Listen, Mental Health Matters: Justin Olsen and Jen Katzenstein, Johns Hopkins All Children's Hospital

In the sixth episode of “Listen, Mental Health Matters,” Brian Giebink, HDR’s behavioral and mental health practice lead, speaks with Johns Hopkins All Children’s Director of Psychology, Neuropsychology and Social Work Dr. Jennifer Katzenstein and Vice President and Chief Operating Officer Justin Olsen. Their discussion explores the importance of providing the proper continuum of care for children, how novel therapies — like the use of virtual reality in telepsychiatry — can contribute to both physical and behavioral health, expanding training programs, and implementing programs for staff well-being.

Episode Transcript

(00:04):
I'm John Torek, and I'm Danny Sullivan, and
you're listening to Speaking of Design, bringing you
the stories of the engineers and architects
who are transforming
the world one project at a time. Today,
we bring you another episode of a special
podcast series on behavioral and mental health called
Listen, Mental Health Matters.

(00:24):
As part of this series, Brian Geebink, behavioral
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Giebink, and I hope that by
listening, this series helps us consider new perspectives

(00:46):
in our quest to create transformational mental health
facilities that improve the quality of life for
individuals and families and promote a shared sense
of community. And now, we bring you a
conversation from Brian's visit to Johns Hopkins All
Children's Hospital
in Saint Petersburg, Florida. There, he spoke with
Jen Kasenstein,
co director of the Center for Behavioral Health,

(01:07):
and Justin Olson, chief operating officer.
This is Brian Geebink with HDR. I'm an
architect and behavioral health planner. I lead HDR's
behavioral health practice. We're here in St. Petersburg,
Florida with Johns Hopkins All Children's. This is
a very special episode because we're focusing specifically
on pediatric behavioral health care. With me today
are Jen Katzenstein, and Steen, the co director

(01:29):
of the Center for Behavioral Health, and Justin
Olsen, the chief operating officer for Johns Hopkins
All Children's.
Justin and Jen, welcome. Thank you for being
here. Thank you. It's a pleasure. Thanks for
having us. Glad glad to have you here.
Jen, would you like to introduce yourself briefly
and tell us a little bit about what
you do and then Justin will do the
same with you. Sure. So thanks again for

(01:50):
having us. I'm Jen Katzenstein.
I, by training, am a pediatric neuropsychologist,
meaning that the majority of my clinical work
is focused on evaluating the cognitive strengths and
challenges of children in the context of their
medical conditions and then working to set up
treatment planning and educational planning for success.
At my time here at All Children's over
the past nine years, that has evolved

(02:11):
to building not only our neuropsychology
services but also all of our behavioral health
services,
including both our behavioral health social work team
and our medical social work team,
to initially
really expand our outpatient care services.
And then
as time has evolved and as behavioral health
needs have evolved and access to care, think

(02:34):
about what a continuum of care looks like
and how to best be able to
treat the significant behavioral health concerns our kids
have
in a way that is financially viable and
also in a community context utilizing the resources
that we have here in our Tampa Bay
area. You mentioned financially viable sort of towards
the end there, and I think that might

(02:54):
be a good good segue to you, Justin.
I am the chief operating officer. So, I
mean, I have a broad array of areas
and services that I help support.
And, certainly, part of my job is making
sure that we have the team and the
resources and the structures to support the care
we provide. So
my angle is a little different. I have
been a children's health executive for about fifteen

(03:14):
years now, so I'm well versed in the
pediatric
universe and excited to do this podcast and
shed some light on a really important topic.
I I think the first question would be
great for both of you to answer.
What we would really like to know is
how has your focus on behavioral health evolved
over the past few years? Jen, maybe we
start with you. Absolutely. So, as we went
through the COVID pandemic, we did see significant

(03:34):
increases in suicidality in our youth
and significant utilization of the emergency room for
a crisis. We see that through multiple pieces
of literature that were published during that time.
And I think as a behavioral health community,
we were really focused on the crisis piece
and inpatient
psychiatry,
what an inpatient psych unit looks like. And

(03:54):
as I took a step back to think
about that and as we've emerged from the
pandemic, we're still missing a really important piece
of the puzzle, which is the continuum of
care. You can't go from a seventy two
hour inpatient stay back to one hour a
week of therapy,
and we can't expect that cycle not to
continue. Right?
So as we have evolved really over the
past probably seven to eight years here, we

(04:16):
had inpatient psych kind of in our mindset
as a one potential option.
But at taking a step back, you know,
what is
the outcome? What is the positive of a
seventy two hour inpatient stay?
Does that result in long term change?
And really the answer is no unless you
have the right continuum of care supporting a
child. And over that time, the Tampa Bay

(04:38):
Area has also evolved in the number of
pediatric beds available.
So, is it our responsibility, and I feel
that it is, to be able to provide
a stronger continuum of care with more intensive
services so that we can break that cycle
of emergency room visits for crisis, of inpatient
site crisis stabilizations,
and move us back to intensive
intervention and programming that best meets our kids'

(04:59):
needs
instead of thinking about it more as crisis
to an outpatient appointment.
When I think back over, you know, the
last fifteen years,
I believe behavioral health has always been an
important component in children's health. I think it
really reached fever pitch status during the pandemic,
and it brought new light and new focus
to it that I don't think maybe had
been there before. We'll talk at many times

(05:21):
today about probably payment parity, and and and
it's not equitable in terms of med surge
at this point in time. But, frankly, this
really has created new energy and need to
solve and at least provide some solution set
for what is a crisis. As an organization,
we have just below a 70% Medicaid rate,
so all of our patients are Medicaid. And
in the behavioral health space, it's higher than

(05:42):
that. What we've discovered is
we do have to use our other services
that generate better revenue to support this work.
And so our strategic plans have been about
both, but really bringing together service lines with
higher revenue so that we can support critical
services that that and that's not new to
us, but it's just
in terms of how it's worked. But we

(06:04):
are prioritizing those dollars that revenue offset to
dedicate towards programs like behavioral health. Point out
this has been an ongoing concern for years
and really a challenge that hasn't had
a financially viable solution for probably
any system really in the in the country.
It's been a really challenge.
So, yeah, I don't think it's new. I

(06:24):
do think it's intensified. So are there any
novel therapies that you can expand on as
you're thinking about what you're currently focusing on
and shifting your focus? As As telepsychology,
telepsychiatry
services have evolved over the past couple of
years, we've found mixed acceptability of our families
to teleservices.
Sometimes it is accessibility and convenience that's preferred.

(06:45):
Other times we're hearing feedback that it feels
impersonal.
They're not getting the care that they would
get in person. And our providers
are often challenged by that too because they're
not setting their eyes on the full patient,
especially for our disordered eating patients where we
really do need to see them and have
them in here to get vitals.
So, we've worked through collaborating
with our providers for really three different

(07:06):
areas that have been evolving. One is in
virtual reality,
so thinking about virtual reality headsets to provide
intensive services, to be able to do
education, to make those mistakes on a virtual
reality headset, and getting feedback and coaching on
that during your therapy appointment, maybe in a
social interaction or in a reaction,
and then using that, leveraging that technology for

(07:28):
intervention services. And And then our two other
areas have been in the psychological components of
pain management and our disordered eating teams. So,
again, we're using a lot of technology.
In our pain management program, we have a
day program
that combines
biofeedback,
a typical therapy intervention,

(07:48):
single individual therapy session,
acupuncture,
and then also time with our educational liaison
so that we can reintegrate our kids back
into school because oftentimes they're really struggling to
get back to school with pain or potentially
needing to utilize a wheelchair and having negative
impact from that.
And our eating disorders team has been really
working on an intensive outpatient program that balances

(08:10):
virtual,
so that teleservices
with in person,
because how better to treat a eating disorder
than a family meal time in your own
home. So, your dietitian and your therapist could
be joining you virtually in your home as
you prepared food together, talked together about
food in general. What did this parent say
about this? What did this parent say about

(08:31):
this? How did you react as
the youth in this situation?
And then
really rethinking food in that context as nutrition
and being, again, to be in the home
environment to do that, but still having our
patients come in during the course of the
week so that we can lay eyes on
them and be able to have that one
to one contact. So, those are a few
of the innovative approaches we've been taking, really

(08:52):
trying to balance the virtual with the in
person
from an access point of view, but also
making sure that it is still high quality
care. The VR sounds really fascinating to me.
So, the idea is that you would have
a VR headset, a parent might come in
and put on the VR headset. Or the
child. There's some, yeah, some great research by
one of our colleagues in Baltimore on fear
of heights.
And so you're in the for exposure therapy,

(09:13):
you can do a lot of different exposures
on a VR headset, and so you're right
up against, you know, a height on the
headset and you're working on your coping strategies
during that time, and then you're working up
to actually being in that in person situation.
Situation. That's amazing. I've done VR where you're
right on the edge of things or even
floating over nothing.
It is absolutely terrifying. So that's that's that's

(09:34):
really cool. I I love that. And I
I was thinking I don't know if you're
doing it with parents as well, but patient
child interactive therapy might be an opportunity there
for a a parent to learn without really
being, you know learn in a virtual environment
before applying. Yeah. Exactly. Yeah. So for PCIT
right now, we have a trial looking at
the total telepsychology
administration in our cancer population. Okay. So that's

(09:55):
the first time we're sending earbuds to the
parents at their house so that we can
be coaching them just like we would be
in person, but then those little earbuds are
getting the coaching from their provider in their
ear while they're in the home environment. That's
amazing. How does your behavioral health service line
contribute to your system's overall strategic goals? So
a couple things. We, in 2023,

(10:16):
refreshed and launched a new strategic plan to
really set the stage for the next ten
years. Again,
recognizing
that we had had a a crisis happening
in behavioral health, it was the only service
line as an organization
that we called out in our strategic plan
to address.
And so as a quaternary tertiary care facility,
we are routinely, I will call it, the

(10:37):
last resort for other hospitals to send their
sickest and highest complex kids to. And so
our strategic
goal is really to provide the continuum of
services, including in behavioral health services.
We want to be a place that has
the destination programs that are treating complex illness.
We want to be the provider of again,

(11:00):
I don't mean last resort, but really when
the the care is too complex or not
sure where to go, we wanna have those
experts. So as an organization,
that that is in our strategic plan because
we really want to bring forward
that continuum of care to our community. It's
an honor really to have the organization be
so focused on behavioral health and understanding that
physical health and behavioral health impact one another

(11:22):
and recognizing that
we exist in a system and making sure
that we're expanding our services to meet our
patients' needs. It's great to hear that the
organization is supportive and focused on it and
able to help with the great work you're
doing every day. Those novel therapies and everything
that comes along with that. What roadblocks do
you face or are there any roadblocks such
as as funding or reimbursement or stigma that

(11:42):
that you've you've faced and have you been
able to to pivot to move some of
your initiatives for it? I think there are
several roadblocks, right, to providing access that's
convenient and that works. And, I mean, I
think funding is clearly a major issue for
us. Behavioral health services aren't paid on parity
with med surg admissions. In fact, it's multiples
lower than med surg.
The other piece is while we might be

(12:04):
able to make an inpatient unit
maybe a breakeven,
It's the wraparound services, and Jen talked about
this really well that it's not just about
that inpatient admission. It's about the post admission
treatment, having the intensive programs to really stabilize
and return to their school environment and home
environment that's successful.
So those are very poorly compensated. And so

(12:26):
at every time we expand our panel, we
really expand a loss.
And it's not that our providers aren't working
really hard to see enough kids or
that our teams aren't, you know, being successful
in the work they're doing. It just is
a fact that the payment methodology
isn't where it needs to be to support
this vulnerable population. And so funding happens every

(12:46):
day. And I think
other systems may cherry pick, but it really
services that only pay and really expand there.
But again, it is important to us that
we offer that continuum. So we haven't done
that, and it does continue to challenge the
financials. What else would you add to some?
I think we've had to think really uniquely
about how to provide high quality care at
the lowest possible cost, right? And sometimes what's

(13:08):
challenging is
existing
in an amazing children's hospital. There's equipment that
our medical team members need to get their
work done that
really helps make it easier or streamlines things
or can kind of take over certain parts.
But at the end of the day for
behavioral health it's brains. I need people,
right? And so as we thought about especially

(13:28):
being all children's, right, we need to serve
all children.
How do we do that even if we're
not paneled on a certain provider or with
such a high percentage of patients who have
a state funded Medicaid program here for us?
So, that's where we really expanded our training
programs
so that we could have fellows and interns
providing those services at a lower cost in
the supervision of an attending who has the

(13:50):
expertise. And then we're both providing that training
opportunity, but also providing those services at a
lower cost
to their bottom line. And I think that's
another issue that we actually have. So teaching
is another, obviously, very important part of our
mission, and we are a teaching facility.
We have learners in any discipline you can
think of. We're we're training people, but there
aren't enough people interested in pediatric subspecialties,

(14:12):
including and maybe specifically in behavioral health. And
so we have a crisis of available providers
because even if we wanted to grow the
programs, we talk about recruitment, pediatric psychiatrists as
an example,
and it can be I mean, you're talking
a very long lead time to find someone
interested in it, and there are many jobs

(14:32):
for every fellow that's graduating with the right
experience. So
I think the team recruitment is really a
significant challenge. Can you elaborate a little bit
more? What are you doing to provide care
for your workforce and to attract and retain?
Because this is an issue we hear across
the board. It's across the country, even across
the world. People seem to be less interested
in going into this field, especially with behavioral

(14:53):
health care. Are there any strategies or any
ideas that you're implementing that you feel are
working well? So, of course, we survey our
team a couple times a year and say,
well, you know, what's on your mind? What's
what's bothering you? What do you think could
be improved? And then we really use that
to build action plans and teams. And I
think you might want to talk about the
RISE program and some of these other programs

(15:13):
we've done to really support
our team members. But I think a lot
of that came out of really the feedback
from our team saying, hey, I need more
support when something challenging happens. So you want
to talk a little bit about RISE? Absolutely.
So we have a RISE program,
resilience and stressful events, that was born out
of our colleagues in Baltimore and brought here
where we have peers available 20 fourseven
to respond to a situation that might occur,

(15:35):
whether that's a stress that an employee is
feeling,
a significant event on a unit or with
a patient, and that can be either in
the individual or group setting. We've recently reinitiated
Schwartz Rounds, so having regular kind of preventative
time where team members get together. Most recently
for our social work team we talked about
feel, like, needing to be helpful, but feeling

(15:57):
helpless,
especially when you don't have the resources to
meet the needs. Could you expand a little
bit more on the Schwartz round and describe
what that means? The Schwartz rounds
was born out of an individual with the
last name of Schwartz who was involved in
treatment. Right? You can jump in, Justin, if
you know this better than me. Yeah. He
was an attorney and patient, and I believe
he saw the stress that care could cause

(16:17):
for caregivers
and wanted to start a way for them
to be able to talk about that. And
so not I I think it's extends beyond
the medical staff. It does. It's to all
staff. Yeah. And you and for everyone from
our food services to EVS team across the
board, environmental services.
And so it's an opportunity for them to
come together and talk about how a specific

(16:38):
case that may or you know care about
that didn't
in the way they wanted or was more
challenging than they wanted to really be able
to freely express what concerned them and and
was challenging for them in an effort to
you know have that
healing process, if you will, from whatever circumstance
happens. And there's it's a hospital, so there
are clearly challenging things that happen here, and

(16:59):
and we wanted to have that as a
level of support. So I think that's one
thing. And then a huge support from the
hospital organization as well, and Justin,
has been having an EAP therapist on-site.
So, we have our EAP therapist here.
She's here three days a week and available
to anyone,
and everybody who is on, who's an employee
of the hospital is able to have five

(17:20):
sessions for each issue.
So, that can lead to quite a few
sessions free of charge, which is fantastic.
Our respite room has been a huge success.
Yeah. Again, from our surveys, we just we
heard this need. I need somewhere to kinda
get away and not necessarily the cafeteria that
is
surrounded by patients. And so we did
take some underutilized space and make an investment
in it to create a really a team

(17:41):
member
space where they can just slip in. There's
some massage chairs. I've been surprised that actually
the utilization. People really are from all disciplines
in this hospital.
Providers,
nursing staff, you know, EVS workers. It doesn't
matter. People are going in there just having
their lunch, listening to music, reading a book.
I mean, just really trying to get away
a little bit from that stress of the

(18:03):
the day. The other thing I think that
we've done as an organization is work really
hard on improving our staffing. And while that
may not seem
as obvious, quite frankly, if you're being asked
to come in to
additional shifts a week, you can imagine you
don't have any time for that recovery. And
and so we've done a our chief nurse
has really done an amazing job in restaffing,

(18:23):
I will call it, following the mass exodus
that happened in the pan pandemic. We are
down to just a handful of travelers.
Our team scores have gone up a lot.
So it's just really, I think, important. That's
that's the the missed piece of staffing is
that really, you know, when you're supposed to
be working three days a week and you're
working five, it's it's an end and the

(18:44):
patients are challenging
and there are stressful situations happening. It's it's
important that you get that away time. And
then when it comes to behavioral health specifically,
we've been very much lucky that we were
building services. So in the past nine years,
for example, we went from I was the
third psychologist to the hospital I've ever hired,
now we have 19.
And so with that, one of the primary

(19:05):
predictors of burnout more broadly
is not having autonomy and decision making surrounding
your specialty.
And so even within behavioral health there's different
specialties, and as we recruit our team members
to come in,
this is a unique opportunity to build what
you want and to build your specialty area.
And I feel like I should knock on
wood, but that's why our retention has been

(19:25):
really well in behavioral health too, because
our team members have come in to build
their programs and feel supported in that, which
we've been so grateful to the organization and
to our philanthropy partners for that.
But with that autonomy and that ability to
really build what they're passionate about, that keeps
them here and keeps them tied in. So
again, knock on wood, we haven't seen in

(19:45):
the psychology and neuropsychology
workforce and even really in psychiatry the turnover
that many other people have experienced. Daniel Pink,
I don't know if you've heard of he's
an author. He says, for people to be
successful in their careers, they need autonomy,
mastery,
and purpose. And purpose. Yeah. And it sounds
like you're giving your staff all three of
those things, and I think that's really important.

(20:05):
I wanna focus a little bit more on
we were talking about roadblocks that you typically
face and how you're able to pivot and
move some of those initiatives forward. How do
you measure success? What are some of those
success metrics? And then how do you communicate
those to the community and to your leadership?
I can start some global metrics that we
track. I mean, we obviously look at how
long it takes our patients to get an
appointment.
That lag time is an important metric.

(20:27):
We do look at how busy we are,
the utilization of our templates, all those things
that I think would be standard work to
really ensure that we are accessible and providing
access. And then you wanna talk about some
specific I think that for our team too,
it has been where are the needs and
what are we missing. So as we see
referral volumes come in, I'm looking at lag

(20:48):
time for scheduling, but I'm also looking at
what are we not scheduling and what has
a longer lag time. So interestingly,
pain management can you can get in pretty
quickly for psychological needs. When it comes to
getting a diagnosis on the autism spectrum and
an evidence based evaluation and then related treatment,
that's where our lag spectrum and an evidence
based evaluation and then related treatment, that's where
our leg time is the longest. And so
I'm looking to see what are those patterns,

(21:08):
where do we need to think about strategically
building,
what is available in the community, because we
do exist in a community and we don't
need to see every patient because there are
other great community providers. Getting back to the
workforce perspective, for me it's been really important
to have a well trained workforce in the
region,
and that's where some of our local community
agencies have been instrumental in collaborating with us,

(21:29):
not only given our pretty robust training programs,
but also a real willingness in the community
to hear our team members say,
for example, no, we need trauma focused cognitive
behavioral therapy in our providers in the community
to the point where we were able to
get our local
agency that distributes our tax funds to offer
a scholarship program for 30 providers in the

(21:49):
area to get free certification
in trauma focused CBT.
And just then knowing that we might have
a lag time in some of our referrals,
maybe we're not the best place for these
patients to be seen. I know trusted providers
in the community that you can go to
who have the right training and were able
to meet your needs. Can you share strategies
you're implementing to improve access and follow-up with

(22:11):
the EverHelp patients? So we are actually about
to make a pretty significant investment in our
physical footprint for behavioral health services. We're really
trying to double the square footage we offer
to outpatient behavioral health, and I'll let you
talk about some of the programs that you're
creating there.
And a little bit forward looking, but we're
revamping really our
ambulatory platform, and our goal is to bring

(22:34):
these services closer to home. It's really a
strategic initiative across our service lines, but behavioral
health
is the same. We really would like to
have
care close to home. So outpatient care in
our outpatient settings, we don't necessarily have that
today. And that is our goal for future
iterations as we continue to develop and expand
these outpatient centers. What other things would you

(22:54):
say? Yeah. I definitely
agree with Justin. We're thrilled to be doubling
our footprint. That's gonna allow for a significant
expansion, not only of our clinical services, but
of the training programs as well, to keep
that pipeline moving forward in terms of having
positions filled more quickly. Psychiatry remains our biggest
challenge, but psychology, neuropsychology, and social work we
do a little better because we have our

(23:14):
own training programs in those areas
in terms of filling quickly.
Thinking about expansion of services,
one of the great pieces about this new
space that we'll be working in
is it has a whole setup for really
some of our priority areas. So, there'll be
a kitchen there, we can have eating disorders
in a kitchen,
have them perking on meal prep together, again,

(23:35):
having that group time. Also involved in that
is some opportunity for some activities of daily
living work to happen with our pain management
team. And then one of the biggest holes
I see in our community is intensive outpatient
services for mood and anxiety disorders.
And so this gives us an amazing capability
to look at other children's hospitals, see how
they have been successful

(23:57):
in doing a four day a week program,
right, three to four hours per day, four
days a week, and getting families engaged both
in person and via teleservices,
again, to step down from those crisis services
and hopefully prevent that cycle of going back
into a crisis intervention situation. And, you know,
I'd also add, we've really, in the last
couple of years, taken a look at the

(24:17):
services we where behavioral health patients show up
Mhmm. And how to make those environments safe
and ready for them. And so I think
one investment we're making
a a small expansion to our organization.
And as part of that, we plan to
create behavioral health safe
emergency department rooms that are really purpose built
to house this population

(24:37):
as they come in, are assessed, and then
their appropriate level of care
is determined and that process can take time.
And so we will have space that is
purpose built to make sure, again, it's safe
while they're in it. There's a a high,
like not likelihood, but high there's an interest
in eloping.

(24:58):
And we are building the space to really
try to mitigate that risk. And and so,
anyways, I just I do think we are
continuing to look across our organization and say,
where are behavioral health patients showing up, and
what do we need to do to make
the care safer?
And that's just another example of a capital
investment really to meet that need. And And
then another organizational investment too, certainly because with

(25:20):
the burnout piece and thinking about workplace violence
has been in our behavioral
personal protective equipment, our BPPE,
and having
carts available to our team members for maybe
some more challenging patients,
some patients who may be going through an
active psychosis or substance misuse or substance abuse,
or even who are really our most challenging

(25:41):
behavioral health patients. So as our team members
see us dedicating that time not only to
safe facilities but having the equipment they need
to do their job safest as well,
that's helping, I think, with our retention. And
they're coming to us with ideas and with
a voice, and whenever possible
we're trying to see how we can make
that happen and how it fits into not
only our work here, but overall how consistent.

(26:03):
I think that highlights for me an important
distinction in children's health, and we're not just
taking care of the child. Clearly, that is
our patient, but we have the family that
shows up too. And that family can be
have just as many sort of maybe needs
as our patient. And so routinely, our teams
are confronted with situations where they have they're
trying to deliver care, and they have a

(26:23):
family member who may have their own behavioral
health issue. And that manifests itself in what
can be violence. It can be
aggression.
You know? So we just as a children's
hospital and and the children's health space, we
have to take care of the whole family
while they're here. That's part of our job.
And while we aren't providing that in terms
of treatment, we are providing that in ways
of de escalation

(26:44):
and making sure that we're providing a safe
environment for the patient and our team to
take care of that patient. And that's actually
takes a lot of energy and a lot
of work. And Jen actually also didn't say
it, but she co leads our workplace violence
prevention committee, and they've done some really good
work to to work on that. Is that
focused just on behavioral health? It's system wide.
Yeah. It's been a great learning opportunity for

(27:05):
me to think about all these different pieces,
and it all really comes back to, in
a lot of ways, a healthy, thriving workforce.
And as we approach everything from
facilities to things as a neuropsychologist
I never thought I'd know about, like public
safety related
pieces, elopement,
where is the boundary on our property, right?
So important for our staff to have clear

(27:26):
expectations on that and to know that the
organizations behind them to both stay safe and
keep our patients and families safe. We're investing
in new training. We've just agreed on a
new module vendor. I'm not actually sure what
the terminology should be, but
to make sure our entire team has that
sort of base level of understanding and education
with respect
to challenging families and and patients. How do
you tap into system best practices from across

(27:48):
your organization? I know you think you've kind
of been alluding to this with what you're
doing with the safety and some other things.
Is there anything else you want to expand
on? I'd say we have the luxury of
being in the Hopkins system. So we have
a number of different organizations and hospitals and
really just the opportunity to chat openly about
what everyone's trying across the whole system.
And we have a very close relationship with

(28:09):
our behavioral health pediatric partners at Children's Center
in Baltimore,
and so we are constantly talking back and
forth visiting.
We go, our behavioral health providers go up
to visit there, they come down here, lots
of good cross collaboration. So we have the
best minds really thinking about how to approach
these areas and then thinking outside the box,
especially sometimes when you are just so

(28:32):
honed into what's happening in your own hospital.
And I think to add to that, Hopkins
is a data intensive organization.
They the research component, it is nice to
have access to some of the most cutting
edge, you know, research and treatment. And And
even when I look outside of sort of
the treatment protocols that are we are connected

(28:52):
across as a system in areas like security
and other places where we can really share
best practices on how we're keeping our our
patients and families safe. And so I think
it is great to be part of the
system in that from that perspective. And, again,
there's so much good stuff that comes out
of the work that I mean, our researchers
here and and in Baltimore
do. I think it's been it's a good
good value for this community. Are there any

(29:14):
team members you wanna highlight?
Actually, Jen and Mark Cabot, who are co
directors co directors of our center for behavioral
health, keep this drum going, to be honest.
They are passionate about their work, and I
think it's important.
So they're they're keeping this going. They're always
again, we talk about funding, right, funding issues,
so they're always willing
to have a discussion about how we could
do something. We won't ever we're not willing

(29:37):
to jeopardize the way we do care, but
we appreciate you can get good results and
quality results different ways. And so we've worked
really, I think, as a team to try
to figure out what that balance is.
And then we've talked a lot about it
today, but, you know, I think there's this
misconception that
behavioral health patients really impact, you know, one
group or that there's one group who are

(29:58):
taking care of them. And it's it's not
like that at all. It's
every division, every the ED is an an
example of ICUs. You have behavioral health patients
that are may have a medical need, and
they're there as well. And so I think
it really is a team an entire team
to make sure these kids get the the
care they need and are safe throughout their

(30:19):
visits. And so I think it I think
it is a misconception to say that it's,
you know, it's
a a unit or a division. It really
is across the organization.
No. I echo that, Justin. I'm so grateful
for our senior leaders. Our executive leadership has
been, again, incredibly supportive, ensuring that behavioral health
is right up there in the strategic plan.
Grateful for our philanthropic partners. We couldn't do

(30:39):
it without philanthropy
and our amazing, generous donors,
as well as the government affairs team. I
mean, we're being able to expand some services
based upon collaboration with the children's hospitals in
the state of Florida.
And then I can't echo what Justin says
enough. Every team member
at every position in this organization
is working to ensure the safety of all

(31:00):
of our patients, but when a behavioral health
issue or an aggressive patient happens it can
be traumatizing, it can be upsetting, and we
haven't always prepared well throughout all of our
education and training to be able to manage
that. So
this is
effort, and I truly couldn't be more grateful
to be working with this team and to
have the support that we have. Well, thank

(31:21):
you both.
This has been a very enlightening podcast. Again,
really focused just on pediatric behavioral health care
and and the challenges that you're facing. I
think our listeners are gonna have a lot
to learn from listening to you, and and
they they may wanna get in touch. So
and it seems like you would welcome that.
So we will, be sure to direct What
is it at, Sweden? Direct and heal your
visitors, especially in the winter.

(31:42):
The weather's perfect.
For more information on our Listen Mental Health
Matters series,
please visit hdrinc.com/listen.
There you'll find more on HDR's approach to
behavioral and mental health design, meet our team,
and see samples of our work.

(32:03):
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