Exploring the world of podcasting and the challenges we face in storytelling, sound editing, & decision-making. We reflect on the evolution of our journeys.

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read Newsletter

The same content as the podcast, but not a verbatim transcript. Could be a book chapter with images. download the printable transcript here

Contents

Proem.. 1

Podcast intro. 1

Introducing Steve Heatherington, Alpaca Shephard. 2

Virtual podcasting friends.  Yes, friends. 2

Podcasting and writing. 3

Sound editing. 3

What’s the story?. 4

Unexpected engagement 5

A word from our sponsor, Abridge. 5

 Call to action. 6

So much to do. Music! 6

Many Decisions to Make. 6

Decisions in disability. 7

Podcast workshop. 8

Reflection. 9

Podcast Outro. 9

Episode

Proem

Photo by Frugal Flyer on Unsplash

Welcome subscribers and patrons to this first exclusive bonus episode #200 (egads, #200). If you could look around the room, you’d see 275 long-standing subscribers, 12 monthly Patrons, and ten one-time supporters who contributed almost $300 in May and nearly $675 in June. Beyond my wildest expectations! I have an advisory call scheduled in early July with some experts who work with emerging adult interns. My colleague and friend Fatima has agreed to help me manage the initiative. I’m burning with excitement to get going. Thanks to you, I can afford it. My friend and crony in podcasting, Steve Heatherington, of Alpaca Tribe fame, joins me in today’s bonus episode as we muse about this intriguing podcasting world. I love that I can still learn with my Swiss cheese brain.  Check out the quilt in Steve’s background if you’re watching the video. Very cool.

Image from https://fineartamerica.com/featured/7-mri-of-multiple-sclerosis-medical-body-scans.html

Podcast intro

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Introducing Steve Heatherington, Alpaca Shephard

Health Hats: Steve. Thank you so much for doing this with me. So, you know that this is for me. This is going to be my first bonus episode. Nice. In my new Patreon world that I'm setting up. I'm excited to talk about all things podcasting with you since we've been buddies for four and a half, five years, and four and a half. Yeah. Four and a half years. And we've been podcasting, and we meet weekly to discuss anything about podcasting and life—the six or seven of us who, however many, it changes from time to time.

So anyway, thank you. Why don't you introduce yourself?

Steve Heatherington: It's a pleasure and a privilege to meet up like this, and Wow. Honor to be part of the first bonus episode. Wow, that's so exciting. Yeah. How did this happen? It happened by mistake almost.

I'm based in Swansea in the UK. And we have a farm, and I'm an alpaca shepherd. So, we got currently got 36 alpacas that I care for. Most of the time, it's straightforward, but occasionally you turn a corner, and there's something new and challenging. I used the alpacas to learn to podcast, and it's kept going. So I've been going over four years now. Episode 224 just went out the door yesterday, and that was a surprise, wasn't it? In a sense expecting that I was trying to help my wife, who was writing a book at the time, didn't have time to do the prod podcasting workshop, so I thought I'd do that workshop. So you carry on writing the book, I'll do the workshop, and we'll see whether that goes, and I'll teach you how to do the podcasting bit later. And we still not quite got around to that bit, but it's come close a few times. Yeah. So, it's interesting, I discovered a few weeks ago that I'm a podcaster, but I've always been a podcaster. Even before I was podcasting, I was a podcaster. And it was a similar thing when I started with the alpacas. I realized I was a shepherd, although I'd never had an opportunity to express that. Podcasting is just a perfect fit for me. And there are many side benefits and things that have been added in there, and many exciting people I met and worked with, such as yourself.

Virtual podcasting friends.  Yes, friends.

Health Hats: Goodness. So, I'm just working on episode 196, and I feel the same way. Podcasting is a perfect nexus for me in that it works for my advocacy. I like to write. I'm a musician. I like technology. So it's a big part of my life, and it brings a lot of different pieces together. And I want to experiment, and an unlimited amount of experimentation is possible in doing this. But I want to say that Steve, I don't know whether I've thanked you enough that Steve was the host of my 70th Zoom party, and there were about 50 or 60 people on the call. And Steve hosted that and was the facilitator the moderator, keeping things going and ensuring everybody had a voice. I so appreciate that. Thank you. And I think it just when I tell people that my friend the Alpaca Shepherd from Wales was the host of my birthday party, they think I'm crazy.

Steve Heatherington: That may be true, but probably not for that reason. It's interesting, isn't it, that because we've been meeting so regularly, I feel like I know you and count you as one of my friends. Definitely, and that's just a strange experience, and that all started before the Covid thing and Zoom calls becoming so much part of life, but that regular contact and understanding of each other, but being surprised by each other all the time as well.

Podcasting and writing

And I think there are things that we are still learning and new challenges. And you're right. You are an experimenter. You're always trying to try this thing or that thing. And you mentioned writing, and I think that one of the exciting things I hadn't expected with podcasting is how much writing is involved.

I've found that it's been something that's cleared my thinking. I think better. I communicate better in terms of writing, but also the spoken word. And there are things that I wasn't expecting to have to do that become part of the jigsaw that you are. It's not like jigsaw's the wrong word. It's one of those puzzles that the squares and you, that you got to, you've got one piece that's a gap and you move these things backward and forwards and slide them around too, yes, to move and create the pattern or whatever it is. And podcasting seems to be a bit like that. There are lots of pieces, moving pieces, and things that need to be in place and things that need to be done one after the other or at least have to be done before you, you finish and get the thing out the door.

And it's a fascinating process because there are always things you can do better, and that isn't to say that what you're doing isn't good. It is good, and it's as good as you can do it, but there's still more growing space. You can still learn new things.

Sound editing

Health Hats: I told you that my grandson, Leon, has been doing some editing for me to help make the audio transcript into a newsletter. He makes the sound in his high school for assemblies and musical events. He's listening to the episodes he's done the editing for and coming to me with issues he's hearing. At three minutes and 16 seconds, there's an abrupt transition. And so, which maybe I heard but didn't pay any attention to.

In talking to him, I realize that when I'm doing sound editing, I am trying to clean up the language by taking out not necessarily all the ums and everything. Still, people are talking in circles, stopping, and starting and, like that, and so I've been noticing that I'm doing less of that, and that's okay.

I play baritone saxophone in a Latin band, and I've been learning a lot differently about music in the last couple of years now that I have more audio expertise. Like I'm much more familiar with Garage Band and then recording myself like with a backing track, or I play in a Latin band, Lechuga Fresca, where I'll play the tune as we played it at a rehearsal or a gig and then work on my part and or work on soloing, but having the comfort with audio, managing audio software has listened to yourself. I remember when we first started, we would have conversations about hating the sounds of our voices. Yeah. And then eventually, that's like the least of it. Because you hear things differently, I like that now, like listening to other people's podcasts and people with ten people on their team when they do their credits. They have producers and editors and are no better than we are. Yeah. Or maybe that's not fair. But I can hear what we've been working on over the years, like, what's the story? What's the balance between the interviewer and the interviewee? How are they using music? How are they doing transitions? It's mainly before that stuff. It just washed over me. I didn't hear that detail. Yeah. And then you start hearing everything, so it's a kick.

You know that now I have more profound knowledge, so I hear differently.

What’s the story?

I wanted to ask you what is your biggest challenge today in podcasting? What's top of mind for you?

Steve Heatherington: I think it's a sense that there's more that I want to do in t

Dr Herndon, former Medicaid CMO: challenges faced to improve mental health care for emerging adults. Better support systems for their transition to independence

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read Newsletter

The same content as the podcast, but not a verbatim transcript. Could be a book chapter with images. download the printable transcript here

Contents

Proem.. 2

Podcast intro. 3

Meet Dr. Mike Herndon. 3

Health is Fragile. 3

Mental Illness in family practice. 3

Readiness to manage mental illness in practice. 4

State Medicaid Director 5

Levers of power 6

Aligning incentives 6

Minor success, at best 7

A word from our sponsor, Abridge. 8

 Call to action. 8

Family Advocacy. 9

Not easy being an emerging adult 10

Reflection. 11

Podcast Outro. 11

Episode

Proem

According to the Commonwealth Fund, in 2016, spending in the US on behavioral healthcare was almost $160 billion, with 58 percent of all behavioral health spending being paid for by Medicare and Medicaid. According to SAMHSA, The Substance Abuse and Mental Health Services Administration, Medicaid is the largest payer in the United States for behavioral health services. Medicaid accounted for 26 percent of all behavioral health spending in 2009. Behavioral health is a term for mental health and substance use disorder conditions to differentiate from physical health. As a clinician, I seldom met a person with chronic physical health issues who didn’t also have behavioral health issues. I don’t know how meaningful statistics are, except to say a lot of people have behavioral health diagnoses in their records. It costs them, their families, and communities a fortune, and government health insurance pays a significant proportion of those direct costs.

Podcast intro

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Meet Dr. Mike Herndon

Health Hats: I invited my friend and colleague, Dr. Mike Herndon, recently retired  Chief Medical Officer for the Oklahoma Healthcare Authority, Medicaid, to chat with us about Emerging Adults with Mental Illness.

Mike, thank you so much for joining me.

Mike Herndon: You bet, Danny. Happy to be here.

Health Hats: Thank you. My friend, Dr. Mike Herndon, and I have done quite a bit together over the years, mainly through PCORI, the Patient-Centered Outcomes Research Institute. We sat on an advisory panel together, then you were appointed to the PCORI Board of Governors, and I came on the board a few years later. You were my Board orientation buddy and helped me navigate and reduce the shock of the experience. I appreciate it. Let's just jump right in. Mike, when did you first realize that health was fragile?

Health is Fragile

Mike Herndon: That's an easy answer for me. I grew up in rural Oklahoma. In the summer between my sixth and seventh-grade years, I was 12 years old, and my mom had a pituitary tumor. That hormonal gland in the brain had gotten so large it caused terrific headaches. She had double and blurred vision and had to have a craniotomy, and brain surgery, to remove the tumor. That set off many health problems in the family, with financial Issues following. The stress on the family, but also the stress in her life and the resulting kind of emotional and mental toll that it took on her and the family, was tremendous. Growing up in a lower socioeconomic environment compounded the devastation. I know some people have faced adverse childhood experiences much worse than that, but that's an easy one for me. Danny did a, when I was 12 years old, having a mom with a life-threatening illness and a craniotomy and significant surgery with all the sequela that came after that. I was very aware that health was fragile.

Mental Illness in family practice

Health Hats: You're a family practice doc. I understand you spent 20 years in practice as the medical director or a clinical doctor in a college health clinic. How did young adult mental illness present to you in those venues?

DALL.E Chosen family adults mixed race in Picasso style

Mike Herndon: To set the kind of frame of reference for that practice, I returned to the town of my alma mater to practice medicine. The university was looking for a campus doctor, so it was a way for me to build a practice. I visited the campus daily to see students as part of my practice. It was typically an hour's commute to the health clinic. Then I went to my practice in the community. Everything, Danny, I can recall a patient with Asperger's to people who just had simple test anxiety, situational depression, and then the spectrum in between. People who had depression, chronic depression, students, and undiagnosed until they left home. Some of that is situational from severe family dysfunction, some genuinely genetic and with an actual chemical imbalance, creating depression.

And then just the vast spectrum of navigating being out of the home, out of your sphere of friends and influence into a new environment, trying to make your way and develop your identity—and so just the stresses of that and the acting out. So, I would include some substance abuse issues.

Quite a range.

Readiness to manage mental illness in practice.

Health Hats: Did you mostly feel like you, did you feel prepared or adequate or that you could be helpful or were, you like, always looking for what services they need and that you couldn't provide and, look for that? What, how, and what was your comfort with dealing with that?

Mike Herndon: Another great question. I think physicians all have their areas of interest. They develop expertise because of that interest. And indeed, one of my areas of interest was depression, anxiety, and mental health, primarily because of my childhood experience and my family experience. My family, my family has a history of depression. I understood it, I think, and I sought to understand it. In medical school, I paid much attention to behavioral health rotations. I've paid particular attention but also read and studied a lot. I understood the actual physiology and the neurochemistry of depression. And how life factors can play into that, but there can also be an underlying disturbance or an imbalance of those neurotransmitter chemicals: serotonin, norepinephrine, and dopamine. I had a basic understanding of that, which was very useful. So, I felt well equipped personally to prescribe antidepressants when appropriate. And to know when it was something that simply needed someone with the skillset to counsel them. I am very fortunate to have a Ph.D. psychologist on the staff, part-time at the university, who taught at the university but also was a provider in the clinic where I worked. So, we had a solid connection that I could use the health counseling center attached to the medical center. We worked collaboratively and beautifully together.

Over the years, we had a couple of different providers as that clinic grew. At one time, we had two counselors, and this is a college community of around with an enrollment of approximately 2000 students—part of the knack of being a good family doctor and treating behavioral health conditions, knowing when. I was always aware of my limitations. When it was beyond something, someone just needed some encouragement, understanding, and a listening ear, and my skillset was not adequate when they had some deeper issues. In my practice, I also developed a network of different types of counselors, LPCs (licensed alcohol and drug counselors), and people with PhDs in religious studies that were also counselors sometimes. It's helpful. And then, of course, the psychiatrists and psychologists. I work to develop that network, that array, that scope. I also used that outside of the student health center. But man, what an absolute gift to have someone on campus with me to help. It was a great relationship, and it worked. It worked well.

State Medicaid Director

Health Hats: Then you went from private practice to being the State Medicaid Medical Director. Goodness. You went from the firing pan to the fire, but I'm not sure that's a good metaphor. How did that happen?

Mike Herndon: To answer that, you must understand why a person would do that and be interested in that type of work and career shift. For me, 20 years of practicing medicine and what I believe to be the right way where you were the medical home, you took care of your patients. You may have heard me say this before, Danny, in some of our meetings, that I think the healthcare system right now is not designed to pay physicians to take care of people. The system’s designed to pay physicians to see patients. There's a difference between caring for and seeing a patient. I took good care of my patients, but it took a toll on me. And after 20 years of that, I was pretty worn out.

I became interested in administrative medicine and had some friends who had an interest in administrative medicine and did some on a part-time basis. An opening came up at the State Medicaid agency, and I knew the chief medical officer, the state Medicaid director....

About McLean Hospital. Referrals, COVID impact, capacity, stigma. Still need more resources & shift towards treating mental health on par with physical health.

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read

The same content as the podcast, but not a verbatim transcript. A newsletter-like version with images. Could be a book chapter. download the printable transcript here

Contents

Proem.. 1

Podcast intro 01:49. 2

Health is fragile 02:41. 2

Leadership at McLean’s Hospital 04:08. 2

Levels of care 05:12. 2

Massachusetts Child Psychiatry Access Project (MCPAP) 07:04. 3

Supporting Primary Care 09:41. 3

Mental illness and Covid 11:59. 4

Capacity – space, and staff 13:28. 4

Using Peer Experts – lived experience 16:12. 5

A word from our sponsor, Abridge 17:56. 5

 Call to action 18:39. 5

Coalitions and partnerships 20:26. 5

Academics, research, advisory panels 24:43. 7

Stigma 27:13. 7

Level the playing field between physical and mental health 30:07. 8

Reflection. 8

Podcast Outro 33:49  9

Episode

Proem

Photo by razvan-mirel-xhYhjMIfsq8-unsplash

Continuing the series spiral with emerging adults with mental illness at the center, along the outbound curve, we experienced a parent, a high school teacher, primary care and emergency doctors, and community services. Now we arrive at mental health providers in the person of Michael Macht Greenberg, who administers an integrated system of mental health medical services, McLean Hospital, of the preeminent healthcare system, Mass General Brigham’s Hospital. I met Michael working together at Boston Children’s Hospital. Michael was the administrative director of the Department of Medicine, and I led the patient/family experience initiative. We both left Boston Children’s more than ten years ago. As circumstances allow, we still meet for coffee at least quarterly, in person or virtually. Michael’s low-key presentation belies his passion and compassion for emerging adults and people with mental illness.

Podcast intro 01:49

Photo by Diana Feil on Unsplash

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Like what you're reading, hearing, or watching? Go to my web page https://health-hats.com/support to choose a method of support that suits you. Thank you.

Health is fragile 02:41

Health Hats: Michael, thank you so much for joining us. I appreciate it. I love seeing you. This is different from our usual coffee at Pete's.

Michael Macht Greenberg: Always good to be with you. Thanks for asking to chat.

Health Hats: Yeah. When did you first realize health was fragile?

Michael Macht Greenberg: Wow. As a kid growing up, when you start losing people, grandparents, and great-grandparents, you start realizing you can lose people. Those people who have been important in your life aren't around anymore. Fortunately, I am a healthy guy, and my experience with fragile health is limited. I'm fortunate that, with limited exception, that hasn't been too dramatic or traumatic. But while growing up and realizing the people you love aren't around forever, that gives you a thought about how important life is.

Leadership at McLean’s Hospital 04:08

Health Hats: Thank you. The reason that we're talking is that you're a director of an adolescent mental health system. Could you tell us about what you do?

Michael Macht Greenberg: Sure. I work at McLean Hospital, a private psychiatric hospital, part of the Mass General Brigham system. My roles at McLean include Senior Director for Child and Adolescent Psychiatry. I'm also one of the Interim Associate Chief Operating Officers at McLean. So, I have a role specifically related to children, youth, and families and a position regarding the hospital's executive leadership.

Levels of care 05:12

Health Hats: Are the services you provide inpatient? Are they inpatient and outpatient? What's the array?

Michael Macht Greenberg: McLean has an extensive range within the child and adolescent division. We have two inpatient units, probably six or eight residential treatment units of various types, and four or five partial hospital day programs. Our outpatient clinic provides what you might think of as typical outpatient care, but there are also subspecialty components, including neuropsychological testing. We have two licensed special education schools. One is a regular high school for kids with emotional problems that impair their ability to participate in education in a typical school setting effectively. We also have a licensed school for kids who are on the autism spectrum. Our school consultation service provides education and outreach to several school districts across Massachusetts. I have to think if I've left anything out. We're trying to meet folks where they are and provide services at the level that people need. So, we have a wide array of care.

Massachusetts Child Psychiatry Access Project (MCPAP) 07:04

Health Hats: How do people find you? Do they get referred by primary care physicians? Do they get referred by community counselors or psychiatrists? Is there an emergency room that you have or have access to?

Michael Macht Greenberg: Folks get to us from various avenues. It can be everything from Google and people searching the internet to see our services. We have an extensive network of coordinated care with primary care doctors. You reminded me. In addition to all those other services we mentioned, McLean Hospital is part of the Massachusetts Child Psychiatry Access Project or MCPAP. That's a consortium of hospitals across Massachusetts that provide consultation and referral to many primary care doctors across Massachusetts. So, you can get to us from the internet.

Health Hats: Wait a minute. Is that referral meaning that people are patients at McClean, and then there's a referral to primary care that's comfortable managing?

Michael Macht Greenberg: Typically, the other way, if I'm a primary care doctor and I have a youngster with a psychiatric issue, and I want to consult with the child psychiatrist about what medication might be appropriate, what clinical services might be indicated, and if I sign up to be part of the MCPAP network, I can reach out according to the protocol we have. And within about 30 minutes or an hour, I'll be on the phone with a child psychiatrist, at least having an initial chat about what it is that's on my mind. Then we can schedule face-to-face consultations with kids. Still, we support that primary care practice in understanding what resources, not exclusively within McLean but across the whole community, you might refer to if you're looking for a therapist.

Supporting Primary Care 09:41

Health Hats: I told you before we started recording that I had interviewed somebody who was the Chief Medical Officer of a state Medicaid program. He was a primary care physician interested in behavioral health and young people. One of the things that he talked about was that these are my words, not his. There's a cohort of primary care physicians comfortable with behavioral health issues and then seeking advice. Then some are at sea. It's not their wheelhouse. So, he spent time in his role trying to increase the proportion of primary care physicians that were comfortable keeping young people and treating them with advice. His challenge was finding advice. He didn't talk about a network as you just spoke about.

Michael Macht Greenberg:  It would be interesting for this individual to become more familiar with something like MCAP. The other exciting news is that other States have implemented the model of MCAP. I don't know which state this individual represented, but it is a transferrable model to other areas. The MCAP design is to avoid taking over care right from the primary care doctor, the pediatrician. For that purpose, we want to help primary care doctors retain patients in their practice with confidence that they can take care of them appropriately and a sense of not being alone, that they can reach out and talk with somebody and get advice. It is purely for consultation.

Mental Illness and Covid 11:59

Health Hats: You and I have talked before, and it comes up with almost everybody I speak with, either the reality or the perception of an explosion in young adults, emerging adults, whatever we want to call them. An increasing need that was already pressing. But then covid came. The challenges of Covid made it much worse. Is that something you guys are dealing with?

Michael Macht Greenberg: Oh, absolutely. I know we will talk more specifically about kids and young adults. There was a strong need for mental health services before the pandemic, and indeed, as the pandemic has continued, we think we're getting the better of it. We are seeing absolutely an uptick in needs and referrals. We see it at McLean Hospital across all age groups. These have been tough years for folks of all ages. So, the factors that have made it difficult have had a meaningful impact on children and families.

Capacity – space, and staff 13:28

Health Hats: So, regarding capacity,...

Exploring Youth Clubhouses, drop-in centers for youth in recovery from/at risk for substance use disorders, focusing on access, partnerships, & peer support.

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read

The same content as the podcast, but not a verbatim transcript. A newsletter-like version with images. Could be a book chapter. download the printable transcript here

Contents

Proem.. 1

Podcast intro 02:45. 2

Health is fragile 04:08. 2

Youth Clubhouses, safe places 07:27. 3

Access to the Clubhouse 10:23. 4

Community partnership and collaboration 13:22. 4

Youth program engagement and leadership 17:03. 5

A word from our sponsor, Abridge 19:03. 6

Coping tools in your toolbox 19:48. 6

Continual learning. 6

Hopeful, hopeless 25:03. 7

Policy change, harm reduction 28:23. 7

OASAS: Office of Addiction Supports and Services 31:01. 8

Clubhouse Radio 31:45. 8

Narcan and Harm reduction 34:36. 9

Reflection 38:16. 10

Tribute to Casey Quinlan 39:53. 10

Tribute to Michael Funk 43:46. 11

Podcast Outro 44:33. 11

Episode

Proem

Figure 1: DALL.E image of Sculpture of community-based research in style of Yoshitoshi Kanemaki

I gravitate toward, am attracted to, community-based programs that build partnerships with their participants. The programs serve well, plant seeds, build capacity, and inspire copying. Medical, professional, or larger companies have a more challenging time serving, planting, building, and inspiring. Perhaps it’s a function of community-based and partnerships with lived-experience experts. I thank Dorothy Cucinelli, last episode’s guest, for introducing Paul Taylor and the Youth Clubhouses at the Mental Health Association of Columbia Greene Counties.

Youth Clubhouses are drop-in centers for youth and young adults in recovery from or at risk of developing a substance use disorder. These programs provide recovery supports – including peer support – as well as skill-building and community engagement opportunities, educational and vocational support, recreational and prosocial activities, family engagement activities, and sessions on health and wellness. Youth and Young Adults | Office of Addiction Services and Supports (ny.gov)

Youth Clubhouses are programs of NY State OASAS.

The New York State Office of Addiction Services and Supports (OASAS) oversees one of the nation’s largest Substance Use Disorder systems of care. Approximately 1,700 prevention, treatment, and recovery programs serve over 680,000 individuals per year. About Us | Office of Addiction Services and Supports (ny.gov)

Kai Hellman invited Paul Taylor and Phoebs Potter to join us. We spoke about youth access to the Clubhouse, Clubhouse partnerships in their communities, youth engagement and leadership, peer support, and harm reduction.

We will end the episode with two tributes, one of Mighty Casey Quinlan who died a couple of weeks ago and to my son, Mike Funk who would have been 47 on May 17th.

Podcast intro 02:45

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this. Like what you’re reading, hearing, or watching? Please support us on Patreon. Link in the show notes. https://patreon.com/healthhats. Membership benefits will include subscriber-only on-mic episodes sharing behind the scenes of podcasting, advocating, musicianship, and life, your name on the producer wall on my website and show notes, mp3s of me playing the sax, invitations to live Zoom chats with fellow subscribers, personal calls and coaching and mentoring with me.  Thank you.

Health is fragile 04:08

Health Hats: Greetings. Thank you very much for joining us today. I have three guests with me, and I will let you introduce yourselves and briefly tell us about when you first realized health was fragile. Paul, do you want to start?

https://www.mhacg.org/clubhouses

Paul Taylor: Sure, my name's Paul Taylor, the Director of Communications and Development for the Mental Health Association. I started in the spring with the agency, trying to put a good spotlight on mental health for the community, build up some of our agency resources, and how we interact with the community. Healthcare is definitely fragile for everyone, especially with the pandemic taking a toll on everyone for their health and well-being. How we approach our livelihood has become very important to overcome for the communities.

Health Hats: Thank you. That's the Mental Health Association of Columbia Greene Counties in upstate New York. Okay. Phoebs, do you want to go next?

https://facebook.com/c2clubhouse

Phoebs Potter: I’m Phoebs Potter. I work with the Youth Clubhouses at the Mental Health Association of Columbia Greene. We work with young adults and 12 to 18-year-olds on prevention and recovery support. Recognizing health is fragile is the reason we exist. The significant part of the fragility we don't always think about enough, is the interconnectedness of all aspects of health. From social health to spiritual health, to physical health, to mental health, they're not so separate. They affect one another. So, if one part of your life is going hard, it can hit all the others. We try to think about our approach holistically in that regard.

Health Hats: Thank you. Kai?

Kai Hellman: Hello. Kai Hellman, Director of the Youth Clubhouse of Columbia Greene under the Mental Health Association of Columbia Greene County. I have a more personal answer. As a young person growing up, I was always the quote-unquote sensitive one. I had insight into health and mental health differently than maybe the parents expected. When mental health was, as you know, is and was stigmatized in ways we don't talk about. But I always wanted to talk about it. So personally, I think from a young age, I just recognize it in myself and other people.

Youth Clubhouses, safe places 07:27

Health Hats: Thank you. So, is that the name of a program that the association provides? Can you tell us a little bit about that program?

Kai Hellman: The Youth Clubhouse is part of a clubhouse chain throughout New York State, funded by the Office of Addiction and Support Services (OASAS). I’m unsure how many clubhouses exist, but over 20 now with were seven in 2017. As Phoebs explained, it's a space for young people at risk or in recovery that needs space, a safe space or a brave space to exist.

Health Hats: So, is that a physical or virtual space or both?

Kai Hellman: Both. We were strictly physical until the pandemic when many agencies created virtual spaces. Now we continue that virtual space.

Health Hats: Is this for young people alone, or is it for young people and their families?

Phoebs Potter: I can step in. It's centering on the young person. We take a person-centered approach. When a young person walks through our doors, we ask for very little information from them, and we tell them out of the gate that confidentiality is something we're going to honor and respect here. In terms of the Clubhouse itself, the family does come through. We have plenty of folks who are comfortable with our staff and friendly and will come in to pick up their kid and say hello. But other kids also go there to escape complex family dynamics. So that's a very different relationship. Kai did collaborate with some other organizations or programs, even just within MHA, to bring on Strengthening Families, a program offered, not necessarily at the Clubhouse when it's open hours for the kids, but separately for families to come in with a young person, and work through family challenges as needed. So, family-based work is happening at MHA much more significantly. The Clubhouse, though, really is for the youth first. We can also help families with gas cards and support like that. When the kids' struggle with transportation, we text or call up their mom and then brainstorm collaboratively. So, we seek those healthy relationships with the entire family.

Health Hats: How long has this program been going on?

Kai Hellman: We were first funded in 2017, so it's been a solid five years.

Access to the Clubhouse 10:23

Health Hats: What's the process of people walking through your real or virtual door? How does somebody access your program? How do they hear about it?

Kai Hellman: We have a very low threshold. Phoebs explained that no paperwork, process, or referral forms exist. We are strictly a drop-in center. They might find out through word of mouth, which is the best way. We have social media. We put out flyers—things like that. We also collaborate with other organizations and youth programs, but word of mouth is the best way of engagement.

Phoebs Potter: The physical location makes a huge difference, too. In some ways, the Clubhouse in Catskill is the Community Center for Youth, especially since the town-run community center closed. I love when Kai tells the story of when they first opened. There was a line almost around the block of young kids just stoked to know there was a place with internet, couches, and food. They could just be themselves and come....

COAST, a 24/7/365 access program in upstate NY, offers access to med-assisted treatment & wraparound services for substance use & mental health concerns

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read

The same content as the podcast, but not a verbatim transcript. A newsletter-like version with images. Could be a book chapter. download the printable transcript here

Contents

Proem.. 1

Podcast intro 01:13. 2

Access through a single number 1:50. 2

Wraparound services 04:16. 2

The behavioral health network collaborative 05:52. 3

Doing something right 08:40. 4

Substance use and mental health 09:32. 4

Warm hand-off 11:52. 4

Partnership with families 12:33. 4

Residential and inpatient? 13:28. 5

A word from our sponsor, Abridge 14:20. 5

Collaboration over competition 15:03. 5

Networking coordination 16:52. 5

Emerging adult priorities 18:07. 6

Matching resources to demand 21:36. 6

Maximize access 25:19. 7

Prevention 28:59. 8

Marketing programs 29:49. 8

Reflection 33:34. 9

Podcast Outro 25:39  9

Episode

Proem

Photo by Nima Ara on Unsplash, reference not found

When I’m in trouble or have a question, I need help when I need it, preferably from a warm person, not an app or a bot. Is this even possible today? One of the health systems I use just shifted the patient portal inquiry responses to a central department, open Monday through Friday, 8 am to 5 pm. No more replies to non-emergent questions from my doctor or nurse within two days as I’m used to. Not a warm person when I need it.

I called my dear friend Dorothy Cucinelli as I planned this Emerging Adult with Mental Illness series. Dorothy, CEO of the Capital Behavioral Health Network (CBHN), sponsors COAST (Coordinated Opioid and Stimulant Treatment) 24/7/365 person-answered hotline for people in need. Kelly Lane joins Dorothy to tell us more.

Podcast intro 01:13

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Access through a single number 1:50

Health Hats: Dorothy and Kelly, thank you for joining us today. I look forward to discussing the COAST program (Coordinated Opioid and Stimulant Treatment). And as we've talked about previously, I'm focused on young adults and their families with mental illness and the services they need and can get. So, I was very excited when Dorothy and I were just catching up to hear about the COAST program. I'm wondering if you could tell us a little about how people access COAST referrals, supportive services, young adults, and families.

Kelly Lane: Sure. It's easy. We've designed this project with a single number that connects you to services anywhere in our eight-county region, south to Columbia Green County, north to Warren, and Washington.

Health Hats: In upstate New York?

Kelly Lane: Yes, the Capitol District, Warren, Washington, and Columbia Green.

Dorothy Cucinelli: For those listeners who might not know this area, the Capitol District is Albany, about three hours' drive north of New York City. We cover the eight counties in that region, to the Massachusetts border and West, then up north to the North Country, to the Adirondacks, and south to the Catskills. It's a big geographic area. It has quite a mix of demographics, everything from people in the cities to very rural locations. One of the challenges we've been able to meet successfully is establishing ways for people to access this program regardless of where they live. It's unique in that, as Kelly said, it’s a phone line, so people can call this number twenty-four seven/three sixty-five. And they are connected immediately with a prescriber. So, someone who can write a prescription and get that person connected to medication-assisted treatment right away.

Wraparound services 04:16

A prescription goes to the pharmacy. If the person doesn't have the means to pay for that medication, our grant program also covers that. And we can even arrange transportation to get that person's prescription. We use the term wraparound services a lot in the mental health field. And this is a form of that because it covers a lot of different bases that individuals sometimes aren't there. And if any of those pieces are not in place, the whole thing doesn't work. We're proud.

photo by Helena Lopes on Unsplash

Health Hats: Wraparound is a comprehensive, strengths-based, planning process put in place to respond to a serious mental health or behavioral challenge involving children or youth. Wraparound shifts focus away from a traditional service-driven, problem-based approach to care and instead follows a strengths-based, needs-driven approach. Meaning it considers the whole people and what they need in their lives and not just the medical services.

So, does that mean it's two in the morning, and I need some help for my son, and I can call and get a live person?

Dorothy Cucinelli: Yes, that's precisely what it means.

Health Hats: Wow, that's amazing. You can't do that with Amazon, that's for sure.

The behavioral health network collaborative 05:52

Health Hats: The little thing you told me about is that this is a collective. Tell us how it is structured and your roles in this.

Dorothy Cucinelli: Well, let me tell you a little about the network, and then I'll toss it over to Kelly. The grant went to the Capital Behavioral Health Network. CBHN is our abbreviation, and we represent about 30 different mental health and substance abuse provider organizations in that eight-county region I described earlier. So, everything from the very large to the small providers who do clinic services, residential the whole range. CBHN brought together a subset of those major players who could best deliver this service, coordinated a program, designed it, and made this happen so that all these providers who do work together sort of on individual case-by-case basis issues. But really, they don't typically work together on a significant project like this. So, our role was to bring them together. And to continue to coordinate. And Kelly's role in this is a lot of that coordination. Kelly, do you want to speak about that?

Kelly Lane: So as the partners came together and identified a critical need in the community. And that's when someone is interested in making a change and the period at which they can get help. And there's typically a significant wait list, especially for folks who need medication-assisted therapies for opioids and stimulants. So, the partners came together and said we want to design something that meets that need to help people immediately connect folks to services and supports. I see incredible commitment and willingness to partner across counties and service types. There are ten funded partners and even more partners who aren't funded but are part of this network of providers in this grant who came together and worked out how they would implement. And continue to meet and improve the project.

Doing something right 08:40

Dorothy Cucinelli: We know there's a need for services of this type because of the opioid epidemic, but what surprised me is the extent to which people are accessing the line. I'm happy that they are, but we're getting an average of about 130 calls per month on that line. People are getting connected to treatment, and many have had callers say I was on the verge of deciding whether to use another hit of a street substance versus calling. And I called you, and it has made all the difference. It's been life-changing for a lot of people. Which is terrific. We're very proud of that. And we hope to continue doing it.

Substance use and mental health 09:32

Health Hats: Is this a service for substance use and severe mental illness, or is this pretty much focused on substance?

Kelly Lane: It's focused on substance use and specifically opioid and stimulant use.

Health Hats: In the years I've done this kind of work, it seems like having a firm line is challenging. It looks like the call might be about substance use, but you probably don't have to scratch the surface too far to find underlying issues. People are often self-medicating because they've significant mental health issues, whether it's despair or anger or voices, and then they get to addiction through self-medication. Is that part of how you decide on referrals and supportive services by what the mix is?

Dorothy Cucinelli: We do get a lot of callers who self-identify as just a mental health issue. This is not a line where we just give you a script and send you on your merry way. There's a significant coordination component with this grant so that the person calling gets connected to services that will help them get started or continue their treatment and recovery, whatever that may be. So, it's not just, okay, we'll give you a script and let you go. It's ongoing care.

Warm hand-off 11:52

Dorothy Cucinelli: The other thing is, as I said, we do get people who call with a mental health issue, who don't have an active addiction, and those people are given that same kind of handoff to other services. So, it's not we just give you a list and say,...

Introducing you to my new Patreon page so that I can earn some revenue to help me keep the lights on. Fans can pay a $small amount each month for bonus rewards.

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read

The same content as the podcast, but not a verbatim transcript. A newsletter-like version with images. Could be a book chapter. download the printable transcript here

Episode Notes

Please comment and ask questions

at the comment section at the bottom of the show notes

on LinkedIn 

via email

YouTube channel 

DM on Instagram, Twitter, Mastadon to @healthhats

Credits

The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute®  (PCORI®), its Board of Governors, or Methodology Committee. Danny van Leeuwen (Health Hats)

Sponsored by Abridge

Creative Commons Licensing

The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge.  Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements.  Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.

The Show

Hey there. As one of my blogging, podcasting, and vlogging cronies, I'm excited to share a sneak peek of a big upcoming launch with you and see what you think.

For the past few weeks, I've been working on a Patreon page so that I can earn some more ongoing revenue through my fans to help me keep the lights on. With Patreon, fans can pay a small amount of money each month in exchange for some bonus rewards. The "About" tab tells you more.

Free will remain an option. https://health-hats.com/free/

I've launched my page, but it isn't finalized. Go here. https://www.patreon.com/user?u=8382489. Click on the "About" and "Membership" tabs. I'd love to hear any feedback you have about it before I make it live for the world.

Specifically, Does everything make sense? Is it clear what Patreon is and what fans get out of joining my community?

What do you think of the rewards?

Do any, in particular, stand out as things you would join Patreon for?

Is there anyone you think I should connect with to help spread the word once I launch?

Thanks for letting me know what you think. I'm excited to get this off the ground and couldn't do it without the support of friends, and family like you.

I'll be sending out an email to my mailing list subscribers once I launch. So feel free to add your email here  https://health-hats.com/free/ if you'd like to stay in the know. I'm looking forward to incorporating your feedback into my final page. Thanks.

Dr. Joel Hudgins muses on up and downstream changes to Peds ED for emerging adults with mental illness. Higher numbers & acuity, too few beds, services, & staff

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read

The same content as the podcast, but not a verbatim transcript. A newsletter-like version with images. Could be a book chapter. download the printable transcript here

Contents

Proem.. 1

Update on Mighty Mouth Casey Quinlan. 2

Podcast intro. 2

Health is fragile. 2

Crossing the threshold into the ED. 2

How can we help up front?. 3

Upstream and downstream issues 4

Can we really help? It takes a toll. 4

A word from our sponsor, Abridge. 5

System interventions/solutions. 5

Hopeful, hopeless 6

Real people all around. 6

Profound knowledge. 7

Academic medical center versus critical access hospital 7

Reflection. 8

Next: Episode #8: COAST. 8

Podcast Outro. 9

Proem

In this series we’ve met Emeka and Annie, two emerging adults with mental illness and Emeka’s mom, Erika. We learned about their ‘something’s wrong’ experience, finding treatment, family dynamics, and recovery. We met Matt, a high school teacher leading a student-run welcoming Ambassador program, and Dr. Bonnie, a primary care doc, managing the care of emerging adults with developing and full-blown illness with limited resources. You can see that I’m starting in the center with lived experience and spiraling out.

Photo by razvan-mirel-xhYhjMIfsq8-unsplash

Welcome to today’s episode, #7 in the series, of the lived experience of another professional, Dr Joel Hudgins, pediatric emergency physician at Boston Children’s Hospital.  Full disclosure, I worked from 2002 to 2008 at Boston Children’s leading their patient family experience initiative and I worked as a nurse/paramedic at two rural hospitals in West Virginia in the late eighties, early nineties. Despite my experience in pediatrics and emergency services, I feel out-of-touch with the dynamics of treating an increasing proportion of youth with mental illness while also faced with exploding infectious disease incidence, COVID, RSV, and flu. Emergency care and pediatrics are near and dear to my heart. Let’s see what we can learn with Dr. Joel Hudgins.

Update on Mighty Mouth Casey Quinlan

Before we begin, I published my last episode on April 1, 2023, the mashup of my chats with Casey Quinlan. Many subscribers reached out to me. Is Casey alive or has she passed? I purposefully left it ambiguous because I didn’t know when people would be reading, listening, or watching. Besides, Casey told me several times over the years when I called her about various deaths in my family, why do funerals and memorial services need to come after death? Anyway, as of today, April 12, 2023, Casey lives in a hospice, with several visitors a day, alert for short periods of time, still snarky. Go to CaringBridge.com, for up-to-date information from Jan Oldenburg.

From Health Hats, the Podcast https://health-hats.com/pod193/

Podcast intro

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Health is fragile

Health Hats: Thank you so much for joining us. We need your perspective as an emergency room doc. Why don't you introduce yourself by telling us a little about when you first realized health was fragile?

Joel Hudgins: That's an excellent question. I grew up in rural Texas, and my granddad was a general practitioner there. I still remember going around with him back in the early eighties. He would do times where he would go to people's homes, or he had attending privileges at various hospitals. So, I would accompany him on some of his trips. As I look back, I didn't realize it at the time, but I think what interested me was his ability to connect with people uniquely. As part of that, you asked when I learned health was fragile. I think that was probably my exposure to sickness and people who died. I believe that relationship seemed so unique and resonated with me and was something that I think ever since I did that with him when I was young, it felt like that was the path I wanted to go down.

Crossing the threshold into the ED

Photo by Gary Lerude on Flickr/Creative Commons

Health Hats: Great. As an emergency doctor, how do people with behavioral and mental health crises come to you? What is it that you see that comes in the door?

Joel Hudgins: So, I think to answer that, you must take a little bit of a step back to where when I trained, I did my residency in Colorado and my fellowship here in Boston. We did not see this in this way at all. We certainly saw a few patients with mental health crises or behavioral health issues, but it was the minority, and I didn't even think about it then. What we've seen over the last decade, but significantly ramped up in the previous four or five years, and then ramped up even more after Covid has just been teens and tweens in complete crisis—the question of why is so multifactorial. I think what we see is a cohort of patients that vary. So, you can see patients who come in that are suicidal and at high risk for suicidality, and those patients you keep in the ER until they have a place to go because they're not safe to be at home.

Then you have patients who have behavioral dysregulation. Those may be patients who have other comorbid medical conditions or kids that may have autism, and the families are just really struggling to get the behavior under control. We see kids that come in with eating disorders that are overlaid with things like depression or suicidality. We see patients who have issues at school and feel like the school cannot handle some of their behaviors or their behaviors at home aren't able to be addressed. We see kids with severe anxiety and TIC disorders. We'll probably talk about the various reasons, but it does feel like the ED and the ER have become the place to coordinate a lot of the care for these kids, which is not a role we were prepared for. We've responded as best as possible, but that shift, or transition has happened over the last few years.

How can we help up front?

Health Hats: So, what can you do to help?

Joel Hudgins: It's a great question, Danny. I think this is where we run into some, I don't want to say dissatisfiers, but this is an area where I think we feel a little bit unprepared or overwhelmed. An ER is not designed for what it's being asked to do for these patients, and that's not the fault of the patients or the ER. It's just a mismatch, and we've made solutions the best we can. And so, what we can do is, and what we're very good at, is assessing if this patient is safe to go home. Is this patient high-risk enough to need to be kept here in the emergency room with a plan to admit them to a psychiatric facility at some point?

We're good at that initial evaluation for patients who come in crisis for discerning. If this is a medical thing or a psychiatric problem, you know that there's an overlay discerning the medical clearance of patients. We're very good at that. That's a skill that I think most emergency medicine providers have.

We've set up some resources for patients who leave. We're pretty good at providing some discharge instructions for providing resources as an outpatient for connecting people to things they may not have had access to before they came to see us. We struggle when you turn the ER into more of an inpatient facility and keep behavioral or mental health patients in crisis in the emergency room for weeks. We're just not great at that. And we're getting better. But the reality is we're not docs that train for that. The nurses in the ER are not nurses that came into the ER with the idea that we're going to daily rounds on behavioral health patients. We're going to keep them, do therapy, and titrate medications. All this stuff is not over our heads but is new to us. I think those are areas we struggle with, but there are some things we do well. But they're usually in that upfront kind of initial evaluation part of things.

Upstream and downstream issues

Health Hats: Is the reason that people are you're providing inpatient services in an emergency setting that there, there's a shortage of places for people to go?

Joel Hudgins: It's the way I think about it is it's a little bit on both sides. So, the input to our facility has gone up. So, the number of behavioral health patients in crisis or mental health patients in crisis has increased. There's no doubt about that. You look nationally, and that's true across almost every pediatric hospital. So that number's increased. Some people have argued that the severity of illness of those patients is also higher. So, things like the degree of suicidality or the degree of their crisis seem to be more than it was ten years ago or even five years ago. So that means those patients need more help and probably need an inpatient level of care more than they did in the past. The other piece of it is precisely what you said on the output side, where there are just not as many beds, and there are not as many places for these patients to go....

Mid-March,Casey didn’t often sound lucid or humorous. She spun a yarn and offered wisdom sporadically. Grateful for her impact on the patient-caregiver movement

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

We respect Listeners, Watchers, and Readers. Show Notes at the end.

Watch on YouTube

Read

The same content as the podcast, but not a verbatim transcript. A newsletter-like version with images. Could be a book chapter.

If you don't see the embedded newsletter download the printable transcript here

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Episode Notes

Please comment and ask questions

at the comment section at the bottom of the show notes

on LinkedIn 

via email

YouTube channel 

DM on Instagram, Twitter,  to @healthhats

Credits

Music on intro and outro by permission from Joey van Leeuwen, Drummer, Composer, and Arranger including Moe's Blues for Proem and Reflection

Web and Social Media Coach, Dissemination Kayla Nelson @lifeoflesion

Leon van Leeuwen edits the article-grade transcript. 

Intro photo of Vulture Couple by Rich Rieger used with permission

Photo of fire by Ani Kolleshi on Unsplash 

Photo of fist by Dan Burton on Unsplash 

Photo of silos by Ricardo Gomez Angel on Unsplash 

Photo of ice cream by Food Photographer | Jennifer Pallian on Unsplash

The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute®  (PCORI®), its Board of Governors, or Methodology Committee. Danny van Leeuwen (Health Hats)

Sponsored by Abridge

Inspired by and grateful to Jan Oldenberg, Geri Lynn Baumblatt, Fred Trotter, Claire Sachs, Lygeia Ricciardia, and hundreds of others

Links

In hospice, Mighty Casey receives SPM’s “Doc Tom” Award

Related podcasts

https://health-hats.com/pod127/

 

https://health-hats.com/pod132/

 

https://health-hats.com/pod139/

 

https://health-hats.com/pod181/

 

Creative Commons Licensing

The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge.  Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements.  Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.

Discover how PCP Dr. Bonnie Engelbart manages the referral maze & limited resources when caring for emerging adults with mental illness.

Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post.

Subscribe to Health Hats, the Podcast, on your favorite podcast player

This episode can be watched on YouTube

Episode Notes

Prefer to read, experience impaired hearing or deafness?

Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here

Contents with Time-Stamped Headings

to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)

Proem.. 1

Podcast intro 01:26. 2

Health is fragile 02:00. 2

Primary care practice at Cambridge Health Alliance 05:31. 3

Screening for mental illness 06:29. 3

The referral maze 08:10. 3

Team building 11:40. 4

Toll on staff 14:02. 4

The burden of stigma, lack of resources, barriers to continuity 14:41. 5

Need more bodies 17:00. 5

Care partners 18:31. 5

A word from our sponsor, Abridge 19:27. 6

Complex time 20:09. 6

Changes over the past twenty years 21:27. 6

Self-medication 22:56. 7

Questions for emerging adults 24:03. 7

Questions for administrators 25:27. 7

The burden of cost to families 27:19. 7

Culture and language 28:09. 8

Reflection 30:35. 8

Next #7 Emergency medicine: We’re not trained for this 32:25. 9

Podcast Outro 33:02. 9

Please comment and ask questions

at the comment section at the bottom of the show notes

on LinkedIn 

via email

YouTube channel 

DM on Instagram, Twitter, Mastadon to @healthhats

Credits

Music on intro and outro by permission from Joey van Leeuwen, Drummer, Composer, Arranger including Moe's Blues for Proem and Reflection

Web and Social Media Coach, Dissemination Kayla Nelson @lifeoflesion

Intro photo of Vulture Couple by Rich Rieger used with permission

Photo of Swaziland by Ndumiso Silindza on Unsplash

Images of emerging adult with mental illness and community collaboration from DALL.E

The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute®  (PCORI®), its Board of Governors, or Methodology Committee. Danny van Leeuwen (Health Hats)

Sponsored by Abridge

Inspired by and grateful to Laura Zucker, Mike Herndon, Sue Donnelley, Luc Pelletier

 

Links

World Health Organization (WHO) Adolescent Mental Health

Most mental health concerns, especially for emerging adults, first present in primary care, placing them in a critical role for addressing these concerns.

The PSC-17 Pediatric System Checklist is a brief questionnaire that helps identify and assess changes in emotional and behavioral problems in children

When kids turn 18, we transition to a form called the AWQ, Cambridge Health Alliance Adult Wellbeing Scale, which screens for depression, anxiety, and substance use.

National Alliance of Mental Health: Kids, Teens, and Young Adults,

White House Fact Sheet: Improving Access and Care for Youth Mental Health and Substance Abuse Conditions,

American Academy of Family Practice (AAFP) article, Managing Behavioral Health Issues in Primary Care: Six Five-Minute Tools.

Related podcasts

Series: Emerging Adults with Mental Illness

Pediatric Transition to Adult Care | Danny van Leeuwen Health Hats (health-hats.com)

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

To subscribe, go to https://health-hats.com/

Creative Commons Licensing

The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge.  Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements.  Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.

The Show

Proem

According to the World Health Organization (WHO)

Globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group.

Depression, anxiety, and behavioral disorders are among the leading causes of illness and disability among adolescents.

Suicide is the fourth leading cause of death among 15–29-year-olds.

The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Most mental health concerns, especially for emerging adults, first present in primary care, placing them in a critical role for addressing these concerns.

I’m delighted to speak with Dr. Bonnie Engelbart, primary care physician, in this sixth episode in my series on Emerging Adults with Mental Illness.

Podcast intro

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Health is fragile.

Health Hats: Bonnie. So good to see you. Thanks for joining me. I love that we can do this. So that everybody knows, we're friends, and I'm taking advantage of our friendship to mine your experience and skills. For a long time, I've been interested in young adults and healthcare for young adults. I did a series about young adults transitioning from pediatric medical care to adult medical care a few years ago. And that was fascinating. It's so different. And when I worked at Boston Children's, the adolescent community was very outspoken, and I learned a lot just by sitting back and listening to them. So anyway, why don't we start when you first realized that health was fragile?

Bonnie Engelbart: The first time it was apparent to me was during my last year of medical school. I spent two months in Swaziland, a small country in the middle of South Africa—an impoverished country with minimal healthcare resources. I went there with a few other medical students, some residents, and a physician supervising us. But as medical students, we were thrown in and put in charge of things that it would never be given to medical students in the United States. I oversaw the men's medical ward in the hospital for the two months that I was there. And the medical conditions we were seeing were things you wouldn't see in the United States, like an enormous number of people with Malaria. They were estimated possibly as high as 20-25% of the population was HIV positive then. We were seeing people with end-stage HIV in the hospital.

Health Hats: You were in charge?

Bonnie Engelbart: I was in charge. We cared for many people with injuries from car accidents and unsafe working conditions. These things wouldn't happen as frequently in the United States because we had better preventative care for infectious diseases. We had more rules around driver's licenses and traffic control, and we had OSHA to regulate working conditions. So, I think that was the first time I was aware of the fragility of life.

Primary care practice at Cambridge Health Alliance

Health Hats: Please tell us briefly about your practice.

Bonnie Engelbart: I work for Cambridge Health Alliance, an organization with two hospitals in the Boston area and several primary care clinics based in the community. I am the medical director for one of those primary care centers in Everett, a city of about 50,000 people just outside Boston. It's essentially an immigrant community. And I'm a family doctor, so I see people from birth through death. I do the full spectrum of ages.

Screening for mental illness

Health Hats: When you think about the young adults in your practice, what do you see that you're thinking, oh goodness, there might be mental illness here?

Bonnie Engelbart: Unlike a pediatrician, I see patients as they progress from being children to adults. They don't leave my care. Nor do they initiate my care during that transition from childhood to adulthood. They can stay with me. I see them as they go through that transition. And for all ages, we're doing mental health developmental and screeners. It's once a year. It's not at every visit. But we have a standard screening form for teenagers called the PSC, which includes questions about depression, anxiety, attention problems substance use.

The PSC-17 Pediatric System Checklist is a brief questionnaire that helps identify and assess changes in emotional and behavioral problems in children.

Bonnie Engelbart: When kids turn 18, we transition to a form called the AWQ, Cambridge Health Alliance Adult Wellbeing Scale, which screens for depression, anxiety, and substance use.

The referral maze

Health Hats: So, you're dealing with mental health, emotional health, and physical health. In our system of fragmentation as a family doc, you're dealing with all of it. But then you end up referring people out when you start feeling like this is a little more than you can handle. When that ends up being mental anxiety, depression, harm, whatever. How do you decide it's time? Is it more than I can do?

...

Costa Rica welcomes travelers with disabilities. Juve Acuna, travel guide, spent a week with us sharing his expertise in flora, fauna, history, & disabilities.

Blog subscribers: Listen to the podcast here. Scroll down through the show notes to read the post.

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Episode Notes

Prefer to read, experience impaired hearing or deafness?

Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here

Contents with Time-Stamped Headings

to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript)

Proem.. 1

Podcast intro 03:58. 2

Grandfather of disability travel 04:33. 2

Capabilities and preferences 07:07. 3

Building a network 08:30. 3

Preparation 10:51. 4

National Tourism Board 12:48. 4

Building infrastructure for accessibility 13:44. 5

The network for accessibility 16:39. 5

Pride 17:30. 5

Possibilities, safety 19:42. 6

A word from our sponsor, Abridge 21:14. 6

Photo highlights of the trip 21:57. 7

Swimming in the Pacific Ocean 22:16. 7

Howler and white-faced monkeys 23:17. 8

Reflection 24:02. 8

Podcast Outro 24:53  8

 

Please comment and ask questions

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Credits

Music on intro and outro by permission from Joey van Leeuwen, Drummer, Composer, Arranger 

Web and Social Media Coach, Dissemination Kayla Nelson @lifeoflesion

Intro photo of Vulture Couple by Rich Rieger used with permission

Photo by Iswanto Arif on Unsplash

Photos taken by Ann Boland, Paul Boland, Juve Acuna, and Danny van Leeuwen

The views and opinions presented in this podcast and publication are solely my responsibility and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute®  (PCORI®), its Board of Governors or Methodology Committee. Danny van Leeuwen (Health Hats)

Sponsored by Abridge

Inspired by and grateful to Ann Boland, Linda and Mike DeRosa, Kate Higgins, Mary Lawler

Links

Il Viaggio Travel Costa Rica - Plan your trip to Costa Rica with us (ilviaggiocr.com)

Where to Go Bird-Watching in Costa Rica - Tripadvisor

Arenal Hanging Bridges | Experiencing Costa Rica From The Treetops (parenthoodandpassports.com)

Related podcasts

Camino | Danny van Leeuwen Health Hats (health-hats.com)

About the Show

Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this.

To subscribe go to https://health-hats.com/

Creative Commons Licensing

The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge.  Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements.  Please let me know. [email protected]. The material on this site created by others is theirs and use follows their guidelines.

The Show

To see the transcript with images download the printable transcript here

Proem

Figure 1: Skywalk hanging bridge in Arenal National Park, Costa Rica

Figure 2: Danny in his chair with our guide, Juve

Just stay in the middle. Stay in the middle? The suspension bridge was six inches wider on each side than my electric wheelchair. I’m good with my joystick, but am I that good? Gulp, I can’t see the bridge's other end, but Juve knows what he’s talking about.  Juve Acuna Sanchez is the grandfather of disabled travel in Costa Rica. He takes people with spinal cord injuries, limited vision, cognitive challenges, and me on guided tours. He says I can do it. I’m approaching the longest suspension bridge in Costa Rica, 984 feet (a tenth of a mile), stretching 230 feet over the stunning tropical forest canopy. That’s about 30 stories high. OK, I can do this. One hundred feet, so far, so good. Then the bridge starts swaying. By midway, it's swinging about a foot and a half from side to side.  OMG, I’m afraid of heights. There are people in front of me and people behind me. We stop and let the people in front of us finish, so the bridge sways less. But people keep coming behind and wait impatiently. I remember to start recording using my phone on a selfie stick attached to my left armrest. The sides of the suspension don’t attach to the bridge, only the cables holding it up.  My small eight-inch front wheels slide off the edge.  I’m stuck. My large, powered back wheels pull me off the edge. I’m terrified.  I can’t go back. I have to go forward. A few never-ending minutes later, I make it to solid ground. If you’re reading this or listening, check out the five-minute video on YouTube https://youtu.be/Ydjy0ffHPuY.

Traveling with disabilities is equal parts invigorating, self-satisfying, wonderous, and scary. Great for my spiritual health, especially when I reach the other end of bridges and don’t fall backward or tip over the edge. I live to tell a great story.

Figure 3: Juve Acuna

Juve Acuna with Il Viaggio Travel, our full-time guide, appears to be a grandfather of disability travel in Costa Rica. He picked us up at the airport, stayed with us, drove us, and shared his extensive knowledge of Costa Rican flora, fauna, and history for a week. Let me share some of our experiences, images, videos, and an interview with Juve. Travel is good for my spiritual health. I can do it. I can successfully solve moment-to-moment problems and receive and accept loving assistance. This episode may be best as a video. Check it out on my YouTube channel @dvanleeu. Next, we will hear from Juve describing his journey as a guide for people with disabilities, and I’ll highlight of few of the wonders of our travel.

Podcast intro

Welcome to Health Hats, the Podcast. I'm Danny van Leeuwen, a two-legged cisgender old white man of privilege who knows a little bit about a lot of healthcare and a lot about very little. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare. Let's make some sense of all of this.

Grandfather of disability travel

Health Hats: Juve, hello. Thank you so much for joining us today. How are you?

Juve Acuna: Thanks to you for this opportunity.

Health Hats: We met because I'm in your country, Costa Rica. You greeted us at the airport, and we had a wonderful time. And I'm a person with disabilities, and I came to a travel agent who said they specialize in tours for people with disabilities. How did you end up in the line of travel for people with disabilities?

Juve Acuna: About ten years ago, I started working with this company Il Viaggio Travel. A friend of mine since a long time ago, and I realized that the country needs to be more accessible. The uncle of the company's owners lives in Spain, and his wife, with disabilities in a wheelchair. They used to bring it here and take it all over. It wasn't that accessible. We started together as the, all these the National Network of Accessibility and yes seven years ago, we started already like as a for tourists and brought people the idea is that they can do the same that everybody does us, right? For example, doing a zip-line tour. We take them rafting. We have unique chairs to take them off the road on the trails, which has been working well.

Health Hats: It's, so when you say disabilities, is it? All kinds of disabilities. People who are blind or have deafness. Or intellectual challenges or mobility.

Juve Acuna: All kinds.

Capabilities and preferences

Health Hats: When somebody contacts you and asks you to help plan their trip, how do you assess the person coming to try to make sure you understand their capabilities? Yeah, because everybody's disabilities are a big word. There are so many nuances to it.

Juve Acuna: Part of the contract they do is from the office when they already have people coming. Usually, they need to fill out a form, okay? And in the form is all the details, and they must explain what kind of disability they have. So, the company looks for a specialized guide.

Health Hats: When we made those two Camino trips, I told you about, I made a short video of my capabilities, so my wheelchair and folding it up and putting it in the car and that I could do some steps. It just makes it so much easier for somebody to see that.

Building a network

Health Hats: One of the things you told me that I found so interesting is that you've developed a network of people you can call on depending on how many people are in the party. I was going to say how much risky behavior they want. I didn't mean that. Do you know what I mean? That swinging suspension bridge and swimming in the Pacific worried me. But you're saying that people will just do all sorts of stuff. So how did you build this network of people you can call on that you can trust to work with you because you’re one person?

Juve Acuna: It was hard at the beginning. We, as a company, trained the people, tour operators. And we went to the hotels and measured all the doors, bathrooms, and everything so they could be approved to work with us.

Health Hats: Okay, it isn't just other guides or muscles....