January 30, 2024 • 25 mins
In the third episode of “Listen, Mental Health Matters,” Brian Giebink, HDR’s behavioral and mental health practice lead, talks with Grady Health System’s Shannon Sale, executive vice president and chief strategy officer, and Anne Hernandez, vice president of behavioral health. Their discussion explores strategies they’ve implemented to improve access to behavioral health care, including integration with existing specialty centers and new outpatient centers, as well as the creation of an employee resiliency clinic. Through these strategies they have progressed their mission to address the social determinants of health beyond the care environment with programs to address housing, community partnerships and more.
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(00:00):
Health care shouldn't be different
depending on where you are. It should be
the same regardless of where you are, regardless
of your race, of your economic status.
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
(00:21):
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.
As part of this series, Brian Gebink, behavioral
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
(00:43):
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Giebenk, and I hope that by
listening, the series helps us consider new perspectives
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 Brian's conversation with Shannon
(01:06):
Sale, executive vice president and chief strategy officer,
and Anne Hernandez,
vice president of behavioral health for Grady Health
System in Atlanta, Georgia.
Good afternoon. I'm very happy to be here.
(01:28):
I'm Brian Geebink. I'm HDR's behavioral mental health
practice leader. I'm an architect and and planner
and focus specifically on designing behavioral health spaces.
With me today is Shannon Sale and Ann
Hernandez with Grady
Health System.
We're going to hear from them about their
journey into and and through their their behavioral
health. And so I think we'll just have
(01:48):
each of you briefly introduce yourself
to get started. Shannon, would you like to
introduce yourself? Sure. That's great. Good afternoon. I'm
Shannon Sale. I'm the executive vice president, chief
strategy officer for Grady Health System, and I've
been with the health system for eleven years.
Hi. I'm
Anne Hernandez, vice president of behavioral health at
Grady. I've been here for ten years. Glad
both of you are here with us today.
(02:08):
So to start, can you give us a
high level overview of your system? So Grady
is the largest safety net in Georgia and
among the largest in the country. We have
one
acute care hospital with a licensed capacity for
953
beds. We're building to about 900 of those
right now. We're supported by neighborhood health centers
throughout Atlanta. We have six of those.
(02:30):
Large infectious disease program called our POTS Center.
We have a variety of other supporting services
including we respond to all 911 calls in
the city of Atlanta with our hospital based
ambulance program
and a variety of key services
around stroke,
trauma, burn,
cardiac,
and of course our behavioral health services. Anne,
(02:52):
you wanna talk about the range of services
that we offer for behavioral health? Sure. So
we have, I would say, one of the
most comprehensive
continuums of behavioral health services probably in the
country.
As a part of our hospital,
we have a psychiatric emergency room, which has
a capacity for 12 individuals at a time.
We have a inpatient psychiatric unit, which is
(03:12):
a 24 bed unit
at our main hospital. We have a temporary
observation area that can hold up to 32
individuals
while there's a determination of whether or not
they need hospitalization.
And then a med psych unit that will
have 16 beds
to work with individuals who have an acute
medical and acute psychiatric
need and that so they can receive simultaneous
(03:34):
care. In addition to our services within the
hospital, we have three
comprehensive
community mental health center locations
that provide medication management, nursing therapy,
case management, housing support.
We have an integrated behavioral health service in
all of our neighborhood clinics, primary care centers,
where there's a licensed therapist and psychiatric support.
(03:57):
We have a coresponse model. So with EMS,
as Shannon mentioned, we have a unit that
contains a paramedic and a licensed
clinician who can respond to psychiatric emergencies
to prevent unnecessary
emergency room visits if possible.
We have just beginning to expand our justice
involved services. So for individuals who are either,
(04:17):
leaving jail,
we pick them up and help them reintegrate,
or those that we're trying to
prevent unnecessary arrest and incarceration,
where, again, we can connect them to health
and behavioral
services and hopefully get their feet under them
as they progress with their lives.
We have probably the last thing I'll mention.
(04:37):
We have a lots lots of services, but
we have assertive community treatment, which are three
interdisciplinary
teams which visit individuals
wherever they are in the community, whether it's
in a home, if they're unhoused, they may
be in the park or at their job
to help them. Again, it's a hospital without
walls. So it's folks that might otherwise be
in the hospital, but that can be served
and supported in the community. It's amazing. So
(04:59):
you're doing some amazing work.
So so with all of this work, how
does your behavioral health service line contribute to
your overall
systems business strategy? So it is a critical
part of the business strategy. You can imagine
it wasn't always kind of seen that way,
but we have been able to
move from
two core services, one was inpatient and one
was outpatient, to the wide range that Anne
(05:22):
just described
and recognize that
the role that behavioral health plays is in
the whole person,
and be able to help folks manage their
mental health and their physical health really helps
the overall outcomes for the health system. And
so,
we have integrated behavioral health within our population
health strategies, our community benefit strategies.
(05:43):
We have a lot of philanthropic support as
well as health system support to be able
to accomplish these strategies and, again, improve the
health of the whole person. What roadblocks have
you faced and have you been able to
pivot and move some of your behavioral health
initiatives forward? Probably the biggest hurdle that everyone
faces
is stigma around those that experience mental illness
(06:03):
and or substance use and just the ability
to provide
proper optimal care
to folks that have some challenging behaviors at
times. And so that's probably been the biggest
hurdle is wherever the the individual
presents in the health system is to help
the providers understand how they can approach and
support that individual
to get both their health needs and their
(06:25):
behavioral health needs met. I would say some
of the other things there, you know, for
some of the more creative
services and supports we're trying to provide, funding
is always a challenge.
As Shannon mentioned, the philanthropic,
arm through our Grady Foundation, we've got some
great partners that have helped us start really
innovative programs with our integrated health within our
(06:46):
neighborhood centers, with our housing program. They that's
how we actually were able to begin,
providing support for housing. And and right now,
they're looking for some money for support employment.
So I think that's been, a huge driver
to move our innovation forward. Let's say also
building on the funding. When I started at
Grady, we looked to the behavioral health service,
and it was losing x million a year,
(07:08):
and that was a big challenge. And we've
been able to close that gap
by being an expert in the the area,
being a trusted partner
with the county and the state, and being
able to be that service that they know
is needed, and then the funding has helped
to follow that. So there are a variety
of relationships that we have. And just mentioned
support for the housing,
(07:29):
support for our outpatient centers, support for unfunded
patients that we're able to garner, again, through
being that that trusted partner. And that has
been a
last decade at Grady. In addition, you've mentioned
some other strategies you're using to improve access.
Yeah. No. Well, I'll I'll mention a couple.
So we started our integrated behavioral health in
our neighborhood centers about six years ago. And
(07:52):
so what we are actually
in the process of doing now is
adding behavioral health support specifically to specialty centers
like cancer
and burn. So, again, trying to spread and
integrate that across the health system where those
needs are identified.
The other piece that I think where we've
really tried to expand access is opening additional
(08:13):
outpatient clinics. So, traditionally, Grady has had one
very large outpatient
center. In January of this year, '20 '20
'3, we opened two additional sites,
which has allowed us to serve population in
the northern part of the county. If you're
not familiar with Fulton County, Georgia, it's a
very long county. And so we were centrally
located in Downtown Atlanta, but now we have
(08:34):
a center that's in North Fulton and one
that's in South Fulton, which has also increased
that access. We know that attracting and retaining
quality staff is is very challenging, not just
for behavioral health care, but for all of
health care. And and I think burnout and
and mental health is a big part of
that. So can you talk about strategies you're
implementing to provide behavioral health care to your
workforce? Yeah. We're very excited that we've started
(08:56):
two new services in the last probably three
years. During COVID, much like every other health
system, we noted an increase in violence and
just emotional stress that patients were bringing to
the workplace, and our staff were particularly feeling
stressful coming to work during the pandemic.
And so our leadership
agreed,
and we opened a free employee resiliency
(09:18):
clinic, which offers
supportive therapy.
It can be around personal issues, work issues,
stress, whatever the issue is. Our traditional EAP
was not meeting the need of our employees,
and so we have a dedicated office with
therapists who are available six days a week,
day and evening hours. They can do in
person. They can do telephonic. They can do
(09:40):
video
visits. We have done a lot of if
we have a particularly traumatic event, we've had
some employees who have passed away
on the job. We've had multiple
deaths from patients, and so we can do
provide debrief and immediate response
to those units so that the staff can
deal with that emotional
stress. And so that's been, I think, a
(10:02):
huge success for us. The other thing that
we started, again, kind of as a result
of different populations that were being brought to
the hospital, whether they needed to be in
a hospital or not, We have a lot
of individuals with intellectual disabilities, autism that often
get dropped off at the hospital
for their own safety, even though they don't
have a medical need. And so some of
(10:22):
those are people with neurocognitive
disorders.
So some of those individuals can be rather
difficult to manage on a traditional nursing unit,
a med surg floor, and so we've started
a behavioral response team. So whether it's a
patient or a family who may be having
an emotional response
and the nurses are unable to manage that.
Again, it's caused a lot of stress for
(10:42):
nurses trying to do their regular job and
deal with these emotional outbursts. So we have
a behavioral response team now that can respond
and provide proactive rounding, can provide
behavioral planning and teaching,
coaching with the staff to help manage that.
And, again, that's been, I think, really positively
received as folks feel a lot more supported
(11:03):
and less likely to burn out because they
feel like they have someone that can help
them manage through that situation. In both of
these examples
and programs that we've been able to develop,
it really is about having
health care focused
clinicians
from the setting to help the healthcare workers
who need it. I think really understanding the
(11:25):
environment,
whether it's for a need of the resiliency
team or all of the background around the
patients on the units, having that kind of
synergy between
the teams has been really helpful. I don't
think we would have been as successful if
we'd said, okay. We're gonna hire x y
z group to come in and try to
help us with this. It's really about being
a part of that team and knowing the
(11:46):
context within which our workforce are are working.
That's so great that you're doing that for
your for your workforce. So then the next
topic I wanted to ask about are the
initiatives. What initiatives are you currently working on
to address behavioral health needs as part of
your population health strategy? So again, like many
organizations, we've been
implementing and reviewing social determinants of health, which
(12:07):
obviously include things like housing insecurity and food
insecurity and income, transportation,
all of those, items. And so one thing
we know is, again,
because of who we are, Grady, we serve
a high population of uninsured individuals, and that
often equates to being unhoused. And that often
means very chaotic lives, unable to care for
(12:29):
yourself,
manage your appointments, keep your medications.
And so, again, with, really the help of
some philanthropic partners, we were able to start
a housing support program,
which we then leveraged to get money from
our state partners.
And, hopefully, we'll expand again at very shortly
to add more either rapid rehousing using hotelling
(12:49):
and then moving to more permanent,
apartments, providing case management, and helping folks learn
how to be a good neighbor, how to
maintain their their housing, which can be challenging
if you've lived on the street for ten
years. We say lots of people say this
housing is health care. If you don't have
housing, you cannot focus on your overall health.
And that's not a traditional behavioral health service,
(13:10):
I wanna say, but it's critical to maintaining,
again, not only their behavioral health, but their
physical health as well. The other thing that
we've been working on, we've Grady have been
in partnership
here in the city of Atlanta and Fulton
County with other partners around justice reform. So
there was a mental health and justice task
force.
If you look at the population of individuals
(13:30):
that are in jail, again, huge a poor
portion have some sort of mental health or
substance use issue that's keeping them in jail
often or caused them to go to jail.
It also a lot of folks that are,
again, poor have unable to make minimal bonds,
are held in jail longer, and so their
health suffers while while they're there. And so
(13:53):
we have initiated quite a number of services,
including an upcoming center for diversion and services
where
pre booking prior to arrest, someone can be
dropped off at the center for sobering. They
don't have to come to the emergency room
to sober up. They can sober in the
center, get connected to substance use services, housing,
case management.
Again, likewise, someone with a mental illness can
(14:15):
come and and meet with others, with lived
experience,
get connected to services, both both health, behavioral
health. So it's a way to prevent unnecessary
incarceration
and, unnecessary hospitalization,
or ER usage, which is, obviously a problem.
And then those that are leaving,
incarceration,
that maybe have been in there for a
(14:35):
year or two years, we help them reintegrate.
And so, again, it's about finding them housing,
helping them find a job, get connected to
benefits, you know, really reintegrate to to their
highest level possible.
Well, we'd certainly
track all of the HEDIS measures. I think
one of the early successes we had was
around depression screening and getting that throughout the
health system and then getting people into depression
(14:57):
remission
within,
yeah, within a short amount of time. So
being able to kind of measure, those are
a lot of the measures that you would
be kind of tracking to for population health
and behavioral health and again kind of that
commitment to both what happens in the traditional
behavioral health setting, but throughout the health system
was
really I think we had a good early
success that I don't think we saw a
(15:18):
lot of other folks kind of kinda get
to as quickly as we did. So appreciate
the leadership there. The one thing I would
say, Anne said this earlier, of, you know,
housing isn't traditionally a part of our service
or of a behavioral health service, but it
is such a critical one and for all
the reasons she outlined. But as I think
back to
kind of the early days of our working
towards through housing, it was kind of a
(15:39):
why or should we be doing this? It
was really laborious.
We weren't kind of always it wasn't easiest
to get kind of reimbursed for the things
that we were doing, but the team really
pushed through. And that's to get us to
where it is kind of a core sustainable
and then, again, a trusted provider for the
for the city and the the county. So
(15:59):
that's one that I would say, you know,
has been really critical.
We cannot make these things happen if people
don't have housing. We cannot get people to
kind of stability
if they don't have that. And so being
able to kind of push through barriers there
that were really around red tape and, you
know, paperwork and things like that to to
make it to make it happen was really,
really a critical piece. I think you mentioned
(16:20):
HEDIS measures today. Can Can you define and
explain what HEDIS measures are? But they're typically
the ambulatory measures, like, so you have the
inpatient measures around quality or safety events, readmissions.
HEDIS would become that ambulatory
measures around that. So they're typically
managed diabetes,
managed blood pressure. Did you get vaccinations,
kind of the flu, the children's vaccinations, things
(16:43):
like that. And then a part of those
measures is typically depression screening and depression remission.
Got it. Well, and I will just toot
our horn on the depression remission.
For those, what we've compared is overall for
our neighborhood health clinics, the improvement on depression
remission is running at about fifteen to sixteen
percent, which is great.
For those that actually get connected with our
(17:04):
baby health therapist,
it's more like thirty five to forty percent
remission,
and that's within 12. So, again, I think
having that that intervention, that support available shows
an increase in in that depression remission. So
you have a lot of different spaces you're
providing care across the continuum.
Do you have any insights or lessons learned
(17:25):
that you can share about the design of
your spaces,
whether it's it's related to patient safety or
privacy or dignity? Anything you wanna
elaborate on? Absolutely. So I'd say most of
our behavioral health spaces, particularly within the hospital,
were found spaces over time. People, they weren't
necessarily,
you know, years and years ago thought to
(17:45):
be, well, this is where behavioral health should
be.
And, historically, they were maybe a little darker
or, you know, the lighting wasn't as good
or the separation wasn't as strong. And so
we have been able
to put in place several renovations
recently that help
on kind of create brighter spaces as well
as more more privacy for patients. And I
(18:06):
can definitely speak to that. We've been working
towards having a really ensuring that it is
a strong healing environment. And so definitely lessons
learned on how we plan for that. Yeah.
I mean, I think the biggest struggle is,
as Shannon said, most organizations are gonna retrofit,
a space for behavioral health, and you'd really
kinda ideally not like to do that. But
(18:26):
that's yeah. I think that's what happens. Right?
I mean, we're not we're not the, revenue
generator.
But I do think if you can at
least then design
that space in a more therapeutic way
to allow for,
group interaction and and good conversation,
privacy for interviews and consultation,
therapy, certainly ways to
(18:48):
decrease,
stimulation and noise because folks can often get
kinda loud. I think those kinds of bright,
you know, cheerful, you want much more cheerful
spaces
are are definitely necessary.
Other pieces that have gone into certainly the
safety for our staff. And so
good line of sight, obviously, but also where
you need that separation, where you can still
(19:09):
have that line of sight, but have that
separation
so that you can really look out and
be able to see folks, but nobody's kind
of off out of sight for for folks.
And so and that there can be when
when we need to deescalate a situation that
there's an ability to do that and then
separate somebody as needed. And so safety is
a big part of how we how we
looked at the space as well. Last two
(19:29):
questions. So the first one, tell us about
you. We wanna hear a little bit more
about you and maybe your your personal journey
or or Grady Hall system. And how has
your background or career path built a strong
foundation
for you to position you as a leader
in behavioral health? I have been in this
field for almost four years. And I think
the reason I got interesting as we were
talking earlier, the reason I got into it,
my father
(19:51):
was the maintenance
engineer
at a state hospital. And so I was
very familiar and happened to have a friend
whose sister had a mental illness.
And so I had just a lot of
early
experience,
being with people. So I didn't have the
natural
a lot of people are fearful
of individuals who have mental illness. And I
(20:11):
didn't I didn't have that because I it
was kinda normal for me. And so
as I grew older and went to college,
I decided to be a social worker. And
so I've had a great experience in community
mental health my entire career or with underserved.
I have worked with traditionally Medicaid Medicare populations.
So I think the fit for me when
(20:32):
I came to Grady was the chance to
be within a larger health
system where it was integrated with health and
behavioral health. And then I've learned so much
about how to do that. I mean, it's
very easy when you're in an organization that's
dedicated to behavioral health to push your initiatives
forward. But in a traditional health care system,
(20:52):
to really do that integration
has been a great learning experience and and
blessed to have some great leaders here that
have supported us in that. So my career
path was a little different.
I started as a consultant, and I was
a consultant for thirteen years doing strategic and
facility planning, probably alongside some of your colleagues
at Mumbull and along the way. When I
came to Grady in 2012,
(21:14):
I became the vice president of planning and
business development. I'd say what brought me to
Grady and what kind of led my career
through consulting was always kind of an interest
and a leaning towards the safety net, the
academic environment,
often an urban area or rural that kind
of is a part of a bigger system.
But my personal passion was always that healthcare
shouldn't be different
(21:36):
depending on where you are. It should be
the same regardless of where you are, regardless
of your race, of your economic status. And
so that's always been my challenge is how
to make it successful
to where you can put investments, you can
put resources towards all of the services that
people need and to be able to drive
that better health outcome overall. And so that's
(21:56):
been my focus at Grady. I am an
Atlanta native and so to be able to
do this work where I grew up in
the community that I grew up in and
to really help to drive kind of that
overall health outcome.
My fortune of being able to work directly
with behavioral health services for the last four
years, four or five years,
has been, you know, just taking that even
(22:17):
to the next level. And so you can
do it at a strategic level and help
to set those priorities, but to also be
able to do it at the operational level
to help to break down the barriers, to
help to make sure that we get the
investments to the right place really just kind
of ties that thread through what I've always
wanted to do and what I get to
do now. Sounds like you're both very passionate
about what you do and in the right
place.
(22:40):
If you could go back to the start
of your career, what's one thing you wish
you would have known? So I think, you
know, I think at the start of my
career, kind of sitting in my master of
health care administration classes and someone saying health
care has never changed as much as it's
changing right now,
however long ago that was. It is always
evolving and changing,
and that is what makes it exciting
in many ways and frustrating in some ways
(23:02):
too. But we are always having we're always
gonna have to move. Some folks would say
we're kind of behind the times from a
business perspective, but, you know, it's really all
about the payment structures and how you're able
to kind of all the different forces that
go into health care. So it is always
changing and evolving, which is why we started
and where we are now. I think for
behavioral health, and Anne can probably speak more
(23:22):
to this too, but I would speak
to my time even just here. We've heard
us say it kind of throughout. If behavioral
health is a separate entity,
then you're you're kind of not gonna optimize
from the effectiveness of the service, the service
line, and truly kind of the overall health
of a health system
overall. And so I think, you know, my
(23:43):
first few years here, we certainly were looking
at behavioral health as, again, what happened two
or three places across the health system and
the losses and the things like that. But
being able to move that forward and understanding
that importance of integration, I wish maybe we
had known a little sooner. Well, I mean,
you know, again, my career has totally been
in behavioral health, and I think what
I have learned, I think, since being at
(24:05):
Grady is
I wish I'd taken more challenges
and more risk earlier to push it forward
because our services have evolved slowly.
And health care may have evolved, but behavioral
health has evolved fairly slowly. And I think
just taking some risk early on and really
pushing those boundaries to get where we needed
to for individuals right at that individual level.
(24:27):
And, you know, often you just back up
and say, okay, that's what it's always been.
That's what it's gonna be. And we've proven,
I think, here that it doesn't have to
be that way. And so I think that's
probably what I would say I've learned. Take
the risk. I think it's been really fantastic.
And my big takeaway from our conversation is
that the health system is not separate from
behavioral health. Mhmm. That they're really one in
(24:48):
the same mental health as health, and we
need to treat it all holistically. And you
guys are doing a really great job at
that. Oh, thank you. Thank you. So thank
you for your time today. Yes. Absolutely. Thank
you. I'm happy to have you on.
For more information on our listen mental health
matters series,
(25:09):
please visit hdrinc.com/listen.
There you'll find more on HDR's approach to
behavioral
Apple Podcasts,
Spotify,
or wherever you get your podcasts.
Health care shouldn't be different
depending on where you are. It should be
the same regardless of where you are, regardless
of your race, of your economic status.
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
(00:21):
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.
As part of this series, Brian Gebink, behavioral
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
(00:43):
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Giebenk, and I hope that by
listening, the series helps us consider new perspectives
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 Brian's conversation with Shannon
(01:06):
Sale, executive vice president and chief strategy officer,
and Anne Hernandez,
vice president of behavioral health for Grady Health
System in Atlanta, Georgia.
Good afternoon. I'm very happy to be here.
(01:28):
I'm Brian Geebink. I'm HDR's behavioral mental health
practice leader. I'm an architect and and planner
and focus specifically on designing behavioral health spaces.
With me today is Shannon Sale and Ann
Hernandez with Grady
Health System.
We're going to hear from them about their
journey into and and through their their behavioral
health. And so I think we'll just have
(01:48):
each of you briefly introduce yourself
to get started. Shannon, would you like to
introduce yourself? Sure. That's great. Good afternoon. I'm
Shannon Sale. I'm the executive vice president, chief
strategy officer for Grady Health System, and I've
been with the health system for eleven years.
Hi. I'm
Anne Hernandez, vice president of behavioral health at
Grady. I've been here for ten years. Glad
both of you are here with us today.
(02:08):
So to start, can you give us a
high level overview of your system? So Grady
is the largest safety net in Georgia and
among the largest in the country. We have
one
acute care hospital with a licensed capacity for
953
beds. We're building to about 900 of those
right now. We're supported by neighborhood health centers
throughout Atlanta. We have six of those.
(02:30):
Large infectious disease program called our POTS Center.
We have a variety of other supporting services
including we respond to all 911 calls in
the city of Atlanta with our hospital based
ambulance program
and a variety of key services
around stroke,
trauma, burn,
cardiac,
and of course our behavioral health services. Anne,
(02:52):
you wanna talk about the range of services
that we offer for behavioral health? Sure. So
we have, I would say, one of the
most comprehensive
continuums of behavioral health services probably in the
country.
As a part of our hospital,
we have a psychiatric emergency room, which has
a capacity for 12 individuals at a time.
We have a inpatient psychiatric unit, which is
(03:12):
a 24 bed unit
at our main hospital. We have a temporary
observation area that can hold up to 32
individuals
while there's a determination of whether or not
they need hospitalization.
And then a med psych unit that will
have 16 beds
to work with individuals who have an acute
medical and acute psychiatric
need and that so they can receive simultaneous
(03:34):
care. In addition to our services within the
hospital, we have three
comprehensive
community mental health center locations
that provide medication management, nursing therapy,
case management, housing support.
We have an integrated behavioral health service in
all of our neighborhood clinics, primary care centers,
where there's a licensed therapist and psychiatric support.
(03:57):
We have a coresponse model. So with EMS,
as Shannon mentioned, we have a unit that
contains a paramedic and a licensed
clinician who can respond to psychiatric emergencies
to prevent unnecessary
emergency room visits if possible.
We have just beginning to expand our justice
involved services. So for individuals who are either,
(04:17):
leaving jail,
we pick them up and help them reintegrate,
or those that we're trying to
prevent unnecessary arrest and incarceration,
where, again, we can connect them to health
and behavioral
services and hopefully get their feet under them
as they progress with their lives.
We have probably the last thing I'll mention.
(04:37):
We have a lots lots of services, but
we have assertive community treatment, which are three
interdisciplinary
teams which visit individuals
wherever they are in the community, whether it's
in a home, if they're unhoused, they may
be in the park or at their job
to help them. Again, it's a hospital without
walls. So it's folks that might otherwise be
in the hospital, but that can be served
and supported in the community. It's amazing. So
(04:59):
you're doing some amazing work.
So so with all of this work, how
does your behavioral health service line contribute to
your overall
systems business strategy? So it is a critical
part of the business strategy. You can imagine
it wasn't always kind of seen that way,
but we have been able to
move from
two core services, one was inpatient and one
was outpatient, to the wide range that Anne
(05:22):
just described
and recognize that
the role that behavioral health plays is in
the whole person,
and be able to help folks manage their
mental health and their physical health really helps
the overall outcomes for the health system. And
so,
we have integrated behavioral health within our population
health strategies, our community benefit strategies.
(05:43):
We have a lot of philanthropic support as
well as health system support to be able
to accomplish these strategies and, again, improve the
health of the whole person. What roadblocks have
you faced and have you been able to
pivot and move some of your behavioral health
initiatives forward? Probably the biggest hurdle that everyone
faces
is stigma around those that experience mental illness
(06:03):
and or substance use and just the ability
to provide
proper optimal care
to folks that have some challenging behaviors at
times. And so that's probably been the biggest
hurdle is wherever the the individual
presents in the health system is to help
the providers understand how they can approach and
support that individual
to get both their health needs and their
(06:25):
behavioral health needs met. I would say some
of the other things there, you know, for
some of the more creative
services and supports we're trying to provide, funding
is always a challenge.
As Shannon mentioned, the philanthropic,
arm through our Grady Foundation, we've got some
great partners that have helped us start really
innovative programs with our integrated health within our
(06:46):
neighborhood centers, with our housing program. They that's
how we actually were able to begin,
providing support for housing. And and right now,
they're looking for some money for support employment.
So I think that's been, a huge driver
to move our innovation forward. Let's say also
building on the funding. When I started at
Grady, we looked to the behavioral health service,
and it was losing x million a year,
(07:08):
and that was a big challenge. And we've
been able to close that gap
by being an expert in the the area,
being a trusted partner
with the county and the state, and being
able to be that service that they know
is needed, and then the funding has helped
to follow that. So there are a variety
of relationships that we have. And just mentioned
support for the housing,
(07:29):
support for our outpatient centers, support for unfunded
patients that we're able to garner, again, through
being that that trusted partner. And that has
been a
last decade at Grady. In addition, you've mentioned
some other strategies you're using to improve access.
Yeah. No. Well, I'll I'll mention a couple.
So we started our integrated behavioral health in
our neighborhood centers about six years ago. And
(07:52):
so what we are actually
in the process of doing now is
adding behavioral health support specifically to specialty centers
like cancer
and burn. So, again, trying to spread and
integrate that across the health system where those
needs are identified.
The other piece that I think where we've
really tried to expand access is opening additional
(08:13):
outpatient clinics. So, traditionally, Grady has had one
very large outpatient
center. In January of this year, '20 '20
'3, we opened two additional sites,
which has allowed us to serve population in
the northern part of the county. If you're
not familiar with Fulton County, Georgia, it's a
very long county. And so we were centrally
located in Downtown Atlanta, but now we have
(08:34):
a center that's in North Fulton and one
that's in South Fulton, which has also increased
that access. We know that attracting and retaining
quality staff is is very challenging, not just
for behavioral health care, but for all of
health care. And and I think burnout and
and mental health is a big part of
that. So can you talk about strategies you're
implementing to provide behavioral health care to your
workforce? Yeah. We're very excited that we've started
(08:56):
two new services in the last probably three
years. During COVID, much like every other health
system, we noted an increase in violence and
just emotional stress that patients were bringing to
the workplace, and our staff were particularly feeling
stressful coming to work during the pandemic.
And so our leadership
agreed,
and we opened a free employee resiliency
(09:18):
clinic, which offers
supportive therapy.
It can be around personal issues, work issues,
stress, whatever the issue is. Our traditional EAP
was not meeting the need of our employees,
and so we have a dedicated office with
therapists who are available six days a week,
day and evening hours. They can do in
person. They can do telephonic. They can do
(09:40):
video
visits. We have done a lot of if
we have a particularly traumatic event, we've had
some employees who have passed away
on the job. We've had multiple
deaths from patients, and so we can do
provide debrief and immediate response
to those units so that the staff can
deal with that emotional
stress. And so that's been, I think, a
(10:02):
huge success for us. The other thing that
we started, again, kind of as a result
of different populations that were being brought to
the hospital, whether they needed to be in
a hospital or not, We have a lot
of individuals with intellectual disabilities, autism that often
get dropped off at the hospital
for their own safety, even though they don't
have a medical need. And so some of
(10:22):
those are people with neurocognitive
disorders.
So some of those individuals can be rather
difficult to manage on a traditional nursing unit,
a med surg floor, and so we've started
a behavioral response team. So whether it's a
patient or a family who may be having
an emotional response
and the nurses are unable to manage that.
Again, it's caused a lot of stress for
(10:42):
nurses trying to do their regular job and
deal with these emotional outbursts. So we have
a behavioral response team now that can respond
and provide proactive rounding, can provide
behavioral planning and teaching,
coaching with the staff to help manage that.
And, again, that's been, I think, really positively
received as folks feel a lot more supported
(11:03):
and less likely to burn out because they
feel like they have someone that can help
them manage through that situation. In both of
these examples
and programs that we've been able to develop,
it really is about having
health care focused
clinicians
from the setting to help the healthcare workers
who need it. I think really understanding the
(11:25):
environment,
whether it's for a need of the resiliency
team or all of the background around the
patients on the units, having that kind of
synergy between
the teams has been really helpful. I don't
think we would have been as successful if
we'd said, okay. We're gonna hire x y
z group to come in and try to
help us with this. It's really about being
a part of that team and knowing the
(11:46):
context within which our workforce are are working.
That's so great that you're doing that for
your for your workforce. So then the next
topic I wanted to ask about are the
initiatives. What initiatives are you currently working on
to address behavioral health needs as part of
your population health strategy? So again, like many
organizations, we've been
implementing and reviewing social determinants of health, which
(12:07):
obviously include things like housing insecurity and food
insecurity and income, transportation,
all of those, items. And so one thing
we know is, again,
because of who we are, Grady, we serve
a high population of uninsured individuals, and that
often equates to being unhoused. And that often
means very chaotic lives, unable to care for
(12:29):
yourself,
manage your appointments, keep your medications.
And so, again, with, really the help of
some philanthropic partners, we were able to start
a housing support program,
which we then leveraged to get money from
our state partners.
And, hopefully, we'll expand again at very shortly
to add more either rapid rehousing using hotelling
(12:49):
and then moving to more permanent,
apartments, providing case management, and helping folks learn
how to be a good neighbor, how to
maintain their their housing, which can be challenging
if you've lived on the street for ten
years. We say lots of people say this
housing is health care. If you don't have
housing, you cannot focus on your overall health.
And that's not a traditional behavioral health service,
(13:10):
I wanna say, but it's critical to maintaining,
again, not only their behavioral health, but their
physical health as well. The other thing that
we've been working on, we've Grady have been
in partnership
here in the city of Atlanta and Fulton
County with other partners around justice reform. So
there was a mental health and justice task
force.
If you look at the population of individuals
(13:30):
that are in jail, again, huge a poor
portion have some sort of mental health or
substance use issue that's keeping them in jail
often or caused them to go to jail.
It also a lot of folks that are,
again, poor have unable to make minimal bonds,
are held in jail longer, and so their
health suffers while while they're there. And so
(13:53):
we have initiated quite a number of services,
including an upcoming center for diversion and services
where
pre booking prior to arrest, someone can be
dropped off at the center for sobering. They
don't have to come to the emergency room
to sober up. They can sober in the
center, get connected to substance use services, housing,
case management.
Again, likewise, someone with a mental illness can
(14:15):
come and and meet with others, with lived
experience,
get connected to services, both both health, behavioral
health. So it's a way to prevent unnecessary
incarceration
and, unnecessary hospitalization,
or ER usage, which is, obviously a problem.
And then those that are leaving,
incarceration,
that maybe have been in there for a
(14:35):
year or two years, we help them reintegrate.
And so, again, it's about finding them housing,
helping them find a job, get connected to
benefits, you know, really reintegrate to to their
highest level possible.
Well, we'd certainly
track all of the HEDIS measures. I think
one of the early successes we had was
around depression screening and getting that throughout the
health system and then getting people into depression
(14:57):
remission
within,
yeah, within a short amount of time. So
being able to kind of measure, those are
a lot of the measures that you would
be kind of tracking to for population health
and behavioral health and again kind of that
commitment to both what happens in the traditional
behavioral health setting, but throughout the health system
was
really I think we had a good early
success that I don't think we saw a
(15:18):
lot of other folks kind of kinda get
to as quickly as we did. So appreciate
the leadership there. The one thing I would
say, Anne said this earlier, of, you know,
housing isn't traditionally a part of our service
or of a behavioral health service, but it
is such a critical one and for all
the reasons she outlined. But as I think
back to
kind of the early days of our working
towards through housing, it was kind of a
(15:39):
why or should we be doing this? It
was really laborious.
We weren't kind of always it wasn't easiest
to get kind of reimbursed for the things
that we were doing, but the team really
pushed through. And that's to get us to
where it is kind of a core sustainable
and then, again, a trusted provider for the
for the city and the the county. So
(15:59):
that's one that I would say, you know,
has been really critical.
We cannot make these things happen if people
don't have housing. We cannot get people to
kind of stability
if they don't have that. And so being
able to kind of push through barriers there
that were really around red tape and, you
know, paperwork and things like that to to
make it to make it happen was really,
really a critical piece. I think you mentioned
(16:20):
HEDIS measures today. Can Can you define and
explain what HEDIS measures are? But they're typically
the ambulatory measures, like, so you have the
inpatient measures around quality or safety events, readmissions.
HEDIS would become that ambulatory
measures around that. So they're typically
managed diabetes,
managed blood pressure. Did you get vaccinations,
kind of the flu, the children's vaccinations, things
(16:43):
like that. And then a part of those
measures is typically depression screening and depression remission.
Got it. Well, and I will just toot
our horn on the depression remission.
For those, what we've compared is overall for
our neighborhood health clinics, the improvement on depression
remission is running at about fifteen to sixteen
percent, which is great.
For those that actually get connected with our
(17:04):
baby health therapist,
it's more like thirty five to forty percent
remission,
and that's within 12. So, again, I think
having that that intervention, that support available shows
an increase in in that depression remission. So
you have a lot of different spaces you're
providing care across the continuum.
Do you have any insights or lessons learned
(17:25):
that you can share about the design of
your spaces,
whether it's it's related to patient safety or
privacy or dignity? Anything you wanna
elaborate on? Absolutely. So I'd say most of
our behavioral health spaces, particularly within the hospital,
were found spaces over time. People, they weren't
necessarily,
you know, years and years ago thought to
(17:45):
be, well, this is where behavioral health should
be.
And, historically, they were maybe a little darker
or, you know, the lighting wasn't as good
or the separation wasn't as strong. And so
we have been able
to put in place several renovations
recently that help
on kind of create brighter spaces as well
as more more privacy for patients. And I
(18:06):
can definitely speak to that. We've been working
towards having a really ensuring that it is
a strong healing environment. And so definitely lessons
learned on how we plan for that. Yeah.
I mean, I think the biggest struggle is,
as Shannon said, most organizations are gonna retrofit,
a space for behavioral health, and you'd really
kinda ideally not like to do that. But
(18:26):
that's yeah. I think that's what happens. Right?
I mean, we're not we're not the, revenue
generator.
But I do think if you can at
least then design
that space in a more therapeutic way
to allow for,
group interaction and and good conversation,
privacy for interviews and consultation,
therapy, certainly ways to
(18:48):
decrease,
stimulation and noise because folks can often get
kinda loud. I think those kinds of bright,
you know, cheerful, you want much more cheerful
spaces
are are definitely necessary.
Other pieces that have gone into certainly the
safety for our staff. And so
good line of sight, obviously, but also where
you need that separation, where you can still
(19:09):
have that line of sight, but have that
separation
so that you can really look out and
be able to see folks, but nobody's kind
of off out of sight for for folks.
And so and that there can be when
when we need to deescalate a situation that
there's an ability to do that and then
separate somebody as needed. And so safety is
a big part of how we how we
looked at the space as well. Last two
(19:29):
questions. So the first one, tell us about
you. We wanna hear a little bit more
about you and maybe your your personal journey
or or Grady Hall system. And how has
your background or career path built a strong
foundation
for you to position you as a leader
in behavioral health? I have been in this
field for almost four years. And I think
the reason I got interesting as we were
talking earlier, the reason I got into it,
my father
(19:51):
was the maintenance
engineer
at a state hospital. And so I was
very familiar and happened to have a friend
whose sister had a mental illness.
And so I had just a lot of
early
experience,
being with people. So I didn't have the
natural
a lot of people are fearful
of individuals who have mental illness. And I
(20:11):
didn't I didn't have that because I it
was kinda normal for me. And so
as I grew older and went to college,
I decided to be a social worker. And
so I've had a great experience in community
mental health my entire career or with underserved.
I have worked with traditionally Medicaid Medicare populations.
So I think the fit for me when
(20:32):
I came to Grady was the chance to
be within a larger health
system where it was integrated with health and
behavioral health. And then I've learned so much
about how to do that. I mean, it's
very easy when you're in an organization that's
dedicated to behavioral health to push your initiatives
forward. But in a traditional health care system,
(20:52):
to really do that integration
has been a great learning experience and and
blessed to have some great leaders here that
have supported us in that. So my career
path was a little different.
I started as a consultant, and I was
a consultant for thirteen years doing strategic and
facility planning, probably alongside some of your colleagues
at Mumbull and along the way. When I
came to Grady in 2012,
(21:14):
I became the vice president of planning and
business development. I'd say what brought me to
Grady and what kind of led my career
through consulting was always kind of an interest
and a leaning towards the safety net, the
academic environment,
often an urban area or rural that kind
of is a part of a bigger system.
But my personal passion was always that healthcare
shouldn't be different
(21:36):
depending on where you are. It should be
the same regardless of where you are, regardless
of your race, of your economic status. And
so that's always been my challenge is how
to make it successful
to where you can put investments, you can
put resources towards all of the services that
people need and to be able to drive
that better health outcome overall. And so that's
(21:56):
been my focus at Grady. I am an
Atlanta native and so to be able to
do this work where I grew up in
the community that I grew up in and
to really help to drive kind of that
overall health outcome.
My fortune of being able to work directly
with behavioral health services for the last four
years, four or five years,
has been, you know, just taking that even
(22:17):
to the next level. And so you can
do it at a strategic level and help
to set those priorities, but to also be
able to do it at the operational level
to help to break down the barriers, to
help to make sure that we get the
investments to the right place really just kind
of ties that thread through what I've always
wanted to do and what I get to
do now. Sounds like you're both very passionate
about what you do and in the right
place.
(22:40):
If you could go back to the start
of your career, what's one thing you wish
you would have known? So I think, you
know, I think at the start of my
career, kind of sitting in my master of
health care administration classes and someone saying health
care has never changed as much as it's
changing right now,
however long ago that was. It is always
evolving and changing,
and that is what makes it exciting
in many ways and frustrating in some ways
(23:02):
too. But we are always having we're always
gonna have to move. Some folks would say
we're kind of behind the times from a
business perspective, but, you know, it's really all
about the payment structures and how you're able
to kind of all the different forces that
go into health care. So it is always
changing and evolving, which is why we started
and where we are now. I think for
behavioral health, and Anne can probably speak more
(23:22):
to this too, but I would speak
to my time even just here. We've heard
us say it kind of throughout. If behavioral
health is a separate entity,
then you're you're kind of not gonna optimize
from the effectiveness of the service, the service
line, and truly kind of the overall health
of a health system
overall. And so I think, you know, my
(23:43):
first few years here, we certainly were looking
at behavioral health as, again, what happened two
or three places across the health system and
the losses and the things like that. But
being able to move that forward and understanding
that importance of integration, I wish maybe we
had known a little sooner. Well, I mean,
you know, again, my career has totally been
in behavioral health, and I think what
I have learned, I think, since being at
(24:05):
Grady is
I wish I'd taken more challenges
and more risk earlier to push it forward
because our services have evolved slowly.
And health care may have evolved, but behavioral
health has evolved fairly slowly. And I think
just taking some risk early on and really
pushing those boundaries to get where we needed
to for individuals right at that individual level.
(24:27):
And, you know, often you just back up
and say, okay, that's what it's always been.
That's what it's gonna be. And we've proven,
I think, here that it doesn't have to
be that way. And so I think that's
probably what I would say I've learned. Take
the risk. I think it's been really fantastic.
And my big takeaway from our conversation is
that the health system is not separate from
behavioral health. Mhmm. That they're really one in
(24:48):
the same mental health as health, and we
need to treat it all holistically. And you
guys are doing a really great job at
that. Oh, thank you. Thank you. So thank
you for your time today. Yes. Absolutely. Thank
you. I'm happy to have you on.
For more information on our listen mental health
matters series,
(25:09):
please visit hdrinc.com/listen.
There you'll find more on HDR's approach to
behavioral
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or wherever you get your podcasts.
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