October 2, 2023 • 25 mins
"Listen, Mental Health Matters" is a special Speaking of Design podcast series. Brian Giebink, behavioral and mental health practice leader at HDR, visits some of the world’s leading healthcare providers for candid conversations about the challenges they face and the opportunities to transform the patient and caregiver experience.
The importance of mental health services has never been more evident, and many healthcare organizations are striving to improve access to care and the environments in which that care is provided. In this inaugural episode, Brian sits down with Stacey Johnson, president of Riverside Mental Health & Recovery Center in Hampton, Virginia, for a discussion about her approach to leading the growth of the organization’s services, designing new environments for care delivery and the personal motivation that drives her to help people who are in need.
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Episode Transcript
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(00:00):
The Riverside mission is to care for others
as you would care for those you love.
And I think if we use that to
guide what we're doing as an organization,
it's always going to lead us down the
right path.
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
(00:22):
architects who are transforming the world one project
at a time. Today, we bring you the
first 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
(00:43):
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
in our quest to create transformational mental health
facilities that improve the quality of life for
individuals and families and promote a shared sense
(01:04):
of community. And now Brian's conversation with Stacy
Johnson, president of the Riverside Mental Health and
Recovery Center in Hampton, Virginia.
(01:26):
Hi. I'm Brian Geebink, behavioral mental health practice
leader at HDR.
I am in Hampton, Virginia with Stacy Johnson,
the president of Riverside
Behavioral Health Center, but it's now going to
be called go ahead. Riverside Mental Health and
Recovery Center. So we're gonna hear a little
bit about Stacy's story here. Stacy, do you
(01:46):
wanna introduce yourself and tell us a little
bit about who who you are and your
background and what you do? Yeah. Sure. Sure.
Happy to chat about that. So as you
mentioned, I'm Stacy. I am the president here
at Riverside Mental Health and Recovery Center in
Hampton.
We are a mental health hospital where we're
we treat folks on an inpatient and outpatient
basis and, you know, really working to expand
(02:09):
some of our services.
So kind of in terms of me and
my history,
I started off my career as a social
worker. So I kind of always knew I
wanted
to help people when I grew up. I
wasn't really sure what that meant. If you
told me when I was 10 that I
was going to be a hospital president, I
probably would have laughed and and said, no.
(02:29):
No one wants to do that. But I
I think I'm exactly where I'm supposed to
be. So
I I really grew up on the clinical
side working on inpatient units
and outpatient
therapy with both adults and adolescents
in mental health, as as well as in
addiction services
and, and really my goal was to see
(02:50):
how many people can I help and how
do I continue to grow my, my bandwidth
to be able to help more people and
that's kind of how I got into leadership
and I think it really led me to,
to here where we're able to help all
the folks in our community? What about Riverside
attracted you or why, why did you decide
to join Riverside? Sure. So I joined Riverside
(03:11):
going on five years ago and everyone that
I spoke to in the interview process just
seemed so genuinely happy to be here.
And they were so hungry for
opportunities to grow behavioral health services and that
really spoke to me as somebody who's
health services and that really spoke to me
as somebody who's worked, you know, in in
this area,
(03:32):
my career, it's not very common that you
find places eager to to treat this population
and expand services. So definitely touched my soul
a little bit. One of the things that
drives me as a person is really to
help vulnerable populations.
Who are the people that folks aren't flocking
(03:52):
to? When when you look at healthcare organizations,
it's very common folks have ortho service or
or cardiac services.
But I I'm really driven to help people
that aren't always able to speak for themselves
and it it definitely has become my calling
and something that that I, you know, hope
to do with with the remainder of my
(04:13):
life. Give us a high level overview of
the entire system very briefly. Sure. So Riverside
started in 1915
in Eastern Virginia where where it remains. We've
got our behavioral health hospital, of course, and
then four acute care hospitals.
We have a very large outpatient practice as
well. Our Riverside Medical Group has about seven
(04:35):
fifty providers.
Another area that Riverside is in is in
the lifelong health area. So there's several,
skilled nursing facilities,
retirement homes, and then also there is a
rehab hospital that's done in partnership with with
others.
I should also mention we are opening our
fifth acute care hospital in Smithfield, Virginia, and
(04:57):
that's slated for 2026. We have a lot
going on. A lot lot opening, a lot
of growing and expanding. It's really exciting.
So many organizations have one or a series
of key moments that
define who they've become and why they do
what they do. Was there a moment or
or moments that shaped Riverside into the organization
that it is today related to behavioral health
(05:18):
care? Sure. So I
believe that this happened long before I was
a part of Riverside, but the Riverside mission
is to care for others as you would
care for those you love.
And I think if we use that to
guide what we're doing as an organization,
it's always going to lead us down the
right path and really helping folks. So
I think that
(05:39):
defines Riverside and I think that it also
defines the opportunity to care for mental health
patients as well as those with, need for
addiction services. So, yeah, probably happened long before
me, but it's a a mission we continue
to live for today. And I think if
you ask our team members here,
they can all repeat that. And and that's
(06:00):
pretty amazing to have an organization
that, you know, culturally believes in it in
its mission.
What are you striving to provide for people
in communities that Riverside serves?
You know, is there something that they need
need more of right now? Or what what
what does the community need the most? And
and then in other words, how are you
growing to fill the gaps in services? Sure.
So as I think about that question, I
(06:22):
kind of go back to three years ago
and we sat and we said, okay, where
are the holes? What do we need? And
what we felt like was happening in our
community is there wasn't that full continuum of
care. We were able to provide inpatient
services.
We have our medical emergency departments where we
know some of our patients were being treated.
But we really didn't
(06:44):
didn't offer everything that that our patients need.
So when they leave here, they're going to
another organization and then they might come back
here. And just that continuity
does have some gaps if those services that
they need exist at at all. So when
we kind of drew this all out, we
said, okay. How do we create the continuum
of care? So what we did first was
(07:06):
really restructure our hospital to be able to
treat as many patients as we can.
We knew our community,
really needed some addiction resources and recovery resources.
So at that time,
we did add detox services. And what we
know about recovery is it's not just one
stop and and then you're better. It's just
(07:27):
like any medical illness. You've got to really
continue that care. So that's when we added
that day treatment service for addiction and then,
which is known as a partial hospital program
and then our intensive outpatient program. So we
feel really comfortable and confident that we've got
those resources available for our patients but but
that left several other gaps. Where do where
(07:48):
do our patients go in crisis
and then, you know, how about that continuum
appear on the mental health side? So that's
what we're, we're developing now for the hospital
and the community.
You're about to open a new psychiatric emergency
department that's attached to your existing center. What
was the impetus
behind putting all of this energy into psychiatric
emergency care? There was a lot that went
(08:10):
into us deciding
if we were going to open a Psyche
ED. Are we gonna open a a crisis
clinic? Are we gonna open an urgent care?
What what's the need? And really, when we
took a look at what was happening in
our medical emergency departments, it became pretty clear
for us
that we had patients for hours, days sometimes,
(08:31):
even more on on end that were sitting
in a medical emergency room not getting
care that they needed.
And that's not unique to us certainly. I
think that that's a much more global problem
but it's just was our decision to to
kind of tackle it. So,
seeing that and really looking at that data,
(08:52):
we said, okay, let's create a space for
these patients where patients can start in one
location,
go through that continuum of care and always
have a place they can call home
to get that care. So that's really kind
of the the premise for it is getting
folks started at the right place and and
having behavioral health and mental health experts there
(09:13):
to to provide that care around the clock
was really critical.
I wanna ask about roadblocks, about what roadblocks
you typically face and how you're able to
pivot to move behavioral initiatives forward. But then
specifically with the Psyche ED,
how you know, I know there were a
number of challenges. Just this is the first
one in the state. So if you could
kind of explain
some of those challenges as well, just getting
(09:34):
the Psyche ED up and running and what
you had to do and who you had
to talk to and Sure. Sure.
So
to
start, certainly
to start globally,
I think the challenges
that we have in mental health care here
at Riverside are very similar to what others
face.
Healthcare profit margins are very small. Behavioral healthcare
(09:58):
profit margins are even smaller. So being able
to do this, you know, really takes a
commitment from an organization
to help you be successful.
So we were really lucky to to have
that. I think Virginia is making strides to
improve
whether it be reimbursement,
start up costs, etcetera. I think that that
(10:18):
there really is a lot of initiatives
to to aid with that. So hopefully things
will will improve down the line. Now to
answer your second part of the question,
what opportunities
did we have when when we were opening
it up. But but truly there was a
lot of roadblocks. So being the first of
your kind in a state
(10:38):
is amazing and it's exciting,
but it also probably is going to mean
that you don't have appropriate regulatory
body set up that that comes to this
specifically.
What what laws do you need to consider?
I think when you look at medical care,
it's what's the standard of care. And there
isn't a standard of care if there isn't
(11:00):
others in your area.
So
when we were really learning about these models,
it was us going to other states, learning
from them, really just a tremendous amount of
research as to what best practices are in
this. And there was certainly help from a
lot of legal counsel in what is okay
to do, what's not okay to do, and
(11:22):
how do we align practices that match our
medical EDs as well. So
I think that
those were huge opportunities for us as well
as how are we going to integrate
this service within our health system, whether it
be a transport or
a transfer
and really understanding
(11:43):
what that means for us. Another area that
I think is important to talk about is
our team members and that's both providers as
well as your nurses, your techs.
It's easy to train somebody when you have
a unit open for them to train in.
When that unit doesn't exist yet, the unknown
is is very present. So we've needed to
(12:04):
get a little bit creative with what that
training looks like and having folks, you know,
leveraging our health system. We're we're lucky to
be a part of and getting training and
orientation in those emergency departments that already exist
is another really great opportunity that we have
as as well as the electronic medical record
build is something else. If there's not a
(12:25):
lot of programs like these, you don't have
a lot
of other
opportunities
to to build. So certainly,
we've all learned a lot and and are
eager to share it for others that might
be considering this. Thinking back
to just before COVID started is when we
decided we were going to open this emergency
(12:46):
department and when we looked at the actual
volumes of psychiatric patients in our health system,
our actual volume was about 14 patients per
day.
Fast forward,
we're at 22 patients per day. So I
think that we believe
that when we build this, that our volumes
would increase.
(13:07):
We weren't anticipating a pandemic, certainly, when when
we were building this pro form a.
But I think that
that has has required us to shift a
bit in our operational model and how quickly
we treat patients and and triage them and
get them to the appropriate level of care.
Once you're this far into the construction, you
(13:28):
can't say, hey, let's add another couple of
rooms. It's it's
certainly not that easy. So that's when you
start to need to make those operational shifts.
But when your projected senses
increases that significantly
before you even open, you you've got to
look at other things as well. When When
you talk about margins and cost as part
of a big investment for our health system,
how did you get everybody on the same
(13:49):
page and aligned with this new approach?
Sure. So when we were building this model,
we built it on
strict numbers of patients that were in our
emergency departments, our medical emergency departments, and the
true minutes that they were there, the volumes
that they were there. And when you look
(14:09):
at cost of that in a medical ED,
that can,
you know, a long stay patient
does drive cost up. Right? So really looking
at the right setting for that. And I
do think that it was part of our
mission. We've also been really lucky to build
some partnerships with the City Of Newport News
as well as the City Of Hampton.
(14:30):
And the City of Hampton has designated
some ARPA funds for for some of the
start up costs for this, whereas Newport News
dedicated dollars
to the development of our outpatient services because
both know that neither of these can be
successful independently. So we were really lucky to
to receive those grants. And
(14:52):
I also in talking about that, it's important
to mention the Department of Behavioral Health where
we did have a a partnership with them
to develop some of our detox and addiction
outpatient services. So certainly helpful with with all
of this, and we're eager to see what
budget gets approved and what other opportunities that
are will be there. I I love that
(15:13):
you see Roblox as opportunities.
What other considerations did you have with stigma
or how your organization is perceived?
So over the past six months, we've really
taken a look at at our name, Riverside
Behavioral Health Center,
and felt that it didn't really fit
what we were doing anymore.
More. So taking a step back from that
(15:35):
name and really looking at how our community
understands behavioral health, mental health, addiction, recovery,
really has kind of guided us to our
new name, Riverside Health and Recovery Center.
And I think part of that that has
happened is through the destigmatization
of mental health.
My dream is is at some point in
(15:57):
my lifetime that we're as comfortable talking about
mental health as we are our physical
health. And I think that COVID,
while it's been a, a very tragic, event
and, so many people are impacted by it,
it has facilitated more conversations about mental health.
And people are looking for resources.
(16:17):
They're comfortable saying, Hey, I'm anxious today. Hey,
I'm depressed. Where I think at the start
of my career, that wasn't an okay thing
to say. I think organizations
are saying, Okay, we need to consider mental
health days. And schools are talking about it,
and I think that's going to help guide
us
as we continue to care for for folks
(16:37):
and hopefully integrate this care into outpatient practices
and primary care offices and things like that.
But I think destigmatization
is really
growing folks interested in seeking care, which is
needed. You're doing so many things and you're
transforming, I think, the the landscape of behavioral
health care here, locally, if not in the
(16:58):
region, the state.
And you're doing a lot of things really
well. What what do you think you're doing
really well and what do you think you're
doing differently than your peers? So
I think that that we're in a place
today where a lot of people are focusing
on mental health.
I want to commend everyone that's doing it.
I think strategic
planning has really gotten us to where we
(17:18):
are today. We set a mission, we set
a goal, and and started tracking that and
how we get there is really what's laid
that foundation
for us and that's what's kept us on
track. It's something that I find incredibly important
just in general in leadership.
Your team needs to know where where you're
going so that they can help it as
(17:39):
well because these types of growth can't happen
with one person. So it's an entire team
really working together to lay out that plan.
So
I think that the simple answer is having
a plan and a road map that everyone
can see and everyone knows. And and that's
how everyone's gonna start rowing in the same
direction. So I think that's been our strength
(17:59):
in this whole process.
I think that during the construction of the
Psyche, you've been very inclusive of the team
members you bring to the table. If you
engaged your clinicians and you spoke with them,
you so I think just the
the inclusive
nature of of everything has really, I think,
helped.
At least with the construction, but I imagine
that's just you as a leader. Right? You're
you're probably pretty inclusive in in your initiative.
(18:22):
I think that it's critical to include team
members. I can sit here and make a
decision, but the reality is they're the ones
with the patients every day, and they're the
face. So it they have to, you know,
buy into whatever change is happening. So getting
feedback from them is really important. And
quite honestly, some of them are
smarter than me, so they can, you know,
can probably make a better recommendation. We've just
(18:43):
got to take that time to listen to
our our team. Can you tell us how
that inclusiveness extends to other organizations within the
community? Certainly. You can't build,
an emergency department or even outpatient services alone.
Virginia
has community services boards, and that's who would
do an evaluation for a patient if they
are incompetent to make a decision on their
(19:05):
own. So that feedback, we've been able to
talk to the magistrates
and see what they need. Our local EMS
has been really amazing
in setting up protocol
for who they can bring here versus a
medical emergency room and that partnership has just
been been priceless.
I think in terms of community,
(19:27):
the community is hungry for knowledge and such
as well. So we do have a behavioral
health education coordinator who is all throughout the
Peninsula
really, you know, talking about this and and
seeing what the community needs. I would say
that team member feedback is really important
when you're building programs like this and
and the success of those programs. And as
(19:49):
we were structuring our hospital, doing those safety
huddles with each team as a new unit
opened,
it could be something as simple as we
need post its to hey, this space doesn't
feel safe. That that's what we need to
be successful.
Many organizations have unique strategies they implement to
improve access to care and access to follow-up
care. Would you share some strategies that you've
(20:12):
found to be the most effective? And are
there any lessons
that other communities or organizations can learn from
your experiences?
One of the things that we we've found
incredibly important
is
ensuring that
all providers in our health system are aware
of the services that we provide. So we
have someone go out and educating
(20:32):
and going to their space.
The reality is behavioral health patients
are everywhere.
Our patients are in an oncology unit. They're
in an ICU unit. They're everywhere. So how
can we
meet those, really those frontline
team members to
advise them of what we've got, what resources
are available,
(20:52):
and even some simple things like what are
some signs and symptoms to look for and
and how can we help support. There's a
lot of things
related to how to talk to a patient
if you're worried they might be having thoughts
about self harm and really getting comfortable with
some of those uncomfortable
conversations. I think that's what's been most pivotal
(21:13):
for us as an organization.
And one of the the nice things to
see as we kind of go through this
destigmatization
process is parents hungry for for information.
How do I talk to my my teenager
or or my second grader? What does this
mean? What have I done wrong?
And really being able to create some of
(21:34):
those opportunities. It doesn't mean you've done anything
wrong. It's just we've got to get comfortable
with mental health. So I think that's been
really helpful for us is is engaging folks.
You serve many different populations at Riverside. You
have different ages, genders.
How do you manage that? How do you
manage when a patient shows up? They're a
(21:54):
a child or adolescent versus when they're an
adult. So I think the differences in in
age are one of the reasons we're really
looking forward to the psychiatric emergency department. So
we will have dedicated pediatric and adult treatment
areas.
That was really, really important
to us.
So the goal of the emergency department is
(22:14):
really to have that calming
area
where folks can get the best behavioral healthcare
possible.
So having those separate treatment areas was was
critical. We will certainly not close our doors
to anyone regardless of age, race, gender, any
of that. Regardless of diagnosis,
we are willing to treat anything from an
(22:36):
anxiety
disorder all the way up through a psychotic
disorder.
Recovery services will certainly be available.
And our ED is really laid out. We
had amazing architects that we worked with that
really kind of helped us
look at the flow and how that that
is is to really screen,
(22:56):
intervene,
and and then start treatment and referral right
away. And that our
layout will look like that, but it also
lends itself to a patient getting care really
quickly and whatever intervention they need
can happen almost immediately upon arrival. So that
was really important for us as well. We'll
also be accepting ambulances,
(23:17):
walk ins. We're just we're here to serve
the community.
You have two separate pods in your ED.
You have your adult pod and your pediatric
pod. And will your staff flex between the
two pods, or are you going to have
separate staff for each side? Certainly. So I
think both is probably the answer.
Our provider will certainly be able to see
both adults
(23:38):
and and pediatrics
depending on volumes. We've been able to create
some flex space as well, so it really
depends on what volumes look like on the
adult and pediatric side as to what assignments
might look like on that shift, But all
of our team members will be trained to
treat both adults and pediatrics.
That's great. What's next? What's next for you?
(23:59):
What's next for Riverside?
What's next I think is to continue to
grow. Right? To be able to meet whatever
our our patient needs are.
We have a good idea of what we're
going to see in our emergency department
but you don't know for sure till it's
here. So I think really taking a look
at the patients that are there and what
other resources
are needed. For them, I think that's going
(24:20):
to be really critical for our next step.
I think long term is really building that
integrated health system
where we can meet the behavioral health needs
of somebody that might be in a primary
care office or ortho office and really caring
for that whole person as opposed to segregating
the mental health and the physical health. So
let's care for the whole person. So
(24:42):
I think that's that's the dream. That's really
great. And you have plans to do that
with within the health system to integrate mental
health into primary care. And are you leading
the charge?
So I do have this amazing opportunity to
help set up a behavioral health service line
here at Riverside.
So we are excited. So, yes, those those
initiatives will be reporting to me as well.
(25:04):
Well, we're really excited to see this open.
The ribbon gutting is on October 5. Yes.
It's gonna be a a big event. It's
it's really important for the community and and
important for Riverside and every individual that needs
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(25:28):
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(25:48):
or wherever you get your podcasts.
The Riverside mission is to care for others
as you would care for those you love.
And I think if we use that to
guide what we're doing as an organization,
it's always going to lead us down the
right path.
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
(00:22):
architects who are transforming the world one project
at a time. Today, we bring you the
first 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
(00:43):
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
in our quest to create transformational mental health
facilities that improve the quality of life for
individuals and families and promote a shared sense
(01:04):
of community. And now Brian's conversation with Stacy
Johnson, president of the Riverside Mental Health and
Recovery Center in Hampton, Virginia.
(01:26):
Hi. I'm Brian Geebink, behavioral mental health practice
leader at HDR.
I am in Hampton, Virginia with Stacy Johnson,
the president of Riverside
Behavioral Health Center, but it's now going to
be called go ahead. Riverside Mental Health and
Recovery Center. So we're gonna hear a little
bit about Stacy's story here. Stacy, do you
(01:46):
wanna introduce yourself and tell us a little
bit about who who you are and your
background and what you do? Yeah. Sure. Sure.
Happy to chat about that. So as you
mentioned, I'm Stacy. I am the president here
at Riverside Mental Health and Recovery Center in
Hampton.
We are a mental health hospital where we're
we treat folks on an inpatient and outpatient
basis and, you know, really working to expand
(02:09):
some of our services.
So kind of in terms of me and
my history,
I started off my career as a social
worker. So I kind of always knew I
wanted
to help people when I grew up. I
wasn't really sure what that meant. If you
told me when I was 10 that I
was going to be a hospital president, I
probably would have laughed and and said, no.
(02:29):
No one wants to do that. But I
I think I'm exactly where I'm supposed to
be. So
I I really grew up on the clinical
side working on inpatient units
and outpatient
therapy with both adults and adolescents
in mental health, as as well as in
addiction services
and, and really my goal was to see
(02:50):
how many people can I help and how
do I continue to grow my, my bandwidth
to be able to help more people and
that's kind of how I got into leadership
and I think it really led me to,
to here where we're able to help all
the folks in our community? What about Riverside
attracted you or why, why did you decide
to join Riverside? Sure. So I joined Riverside
(03:11):
going on five years ago and everyone that
I spoke to in the interview process just
seemed so genuinely happy to be here.
And they were so hungry for
opportunities to grow behavioral health services and that
really spoke to me as somebody who's
health services and that really spoke to me
as somebody who's worked, you know, in in
this area,
(03:32):
my career, it's not very common that you
find places eager to to treat this population
and expand services. So definitely touched my soul
a little bit. One of the things that
drives me as a person is really to
help vulnerable populations.
Who are the people that folks aren't flocking
(03:52):
to? When when you look at healthcare organizations,
it's very common folks have ortho service or
or cardiac services.
But I I'm really driven to help people
that aren't always able to speak for themselves
and it it definitely has become my calling
and something that that I, you know, hope
to do with with the remainder of my
(04:13):
life. Give us a high level overview of
the entire system very briefly. Sure. So Riverside
started in 1915
in Eastern Virginia where where it remains. We've
got our behavioral health hospital, of course, and
then four acute care hospitals.
We have a very large outpatient practice as
well. Our Riverside Medical Group has about seven
(04:35):
fifty providers.
Another area that Riverside is in is in
the lifelong health area. So there's several,
skilled nursing facilities,
retirement homes, and then also there is a
rehab hospital that's done in partnership with with
others.
I should also mention we are opening our
fifth acute care hospital in Smithfield, Virginia, and
(04:57):
that's slated for 2026. We have a lot
going on. A lot lot opening, a lot
of growing and expanding. It's really exciting.
So many organizations have one or a series
of key moments that
define who they've become and why they do
what they do. Was there a moment or
or moments that shaped Riverside into the organization
that it is today related to behavioral health
(05:18):
care? Sure. So I
believe that this happened long before I was
a part of Riverside, but the Riverside mission
is to care for others as you would
care for those you love.
And I think if we use that to
guide what we're doing as an organization,
it's always going to lead us down the
right path and really helping folks. So
I think that
(05:39):
defines Riverside and I think that it also
defines the opportunity to care for mental health
patients as well as those with, need for
addiction services. So, yeah, probably happened long before
me, but it's a a mission we continue
to live for today. And I think if
you ask our team members here,
they can all repeat that. And and that's
(06:00):
pretty amazing to have an organization
that, you know, culturally believes in it in
its mission.
What are you striving to provide for people
in communities that Riverside serves?
You know, is there something that they need
need more of right now? Or what what
what does the community need the most? And
and then in other words, how are you
growing to fill the gaps in services? Sure.
So as I think about that question, I
(06:22):
kind of go back to three years ago
and we sat and we said, okay, where
are the holes? What do we need? And
what we felt like was happening in our
community is there wasn't that full continuum of
care. We were able to provide inpatient
services.
We have our medical emergency departments where we
know some of our patients were being treated.
But we really didn't
(06:44):
didn't offer everything that that our patients need.
So when they leave here, they're going to
another organization and then they might come back
here. And just that continuity
does have some gaps if those services that
they need exist at at all. So when
we kind of drew this all out, we
said, okay. How do we create the continuum
of care? So what we did first was
(07:06):
really restructure our hospital to be able to
treat as many patients as we can.
We knew our community,
really needed some addiction resources and recovery resources.
So at that time,
we did add detox services. And what we
know about recovery is it's not just one
stop and and then you're better. It's just
(07:27):
like any medical illness. You've got to really
continue that care. So that's when we added
that day treatment service for addiction and then,
which is known as a partial hospital program
and then our intensive outpatient program. So we
feel really comfortable and confident that we've got
those resources available for our patients but but
that left several other gaps. Where do where
(07:48):
do our patients go in crisis
and then, you know, how about that continuum
appear on the mental health side? So that's
what we're, we're developing now for the hospital
and the community.
You're about to open a new psychiatric emergency
department that's attached to your existing center. What
was the impetus
behind putting all of this energy into psychiatric
emergency care? There was a lot that went
(08:10):
into us deciding
if we were going to open a Psyche
ED. Are we gonna open a a crisis
clinic? Are we gonna open an urgent care?
What what's the need? And really, when we
took a look at what was happening in
our medical emergency departments, it became pretty clear
for us
that we had patients for hours, days sometimes,
(08:31):
even more on on end that were sitting
in a medical emergency room not getting
care that they needed.
And that's not unique to us certainly. I
think that that's a much more global problem
but it's just was our decision to to
kind of tackle it. So,
seeing that and really looking at that data,
(08:52):
we said, okay, let's create a space for
these patients where patients can start in one
location,
go through that continuum of care and always
have a place they can call home
to get that care. So that's really kind
of the the premise for it is getting
folks started at the right place and and
having behavioral health and mental health experts there
(09:13):
to to provide that care around the clock
was really critical.
I wanna ask about roadblocks, about what roadblocks
you typically face and how you're able to
pivot to move behavioral initiatives forward. But then
specifically with the Psyche ED,
how you know, I know there were a
number of challenges. Just this is the first
one in the state. So if you could
kind of explain
some of those challenges as well, just getting
(09:34):
the Psyche ED up and running and what
you had to do and who you had
to talk to and Sure. Sure.
So
to
start, certainly
to start globally,
I think the challenges
that we have in mental health care here
at Riverside are very similar to what others
face.
Healthcare profit margins are very small. Behavioral healthcare
(09:58):
profit margins are even smaller. So being able
to do this, you know, really takes a
commitment from an organization
to help you be successful.
So we were really lucky to to have
that. I think Virginia is making strides to
improve
whether it be reimbursement,
start up costs, etcetera. I think that that
(10:18):
there really is a lot of initiatives
to to aid with that. So hopefully things
will will improve down the line. Now to
answer your second part of the question,
what opportunities
did we have when when we were opening
it up. But but truly there was a
lot of roadblocks. So being the first of
your kind in a state
(10:38):
is amazing and it's exciting,
but it also probably is going to mean
that you don't have appropriate regulatory
body set up that that comes to this
specifically.
What what laws do you need to consider?
I think when you look at medical care,
it's what's the standard of care. And there
isn't a standard of care if there isn't
(11:00):
others in your area.
So
when we were really learning about these models,
it was us going to other states, learning
from them, really just a tremendous amount of
research as to what best practices are in
this. And there was certainly help from a
lot of legal counsel in what is okay
to do, what's not okay to do, and
(11:22):
how do we align practices that match our
medical EDs as well. So
I think that
those were huge opportunities for us as well
as how are we going to integrate
this service within our health system, whether it
be a transport or
a transfer
and really understanding
(11:43):
what that means for us. Another area that
I think is important to talk about is
our team members and that's both providers as
well as your nurses, your techs.
It's easy to train somebody when you have
a unit open for them to train in.
When that unit doesn't exist yet, the unknown
is is very present. So we've needed to
(12:04):
get a little bit creative with what that
training looks like and having folks, you know,
leveraging our health system. We're we're lucky to
be a part of and getting training and
orientation in those emergency departments that already exist
is another really great opportunity that we have
as as well as the electronic medical record
build is something else. If there's not a
(12:25):
lot of programs like these, you don't have
a lot
of other
opportunities
to to build. So certainly,
we've all learned a lot and and are
eager to share it for others that might
be considering this. Thinking back
to just before COVID started is when we
decided we were going to open this emergency
(12:46):
department and when we looked at the actual
volumes of psychiatric patients in our health system,
our actual volume was about 14 patients per
day.
Fast forward,
we're at 22 patients per day. So I
think that we believe
that when we build this, that our volumes
would increase.
(13:07):
We weren't anticipating a pandemic, certainly, when when
we were building this pro form a.
But I think that
that has has required us to shift a
bit in our operational model and how quickly
we treat patients and and triage them and
get them to the appropriate level of care.
Once you're this far into the construction, you
(13:28):
can't say, hey, let's add another couple of
rooms. It's it's
certainly not that easy. So that's when you
start to need to make those operational shifts.
But when your projected senses
increases that significantly
before you even open, you you've got to
look at other things as well. When When
you talk about margins and cost as part
of a big investment for our health system,
how did you get everybody on the same
(13:49):
page and aligned with this new approach?
Sure. So when we were building this model,
we built it on
strict numbers of patients that were in our
emergency departments, our medical emergency departments, and the
true minutes that they were there, the volumes
that they were there. And when you look
(14:09):
at cost of that in a medical ED,
that can,
you know, a long stay patient
does drive cost up. Right? So really looking
at the right setting for that. And I
do think that it was part of our
mission. We've also been really lucky to build
some partnerships with the City Of Newport News
as well as the City Of Hampton.
(14:30):
And the City of Hampton has designated
some ARPA funds for for some of the
start up costs for this, whereas Newport News
dedicated dollars
to the development of our outpatient services because
both know that neither of these can be
successful independently. So we were really lucky to
to receive those grants. And
(14:52):
I also in talking about that, it's important
to mention the Department of Behavioral Health where
we did have a a partnership with them
to develop some of our detox and addiction
outpatient services. So certainly helpful with with all
of this, and we're eager to see what
budget gets approved and what other opportunities that
are will be there. I I love that
(15:13):
you see Roblox as opportunities.
What other considerations did you have with stigma
or how your organization is perceived?
So over the past six months, we've really
taken a look at at our name, Riverside
Behavioral Health Center,
and felt that it didn't really fit
what we were doing anymore.
More. So taking a step back from that
(15:35):
name and really looking at how our community
understands behavioral health, mental health, addiction, recovery,
really has kind of guided us to our
new name, Riverside Health and Recovery Center.
And I think part of that that has
happened is through the destigmatization
of mental health.
My dream is is at some point in
(15:57):
my lifetime that we're as comfortable talking about
mental health as we are our physical
health. And I think that COVID,
while it's been a, a very tragic, event
and, so many people are impacted by it,
it has facilitated more conversations about mental health.
And people are looking for resources.
(16:17):
They're comfortable saying, Hey, I'm anxious today. Hey,
I'm depressed. Where I think at the start
of my career, that wasn't an okay thing
to say. I think organizations
are saying, Okay, we need to consider mental
health days. And schools are talking about it,
and I think that's going to help guide
us
as we continue to care for for folks
(16:37):
and hopefully integrate this care into outpatient practices
and primary care offices and things like that.
But I think destigmatization
is really
growing folks interested in seeking care, which is
needed. You're doing so many things and you're
transforming, I think, the the landscape of behavioral
health care here, locally, if not in the
(16:58):
region, the state.
And you're doing a lot of things really
well. What what do you think you're doing
really well and what do you think you're
doing differently than your peers? So
I think that that we're in a place
today where a lot of people are focusing
on mental health.
I want to commend everyone that's doing it.
I think strategic
planning has really gotten us to where we
(17:18):
are today. We set a mission, we set
a goal, and and started tracking that and
how we get there is really what's laid
that foundation
for us and that's what's kept us on
track. It's something that I find incredibly important
just in general in leadership.
Your team needs to know where where you're
going so that they can help it as
(17:39):
well because these types of growth can't happen
with one person. So it's an entire team
really working together to lay out that plan.
So
I think that the simple answer is having
a plan and a road map that everyone
can see and everyone knows. And and that's
how everyone's gonna start rowing in the same
direction. So I think that's been our strength
(17:59):
in this whole process.
I think that during the construction of the
Psyche, you've been very inclusive of the team
members you bring to the table. If you
engaged your clinicians and you spoke with them,
you so I think just the
the inclusive
nature of of everything has really, I think,
helped.
At least with the construction, but I imagine
that's just you as a leader. Right? You're
you're probably pretty inclusive in in your initiative.
(18:22):
I think that it's critical to include team
members. I can sit here and make a
decision, but the reality is they're the ones
with the patients every day, and they're the
face. So it they have to, you know,
buy into whatever change is happening. So getting
feedback from them is really important. And
quite honestly, some of them are
smarter than me, so they can, you know,
can probably make a better recommendation. We've just
(18:43):
got to take that time to listen to
our our team. Can you tell us how
that inclusiveness extends to other organizations within the
community? Certainly. You can't build,
an emergency department or even outpatient services alone.
Virginia
has community services boards, and that's who would
do an evaluation for a patient if they
are incompetent to make a decision on their
(19:05):
own. So that feedback, we've been able to
talk to the magistrates
and see what they need. Our local EMS
has been really amazing
in setting up protocol
for who they can bring here versus a
medical emergency room and that partnership has just
been been priceless.
I think in terms of community,
(19:27):
the community is hungry for knowledge and such
as well. So we do have a behavioral
health education coordinator who is all throughout the
Peninsula
really, you know, talking about this and and
seeing what the community needs. I would say
that team member feedback is really important
when you're building programs like this and
and the success of those programs. And as
(19:49):
we were structuring our hospital, doing those safety
huddles with each team as a new unit
opened,
it could be something as simple as we
need post its to hey, this space doesn't
feel safe. That that's what we need to
be successful.
Many organizations have unique strategies they implement to
improve access to care and access to follow-up
care. Would you share some strategies that you've
(20:12):
found to be the most effective? And are
there any lessons
that other communities or organizations can learn from
your experiences?
One of the things that we we've found
incredibly important
is
ensuring that
all providers in our health system are aware
of the services that we provide. So we
have someone go out and educating
(20:32):
and going to their space.
The reality is behavioral health patients
are everywhere.
Our patients are in an oncology unit. They're
in an ICU unit. They're everywhere. So how
can we
meet those, really those frontline
team members to
advise them of what we've got, what resources
are available,
(20:52):
and even some simple things like what are
some signs and symptoms to look for and
and how can we help support. There's a
lot of things
related to how to talk to a patient
if you're worried they might be having thoughts
about self harm and really getting comfortable with
some of those uncomfortable
conversations. I think that's what's been most pivotal
(21:13):
for us as an organization.
And one of the the nice things to
see as we kind of go through this
destigmatization
process is parents hungry for for information.
How do I talk to my my teenager
or or my second grader? What does this
mean? What have I done wrong?
And really being able to create some of
(21:34):
those opportunities. It doesn't mean you've done anything
wrong. It's just we've got to get comfortable
with mental health. So I think that's been
really helpful for us is is engaging folks.
You serve many different populations at Riverside. You
have different ages, genders.
How do you manage that? How do you
manage when a patient shows up? They're a
(21:54):
a child or adolescent versus when they're an
adult. So I think the differences in in
age are one of the reasons we're really
looking forward to the psychiatric emergency department. So
we will have dedicated pediatric and adult treatment
areas.
That was really, really important
to us.
So the goal of the emergency department is
(22:14):
really to have that calming
area
where folks can get the best behavioral healthcare
possible.
So having those separate treatment areas was was
critical. We will certainly not close our doors
to anyone regardless of age, race, gender, any
of that. Regardless of diagnosis,
we are willing to treat anything from an
(22:36):
anxiety
disorder all the way up through a psychotic
disorder.
Recovery services will certainly be available.
And our ED is really laid out. We
had amazing architects that we worked with that
really kind of helped us
look at the flow and how that that
is is to really screen,
(22:56):
intervene,
and and then start treatment and referral right
away. And that our
layout will look like that, but it also
lends itself to a patient getting care really
quickly and whatever intervention they need
can happen almost immediately upon arrival. So that
was really important for us as well. We'll
also be accepting ambulances,
(23:17):
walk ins. We're just we're here to serve
the community.
You have two separate pods in your ED.
You have your adult pod and your pediatric
pod. And will your staff flex between the
two pods, or are you going to have
separate staff for each side? Certainly. So I
think both is probably the answer.
Our provider will certainly be able to see
both adults
(23:38):
and and pediatrics
depending on volumes. We've been able to create
some flex space as well, so it really
depends on what volumes look like on the
adult and pediatric side as to what assignments
might look like on that shift, But all
of our team members will be trained to
treat both adults and pediatrics.
That's great. What's next? What's next for you?
(23:59):
What's next for Riverside?
What's next I think is to continue to
grow. Right? To be able to meet whatever
our our patient needs are.
We have a good idea of what we're
going to see in our emergency department
but you don't know for sure till it's
here. So I think really taking a look
at the patients that are there and what
other resources
are needed. For them, I think that's going
(24:20):
to be really critical for our next step.
I think long term is really building that
integrated health system
where we can meet the behavioral health needs
of somebody that might be in a primary
care office or ortho office and really caring
for that whole person as opposed to segregating
the mental health and the physical health. So
let's care for the whole person. So
(24:42):
I think that's that's the dream. That's really
great. And you have plans to do that
with within the health system to integrate mental
health into primary care. And are you leading
the charge?
So I do have this amazing opportunity to
help set up a behavioral health service line
here at Riverside.
So we are excited. So, yes, those those
initiatives will be reporting to me as well.
(25:04):
Well, we're really excited to see this open.
The ribbon gutting is on October 5. Yes.
It's gonna be a a big event. It's
it's really important for the community and and
important for Riverside and every individual that needs
please
(25:28):
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