Advancing Health Podcast

00:00:00:08 - 00:00:22:19
Tom Haederle
Welcome to Advancing Health. Roughly 50% of victims of violence develop depression or PTSD afterwards. Today, we hear how Penn Medicine's Violence Recovery Program offers psychosocial support and individualized interventions that accelerate the path to healing.

00:00:22:21 - 00:00:43:25
Jordan Steiger
My name is Jordan Steiger, and I am the director of Behavioral Health and Violence Prevention at the American Hospital Association. I'm really excited for this episode today. I am joined by Dr. Elinore Kaufmann, who is the medical director of the Penn Trauma Recovery Program, and by Michele Volpe, who is the chief operating officer of the University of Pennsylvania Health System.

00:00:43:25 - 00:01:05:07
Jordan Steiger
And we're going to discuss today the Penn Trauma Violence Recovery Program, which is a hospital based violence intervention program based at the Level One Trauma Center at Penn Presbyterian Medical Center in Philadelphia. We're going to learn more today about what an HBV VIP actually is. For those that don't know and discuss how senior leaders can lend their support to these programs.

00:01:05:08 - 00:01:08:24
Jordan Steiger
So, Dr. Kaufman and Michelle, thank you so much for being here today.

00:01:08:28 - 00:01:09:24
Elinore Kaufman, M.D.
You're welcome.

00:01:09:27 - 00:01:10:28
Michele Volpe
Thank you so much.

00:01:11:00 - 00:01:24:12
Jordan Steiger
So, before we dive into the details of your program and talking about some more information, Dr. Kaufmann, can you just explain to our listeners what a hospital based violence intervention program is and tell us a little bit more about your program?

00:01:24:16 - 00:01:53:13
Michele Volpe
Yeah, absolutely. Patients who are injured through interpersonal violence, community violence, often really struggle with their recovery after injury. They face a lot. They have physical injuries, of course, which is what I'm trained to focus on as a trauma surgeon. But they also have to grapple with the mental health consequences of being hurt in that way. So we know that about 50% of people go on to develop depression and/or PTSD.

00:01:53:15 - 00:02:18:09
Michele Volpe
Community violence is also very tied to social factors - poverty and discrimination, lack of access. So our patients come in with a lot of adversity, and then the experience of injury can make it worse. Hospital based violence intervention programs have been around for about 25 years. Ours is relatively new, but these programs exist to provide dedicated support to survivors of violence.

00:02:18:15 - 00:02:43:25
Michele Volpe
We work with credible messengers who have a shared background and set of experiences can really connect to our patients. They provide psychosocial support and an enormous amount of case management and navigation of hospital health system, community municipal resources to try to get patients all of the things, all of the components that they need to make as full a recovery as possible.

00:02:43:28 - 00:02:52:19
Jordan Steiger
So walk me through what that looks like. So say you have a patient that's coming in that you're treating as the trauma surgeon. Tell me what happens after the surgery.

00:02:52:21 - 00:03:21:22
Michele Volpe
Yeah. So in our program, our frontline workers are called violence recovery specialists. And they try to meet with any patient who's affected by violence as soon as possible after the patient is stabilized. They generally start by just trying to connect with them, build rapport, let the patient know what the program is, what resources are available to them, and every patient really receives an individualized intervention.

00:03:21:22 - 00:03:44:21
Michele Volpe
So many patients, like I mentioned, have mental health care needs. And we have therapists who work with our program who are accessible to our patients. Many patients struggle with housing or need to relocate for their safety. So our violence recovery specialists are really experts at walking patients through working with relocation agencies through the Philadelphia city government, for example.

00:03:44:28 - 00:04:15:21
Michele Volpe
Those are two of the most common needs that our patients have, but it ranges from getting people back to school, getting people job training, replacing things that were lost, like patients' driver's licenses and phones and identification. It really runs the gamut. So our violence recovery specialists start working with patients as soon as possible after injury. But what makes the program or programs like this really special is how long the relationship can last.

00:04:15:21 - 00:04:42:20
Michele Volpe
So when I take care of a patient, they get through their hospitalization, they get through their surgery, they recover, they leave the hospital, they go home, ideally. Maybe I see them in the office once or twice to check on their healing. Our violence recovery specialists are working with patients. They're connecting with them twice a week, every week, sometimes every day, depending on the patients need for months after injury oftentimes until patients are really back on their feet.

00:04:42:20 - 00:04:51:04
Michele Volpe
So they really help bridge that gap between the acute hospitalization and the community and true recovery.

00:04:51:07 - 00:05:11:06
Jordan Steiger
That makes total sense. It sounds really like this HBPIBV model is that bridge between community and hospital and trying to fill that gap between. So I'd love to hear - maybe Michelle, we can start with you - why is this an issue that health systems should care about? And why is this not just a community issue? Why should hospitals be involved?

00:05:11:08 - 00:05:52:04
Elinore Kaufman, M.D.
So violence touches everyone. It affects everyone. The victim obviously, of the of the violence, their family, friends, the community, but also staff. Every trauma patient that comes in to our trauma center is an emotional experience for our staff. Across the board, physicians, nurses, and they take our staff, takes every death personally as well as every success. Meaning a patient, a trauma patient, gets through an awful experience.

00:05:52:07 - 00:06:23:26
Elinore Kaufman, M.D.
They have a long way forward in terms of their recovery. They take that personally, I hear that. I hear that all the time from members of our trauma team. The health system is also a part of the community, particularly where Presbyterian is located in West Philadelphia. Although Presbyterian treats many, many patients from well outside of the West Philadelphia community, many trauma patients are from

00:06:23:27 - 00:06:58:08
Elinore Kaufman, M.D.
our West Philadelphia neighborhoods and/or surrounding neighborhoods. Trauma victims are frequently known by community members. Not only are they frightened about what has happened in their community, but they are also very concerned about the recovery for a member of their community. This program is one that helps trauma victims heal. It helps them in a way where at some point they can -

00:06:58:09 - 00:07:13:05
Elinore Kaufman, M.D.
I don't mean just physically return to their community - but emotionally return to their community and contribute to their community once again, and many times in a way much more significant than they had previously.

00:07:13:06 - 00:07:16:10
Jordan Steiger
That makes a lot of sense. Elinore, anything to add to that?

00:07:16:16 - 00:07:36:18
Michele Volpe
When we started our program in 2021, it was new to Penn, and although it was an established model, we were really looking to see how it would go here. It's been wonderful with patients, but our program and our team has also been so welcomed by staff across the board. And, you know, our primary mode is that we pick patients up on the trauma service

00:07:36:18 - 00:08:08:24
Michele Volpe
of course, like I was saying. But we get referrals from social work, certainly, but also from physical therapy, from OBGYN, from family medicine. And I think it really speaks to how much staff and clinicians recognize the need, recognize their community members, like Michelle was saying, and how much they welcome having those additional resources to offer. I think it's a little bit of an antidote to some of the burnout that we experience when we're taking care of problems that on some level, we really can't fix.

00:08:08:24 - 00:08:32:15
Michele Volpe
So I think it helps us and it helps the health system reach further into the community and go that extra mile. The other thing I would add that we haven't talked about is one of the reasons that programs like ours were started is because of the challenge of recurrent violent injury. So violence, like other medical problems, like heart disease, like stroke, can become a recurrent disease.

00:08:32:15 - 00:09:02:10
Michele Volpe
So patients had risk factors beforehand. And now they have more risk factors. And there's very few things that's worse as a clinician, as a trauma surgeon than to take excellent care of a patient and then see them come back with the same or worse injuries, of course. Programs like this have been shown to reduce recurrent violent injury dramatically in some studies where a quarter of people were coming back, now it's down to 5%. Where 10% of people were coming back,

00:09:02:13 - 00:09:32:21
Michele Volpe
in some studies it's down to 0%. I always get anxious when I quote our numbers, because I worry about the next person and wanting to protect them, but we've seen similar effects here. That's good for patients, it's good for staff. And, you know, I will have to acknowledge that it's good for the economics of health care as well. Hospitalization that we can prevent is money we can save and use for other necessary care.

00:09:32:25 - 00:09:34:24
Michele Volpe
So it's really good for us all around.

00:09:34:25 - 00:09:54:16
Jordan Steiger
Thank you for sharing those statistics. I mean, hearing that, you know, that recurrent, you know, time back in the hospital can get down to 5% or 0% in different studies is really, really incredible. And you did touch on the financial piece, which I'm sure is something that people listening to this might be worrying and wondering about, you know, how would I start this at my organization?

00:09:54:16 - 00:10:06:12
Jordan Steiger
How much does this cost? And I think, Michelle, you can really give some insight as the COO of your health system. Tell me a little bit about why making this kind of investment matters to you and matters to your system.

00:10:06:14 - 00:10:33:01
Elinore Kaufman, M.D.
It matters because it is an investment in people. And when you invest in people, it is a benefit that gives back time and time and time again. Employees, those who have supported trauma patients, not just those who have supported trauma patients, but, you know, many across the system, they see the work that that is being done in this program.

00:10:33:01 - 00:11:06:15
Elinore Kaufman, M.D.
And they recognize, you know, that Penn has stepped up and it has made a commitment in people. And when you see that a commitment in people is being made. I mean, now I'm speaking for myself, you know, that makes me feel as though I'm with a health system that really cares. Also, Elinore shared that this program has shown, I mean, statistically, to help reduce violence in the future.

00:11:06:19 - 00:11:36:19
Elinore Kaufman, M.D.
Those individuals who go through this program, they are many times over individuals that will not again get involved in similar types of situations. And that's a benefit, obviously, to the community. It's a benefit to the hospital, but it's also a benefit in terms of, you know, health care costs, right? I would also say that this commitment is one that staff takes very seriously.

00:11:36:20 - 00:12:11:21
Elinore Kaufman, M.D.
I've been in a number of sessions where Eleanor and her team members have spoken, and I'm telling you, there's not a dry eye in the room. Stories are brought forward, individuals who have had some very serious things happen to them. They've been able to recover physically, but then seeing that they were able to recover and/or are recovering emotionally, holding down meaningful jobs, the value of that is almost priceless.

00:12:11:24 - 00:12:15:03
Jordan Steiger
I mean, absolutely. And, Elinore, do you have anything to add to that?

00:12:15:07 - 00:12:42:03
Michele Volpe
I mean, I could talk about this all day. I'm a researcher as well, and I love the numbers. But one of the great privileges that I have in working with this program is all the stories that I get to hear. And so there's a lot of challenges that I hear about as well. But when I hear a patient say, you know, this program was the thing that got me to go out of the house because I was having such severe hypervigilance and PTSD symptoms.

00:12:42:04 - 00:13:07:06
Michele Volpe
This program kept me from going back to selling drugs when I thought that might have been my only option. This program encouraged me to encourage my friends and family not to go look for the person who hurt me, not to get involved in retaliatory violence. Working with my violence recovery specialist made me realize I want to get back in school.

00:13:07:13 - 00:13:28:02
Michele Volpe
We hear these stories time and time again and like I said, we hear other more challenging stories too. But our patients give us these gifts over and over again of resilience and hope and encouragement, and to be able to support that from our side is really special. And I think, like Michelle said, it's another way of caring about them.

00:13:28:02 - 00:13:31:06
Michele Volpe
And they feel that and they know that and they believe in it.

00:13:31:10 - 00:13:50:18
Jordan Steiger
Yeah, that investment in whole person care, I think, is just so palpable. And hearing the way both of you are talking about this and I mean, just thinking about them in every aspect of their life, not just their health care, I think it's something we can all aspire to that are listening today. So I think that's incredible, incredible work that you're doing.

00:13:50:20 - 00:13:59:25
Jordan Steiger
If somebody is listening to this and maybe feels inspired to look into this for their own organization, what would you tell them? What's your big piece of advice?

00:13:59:27 - 00:14:24:08
Michele Volpe
Like I mentioned, programs like this have been around for about 25 years. Ours started in 2021. The national organization that provides training and support and structure for programs like this is called the HAVI, the Health Care Alliance for Violence Intervention. So that's a great resource if you want to learn more about HVIPS or you're thinking about starting a program.

00:14:24:10 - 00:14:46:08
Michele Volpe
When I was thinking about starting this program, I was strongly and immediately encouraged by community members that I talked to, by staff members that I talked to. So I think if you if you get out in your community, it will be easy for people to recognize the need and the opportunity. Like I said, I can talk about this all day, and I think anybody who works with this program will.

00:14:46:08 - 00:14:54:04
Michele Volpe
So I'm certainly happy to be a resource with whatever I know. And I think anybody in a similar program wants to share.

00:14:54:07 - 00:15:47:26
Elinore Kaufman, M.D.
I would add that particularly if you have a trauma program that you almost cannot not do this, you must do this. It's so important. And I've learned this from Elinore and her team. It is just so important to heal both the physical and the emotional. And the emotional goes, you know, just beyond psychological, right? This investment is necessary to be able to have a full trauma program, and one that just doesn't fix the physical injuries, but goes well beyond that and provides a significant healing.

00:15:47:28 - 00:16:08:28
Jordan Steiger
Absolutely. And AHA is a member of the HAVI as well. I'll echo that it's a great resource and we can definitely link to the HAVI's website in the description so people can access that information. If I could add my own lesson learned from listening to you, I think one thing I really want to point out to our listeners is that we have a great combination of leaders here.

00:16:08:28 - 00:16:28:27
Jordan Steiger
We have, you know, our trauma surgeon who leads the program, and we have our COO. And I think having both of you engaged and as passionate as you are about this work really has helped it move forward. You are doing incredible work and we are just so, you know, happy and proud that you are members of AHA and willing to share your story with us.

00:16:29:00 - 00:16:31:06
Jordan Steiger
So thank you both so much for being here.

00:16:31:12 - 00:16:33:08
Michele Volpe
Thank you so much for having us.

00:16:33:10 - 00:16:35:13
Elinore Kaufman, M.D.
Yes. Thank you.

00:16:35:15 - 00:16:44:10
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.

00:00:00:04 - 00:00:17:21
Tom Haederle
Welcome to Advancing Health. For families living in poverty, health care can take a back seat in the list of daily priorities. Today we hear about a remarkable partnership in Kansas City that is turning that paradigm around by bringing care to kids.

00:00:17:23 - 00:00:44:21
Julia Resnick
When families are navigating poverty, accessing health care can become just one more challenge in an already complex system. That's why reducing those barriers and bringing care closer to where families are matters so much. In today's episode of Advancing Health, I'm joined by leaders from two organizations working together to do just that for children in Kansas City. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association.

00:00:44:23 - 00:01:08:13
Julia Resnick
I'm talking with Dr. Alejandro Quiroga, president and CEO of Children's Mercy Kansas City, and Mary Esselman, president and CEO of Operation Breakthrough. Together, their partnership embeds pediatric care within a trusted community setting, bringing services closer to the children and families that need them most. Ale, Mary, thank you so much for joining me today to talk about this remarkable partnership.

00:01:08:15 - 00:01:09:19
Mary Esselman
Excited to be here.

00:01:09:21 - 00:01:12:10
Alejandro Quiroga, M.D.
Thank you for having us, Julia. Very excited to be here.

00:01:12:12 - 00:01:22:14
Julia Resnick
So for listeners who are unfamiliar with Kansas City, what does it look like to grow up as a kid in the community you serve, particularly related to factors that influence those kids health?

00:01:22:16 - 00:01:45:06
Mary Esselman
Well, I'd love to jump in on this one because I think if you can just picture where we're located, it really gives you an idea. We're located at the corner of 31st and Troost, which is always been known as the dividing line in Kansas City, not only in terms of prosperity, but also in terms of race. So you're looking at a community that has had a long period of time in which there they've been underserved.

00:01:45:09 - 00:01:48:03
Mary Esselman
And so that kind of gives you a visual.

00:01:48:05 - 00:01:49:26
Julia Resnick
Ale, anything you want to add?

00:01:49:28 - 00:02:12:11
Alejandro Quiroga, M.D.
I mean, I think where our community has come through is like many communities in the US. I think we're talking about Kansas City, but like everything that we're going to say, it's something that can be translated to any community in the US. And therefore the responsibility of local leaders, local partnerships to make sure that we serve them in the same way.

00:02:12:13 - 00:02:19:02
Julia Resnick
So what are some of those barriers that families face when it comes to health and education and economic opportunity?

00:02:19:05 - 00:02:39:11
Mary Esselman
Well, I think one thing you can look at is like in in Kansas City, only 18% of jobs can be reached in about 90 minutes. So you can already think about childcare access, transportation. I know, over the last 20 years, I mean food access and food scarcity goes up and down. We do a bus tour called The City.

00:02:39:11 - 00:02:56:28
Mary Esselman
You Never See. And one of the things we ask people to look at is like, as you're driving around the east side, like, where would you get groceries, you know? How would you access services if you didn't have transportation? And I think when you have those kinds of fundamental needs that are missing, health care can oftentimes take a backseat.

00:02:57:02 - 00:03:11:06
Mary Esselman
So instead of creating a proactive culture of health, it's reactive. You're only going when it's absolutely necessary. And then it tends to be to the emergency room, not a trusted physician or health care partner.

00:03:11:08 - 00:03:31:18
Julia Resnick
Yeah. And I think all of that just impacts the long term health of kids and families in your community. Which brings us to the topic of our conversation, which is really Operation Breakthrough. So I've had the privilege of visiting, but I know that many of our listeners have not. So, Mary, can you tell us what it is and how it was designed to meet the needs of kids and families in Kansas City?

00:03:31:20 - 00:03:54:17
Mary Esselman
Well, this year is actually our 55th year, hard to believe. But it actually started in a living room. Two nuns were teaching on the east side. And, you know, they had school aged kids, but parents were like, if we just had someone to watch our younger children, we could work. And so they thought, we can do this. And so four in the living room turned to 40 to 400, and today it's over 780 children and families that are served.

00:03:54:17 - 00:04:10:02
Mary Esselman
But what makes it unique is the fact that it's not just about education or care, it's about social services and health. And that's what I think, where you see that uniqueness going from cradle to career and this tight knit community and everything we do is based on relationships.

00:04:10:05 - 00:04:13:16
Julia Resnick
Fantastic. Ale, anything you want to add there?

00:04:13:18 - 00:04:33:05
Alejandro Quiroga, M.D.
I'll tell you, when I first got to Kansas City, I got the call from Mary. And of course, my team told me that you have to go visit. And it's the most I mean, it's a jewel in the middle of Kansas City of something that is so hard to describe. But when I did tour, my first tour, we walked through it.

00:04:33:05 - 00:04:59:07
Alejandro Quiroga, M.D.
And you see a classroom, then you're all of a sudden across a hallway and you're in the middle of a clinic. Then you cross a bridge and you're in workshop where there's welding of cars that people are learning trades, and everybody is all around this pantry. There's volunteers. It is the most purposeful place that you can see to help this community.

00:04:59:10 - 00:05:11:27
Alejandro Quiroga, M.D.
And as you will hear from Mary, it's actually doing that job. But through relationships in an extremely meaningful way. So it's is a very unique model that more communities should have.

00:05:12:00 - 00:05:32:29
Julia Resnick
Yeah. And when I visited, I was also blown away by, you know, the hydroponic gardens and kids learning how to run restaurants alongside early childhood education, just like how incredible that you've created that space for kids to learn and feel safe and grow. So I want to talk a little bit about the partnership between Children's Mercy and Operation Breakthrough.

00:05:33:01 - 00:05:41:03
Julia Resnick
Can you talk about how that started, and how you realized that bringing health care directly into the community could really make an impact?

00:05:41:05 - 00:05:57:19
Mary Esselman
Well, our founders, you know, Sister Verna was like a little firecracker. You know, if she thought we needed something, she just started it, and she might start it with the volunteer. And then she'd find a way to get everyone who can. And so it actually started 30 years ago, where she said, we have got to have a nurse.

00:05:57:21 - 00:06:35:27
Mary Esselman
And so, you know, what is now an office used to be the place where the nurse was, and we could start to really be more proactive. And then in 2008, we got to do an expansion, and then we got the full clinic. And that's been amazing. And then when you kind of track forward a little bit, which I think was one of the most important things we did is in 2013, we formed a partnership for Resilient Families, and it's something that happens quarterly between, Children's Mercy and ourselves. And everybody from the top of the organization to those directly practicing with families, get together to really talk about how do we help families and what

00:06:35:27 - 00:06:42:18
Mary Esselman
are the current pressing issues that we need to address together to encourage that culture of health for our families.

00:06:42:20 - 00:06:48:13
Julia Resnick
So talk to me a little bit about what the clinic looks like and how does it work. Like, walk me through it.

00:06:48:16 - 00:07:03:19
Mary Esselman
Well, so when you come in, it's like, right front and center. And when the beauty of is it's not just for kids here, although we have plenty of them, it's also for the community. So imagine if you're here for early care and education and then you go off to school, and you may not stay in the program for before and after school.

00:07:03:26 - 00:07:25:29
Mary Esselman
A lot of those families still come here because of those relationships. So you can come in and the clinic is there, they've got core exam rooms. I mean, there's someone that goes and walks kids from class, an amazing telehealth model that keeps parents working. And, you know, one of our biggest challenges for our parents is oftentimes their jobs don't have benefits or accrued time off.

00:07:25:29 - 00:07:44:12
Mary Esselman
And so just making a health appointment, you know, can put their job at risk. And so we were seeing a lot of missed appointments. And now Children's Mercy contacts the supervisor wants to know we're going to need mom for a few minutes to step aside. And, we're seeing a lot more of our preventative care happening, but it's a great space.

00:07:44:12 - 00:08:00:15
Mary Esselman
It's front and center, but it doesn't stop in the doors of the clinic. One of the things I love the most is the fact that there's a school nurse. She makes over 5,000 classroom visits a year. We're actually talking about a second nurse because we just opened the school and, you know, realizing that we have a lot more money.

00:08:00:15 - 00:08:21:27
Mary Esselman
But imagine when every day you're seeing a nurse,  suddenly sometimes there's a lack of trust, especially for underserved in underserved communities. But when you're building those relationships as a child and a parent and you have the freedom to ask questions, not just when you're sick, I think it changes everything. So there's just a lot of little pieces.

00:08:22:02 - 00:08:41:20
Mary Esselman
Children, staff from across the hospital pop in on Monday. Word on the street so they can help do other things. And I will say during Covid, we wouldn't have been able to stay open the whole time if we hadn't had Children's Mercy, because the minute that we thought there might be a symptom, we were able to do that testing and keep everyone safe.

00:08:41:22 - 00:08:49:17
Mary Esselman
And even beforehand, just the idea of washing hands and all of the things that we need people to know. Children's was there, hand-in-hand.

00:08:49:19 - 00:08:58:27
Julia Resnick
And, you know, I think it's pretty unique to have a hospital that's so deeply embedded in community. Ale, can you can you share your perspective on that?

00:08:58:29 - 00:09:32:28
Alejandro Quiroga, M.D.
We've been here for 129 years. And for the first 50 years, we operated in the same way that Operation Breakthrough came about. Very organic. One of our founders was a surgeon, the other under was a dentist. And imagine two very strong women with a conviction that pediatric care has to be different. And before they have the right to vote, they founded a hospital before they have the right to practice in the same way that they males did,

00:09:33:00 - 00:09:58:06
Alejandro Quiroga, M.D.
they found that a hospital. And for the first 50 years not a single bill came out of our institution. So when you're asking, like how these two organizations came together. Like, that's not the question. Nothing would have stopped these two organizations coming together and being embedded, because our missions are so similar. We see the world so like alike, of course, we came about. Pediatric health care is quite comprehensive.

00:09:58:07 - 00:10:24:06
Alejandro Quiroga, M.D.
You can go from these type of partnerships to then you're talking about cardiac transplants. And they're all different. And you take different muscles, have different understandings and you have to have the right focus to know where to put your resources and what is being covered by other, partners in the community or other organizations. And I think that's what we're doing here.

00:10:24:09 - 00:10:26:01
Julia Resnick
Mary, anything you want to add?

00:10:26:03 - 00:11:01:03
Mary Esselman
I think it's pretty amazing when you have organizations that have been around this long and you still have those original missions intact that. And I love when you talk about relationships, because in both organizations, everything we do coalesces around building relationships, and you can really see it. The other thing I think for those listening, I think it's important is it shows that you can take, you know, a large hospital system and you can take a smaller, nimble nonprofit and you can find ways - I feel like it doesn't matter what the barriers we encounter.

00:11:01:03 - 00:11:12:22
Mary Esselman
We find ways to, work through them. And I think that's what it takes when you look at the length of our partnership and how we continue to grow and thrive.

00:11:12:25 - 00:11:25:27
Julia Resnick
I love that everything is built on relationships and trust. But really, just like when it gets down to it, what are those elements that you need to get this kind of community clinic running and running smoothly for as long as you have?

00:11:25:29 - 00:11:46:19
Alejandro Quiroga, M.D.
The funding part is really difficult, right? You have to think about how do you allocate funding to that. And that comes in a partnership. We raise funds together, we raise funds separately, we allocate different budgets. And it's a tough conversation. And that's where most of these partnerships will start. You have to be fueled by the mission, but you have to find the funding to be able to do this.

00:11:46:22 - 00:12:10:02
Alejandro Quiroga, M.D.
And this will not be a typical PNO. And most health care systems would get stuck there. So what is the return on investment here? And you have to see the return on investment beyond just a very plain ROI. You have to see moms being able to work. How does this have community benefit in a way that is not traditional?

00:12:10:05 - 00:12:24:06
Julia Resnick
And I'm sure that you see the impact of this every day, whether it is in those health outcomes, whether it's mom being able to work. Do you have any stories about a child or a family that really, reflects why this is so important?

00:12:24:09 - 00:12:44:26
Mary Esselman
One that comes to mind just because we've been talking about it recently is, you know, we get a lot of children that have really high health needs. I mean, when you think about, sometimes it's environmental, sometimes it's multi-generational. And so the ability to be able to serve children with high needs, we had, we had a baby who's now in kindergarten.

00:12:44:29 - 00:13:05:04
Mary Esselman
So you can imagine, I mean, this has been over a span, but, you know, failure to thrive, leading to couldn't digest, produce a lot of medical needs. You can imagine a classroom teacher and the fear that goes with trying to make sure we're providing adequate care and to be able to have a nurse to come in and help with that and be there day to day through that process.

00:13:05:11 - 00:13:26:26
Mary Esselman
And then be able to share jointly when that feeding tube comes out five years later. I mean, those are the kinds of stories, I think, that, really showcase not only from a medical perspective, but just relationships, that create trust amongst children, families, health care workers. What does it take to make this type of a partnership? I think it takes patience.

00:13:26:26 - 00:13:45:23
Mary Esselman
You know, I'm never that patient. So like when I have an idea, I'm ready to like, charge in and make it happen. And I think in both our cases, like the desire and the want is always there. But the mechanics of getting there can be difficult. And I have a little grid on my wall that says find the third way.

00:13:45:23 - 00:14:07:00
Mary Esselman
And I always laugh because sometimes we're on the 30th way, but I feel like we always stick it out and find a way to make it work, because I think we make it sound really easy, but there's we both live in the in the world of licensing and rules. And so as much as we might want something, we still have to make it happen within those boundaries.

00:14:07:00 - 00:14:33:22
Mary Esselman
And I love the fact that we all are back at the table at our meetings as we're working on things. And I love that, you know, I talked about the partnership for Resilient Families, but we also have a weekly call with direct providers. So we're really navigating what's trending in terms of health challenges. How do we communicate it where there isn't a lot of health and literacy and families and to work together on those.

00:14:33:25 - 00:14:54:29
Mary Esselman
And then I think it makes a robust environment for residents. They have made it a priority to have all of their pediatric residents spend two days here. So they're really feeling firsthand how important health is and doing it directly with populations that aren't taking place kind of in a sterile clinic room.

00:14:55:01 - 00:15:05:24
Julia Resnick
You've both been doing this for a while. I'd love to hear your advice to other hospitals, to other community based organizations that are thinking about embarking on this sort of partnership.

00:15:05:27 - 00:15:31:19
Alejandro Quiroga, M.D.
I think when you live within a large health care system, people will see that as a soft call or something that is like a given. The literature will tell you that that is not the case. If you want to get these things, you have to first build trust, build a relationship, get alignment. And you know there is a system of doing that.

00:15:31:22 - 00:15:55:00
Alejandro Quiroga, M.D.
This has falling into an organic way, but we have developed it systems that reinforce that relationship. Relationships have an ROI. Aligning missions across what's important and then using those relationships to deliver better care will have an ROI for the community. You're going to have to be creative, kind of have to think different, but you have to push yourself to do so.

00:15:55:02 - 00:15:57:26
Julia Resnick
Absolutely, Mary, take us home.

00:15:57:28 - 00:16:16:01
Mary Esselman
So for those of the thinking we could do this and you can, it might start out small, but if you're really persistent and you really believe in it, I think I would always say don't wait because you can plan for years and life will have changed three times since then. I think you just have to you have to step in and start.

00:16:16:04 - 00:16:36:26
Mary Esselman
And then I think you have to be willing to engage up and down through the hospital. It can't just be the clinic director. It can't just be the nurse. It has to be something that's shared across the organizations. And it will change the ability to ensure that kids are meeting developmental milestones when you see these kinds of partnerships.

00:16:36:28 - 00:16:54:25
Julia Resnick
And I think that, you know, when you have your missions aligned and you're both committed to the relationship and working through the challenges, you are just a fabulous example of what you can build. So Mary, Ale, thank you both for being here and sharing this work with us and for the work that you both do every day to help the kids of Kansas City.

00:16:54:27 - 00:17:03:09
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.

00:00:00:02 - 00:00:22:28
Tom Haederle
Welcome to Advancing Health. People facing psychiatric or substance use disorders have enough to deal with without the added burden of shame or stigma attached to their challenge. Today, we hear about the power of a large health care organization that's decided to push back against stigma and the difference it's making.

00:00:23:01 - 00:00:50:25
Rebecca Chickey
My name is Rebecca Chickey, and I'm the vice president of behavioral health and trustee services for the American Hospital Association. It's my honor today to be joined by three exceptional behavioral health leaders from CommonSpirit. Dr. Sapra, who is the system vice president for behavioral health, Kathy Krebs-Dean, who is director of behavioral health expansion and development, and Robin Conyers, vice president of CHI’s Behavioral Health.

00:00:50:28 - 00:01:16:29
Rebecca Chickey
Thank you so much for joining us here today to talk about your incredible stigma reduction campaign as it relates to the stigma surrounding psychiatric and substance use disorders. The treatments for those and the individuals who suffer well from those conditions. So, Dr. Sapra, I'm going to ask you to kick us off for those people for whom CommonSpirit is a term they'd never heard,

00:01:17:02 - 00:01:31:12
Rebecca Chickey
doubtful if they're in the health care field. But sometimes we get non-health care, listeners to our podcast. Tell us about CommonSpirit's footprint. Just give the listeners a sense of when I say CommonSpirit, what that means.

00:01:31:15 - 00:01:57:00
Manish Sapra, M.D.
Yeah. So, CommonSpirit is one of the largest health systems in the country. It was formed in 2019 with the alignment of Catholic Health Initiatives, or  with CHI and Dignity Health. And together, these institutions bring over 150 years of combined experience, with focus on providing compassionate health care, especially to vulnerable populations. We have a broad national reach.

00:01:57:02 - 00:02:18:22
Manish Sapra, M.D.
Approximately 1 in 4 Americans live within the CommonSpirit service areas. And we operate over 160 hospitals in 24 states. Our national footprint and the dedication to our core priorities, like compassionate care, high quality health services, and social justice position us uniquely to confront behavioral health disparities.

00:02:18:25 - 00:02:41:29
Rebecca Chickey
I really appreciate the fact that you continue to talk about the mission and vision, and how because of that CommonSpirit has dedicated a number of resources related to behavioral health. So I'm going to turn to Kathy, though, because today, the focus of our podcast is really the journey that CommonSpirit has been on to reduce the stigma surrounding behavioral health.

00:02:42:01 - 00:02:52:06
Rebecca Chickey
And, Kathy, I'm going to put you on the spot, ask you to share, you know, why did CommonSpirit make such a strategic investment in an anti-stigma campaign?

00:02:52:08 - 00:03:03:28
Kathy Krebs-Dean
This is a system wide effort to address and reduce the stigma that's associated with substance use disorder. And it's intended to improve patient care and outcomes. It has three main components.

00:03:04:06 - 00:03:31:16
Kathy Krebs-Dean
First and foremost, there is a data driven foundation. We surveyed over 500 providers to get a sense of knowledge, attitudes and beliefs. And the results that we obtained confirm there's a high recognition of substance use disorder as a medical condition and strong support for medication assisted treatment, and also help to inform some of the targeted interventions that we're doing including our anti-stigma education campaign.

00:03:31:18 - 00:04:02:00
Kathy Krebs-Dean
So that campaign has been phenomenally well embraced by our associates and providers. It's a voluntary training and, we also have a train the trainor component so that there's an opportunity to help us scale this further. There's aspects that include impactful storytelling. So we created a video series to share the powerful impact of stigma and its reduction from the perspective of both patients and then also from providers.

00:04:02:03 - 00:04:26:16
Kathy Krebs-Dean
And, we're also dovetailing with some of the work that we're doing around the clinical care. So there's an intersection with some of our community commitments, such as increasing access to care to our emergency department, addiction care, for people that are impacted by opioid use disorder. And then last but not least, we have this focus on language and culture that's woven in.

00:04:26:19 - 00:04:41:26
Kathy Krebs-Dean
And this is made possible through our partnership with the American Hospital Association and the 'People Matter Words Matter' campaign. And that's all about promoting consistent use of non-judgmental language across our facilities and then upholding this culture of understanding and support.

00:04:41:29 - 00:05:03:21
Rebecca Chickey
There is such a broad swath and different types of stigma as Dr. Sapra mentioned earlier, I think that makes so much sense to focus on one core piece and make an impact on reducing the stigma around addiction, because I do believe in many cases and perhaps your survey showed this - be interesting to know if it did - that

00:05:03:23 - 00:05:28:24
Rebecca Chickey
often there's more stigma around addiction or substance use disorders than, let's say, major depression or anxiety. If that is the case, then you picked a tough nut to crack, as they say. And, just really, I'm so grateful that your going down that that journey. I'd also like to thank you for mentioning People Matter, Words Matter.

00:05:28:25 - 00:06:05:25
Rebecca Chickey
That was an initiative that the American Hospital Association started back in 2021. It's a series of posters. The first one surrounded on people first language and the importance of that. We worked with member organizations around the country to create these posters, to help educate around what words or phrases are stigmatizing and perpetuate that, and then offering solutions and alternatives for our own workforce to know so that they can choose their words and use their words more carefully to reduce the stigma.

00:06:05:28 - 00:06:29:21
Manish Sapra, M.D.
Yeah, I think it's really goes back to the values that I was describing, right. And, you know, I feel like how we ended up here is understanding the value  of large organizations inability to affect stigma. And, you know, to understand that we probably just need to understand stigma a little bit more. You know, stigma comes in multiple layers or contexts.

00:06:29:23 - 00:06:57:06
Manish Sapra, M.D.
For example, this cultural stigma that we all sort of know, which is societal or community beliefs, values and traditions that view mental health as shameful, taboo or sign of weakness. And there is institutional stigma, right? Or a structural stigma that affects policies and laws and regulations which may lead to like lower funding of mental health, whether it's research or services or within the organization, you know, helping grow these services.

00:06:57:09 - 00:07:19:25
Manish Sapra, M.D.
There's, of course, the interpersonal stigma that we feel towards, you know, family, friends or coworkers. Even into professional stigma, right, where for folks who have had a history of mental illness working together with us, I think the employers or organizations have a lot of responsibility in busting the stigma. CommonSpirit really looked at it as an institutional priority.

00:07:20:03 - 00:07:37:29
Manish Sapra, M.D.
And again, as a responsibility of what a large organization, especially in health care, which is providing behavioral health, which includes substance use, as you said earlier and took that initiative. And I'll ask, Kathy to chime in here and just give us the history of when this program started about three years ago.

00:07:38:02 - 00:08:15:07
Kathy Krebs-Dean
Well, I would say that this work has been deeply aligned with our mission, our focus on compassion and our tagline: Hello, Human Kindness. There's no greater kindness than fostering a culture of non-judgment. So it definitely supports a culture that is supportive not only of our patients, our providers, but also our wider communities that we serve. And then there's been this catalyst from our philanthropic partners, this investment in helping to create and sustain this work over the last three years.

00:08:15:09 - 00:08:39:13
Kathy Krebs-Dean
And they helped us to create, for instance, some wonderful content, the video series on the impacts of anti-stigma and the reduction of that. The training program that we're utilizing. So all this has helped to create this momentum, and this interest across our system and then finally, without a doubt, it's been incredible to see the passion of our associates and our providers.

00:08:39:16 - 00:09:00:12
Kathy Krebs-Dean
This has been sort of a bit of a grassroots movement in that it's, been widely embraced by people. And I think it's because of the fact that many people have been personally impacted by substance use disorder. They realize just how widespread it is and how, how it impacts so many lives. And there's a lot of enthusiasm about being part of this transformative work.

00:09:00:15 - 00:09:19:26
Kathy Krebs-Dean
And that manifests in ways like some participating in training, some teaching the training, and then, utilizing our videos as as reflection and in meetings and that sort of thing. So it's been incredibly impactful. And I think we've been seeing a lot of interest in continuing the work.

00:09:19:28 - 00:09:23:08
Rebecca Chickey
Thank you for making that idea kind of come alive

00:09:23:11 - 00:09:49:08
Rebecca Chickey
across the footprint of CommonSpirit, because that's where the real work is, in your organizations, in your hospitals, day in, day out. And to see it spread across the country. Robyn, let's turn to you now. Cathy described the overall anti-stigma campaign across the footprint of CommonSpirit. But it's my understanding that it was really your grassroots efforts in your own organization

00:09:49:08 - 00:10:17:26
Rebecca Chickey
that really was where this initiative was given birth, as they say. So can you help the listeners understand how AHA's People Matter, Words Matter substance use disorder posters have been used? What that looks like, physically, would they see posters? Would it be on screenshots? Really help paint a picture for the listeners - how you rolled this out at your own organization?

00:10:17:29 - 00:10:37:25
Robin Conyers
Sure. So being members of the AHA and having the listservs and the communication come out, we heard about, People Matter, Words Matter initiative. And I was just so intrigued by the impact that it could have within our organization and really even beyond. In behavioral health, we're always looking for ways to educate and to break down stigma.

00:10:37:27 - 00:11:15:15
Robin Conyers
And these posters, the series of posters that have come out and have continued to be refined over the years are just such a simplistic way to educate and to bring it into a layperson's terms, if you will, of being able to have conversations. And so as I was reading these posters, obviously overseeing behavioral services in the Omaha, Nebraska area and southwest Iowa, this was an easy way to work within our organization to say, hey, we're a large footprint of behavioral health, but yet we know behavioral health patients see primary care, they see ObGyn, they see orthopedics.

00:11:15:15 - 00:11:36:17
Robin Conyers
They have, you know, oncology and a variety of areas. And is there a way that we can speak these words and this platform of the emphasis that people matter, words matter. Again, such simplicity that the AHA came up with, how can we work with outside behavioral health with our partners to educate? And so I met actually met with our vice presidents of patient care,

00:11:36:17 - 00:11:58:22
Robin Conyers
so our chief nurses within the organization to see if they had an interest in owning that for their campuses or within our primary health clinics. I met with our marketing teams, and what we ended up doing with our marketing teams was we partnered with AHA to - all of a series of posters - to put the AHA logo if you will, along with our CHI health logo on the bottom of the posters

00:11:58:22 - 00:12:19:05
Robin Conyers
so that show in partnership of this work that's together. And then we also paired the variety of the posters with the months. So there's a eating disorder month, there's mental health awareness month, there's posters specific to suicide awareness. So there's pertinent p posters that align very nicely with, if you will, areas of the month of focus across the country.

00:12:19:05 - 00:12:47:14
Robin Conyers
And so, as we put those posters together, we tied them, if you will, with a focus of the month, a topic of the month that paired well. And then we also designed the ability for posters, table tents in the dining areas. The other unique thing that we did within our marketing department is recognizing that perhaps a poster of focusing on eating disorders may not be top of mind that patients or families are coming in for treatment in regards to orthopedics, but they're seeing their orthopedic provider, if you will, in their clinic.

00:12:47:16 - 00:13:04:18
Robin Conyers
Yet recognizing they could put those posters up in those clinics so that individuals could see them while they're waiting for their provider to come in. But it allowed the nimbleness too for those clinic leaders to pick the posters that are pertinent to their areas. So we're not putting something up that really has not no applicability to the patients they're serving.

00:13:04:21 - 00:13:26:15
Robin Conyers
But there are other broader topics of recognizing caring for the caregivers, suicidality, substance use disorders that could have applicability across the board. So we started that grassroots, really in the Omaha area, piloted it, met with our executive leaders, within CommonSpirit Health in the behavioral health service line, talked about how this could have a broad implication within all of CommonSpirit Health, if you will.

00:13:26:17 - 00:13:48:11
Robin Conyers
And so then what we did was we worked with our national teams, took those posters, and we have them now digitally readily available for any leader within CommonSpirit Health can go in, pick whatever subject they want, whatever poster they want, and they can also then choose their markets or the their name of their hospital or their clinic, and they can put that at the bottom of their poster as well.

00:13:48:11 - 00:14:14:03
Robin Conyers
So it shows a nice collaboration amongst the AHA initiative and tying it into with the department, if you will, in market that we're in. So because as Dr. Sapra talked earlier about our broad brush and where we're at within, across the country, to this day by launching that beyond just the Omaha, Nebraska - Council Bluffs Iowa market, we have over 2000, materials that have been downloaded within CommonSpirit Health.

00:14:14:03 - 00:14:25:20
Robin Conyers
So we have a broad brush across the country, that really has a vested interest in adopting these materials as well. So it has grown way beyond just the Nebraska-Iowa markets.

00:14:25:23 - 00:14:36:05
Rebecca Chickey
So, Robin, now that the initiative has been in place for a year or more, what impact have you seen? Has there been a change in culture?

00:14:36:08 - 00:14:43:13
Rebecca Chickey
A change in tone? Have you seen people actually using the different words that are suggested on the posters?

00:14:43:15 - 00:15:00:23
Robin Conyers
The visibility alone, if you're in an elevator, reading the information that's there while you're waiting for, you know, to go up and down the floors or you're waiting for your provider to come in your clinic setting. I actually was just in my primary care clinic last week, and as I was sitting for the provider to walk in, I look to the right and there's a poster on the door.

00:15:00:26 - 00:15:22:24
Robin Conyers
But I have had nurses across our organization actually not in behavioral health, but when we posted these out on the internet and again and they're available. I have had nurses email and just say thank you, you know, I don't work in behavioral health, but I do care for behavioral health patients in critical care or in you know, the NICU or excuse me, in OB or in the emergency department.

00:15:22:24 - 00:15:41:05
Robin Conyers
And this was such an easy tool for me. I had no idea that that I was being kind of disrespectful in some ways of not being conscious of the words I was choosing. So, for example, of saying that, well, the patient's an addict, that person is an addict. Well, actually, we're encouraging to say this person has a substance use disorder.

00:15:41:06 - 00:15:58:11
Robin Conyers
And one has said, and when I give report, when a patient's going forward to critical care to detox or they're going up to behavioral health because they have suicide ideation and maybe have a substance use component to the treatment, I have found myself saying, now there you have substance use disorders. I don't refer them. This is an addict that now has to be detox.

00:15:58:11 - 00:16:06:07
Robin Conyers
So just that shift in nomenclature in words matters. And it gives me goosebumps to think to hear that.

00:16:06:09 - 00:16:28:18
Rebecca Chickey
So as we bring this podcast to a close, I'd love to have each of you think about what call to action you would suggest for the listeners. What should they do? What first step or second step should they take to perhaps go on their own anti-stigma or stigma reduction journey at their own hospital or health system?

00:16:28:21 - 00:17:01:00
Manish Sapra, M.D.
There are ways to address this, issue of stigma. And large employers, especially in health care space, have that responsibility to do that. And there are ways that that they can create a culture, the language, the culture of well-being and treating each other kindly and with awareness of these you know, illnesses in a way that we can bring that whole culture of compassionate care.

00:17:01:02 - 00:17:24:17
Manish Sapra, M.D.
And also when we're dealing with each other as health care workers, that we are being kind and compassionate. And there are initiatives that can be very effective in this space. So I think the call to action is do to see that this works. And it is a responsibility of our large organizations to take this on.

00:17:25:16 - 00:17:55:25
Kathy Krebs-Dean
One of the first steps would be recognize stigma associated with substance use disorder as something that can impede a person's progress in seeking the care that they need. It's a condition that impacts millions of people every year. And when we are more supportive and recognize substance use disorder as a medical condition versus something like a moral failing, we know that people are more apt to get the care that they need.

00:17:55:27 - 00:18:14:08
Robin Conyers
When I think about caring for individuals that have substance use disorder or mental health challenges, I think that nobody woke up one morning and said, okay, Lauren, hand it down to me, I want the substance use disorder. I want to be called an addict. I want to have those suicidal thoughts. I want people to be afraid of me. I want people to judge me

00:18:14:08 - 00:18:35:19
Robin Conyers
because it's all my fault that I've lost my job, or I'm homeless, or because of choices that I've made. Nobody woke up and said, hand me that. I want to be stigmatized in that way, or to be thought of in a different light. And yet it's our job to be able to recognize that mental illness, substance use disorders has no demographics.

00:18:35:21 - 00:19:11:15
Robin Conyers
It has no impact on age. It has no impact on career. We see it all across the board. And so the ability to just be kind to one another and to have a curiosity in how we care for people as whole, not just as patients, but people as whole. So to be curious in the way of how you can self educate so that when your friends, your family members, your colleagues are reaching out to you in times of, of struggle or in times of sadness or feeling hopeless, the ability to just in a very simple way, to be curious, and how to educate yourself so that you can show it better for them.

00:19:11:18 - 00:19:22:17
Robin Conyers
And the People Matter, Words Matter campaign is again, as I mentioned, it's a very simplistic, non-confrontational way to, if not this, do that.

00:19:22:19 - 00:19:36:27
Rebecca Chickey
Well, thank you very much. Thank you for partnering in this effort. Thank you for, as they say, taking the ball and running with it. Really appreciate the inspiration that you've shared for our listeners today to take a look at People Matter,

00:19:36:27 - 00:19:58:13
Rebecca Chickey
Words Matter as one way of beginning to reduce the stigma, in this case around substance use disorders. But whatever they might want to go on their journey. You're changing culture one word at a time, and that is difficult work. So, applause and thank you for being here with us today.

00:19:58:15 - 00:20:06:26
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;04 - 00;00;13;24
Tom Haederle
Welcome to Advancing Health. Coming up in today's podcast, why isn't a normal phase of life that affects all women met with more understanding and attention by the medical community?

00;00;13;27 - 00;00;39;23
Julia Resnick
All women who are fortunate enough to live till middle age experienced menopause. Yet for something that impacts half the population, menopause remains one of the most overlooked areas in health care. It's time for that to change. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. On today's episode, I'll be talking with two leaders in menopause research and practice from University of Illinois at Chicago's College of Medicine.

00;00;39;25 - 00;01;03;22
Julia Resnick
Dr. Pauline Mackie is a professor of psychiatry, psychology and obstetrics and gynecology. And Dr. Makeba Williams is a professor in the Department of Obstetrics and Gynecology. Together, they are the leaders of the Center for Health Awareness and Research on Menopause. Also known as CHARM. We'll be discussing why menopause awareness matters and how hospitals can step up to provide better, more responsive care to women as they age.

00;01;03;25 - 00;01;10;13
Julia Resnick
So let's get right into it. Dr. Williams, Professor Maki, thank you so much for being here for this conversation.

00;01;10;15 - 00;01;12;08
Makeba Williams, M.D.
Thank you so much for having us.

00;01;12;10 - 00;01;13;17
Pauline Maki, Ph.D.
It's great to be with you.

00;01;13;20 - 00;01;26;18
Julia Resnick
So let's do a little bit of level setting for our listeners. How does menopause affect women's health as they age and why should health systems and clinicians be paying closer attention to it? Dr. Williams, let's start with you.

00;01;26;20 - 00;02;04;23
Makeba Williams, M.D.
We know that about 1.5 million women will become menopausal every year, and that's half of the world's population. Menopause follows the aging ovary and we see declines in many of those hormones, namely estrogen. Estrogen has an important role throughout the body, binding to more than 300 receptor sites. And as a consequence of the changes in hormones, the changes in estrogen, and the eventual decline, we can see changes throughout many of the organ systems within the body.

00;02;04;26 - 00;02;40;28
Makeba Williams, M.D.
We see changes to our cardiovascular systems, our neurocognitive systems, our muscles, our bones, our urinary systems, brain mood, you name it. There can be many changes. And these changes also present at a critical, pivotal time in a woman's life. And we see this as a window of opportunity to optimize health, to optimize and minimize disease - states that may present during this critical midlife window.

00;02;40;29 - 00;02;54;23
Makeba Williams, M.D.
So this is an important area of health because these symptoms, unaddressed symptoms, can impact overall quality of life, well-being and have social and economic consequences as well.

00;02;54;25 - 00;02;57;16
Julia Resnick
Professor Maki, anything you want to add to that?

00;02;57;18 - 00;03;13;06
Pauline Maki, Ph.D.
I think it's really important for women, both in their immediate lives - what can I do right now to feel better - and also to understand the long term consequences of the decisions that we make at this point in our lives for our long term health.

00;03;13;08 - 00;03;22;19
Julia Resnick
Half of the population experiences this, and it seems like right now menopause is kind of having a bit of a moment in public conversation. Why do you think that is?

00;03;22;22 - 00;03;58;11
Pauline Maki, Ph.D.
I think most of this started when there was an introduction of the first FDA approved, highly effective non-hormonal medication for hot flashes. And with that came advertising at the Super Bowl and the Golden Globes. And people were like, what is VMS?" Paired with that was a highly influential article that came out in the New York Times Sunday Magazine saying, women have been misled about menopause.

00;03;58;13 - 00;04;30;18
Pauline Maki, Ph.D.
And that was the number one gifted article of all articles in The New York Times that year. So women were asking questions. There was a new solution that might have addressed women's fears about using hormone therapy and possible risks to their health. And we hit it. And I would say it's beyond a moment now. It is everywhere. And I think that's a beautiful thing because we're not feeling the stigma that we used to feel about menopause.

00;04;30;19 - 00;04;40;08
Pauline Maki, Ph.D.
We're having the conversation. So now we just need to meet the questions with the appropriate evidence-based answers.

00;04;40;10 - 00;05;07;12
Julia Resnick
Yeah, and I've definitely noticed that too. Like talks of the estrogen sticker are everywhere. And you know, 40 isn't old anymore. It's our generation who's using Instagram and all the other social media to elevate these issues beyond just medical encounters with doctors. Despite all of this, I know there continue to be gaps in awareness in research. So what do you think those gaps are and how can we help fill them?

00;05;07;14 - 00;05;46;21
Makeba Williams, M.D.
Well, we certainly see that there are gaps in medical education, medical training that have left many clinicians, whether it's a physician, a physical therapist across the healthcare spectrum have been left underprepared to meet this increased awareness, the increased demand and self-advocacy that we see many women and patients expressing during this time period. We know that we have to work really hard to meet those existing gaps in medical education and training, so that we are better providing care for women.

00;05;46;23 - 00;06;01;24
Makeba Williams, M.D.
Additionally, we know that there's more research. My colleague Dr. Maki can certainly address that, but there are some clinical and research questions that we also need to be answering while we are meeting these unmet needs and training.

00;06;01;26 - 00;06;04;29
Julia Resnick
Professor Maki, can you talk a little bit about what those are?

00;06;05;02 - 00;06;35;16
Pauline Maki, Ph.D.
It's important firstly to recognize that we do know a lot about menopause. I think we hear, oh, we don't know anything about menopause. And that's just not true. We have guidelines that are, you know, 3 to 4 inches thick because of the amount of evidence-based information we have on menopause. And of course, we need to know more. We know a lot from the Gold Standard Natural history study, which is the study of women's health across the nation, or SWAN.

00;06;35;18 - 00;06;57;11
Pauline Maki, Ph.D.
And that really told us what happens to our bodies that's due to menopause versus the fact that we're getting older versus a combination of the two really important information for women to know. Because if a symptom or a change is menopause related versus if it's aging related, sometimes that can tell us that the treatment is different depending on the cause, right?

00;06;57;11 - 00;07;24;24
Pauline Maki, Ph.D.
So that's really important. But that study was initiated back in the mid 1990s. And our population has changed. Thankfully our scientific methods have changed. They've gotten better. And we also have a better sense of what biomarkers. What should we be measuring in the blood? What should we be measuring in my own work in the brain, for example? And so I think we're ready for an overhaul of kind of the next generation of science on this area.

00;07;24;25 - 00;07;55;15
Pauline Maki, Ph.D.
And in addition, we have some really important clinical questions, a lot of questions about hormone therapy. I think we have a very good understanding of what it's good for and what it's not good for. We have perhaps less of an understanding of the perimenopause. This really for some women and not for all, clearly, 29% of women sail through menopause without a problem, but for some women the perimenopause is really problematic and you know, we don't have any FDA approved medications for symptoms in the perimenopause.

00;07;55;15 - 00;08;13;03
Pauline Maki, Ph.D.
So I think that in particular is an unmet need in women's health. What's the best way to treat the perimenopausal woman who is having a new onset of cognitive symptoms or mood symptoms. How do we best help women along the life course of the menopause transition?

00;08;13;06 - 00;08;30;03
Julia Resnick
Absolutely. And how do we help women so they don't have to suffer through this period of several years? I'm sure that there are differences in how people experience menopause in different communities, in different populations. Can you speak to that at all? And what factors might drive those differences?

00;08;30;06 - 00;09;02;09
Makeba Williams, M.D.
The study of women's health across the nation was a multi-site, multi ethnic cohort study that looked at various groups of women: Chinese women, African American women, Hispanic women, as well as white women to detect differences and how women were transitioning into menopause. We looked at seven different cities across the nation. Cities like Chicago, Detroit, Pittsburgh, Newark, Oakland and Los Angeles.

00;09;02;10 - 00;09;40;01
Makeba Williams, M.D.
And from this study, we gleaned that while menopause is a universal event experienced by women who live long enough with their ovaries, the ways in which these women experience it is very unique. So we saw some differences. Where we saw that women of color, African-American women will experience these hot flashes and night sweats for a longer duration. In fact, it was about ten years compared to white women who experienced these symptoms for 6.4 years.

00;09;40;03 - 00;10;07;19
Makeba Williams, M.D.
We saw differences not only in the duration of symptoms, but also in the intensity as well as the frequency. And though this study is more than 30 years old, we are continuing to glean differences and there is more yet to be learned, because that was seven cities across the country. And we know that the demographics of our country have changed.

00;10;07;19 - 00;10;21;02
Makeba Williams, M.D.
So there is much more to learn. But we know that this is a very unique experience, and we need to pay attention to those cultural factors that drive these differences.

00;10;21;04 - 00;10;38;11
Julia Resnick
My one sentence takeaway is that women are complex, and the experience of being a woman differs by woman. Care needs to be individualized to that person. So I want to make sure we talk about CHARM, the center that the two of you lead. Can you tell us about what that is and what you're learning through it?

00;10;38;13 - 00;11;05;12
Pauline Maki, Ph.D.
So the Center for Health Awareness and Research on Menopause was launched last March in an effort to really consolidate everything that we've been doing in this arena in those mission areas. So we've been raising awareness both individually and through our engagement with different societies. Dr. Williams is the president-elect of the Menopause Society. I'm the past president of that organization.

00;11;05;13 - 00;11;37;12
Pauline Maki, Ph.D.
I'm also the current general secretary of the International Menopause Society. And so it's really important that we have these academic medical society partnerships and raising awareness. And we also recognize that the University of Illinois, Chicago, we serve the underserved in Chicago. And so consistent with our mission, we want to do a lot of awareness raising and research and education that address our patient population's needs.

00;11;37;14 - 00;12;01;06
Pauline Maki, Ph.D.
And this is who we focus on in our studies. This is who we focus on in our educational efforts as well. So we want to continue the research that we've been doing -imagine now for more than 25 years of continuous NIH funding. So we're considered old guard. We've been doing this, it's our bread and butter for quite a long time.

00;12;01;09 - 00;12;41;29
Pauline Maki, Ph.D.
And as one of the largest medical schools in the nation, we're in the top three depending on the year. We have a responsibility to make up for these decades of lack of education. And so we're really paving the way, leading efforts to get funding to introduce the medical school curriculum that all of our medical students need, so that the kinds of stopgap measures that Dr. Williams mentioned, you know, training current providers in the field can really be something we do for just a few years so that the actual training is integrated more into medical school and residency training.

00;12;41;29 - 00;12;52;17
Pauline Maki, Ph.D.
So we have an active portfolio of research and activities in all of those mission areas in an attempt just to do better by women.

00;12;52;20 - 00;12;55;28
Julia Resnick
Fantastic. Dr. Williams, anything you want to add?

00;12;56;00 - 00;13;28;23
Makeba Williams, M.D.
You talked about health care system access. One of our initiatives in CHARM is to look at our clinical care delivery models. With increasing demand for menopause care among women and providers that have been underprepared, this presents a challenge, a challenge to access. When we look at where our gaps in care, it would be accessing providers who are certified menopause providers who have been appropriately trained.

00;13;29;00 - 00;14;07;01
Makeba Williams, M.D.
And so while we are working on training and educating the workforce, we're also looking at deploying creative clinical models that can scale the access gaps. Looking at how do we deploy care right at the point of need in the way that communities need that. That might look like shared medical appointments or group medical appointments so that we can deliver community based cares. Working with community health workers, using innovative technologies and telehealth to meet the rural needs of menopause women.

00;14;07;02 - 00;14;17;09
Makeba Williams, M.D.
So that is part of what we do at CHARM is to serve as a think tank, a testing ground for these innovative care delivery models.

00;14;17;12 - 00;14;37;26
Julia Resnick
So you are clearly looking towards the future of health care in your work, whether it's those care models or training the next generation of the workforce. So as you look ahead to the next to the next guard of menopause care and advocacy, how would you like to see care evolve? And also, what is one thing that you want women to understand about this stage of their lives?

00;14;37;29 - 00;15;12;07
Makeba Williams, M.D.
Certainly, we need to get menopause care out of silos. Menopause is it cuts across organ systems as we talked about, and it can't be relegated just to the obstetrician or gynecologist. We need the dermatologist on board. We need the physical therapists on board, the pharmacists on board, so we need to make sure this care is recognized and delivered across specialties and across disciplines.

00;15;12;08 - 00;15;50;07
Makeba Williams, M.D.
So raising that awareness is critically important so that we can have an all hands on deck situation when it comes to menopause. And I would also like to see that the those experiencing menopause see this as an opportunity to optimize health. Women are going to spend more than 40% of their lives during this time period. So recognition by health care providers and those who are experiencing menopause of the grand opportunity we have to improve health overall is essential.

00;15;50;07 - 00;15;53;03
Makeba Williams, M.D.
And what I would like to see in our future.

00;15;53;06 - 00;15;55;25
Julia Resnick
Fantastic. And Professor Maki?

00;15;55;27 - 00;16;20;17
Pauline Maki, Ph.D.
I couldn't agree more with that. You know, menopause care should be primary care. It's a universal phenomenon for women, right? So that's how we view menopause care at term. But at the same time, we know that if you're a woman with a clotting disorder or with a history of breast cancer, you need a professional like Dr. Williams who really knows how to treat these special and more complicated cases.

00;16;20;17 - 00;16;57;18
Pauline Maki, Ph.D.
So we envision a future where women will be referred when necessary to a menopause specialist, but that really the workforce will be trained en masse to do better by women and to understand the basics of menopause care. This is critically important. I see two technological advances that will help women. There are new technologies that will allow women to measure hormonal dynamics in their home environment, to wear, you know, sensors and wearable devices that will be able to feed objective data forward to their providers to help in their care.

00;16;57;21 - 00;17;28;20
Pauline Maki, Ph.D.
I think we need to be united on the types of symptoms and systems that we measure routinely in women and understand, are we making a difference? We need to measure menopause care effectiveness and to deploy models that really show a high return on investment, both for women's overall well-being and for a hospital system writ large. Because the World Economic Forum estimates that it's $128 billion opportunity in GDP annually.

00;17;28;20 - 00;17;52;27
Pauline Maki, Ph.D.
Imagine that. That's the cost of menopause, largely because women are not performing as well at work and presenteeism and absenteeism become issues. So even if one isn't like we are a cheerleader for women's health, there's just a strong economic argument to be made here. And so we need investment from all sectors.

00;17;53;00 - 00;18;09;24
Julia Resnick
Well, thank you both for being such incredible trailblazers in this field, for raising awareness, for training the next generation of the workforce, so that all women can live long and healthy lives. I really appreciate your sharing your expertise with us. And thank you. Thank you for being here.

00;18;09;26 - 00;18;11;24
Makeba Williams, M.D.
Thank you for having us.

00;18;11;24 - 00;18;14;22
Pauline Maki, Ph.D.
Thank you. It's been great to be with you today.

00;18;14;24 - 00;18;23;05
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.