Advancing Health Podcast

00:00:01:02 - 00:00:23:24
Tom Haederle
Welcome to Advancing Health. Today's podcast celebrates Father's Day. Wrenetha Julion from Rush University Medical Center and Paul Florsheim from the University of Wisconsin Milwaukee, Zilber School of Public Health joined the AHA’s Julia Resnick to share the impact of father inclusive prenatal health care.

00:00:23:26 - 00:00:44:01
Julia Resnick
Wrenetha, Paul, so happy to be here with you today to talk about this really important topic. And just so glad that we can release this podcast for Father's Day. So during pregnancy, there's always a lot of focus on the mom for understandable reasons. But we also know that fathers are experiencing a major life event in becoming a parent.

00:00:44:03 - 00:00:52:00
Julia Resnick
Can you talk a little bit about why a father inclusive approach is so important for both maternal and infant outcomes? Paul, why don't we start with you?

00:00:52:03 - 00:01:21:07
Paul Florsheim, Ph.D.
To some extent, it's similar to moms and that particularly for, of course, new fathers that very few young men or even not young men, you know, sort of know a whole lot about how to prepare for parenting, how to parent an infant in particular. Many of them are sort of both excited and intimidated by the idea of having an infant.

00:01:21:09 - 00:01:50:22
Paul Florsheim, Ph.D.
You know, the transition to parenting always involves a lot of relationship challenges. It's a pretty common phenomenon that new parents report their relationship as or aspects of their relationship of having been lost. And so the challenges of sort of managing the connection part, the romantic part of the relationship is something that many of our couples sort of want to talk about when we're working with them.

00:01:50:24 - 00:02:19:01
Paul Florsheim, Ph.D.
I would just add that part of that is that some of these couples and we approach our couples that we work with, as we don't know whether you're going to stay together or split apart, and we don't really have, you know, sort of a stake in that. That's for you to decide and we don't push it one way or the other, but we do want you to be able to work together as a co-parenting team, regardless of what happens to that relationship.

00:02:19:07 - 00:02:37:23
Paul Florsheim, Ph.D.
And so that's another reason that I think men it's important to include the fathers in the process so that they have those skills, the communication skills to navigate even a breakup in that relationship, that they're able to co-parent as well.

00:02:37:25 - 00:02:40:16
Julia Resnick
Absolutely. Wrenetha, anything you want to add?

00:02:40:18 - 00:03:19:27
Wrenetha Julion, Ph.D., R.N.
Fathers have questions. Fathers want to be helpful. They want to be there and I think that they have a really important role in helping keep mothers safe during labor and delivery, and to really be a buffer for her for all that's going on around her. So that every question, everything doesn't come directly to the mother. And then I think there is a lot of information out there about how fathers presence and involvement is beneficial not only to themselves, but to the mothers and to the babies.

00:03:19:29 - 00:03:32:13
Wrenetha Julion, Ph.D., R.N.
So there are multiple reasons why fathers need as much attention, really, as mothers do. Maybe not as much physical attention, but otherwise they need just as much attention as mothers do.

00:03:32:15 - 00:03:49:03
Julia Resnick
Absolutely. And I think that piece about, you know, being in this is a partnership. I want to dive into the work that you're doing with the preparing for Parenthood program, which is going on in the Chicago area through Rush University Medical Center where you work, Wrenetha. And I know that you partner with a lot of community stakeholders.

00:03:49:09 - 00:03:53:15
Julia Resnick
So can you tell us more about the community that your hospital serves?

00:03:53:17 - 00:04:23:24
Wrenetha Julion, Ph.D., R.N.
Our hospital is positioned, I would say towards the center of the city. And so there are numerous neighborhoods that surround us. So there are Latino families. There are African-American families. There are other ethnic origins and other groups that surround us...so we really we speak to the importance of being sensitive and responsive to the communities that we serve.

00:04:23:26 - 00:04:42:27
Wrenetha Julion, Ph.D., R.N.
So it's a really nice, I think, hodgepodge of communities. And so it really is good to be in this space and to serve a large group of people, all of whom may have some challenges. They may not. They may be fine. So it fits with our mission and vision for sure.

00:04:42:27 - 00:04:52:21
Julia Resnick
And knowing Chicago, like I do, you're really at the crossroads of so many different communities. Paul, I know you're based in Wisconsin, so can you talk a little bit about what your role is with the program?

00:04:52:24 - 00:05:17:19
Paul Florsheim, Ph.D.
So, Wrenetha and I are really co-directors of the program. We applied for the grant together. You know, you sort of have to choose a community to do this in. I'm back and forth to Chicago quite a bit. And so we ran this through Rush. You know, Chicago has both a lot to offer, but also, we felt like it was a good place to do a fatherhood program.

00:05:17:21 - 00:05:40:11
Julia Resnick
Wonderful. So we've been dancing around the idea of the program, and I really want to dive into what the Preparing for Parenthood program is. Renee knows this from when I talk to her. I learned about the program when I was riding the train in Chicago and saw an ad for it and said, I absolutely need to know more about the work that they're doing because this is so hugely important for families in Chicago and for other communities across the country.

00:05:40:14 - 00:05:44:14
Julia Resnick
So can you share more about what the program is and what you do?

00:05:44:16 - 00:06:10:01
Paul Florsheim, Ph.D.
So one of the key features of it is that I think we've already sort of talked about a little bit is, is that it is offered in collaboration with prenatal care. And we do that quite intentionally, partly as a preventative program. Like we want to sort of reach fathers as they're getting ready for parenthood, but it's also the case that it's a really nice vehicle for connecting with fathers.

00:06:10:02 - 00:06:33:00
Paul Florsheim, Ph.D.
It's kind of hard to find fathers if you don't go through the services that are being provided to mothers, and mothers we have found to be very invested in fathers getting some services. It's also the case that prenatal care providers have an importance in the lives of both mothers and fathers that sort of lends legitimacy to what we're doing.

00:06:33:00 - 00:07:01:05
Paul Florsheim, Ph.D.
And so that's really helpful in terms of engaging, particularly young men who may not be all that interested in engaging with sort of social service agencies, mental health institutions, that sort of thing. We feel as though through prenatal care, we're able to reach a broader part of the young male population. The program focuses on essentially three things. The co-parenting piece,

00:07:01:07 - 00:07:23:03
Paul Florsheim, Ph.D.
and we sort of talk about that in a different ways. But one of the ways that I like to sort of talk about it is communication skills development. A lot of couples readily acknowledge that communication is an issue for them, and so they kind of resonate with that right away. It's tailored like a prenatal care in a prenatal care setting.

00:07:23:07 - 00:07:48:15
Paul Florsheim, Ph.D.
We work with couples individually in the sense that it's couple by couple rather than groups of couples. And part of the reason we do that is that we like to customize the program to meet the particular needs and wants of those couples. And it's not always the same. So we tailor those communication skills to what the couple is asking for, what they're presenting to us.

00:07:48:18 - 00:08:13:22
Paul Florsheim, Ph.D.
We shift at some point to parenting skills. So, you know for new parents, we of course focus on you know, sort of some basic parenting skills for newborns. We have expanded to also including not just first time parents. And so we also focus on, you know, sort of how to parent with another new child, as well as toddler kinds of issues.

00:08:13:24 - 00:08:38:21
Paul Florsheim, Ph.D.
And then we have case management services - we call care coordination services. And that's a variety of things could be related to jobs, housing and legal entanglements, all the sort of things that some of our couples are challenged by. And we can't really get to the parenting stuff or the co-parenting stuff unless we also attend to all that other stuff.

00:08:38:22 - 00:08:47:19
Paul Florsheim, Ph.D.
You know, in some cases are the social determinants of health. So that's it in a nutshell. And Wrenetha can tell me if I forgot anything.

00:08:47:21 - 00:09:30:21
Wrenetha Julion, Ph.D., R.N.
I'd like to add, which is really our funders require us to include something that's going to support fathers primarily, but we also support mothers in whether or not someone decides they want to continue their education. They want to pursue a new trade or new career. So our workforce development component connects fathers and mothers with a program that's here in the city of Chicago that helps with that. And starts off with preparing to get a job and completing your resume and job interviewing and workplace conflict, potentially.

00:09:30:21 - 00:09:56:21
Wrenetha Julion, Ph.D., R.N.
So how do you handle things when you're at work and something comes up? And so all of those pieces fit into the workforce development component, which I think is what in particular excited me about this opportunity, because there's an awareness that families need more than communication and co-parenting and knowing how to raise children. A lot of families need a job,

00:09:56:21 - 00:10:21:18
Wrenetha Julion, Ph.D., R.N.
want a job, want to do something differently. And then one final thing I think that, when Paul mentioned the parenting, we have specific content that was developed for fathers in that piece because most things are targeted towards mothers. And so how to soothe the baby? What happens when why is your baby crying all the time? Or you know, how can you hold them to make them more comfortable?

00:10:21:18 - 00:10:33:22
Wrenetha Julion, Ph.D., R.N.
And the safety piece is about putting them down to sleep on their back and all those kinds of things. So that's also something I think is important in what we are providing to families.

00:10:33:25 - 00:10:58:26
Julia Resnick
Absolutely. And there are so many parts of this program that are exciting, and I love that you bring them in as a couple. So it's not just fathers together and mothers together, but really focusing on like the couple as a co-parenting unit. It's just really great. And that that whole person approach, recognizing that it's not just about parenting skills, but like feeling economically secure and stable in your community and as parents.

00:10:58:28 - 00:11:06:27
Julia Resnick
So I'm just curious, like you know, if a couple decides to join this program, like, can you walk me through what your experience would look like?

00:11:06:29 - 00:11:38:20
Wrenetha Julion, Ph.D., R.N.
So as we talked about the couples experience and why we work couple by couple. We start with what we call the parent prep check, and we interview the mother and the father to try to get a sense of where they are as a couple, where their relationship is, their hopes and dreams in terms of thinking about what they want as parents and how they want to experience and live through parenthood.

00:11:38:22 - 00:12:02:09
Wrenetha Julion, Ph.D., R.N.
Which is why that couples approach is so important, because in a group setting, you can imagine you've got, say, five groups. You may have five different areas to focus on at the same time. But us starting with that couple is that we can really hone in on what the couple wants and what the couple needs and what they identify as their strengths and opportunities.

00:12:02:12 - 00:12:14:18
Wrenetha Julion, Ph.D., R.N.
So that's the really, I think, fun part about this is because we want to address the couple's needs and starting where they are. I miss something, Paul?

00:12:14:21 - 00:12:41:24
Paul Florsheim, Ph.D.
No, I think that's it. I mean, that's sort of how we have designed the intake process to be very engaging and to make that point...well, we make a couple points. One is that we want to really tailor this to your needs. The other is that we're very deliberate in saying, you know, we are about the co-parenting relationship, and we don't want to sort of assume that this is a relationship that both of you necessarily want to be in or that you don't.

00:12:41:24 - 00:13:07:27
Paul Florsheim, Ph.D.
You know, we want to take the pressure off of that, as well, so that they feel comfortable sort of moving forward with us. The other thing that I would say is, is that, you know, it can be a little intimidating to come in and talk to...like for me, we don't assume that everybody who's delivering the father inclusive prenatal care services is a mental health professional.

00:13:07:27 - 00:13:32:08
Paul Florsheim, Ph.D.
I happen to be a mental health professional. Some of the couples do come in with some pretty significant issues. And so we do want to make sure that they feel comfortable talking about those in a way that feels safe. So we really emphasize we're not about digging into your deep, you know, sort of histories. And we really are oriented towards figuring out how do you guys move forward together.

00:13:32:14 - 00:13:46:08
Paul Florsheim, Ph.D.
And I often say I act as kind of a coach and a referee, so that if it starts to get too stressful in here, you know, I'm going to say, hold on, let's take a timeout.

00:13:46:10 - 00:13:57:14
Julia Resnick
That's great. So after five years of running this program, how are you measuring the impact and what are you seeing that you think is particularly meaningful?

00:13:57:17 - 00:14:21:27
Wrenetha Julion, Ph.D., R.N.
So I'm going to leave the metrics to Paul and talk a little bit about the quality, like we call the qualitative component. And I'll give an example of a father that we interviewed at the second interview, second time point. He spoke about how much he was learning about and from his daughter and how much he enjoyed that relationship that they had developed.

00:14:21:27 - 00:14:53:06
Wrenetha Julion, Ph.D., R.N.
And there were times when he gave her space to explore and to, quote unquote, fail if you will. You know, and it's like, pick yourself up, okay, we're going to keep on moving. And just the joy in listening to this father's interview, that was one of the best interviews that I've heard in this program, is hearing how he felt about himself, how he felt about his daughter, and how they were growing and learning together.

00:14:53:08 - 00:14:57:23
Julia Resnick
That's so special. Paul, do you have the hard quantitative metrics?

00:14:57:26 - 00:15:28:25
Paul Florsheim, Ph.D.
Yeah, I mean, we do quite a bit of measuring, particularly at the follow ups. And we do focus on things like the quality of the co-parenting relationship. Anything from, you know, preventing intimate partner violence to just being, you know, sort of warm and supportive of each other. We also focus on the parenting relationship and sort of how they're feeling about themselves as parents, but also how they are actually parenting, you know, or at least based on their own self-report.

00:15:28:25 - 00:15:53:18
Paul Florsheim, Ph.D.
Previous sort of versions of the of the program, we did videotaped parent child interaction to code the quality of those relationships. So our goal really is to either improve the quality of the co-parenting relationship if they are having a lot of challenges or prevent the development of problems so that down the road they're able to manage that relationship regardless.

00:15:53:21 - 00:16:26:01
Paul Florsheim, Ph.D.
And in a way, I mean, it's always it's hard as someone who works with these couples to not be a little bit invested in their relationship, staying together as a romantic relationship. But honestly, you know, when I think about it, you know, sort of more broadly than that, it is very gratifying as a provider to see them find ways to parent apart if they're able to do that successfully.

00:16:26:03 - 00:16:39:11
Julia Resnick
Wrenetha, Paul, thank you so much for sharing the work that you do and your expertise. But more than that, thank you for the work that you're doing for families in Chicago. It's just such incredibly important and powerful work.

00:16:39:13 - 00:16:42:03
Paul Florsheim, Ph.D.
Well, thanks for the opportunity to talk about our work.

00:16:42:05 - 00:16:44:23
Wrenetha Julion, Ph.D., R.N.
Absolutely. Thank you for having us.

00:16:44:25 - 00:16:53:07
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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:00:00:28 - 00:00:33:24
Tom Haederle
Welcome to Advancing Health. Hospitals and health systems across America regularly take the pulse of the communities they serve, making sure that the care they offer is closely aligned with what people need most. As we kick off 2025 Community Health Improvement Week, we learn in today's podcast how Scottsdale, Arizona-based HonorHealth's adult day health care program delivers great value and expanded freedom for many older adults and the families that care for them, while also serving as an anchor for its community.

00:00:33:27 - 00:00:55:17
Samantha Borrow
Thank you so much for joining us on this Advancing Health podcast. My name is Samantha Borrow. I am a program manager on the AHA's population and community health team, and it's my honor to be joined by three of our colleagues from Honor Health, who are helping us celebrate CHI week by talking about some amazing programing that happens at their hospital.

00:00:55:19 - 00:01:20:12
Samantha Borrow
So today we have with us Michelle Pabis, the vice president of Government and Community Affairs. Haeli Miceli, the Honor Health Desert Mission executive director, and Anne Costa, the Honor Health Desert Mission living well director. Thank you so much for being here with me during CHI week. It's so great to talk to you all today. So, Michelle, I would love to start with you.

00:01:20:19 - 00:01:29:29
Samantha Borrow
Can you just talk about how you have identified needs in your community, how you've worked with your community to better address those needs through all of your programing?

00:01:30:01 - 00:01:50:10
Michelle Pabis
Great. Thanks so much for the opportunity, Samantha. So a little bit about on HonorHealth. We're a nonprofit health system based here in Scottsdale-Phoenix area of Arizona. We are the result of a merger from two systems, Scottsdale Healthcare and John C Lincoln, just over 12 years ago. But really, the combined history of our organizations are over 100 years of serving our community.

00:01:50:12 - 00:02:15:22
Michelle Pabis
Interestingly enough, it actually started with Desert Mission that we're going to talk about today. So over nearly a hundred years - we celebrate in 2027 - Helen Lincoln and her family traveled here looking for the cure for tuberculosis. That time, people were escaping to the desert from other parts of the country and she came here looking for health care. But really, what she did is instilled a sense of community, of neighbors taking care of neighbors.

00:02:15:25 - 00:02:37:19
Michelle Pabis
The Lincoln family actually helped to establish Desert Mission. Very early stages included many of the services we're still serving today and offering today - everything from a clinic to a food bank to childcare, etc.. And so Desert Mission's roots go back over 100 years in serving the Sunnyslope community, but really that much more now as a part of the larger HonorHealth system.

00:02:37:20 - 00:03:01:18
Michelle Pabis
So the four pillars of Desert Mission, as we like to say, is our food bank, our adult day health care, our early childhood education center, and our Living Well programs, which really focus on resource navigation. What we've always done, because it's the right thing to do for the community, is really the future of health care. As we look at the social determinants of health and helping connect patients to their resources available in their community, right?

00:03:01:21 - 00:03:21:29
Michelle Pabis
The American Hospital Association has done a lot of work in this area, showing that just 20% of the medical care you actually receive influence your health outcomes. 80% are those environmental factors, those social determinants of health. We need to look beyond the walls of our hospitals, right? We need to be in the community. And we do that also through our community health needs assessment.

00:03:22:01 - 00:03:44:07
Michelle Pabis
So as a nonprofit community health care system, we now have nine hospitals. And every three years we go through that what we call CHNA process, where we do survey our community. We work with key informants. We have internal teams that help prioritize the health needs of our community. And Desert Mission, without a doubt, is a large part of that strategy and helping to make sure those health needs are addressed.

00:03:44:10 - 00:04:05:19
Samantha Borrow
Thank you so much for that overview. And it's so wonderful, especially during this week that celebrates community and hospital partnerships to really be talking to you about these really strong partnerships that you have for almost 100 years now. So talk about roots in a community. You all are really well established there, and I'm sure that they rely on you for the great services that you provide.

00:04:05:21 - 00:04:25:06
Samantha Borrow
And speaking of those services, one of them is the adult day care program that you all have. And I was watching the video on your website and one of the quotes that stuck out to me as it related to this program said, older adults still need purpose and meaning in their lives and their caregivers sometimes just need a break.

00:04:25:08 - 00:04:42:27
Samantha Borrow
And we know that we have a population in the United States that is just getting older and is going to be really needing these services very soon. So I wanted to just talk more about that program, how that became one of the pillars of this work that you do. Haeli, I would love to have you talk a little bit more about that program.

00:04:42:29 - 00:05:08:08
Haeli Miceli
Well, thank you, Samantha, I would love to. It is an amazing program here at Desert Mission and HonorHealth. And as you said, aging Americans are something that we need to be focusing on. By 2030, 1 in 5 Americans are going to be over 65. And Alzheimer's and dementia projections are up to 6.7 million Americans will have a diagnoses of dementia in 2024.

00:05:08:14 - 00:05:38:03
Haeli Miceli
And so the need for some of these programs becomes very great. And there's some huge benefits to adult day programs, which includes the delays in institutionalization, keeping people home longer. Caregiver support, as you mentioned, is so important for our community. Improved health outcomes is one of the things that we look at. This provides respite for caregivers, but also does some pretty amazing things for our members who come. And enhanced social engagement.

00:05:38:05 - 00:05:44:08
Haeli Miceli
And also, it's more cost effective than some of the other programs that are available to older Americans today.

00:05:44:11 - 00:05:56:17
Samantha Borrow
It's so important all around for both sides. Can you just share maybe anecdotally, is there a bright spot that you saw in a in a family that has used these services? Any words of encouragement that you hear?

00:05:56:20 - 00:06:20:21
Haeli Miceli
I will say we've got wonderful stories that that happen every day. But one of the things that we see almost daily is that we have caregivers that are able to then continue on there in a sandwich generation where they may be taking care of children at home, and they're also taking care of their parents, and they're having to make some pretty critical choices in terms of can they go to work?

00:06:20:25 - 00:06:42:10
Haeli Miceli
Do they need to stay home and be a caregiver? And programs like our adult day health care program allow them to facilitate all of those things that they need to do to operate their family. It also allows folks with family members that have dementia or cognitive decline to be able to relate to people in a way that they haven't been able to in a while.

00:06:42:14 - 00:06:59:05
Haeli Miceli
And so it brings families together. We're fortunate to have a full time social worker onsite, too, and that that allows us to help the families navigate some of those challenges and provide caregiving support groups not only to the folks that are attending our programs, but in the community as well.

00:06:59:07 - 00:07:22:03
Michelle Pabis
Samantha, I would just add it, you know, I really think it's such an important asset for our employees and our community. It is really, as Haeli said, that ability to keep your loved one at home, and caring for them, but at the same time, having that programing and social supports. We know from some of our work that if you don't have that constant stimulation, both mentally and physically, we know that decline can be that much faster.

00:07:22:03 - 00:07:42:14
Michelle Pabis
And the incredible activities that does Desert Mission does  - everything from a bingo game to dancing to painting - it really helps those members really be a part of community and have that socialization. I know I've heard and talked to several families. I was talking to a woman who had recently moved her husband into assisted living because he's declining care, and she talked about that

00:07:42:14 - 00:08:01:28
Michelle Pabis
the adult day care program was the best years of their life as they've gone through this journey. Just because not only for the supports for her husband, but for her as a caregiver. They offer support groups. There is a nurse onsite that's helping them manage medications, managing daily care. It really is, as I say, one of the greatest gifts we could give our community.

00:08:02:01 - 00:08:25:12
Samantha Borrow
That's wonderful that you offer that to the employees and the community. So it's a win win for everyone that's involved with that program. It's so wonderful to hear about that. And speaking of other programing that you have, I know that you all have the Living Well program and, and I was wondering if you could just speak a little bit more about that and how patients access that service and community members access that service?

00:08:25:15 - 00:08:51:10
Anne Costa
Yes. Happy to do that. So, as our Living Well program is our newest program within Desert Mission, and really, it was developed in response to really being able to address the social determinants of health, in conjunction with the community work that we're already doing with our other programs, but also being able to respond to those specific needs that we're seeing with our patients population being that nonprofit, part of that health care system.

00:08:51:17 - 00:09:15:17
Anne Costa
So it's been a really great, opportunity to be able to grow our programs. That's what my role has been here at Desert Mission for the past 12 years is to grow our programs to focus on things like nutrition access, education and empowerment programs around food and around other resources that community members are looking for based on their unique needs.

00:09:15:19 - 00:09:43:03
Anne Costa
I would say that food insecurity is one social determinant health that we really emphasize in conjunction with the health care system, which has been screening for social determinants of health. And particularly we've been receiving referrals for those who screen positive for food insecurity. And what's been really exciting to be in the space is that our resource navigators are on a statewide platform that is through contexture.

00:09:43:04 - 00:10:04:05
Anne Costa
It's called Unite Us. It talks with our electronic medical record, and we have been able to pilot that at Desert Mission. And I think what's different about what we're able to do is because we're part of HonorHealth, we can coordinate and collaborate very closely with our medical health care team, as well as us being the community based organization.

00:10:04:07 - 00:10:17:07
Anne Costa
Over the past year, we've been able to do about 1,000 referrals to Desert Mission to receive food. And then we say that food is you know, a gateway to other resources.

00:10:17:10 - 00:10:33:11
Samantha Borrow
Just so important that once that screening is done to make sure that there is a warm handoff in a process by which someone can actually connect to services and then actually close the loop on those. So outside of the food insecurity and screening, what other issues are you seeing really come up in your community?

00:10:33:13 - 00:11:01:00
Anne Costa
Sure. I know in conjunction with adult day social isolation has been a huge issue where we are looking to how do we bring programs to our community and come to them, which again, transportation is another big need we see. And so this is where we look at how can we take our programs mobile from doing our mobile farmstand program to increasing activities in the community?

00:11:01:02 - 00:11:36:26
Michelle Pabis
Samantha, just to add to that, I really think Anne talked about food being that gateway, right? You know, food insecurity, housing, transportation, they're all symptoms of financial insecurity at the end of the day. And so the philosophy has always been, how do we feed the line and shorten the line? We know that connecting individuals, our patients, our clients, our community members with those outside resources, given that there is a need throughout our community to find safe housing, transportation, food, etc. So their team really helps work with the individual, knows those key words to listen for and then connecting them to those outside resources.

00:11:36:28 - 00:11:52:13
Michelle Pabis
They've gotten a variety of grant programs where they've been able to do utility assistance, housing assistance. So all of those while at the same time setting them up for that longer term success by being able to identify other programs, other supports that that patient client might be eligible for.

00:11:52:15 - 00:12:15:12
Samantha Borrow
So truly that holistic service, that you're offering to patients and meeting them literally where they are with your mobile outreach programs and really getting into the community. As it is Community Health Improvement Week, I would ask if you would all just close with what inspires you right now? What's your bright spots? What keeps you going in this work in community and population health?

00:12:15:14 - 00:12:35:28
Haeli Miceli
I can jump in there to start with. And I would say across all of our programs, it is wonderful to have the opportunity to be able to provide opportunities for folks to have purpose and joy every day. Through our volunteer work, through our employees and through the people that come into our programs. It is a collaborative effort.

00:12:36:00 - 00:12:59:12
Anne Costa
I think for me, the ability to just be able to get out and really listen to what our community is needing to improve their well-being and to improve their health outcomes is something that really keeps me going. Particularly as somebody who is a big advocate in the food systems world, I love that we get to use food as a means to bring the community together.

00:12:59:14 - 00:13:04:17
Anne Costa
And, get everyone excited about their well-being.

00:13:04:19 - 00:13:23:27
Michelle Pabis
I often say I have the best job in HonorHealth. I've been here for 19 years, and our ability to respond to community need using data as well as relationships to build programs and have impact is unparalleled. I would just also say that connecting and convening peace as a large health system anchor for our community, right?

00:13:24:00 - 00:13:50:22
Michelle Pabis
People are looking to us as the model. And so not only has Desert Mission been phenomenal in their own programing, but they also partner with other community-based organizations to help them build and grow and mature and what they're able to offer. So not only are we a resource in the bricks and mortar sense but we're also, to Haeli's point, that collaborator, that partner to help ease their way or show them the way to continue to build programs and help improve the overall health of our community.

00:13:50:24 - 00:13:56:17
Samantha Borrow
Yeah, it's so great to hear that HonorHealth is really taking seriously that role as the anchor institution.

00:13:56:20 - 00:14:15:29
Michelle Pabis
Absolutely. And I think that is also being a locally owned nonprofit that we have a board of directors that also hears our community health needs assessment every three years. They approve our implementation plan. So not only is our staff bought in, our community's bought in, but our board of directors also sees this as our guiding document in completing our work in our mission.

00:14:16:01 - 00:14:39:28
Samantha Borrow
That's amazing. That "all in" approach is essential. What a wonderful way to end this conversation with you all. So thank you for joining us. It is so wonderful to hear about the work happening at HonorHealth. As a reminder, this is Community Health Improvement Week, so be sure to check out the Community Health Improvement Week website, to see how you can share the great work that's happening at your organizations.

00:14:40:00 - 00:14:51:28
Samantha Borrow
And I would like to just say thank you to our speakers today. And thank you for everyone who's listening for all of the work that you do to improve the health and well-being of the communities that you serve. Be well.

00:14:52:00 - 00:15:00:11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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