are so many communities that don't have enough mental health providers that it's really powerful that you can be a lay provider or just a medical provider. I want to pivot slightly. I know that your hospital is doing work in perinatal depression and supporting postpartum women in their families beyond the Rose program.

00:09:01:29 - 00:09:05:20
Julia Resnick
Shannon, can you talk a little bit about what else is going on?

00:09:05:22 - 00:09:44:01
Shannon Sullivan
One of our more proud moments is how dedicated this organization has been to the totality of care of women. Not just their medical care, their psychological care, their socioeconomic care, their social determinants care. And really making sure that they support the whole woman in their family, for many decades now. And that is mostly our premier program, the one that, you know, Dr. Zlotnickwas just talking about, that she had started in is our day hospital program and our partial hospitalization program, which opened 25 years ago.

00:09:44:02 - 00:10:14:09
Shannon Sullivan
It was revolutionary at the time. I would argue it's still revolutionary today. It was a program for assessment and then care of pregnant and postpartum women with perinatal and postpartum depression. And what was so revolutionary about it is it was a program that allowed women to get that intensive outpatient care. So coming every day, but with their baby. Oftentimes you would find women were separated during treatment from their children.

00:10:14:09 - 00:10:42:01
Shannon Sullivan
And then, you know, psychiatrists, psychologists, social workers couldn't really assess bonding. They couldn't really assess how women were doing and caring for their infants as well, as it didn't allow women more time to be able to bond under the professional treatment that they received. So that was opened late 90s, early 2000s and still remains actually one of the only in the country and cares for a wide variety of women, really across the region.

00:10:42:03 - 00:11:04:09
Shannon Sullivan
And since that time, more recently, we've increased the amount of women and the types of care that we're providing. So it's no longer, you know, postpartum and perinatal anxiety and depression. We also have an OCD track. We found there's a higher prevalence, especially for women who've previously experienced obsessive compulsive disorder in the postpartum period. That can be a really difficult time.

00:11:04:11 - 00:11:28:13
Shannon Sullivan
So we've opened an OCD track to the partial hospitalization program, and most recently, within the last six months, we've reopened a substance use track so that we can, you know, try to work together. We work together with a Suboxone program. We have family medicine who's been coming in and helping us to care for not only the patients, but also the babies that are in that program with their mothers.

00:11:28:13 - 00:11:47:18
Shannon Sullivan
And so we're really trying to diversify the types of patients that we're caring for in that program, all along the lines of treating mothers while keeping them together with their children. It's really been well received within the community. We can't keep up with the volume as you can imagine, and so we're continuing to find ways to grow it over time.

00:11:47:21 - 00:12:14:09
Shannon Sullivan
Two other ways that we're really looking is Dr. Emily Miller, who's the division director of maternal fetal medicine here, has an RO1 grant for the Compass Plus program, which embeds social workers and case managers within obstetrical practices for that assessment, grief intervention and then referral. And then our newest program that we're most proud of that hasn't started yet is our mobile van program.

00:12:14:10 - 00:12:40:16
Shannon Sullivan
CVS Health recently gave us a grant to purchase a mobile van, and in that mobile van, we'll have a nurse practitioner and community health workers. What we know about our particular community is especially the patients that Dr. Zlotnick was talking about, our high Medicaid clinic onsite. It's hard for patients to get back. You know, you're asking them to deliver a baby and then they might not have reliable transportation, they might not have reliable child care.

00:12:40:22 - 00:13:12:18
Shannon Sullivan
And, you know, I will tell you, as the mother of three who had reliable transportation, who had reliable child care, getting out of the house with my children during that postpartum period was really challenging, especially to take care of myself. And so the postpartum van is going to be able to go out and really provide that care in communities to patients in their home and in the van, and be able to identify and then refer either to Rose or to Compass Plus or to the day hospital program when they're meeting with patients in their own community and really seeing what's happening in their home.

00:13:12:20 - 00:13:30:18
Julia Resnick
That's really amazing and impressive work. And please keep us posted on all of these new programs. It sounds like they'll be incredibly impactful. To wrap things up, I just want to pick your brains about what you've learned while implementing these programs, because I'm sure we have people listening who are thinking, how do I do this in my community and in my setting?

00:13:30:25 - 00:13:38:11
Julia Resnick
So what do you think those key takeaways are - that others could learn from your experiences to set up their own programs?

00:13:38:13 - 00:14:02:24
Shannon Sullivan
I think execution is always a problem and a lot of that has to do with, you know, these are complex clinics, these are complex patients. And everything, of course, requires resources. And all of those things make it more complicated. I would say that one size does not fit all for everyone. We've seen many people fail trying to implement a postpartum day hospital program.

00:14:02:24 - 00:14:30:19
Shannon Sullivan
We've seen many people with the best intentions. And so you have to partner with a wide, wide variety of people to get any of these programs off the ground. Your payer contracting teams, your operational needs, your clinical needs, your patient liaisons, your community health workers. And so it really does require a multidisciplinary approach to execution and probably much longer than any of us ever

00:14:30:19 - 00:14:42:21
Shannon Sullivan
like when it comes down to that. But I would say if you get the right multi-disciplinary team, embedded in doing your work, you can do it, but you certainly can't do it alone.

00:14:42:24 - 00:14:44:15
Julia Resnick
Anything to add, Caron?

00:14:44:17 - 00:15:16:00
Caron Zlotnick, Ph.D.
I can say the organization has to have the capacity to implement a program like Rose. What I would also like to say is that in recruiting potential sites, it was very heartwarming to hear from administrators, directors of programs really expressing a deep passion about improving maternal mental health. You know, in our study we realized that it makes a difference if you have a cheerleader.

00:15:16:02 - 00:15:48:24
Caron Zlotnick, Ph.D.
Best if leadership is the cheerleader but even those who are delivering Rose. And I just want to mention that on our website at Women & Infants Hospital, we actually have an implementation plan for agencies and hospitals that are thinking about implementing the Rose program. That really helps these sites to think through what it is that they need to do to successfully implement Rose or actually any program similar to Rose.

00:15:48:27 - 00:16:15:03
Julia Resnick
Fantastic. So I think three key themes that I heard was that you need passion, you need partnerships and you need patients. Shannon, Dr. Zlotnick, thank you so much for sharing this fantastic work that you're doing. To our listeners, you should check out the Rose program website on the Women Infants Hospital website. Thank you all for listening. And thank you again to Shannon and Dr. Zlotnick for your passion for this issue and for sharing your expertise with our listeners.

00:16:15:05 - 00:16:15:18
Shannon Sullivan
Thanks so much.

00:16:16:09 - 00:16:19:07
Caron Zlotnick, Ph.D.
Thank you for giving us this opportunity.

00:16:19:09 - 00:16:27:20
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:27 - 00:00:24:15
Tom Haederle
Welcome to Advancing Health. For stroke victims, speed and survival are closely linked. Quicker diagnosis and treatment can make a huge difference. Coming up in today's podcast, a look at how those two letters we hear more and more about in today's health care - A and I - artificial intelligence, are being applied to protocols for stroke treatment.

00:00:24:18 - 00:00:43:24
Tom Haederle
Hi everyone. I'm Tom Haederle, senior communication specialist with the American Hospital Association and pleased today to get to do one of my favorite parts of this job. And that's highlighting the amazing work that goes on every day among our member hospitals and health systems. And here's a great example: the integration of artificial intelligence into treatment protocols for stroke victims

00:00:43:24 - 00:01:08:11
Tom Haederle
at Detroit-based Henry Ford Health. Joining me from Henry Ford to talk about this are Dr. Aaron Lewandowski, an emergency medicine doctor and the emergency medicine stroke representative at Henry Ford West Bloomfield Hospital, and Doctor Alex Chebl, a vascular and interventional neurologist and director of the Henry Ford Stroke Center and the Division of Vascular Neurology. Doctors, thank you both for joining us on this Advancing Health podcast today.

00:01:08:11 - 00:01:09:08
Tom Haederle
Appreciate you being here.

00:01:09:09 - 00:01:10:07
Aaron Lewandowski, M.D.
Thanks for having us.

00:01:10:09 - 00:01:11:10
Alex Chebl, M.D.
Thank you for having me.

00:01:11:12 - 00:01:20:03
Tom Haederle
Dr. Lewandowski, let's start with you and a basic question: why is speed of diagnosis and treatment so critical when treating victims of a stroke?

00:01:20:05 - 00:01:40:23
Aaron Lewandowski, M.D.
There's a common saying in neurology and stroke care that time is brain. It is estimated that millions of neurons are irreplaceably lost each minute during an ischemic stroke. So the sooner that we are able to diagnose and treat a stroke, the more brain we're able to save and the patients are able to have a easier outcome and a better recovery.

00:01:40:25 - 00:01:45:28
Tom Haederle
And what exactly does AI lend to the process? How has it improved how we're doing this now?

00:01:46:00 - 00:02:12:10
Aaron Lewandowski, M.D.
AI has been used in multiple ways across medicine. In stroke care particularly, we're able to use it in helping with diagnosis of stroke in a timely manner. Our program specifically is called Rapid AI. It is a software program that allows for quicker diagnosis of strokes and also facilitates communication between physicians. Dr. Chebl was actually the physician that brought the idea to our stroke committee, and we've been using it for approximately two years.

00:02:12:12 - 00:02:23:19
Tom Haederle
Does it actually paint - and this is a question for both of you - does it paint a picture of what's going on inside the stroke victim inside the brain actually allow you to see something you couldn't see before. Dr. Chebl?

00:02:23:21 - 00:02:44:01
Alex Chebl, M.D.
It's not so much as paints a picture as gives you an exact picture of what's going on. So the challenge we have in stroke neurology, unlike, say, when a patient comes in with a heart attack, you know, a patient grabs a chest, they're having chest pain. You can do an EKG and a cardiologist emergency physician can know immediately where the problem is.

00:02:44:03 - 00:03:08:12
Alex Chebl, M.D.
The trouble in neurology, is that there are many different types of stroke. Some types of stroke are caused by bleeding into the brain. But the more common type of stroke and why we use AI most commonly is called a ischemic stroke where there's a blockage, and the treatment for those two types of stroke are exactly opposite. One causes the other, and so you have to know what type of stroke you're dealing with.

00:03:08:18 - 00:03:17:15
Alex Chebl, M.D.
And this is why it's more complicated. And knowing what's going on inside the brain with the arteries is critical. And this is where the AI helps us.

00:03:17:17 - 00:03:52:12
Aaron Lewandowski, M.D.
Particularly with ischemic strokes, the issue is trying to figure out what part of the brain has been affected by the stroke and also where the blood clot is. And, is it amenable to intervention? There's medicines such as TMK which we're able to use to try and break down the clot during an ischemic stroke. But particularly where I used it for our purposes is in the use of the thrombectomy procedure, which is where you're able to intervascularly go up into the brain and actually remove the clot that's causing the stroke if it's located in an appropriate and amenable position.

00:03:52:15 - 00:04:15:02
Aaron Lewandowski, M.D.
So the program serves multiple purposes. The AI portion of the program evaluates the CT angiogram and the CT perfusion studies of the patient looking for any asymmetry in blood vessel distribution or perfusion. This is able to allow us to quickly evaluate for signs of what we call a large vessel occlusion. Those are the types of strokes that are most amenable to the thrombectomy procedure.

00:04:15:04 - 00:04:24:03
Tom Haederle
How much time has the use of Rapid AI shaved off of the diagnosis and allowed you to figure out accurately what's happening?

00:04:24:06 - 00:04:51:18
Alex Chebl, M.D.
Approximately 30 minutes. When we look at patients who are candidates for mechanical thrombectomy, that's the procedure where we pull the clots from the brain. We've reduced our door-to-puncture time. That is, from the minute the patient arrives in the emergency department until we actually puncture the artery to get to the brain, we've been able to save about 30 minutes, bringing us down to within the 90 minute ideal window for that treatment.

00:04:51:25 - 00:05:13:01
Alex Chebl, M.D.
But, just as importantly, it's also helped us with our door-to-needle time. So that balloon scan mentioned that you can also give the clot busting medication. That has to be given within 4.5 hours. And so we've now are consistently able to treat patients instead of roughly within an hour presentation. We're now being able to treat almost all patients with 45 minutes.

00:05:13:01 - 00:05:19:16
Alex Chebl, M.D.
And we're approaching 30 minutes from door-to-needle. And every minute is essential in that effort.

00:05:19:18 - 00:05:22:27
Tom Haederle
That's really impressive. What's been the impact on patient outcomes?

00:05:23:04 - 00:05:44:13
Alex Chebl, M.D.
Tremendous patient outcomes. If you look nationally, but also at our sites, you look at the number of patients, proportion of patients who recover to normal or nearly normal has increased. If you look at the number of patients who are discharged to home rather than to rehab, a good measure of whether patients have disability, that has also increased.

00:05:44:15 - 00:05:58:13
Alex Chebl, M.D.
And nationally, the data clearly support, this overwhelmingly so, so that the American Heart Association, for example, keeps shortening the time metric, because the sooner we do it, we're getting better outcomes.

00:05:58:15 - 00:06:17:21
Tom Haederle
Really good news for patients. I'm wondering, given the size of Henry Ford, a big, big system you have. And I imagine that rolling out any new technology or software or changing how things are done, particularly across a scale like that, has got its challenges. Did you run into any kind of bureaucratic obstacles or resistance? We don't know what this thing is . . .

00:06:17:21 - 00:06:21:23
Tom Haederle
Prove it to us. Was it hard to sell, or not really?

00:06:21:26 - 00:06:45:08
Aaron Lewandowski, M.D.
What? Dr. Chebl first brought the idea to us at the West Bloomfield emergency Department, it was certainly interest in, you know, ways that we can improve our stroke care. I would say overall, we didn't really experience any significant barriers to implementing Rapid AI here at Henry Ford. I would say the hurdles that we faced were the standard hurdles you faced with integrating any new piece of software or technology into your preexisting hospital system.

00:06:45:10 - 00:07:23:24
Alex Chebl, M.D.
Yeah, I would second that. You know, there was some trepidation amongst some team members. You know, our implementation of Rapid AI, there's many different ways that you could implement such a program. One could be it just notifies the radiologist, "hey, there's a potential stroke. Take a look." We have gone to the exact or most extreme or the deepest implementation, meaning all members of the team are notified when we have a stroke, and this has minimized the number of phone calls we have to make to get the patient ready, to get the OR team ready, etc. and when you have that many people learning something new there can be some trepidation.

00:07:23:24 - 00:07:44:12
Alex Chebl, M.D.
And the biggest fear really was, why do I have to have another app? And this is just going to increase my workload, right? I'm going to be bothered all the time with these unnecessary things. And in fact, it's the exact opposite. Most people got used to it. They could not believe that they were living without it. It's made their lives better.

00:07:44:12 - 00:07:49:11
Alex Chebl, M.D.
Not just the patients lives better. It made all of our lives better because it's simplified the communication.

00:07:49:14 - 00:08:21:26
Aaron Lewandowski, M.D.
And I would certainly second that. From an emergency medicine perspective, a lot of our job on a day to day basis is discussing phone calls with consultants and trying to communicate with other team members. So being able to have that initial phone call with the stroke neurologist to discuss the initial plan of care, but then everything else being in the, HIPAA secure chat with rapid AI has certainly allowed for our communication to be much more effective and much more quicker so that everyone can see in real time what's going on, what's the plan?

00:08:21:26 - 00:08:23:14
Aaron Lewandowski, M.D.
What are we doing for the patient?

00:08:23:16 - 00:08:44:22
Tom Haederle
Yeah. You hear that so often about applications of AI and in almost any capacity, ambient listening or anything else. People are delighted. It's a time saver and a work saver. And you've seen that with the with the implementation of, Rapid AI at Henry Ford. Any thoughts you would share about another system or hospital that is considering going around and maybe integrating it for the first time?

00:08:44:25 - 00:08:50:24
Tom Haederle
What would you say in terms of it's utility, in terms of its ease of use, that kind of thing?

00:08:50:26 - 00:09:17:29
Alex Chebl, M.D.
Well, I mean, I think there's two aspects. One is you've got to lay the groundwork for this. You need a stroke champion, champions. Certainly someone from emergency department is critical. You need someone on the neurology side. And they need to then sell this to everyone. Once you've laid the groundwork and you've got buy-in from everyone

00:09:18:01 - 00:09:41:20
Alex Chebl, M.D.
the actual implementation isn't that difficult. Securing IT, and the firewalls, etc.. The company helped set up. They also have individuals who can come and help train users. How to use it, how to adjust the settings, etc.. So we found that it was pretty straightforward to initiate the Rapid AI in our system.

00:09:41:26 - 00:10:00:29
Alex Chebl, M.D.
And one way to do it, I guess, would be my suggestion would be don't start too big. You know, maybe start if you have a large system like we have, you know, start locally, 1 or 2 smaller hospitals. Don't include every single team member. Get the bugs worked out of the system and then expand.

00:10:01:01 - 00:10:21:13
Aaron Lewandowski, M.D.
And definitely when you're trying to, you know, sell the idea to administration or other departments, certainly focusing on the benefits to patient care, like quicker diagnosis and also the benefits to the team members, such as more effective communication. I think is a really good way to show the positive benefits that can come from this.

00:10:21:16 - 00:10:47:18
Alex Chebl, M.D.
You know, obviously we do everything focused on the patient. We want the best patient outcomes, but we can't deliver good health care without paying for everything that's required to do so. So the money does play a role. And I think this is where it's important for an administrator to understand is that the better the patient does, the shorter length of stay, the less money is spent on that patient.

00:10:47:22 - 00:11:02:22
Alex Chebl, M.D.
And therefore a health system can keep more of that money for the other services that they need. And I think that's very important. I mean, after all, this is why we were able to convince CMS to pay for these very complex treatments is because overall it ends up saving money.

00:11:02:24 - 00:11:09:23
Tom Haederle
It's a great point, thank you. As we wrap up, any final thoughts? Anything we haven't talked about that you'd like to say about Rapid AI?

00:11:09:26 - 00:11:35:20
Alex Chebl, M.D.
You know, these systems now? Although they're mostly started in stroke, there are many competitors, Rapid AI as well, but they have other modules. And so these systems can be used for other disease states, pulmonary embolism, the identification of intracranial hemorrhage, cerebral aneurysms. And so there are many opportunities for multiple different departments to collaborate. And that can also help with the financial aspects of this.

00:11:35:21 - 00:11:46:14
Alex Chebl, M.D.
You know, the more users you have on board, it tends to be, you know, cheaper than just having each individual division having their own systems working independently.

00:11:46:16 - 00:11:51:12
Tom Haederle
That's a great point, thank you. Thank you for bringing that up. Dr, Lewandowski, any final thoughts?

00:11:51:15 - 00:12:09:23
Aaron Lewandowski, M.D.
I've certainly enjoyed the implementation of Rapid AI. It makes my job simpler. It provides better patient care. You know, I don't think that AI will ever replace physician assessment and judgment, but it's very impressive what a powerful tool it can be when used appropriately, to improve the care that we provide to our patients.

:12:09:26 - 00:12:21:22
Tom Haederle
Absolutely. Thank you both so much for your time today and this great discussion. And I hope it reaches a lot of ears and get some people thinking about just how powerful this tool is. So again, appreciate your time. Thank you for being on Advancing Health.

00:12:21:25 - 00:12:22:15
Aaron Lewandowski, M.D.
Thank you very much.

00:12:22:20 - 00:12:25:05
Alex Chebl, M.D.
Thank you. Have a wonderful day.

00:12:25:07 - 00:12:33:18
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.