1 00:00:00,080 --> 00:00:02,720 Welcome everyone to the Becker's Healthcare podcast series. 2 00:00:02,720 --> 00:00:05,359 I'm Mariah Muhammad, writer and moderator with Becker's 3 00:00:05,359 --> 00:00:07,440 Healthcare. I'm thrilled to have with me today 4 00:00:07,440 --> 00:00:10,320 Renee Rafferty. Senior vice president of behavioral health 5 00:00:10,320 --> 00:00:13,199 and wellness is Sabrina Shally, director of behavioral 6 00:00:13,199 --> 00:00:16,355 health integration and program coordinator at Children's Nebraska. 7 00:00:16,574 --> 00:00:18,494 Renee and Sabrina, welcome to the podcast. We're 8 00:00:18,494 --> 00:00:20,355 very excited to have you join us today. 9 00:00:20,414 --> 00:00:21,774 To get a start, would you mind please 10 00:00:21,774 --> 00:00:23,454 introducing yourself and telling us a bit about 11 00:00:23,454 --> 00:00:26,114 your background? Yes. Thanks so much, Mariah. 12 00:00:26,894 --> 00:00:27,954 I'm Renee Rafferty, 13 00:00:28,429 --> 00:00:30,370 senior vice president of behavioral health and wellness. 14 00:00:30,589 --> 00:00:32,829 I am a therapist by trade and have 15 00:00:32,829 --> 00:00:35,070 been in a leadership role for over twenty 16 00:00:35,070 --> 00:00:37,710 years. I have will worked in the full 17 00:00:37,710 --> 00:00:39,489 continuum of care, outpatient, 18 00:00:39,869 --> 00:00:42,369 inpatient residential crisis services, 19 00:00:43,634 --> 00:00:45,954 as well as integrated behavioral health. And and 20 00:00:45,954 --> 00:00:47,634 just I'm very excited to talk with you 21 00:00:47,634 --> 00:00:48,134 today. 22 00:00:48,754 --> 00:00:51,174 And, yes, it's lovely to meet you, Mariah, 23 00:00:51,394 --> 00:00:53,155 and get a chance to share about our 24 00:00:53,155 --> 00:00:55,554 program. My name is Sabrina Shalley. I'm a 25 00:00:55,554 --> 00:00:57,655 licensed clinical social worker by discipline, 26 00:00:58,659 --> 00:01:00,979 and this is actually my thirtieth year in 27 00:01:00,979 --> 00:01:03,399 the field. I began as a, 28 00:01:03,940 --> 00:01:06,840 clinical counselor and therapist for adolescents, 29 00:01:07,140 --> 00:01:09,140 and working with kids and their families has 30 00:01:09,140 --> 00:01:09,640 remained 31 00:01:09,939 --> 00:01:12,040 my passion throughout my career, 32 00:01:12,834 --> 00:01:13,334 and, 33 00:01:13,875 --> 00:01:16,674 have also really been excited to lead Children 34 00:01:16,674 --> 00:01:18,854 Nebraska's efforts for suicide prevention, 35 00:01:19,474 --> 00:01:21,974 in hopes that we can accomplish zero suicides. 36 00:01:22,194 --> 00:01:24,194 So excited to talk more about our efforts 37 00:01:24,194 --> 00:01:25,254 in that space today. 38 00:01:25,670 --> 00:01:27,269 Yes. Yes. Thank you both for giving us 39 00:01:27,269 --> 00:01:30,310 that background and, obviously, amazing work that you 40 00:01:30,310 --> 00:01:33,269 are doing, in that field. Sabrina, going to 41 00:01:33,269 --> 00:01:33,989 you for, 42 00:01:34,469 --> 00:01:36,869 my first question. How did the idea for 43 00:01:36,869 --> 00:01:40,254 implementing caring context in a pediatric setting originate? 44 00:01:40,795 --> 00:01:43,435 And what made Children's Nebraska decide to adopt 45 00:01:43,435 --> 00:01:45,694 this historically adult focused intervention 46 00:01:45,995 --> 00:01:47,055 and lead its utilization 47 00:01:47,594 --> 00:01:48,895 for children and teens? 48 00:01:49,515 --> 00:01:51,034 Well, thank you so much for giving us 49 00:01:51,034 --> 00:01:52,795 a chance to tell this part of our 50 00:01:52,795 --> 00:01:53,295 story. 51 00:01:53,989 --> 00:01:56,310 I am celebrating eight years here at Children's 52 00:01:56,310 --> 00:01:58,549 Nebraska. And prior to the role I'm in 53 00:01:58,549 --> 00:02:01,209 now, I had the great opportunity to, 54 00:02:01,909 --> 00:02:04,709 support and lead the medical social workers, which 55 00:02:04,709 --> 00:02:06,569 included our emergency department 56 00:02:06,895 --> 00:02:09,634 social workers who in our continuum of care 57 00:02:09,854 --> 00:02:12,414 provided the mental health assessment for kids who 58 00:02:12,414 --> 00:02:15,235 were coming in for suicide ideation or suicidal 59 00:02:15,294 --> 00:02:15,794 behaviors. 60 00:02:16,495 --> 00:02:19,074 And when I joined Children's in 2017, 61 00:02:19,689 --> 00:02:21,449 it was right as we really began to 62 00:02:21,449 --> 00:02:23,370 see a ramp up in the number of 63 00:02:23,370 --> 00:02:25,629 kids needing to come in for those services. 64 00:02:26,490 --> 00:02:28,409 And as I was supporting those social workers, 65 00:02:28,409 --> 00:02:29,310 I was hearing 66 00:02:29,689 --> 00:02:31,849 about how difficult it was for them, you 67 00:02:31,849 --> 00:02:34,544 know, in a eight or twelve hour shift 68 00:02:34,544 --> 00:02:37,344 to be working with child after child after 69 00:02:37,344 --> 00:02:37,844 child. 70 00:02:38,784 --> 00:02:40,784 And so we were doing some things to 71 00:02:40,784 --> 00:02:42,085 try and support them. 72 00:02:42,625 --> 00:02:44,865 The medical team that surrounded them was amazing, 73 00:02:44,865 --> 00:02:46,544 but that was on my brain. At the 74 00:02:46,544 --> 00:02:47,444 same time, 75 00:02:47,860 --> 00:02:50,099 as a leader continuing to hear about we 76 00:02:50,099 --> 00:02:52,019 were we were nearly doubling our rates of 77 00:02:52,019 --> 00:02:53,400 kids needing new services. 78 00:02:53,780 --> 00:02:55,539 And I'll be honest, it was, 79 00:02:56,099 --> 00:02:58,659 fall season because I was watching a Kansas 80 00:02:58,659 --> 00:03:00,199 City Chiefs football game. 81 00:03:00,580 --> 00:03:02,519 We are in our glory years. I readily 82 00:03:02,659 --> 00:03:04,915 admit that. But during commercials is when I 83 00:03:04,915 --> 00:03:06,294 like to catch up on magazines. 84 00:03:06,594 --> 00:03:08,594 And there was a Time magazine article in 85 00:03:08,594 --> 00:03:09,895 the 2019 86 00:03:10,194 --> 00:03:12,675 all about these handwritten note cards that were 87 00:03:12,675 --> 00:03:16,534 used in adult substance use and misuse recovery. 88 00:03:17,090 --> 00:03:18,729 And I thought, oh, I don't really want 89 00:03:18,729 --> 00:03:20,709 to read this article right now. It's Sunday. 90 00:03:20,930 --> 00:03:22,930 I'm watching football. And I thought, no. I 91 00:03:22,930 --> 00:03:24,469 probably really need to read this. 92 00:03:24,849 --> 00:03:27,090 And I read it and I just thought 93 00:03:27,090 --> 00:03:30,405 that magic of that personal touch of when 94 00:03:30,784 --> 00:03:32,384 you get to meet someone in their most 95 00:03:32,384 --> 00:03:33,364 vulnerable moments 96 00:03:33,745 --> 00:03:34,245 and, 97 00:03:34,944 --> 00:03:37,344 they tell you their story and then you 98 00:03:37,344 --> 00:03:39,344 help them make recommendations of what the next 99 00:03:39,344 --> 00:03:40,724 step on their journey is, 100 00:03:41,344 --> 00:03:43,424 but then you don't have contact with them 101 00:03:43,424 --> 00:03:45,125 again potentially forever, 102 00:03:46,280 --> 00:03:48,199 how that must feel to the patient, let 103 00:03:48,199 --> 00:03:50,199 alone how that was feeling to the social 104 00:03:50,199 --> 00:03:52,520 workers. So I brought it to our emergency 105 00:03:52,520 --> 00:03:54,439 department social work team, and I said, what 106 00:03:54,439 --> 00:03:56,120 would you think if we tried something like 107 00:03:56,120 --> 00:03:56,620 this? 108 00:03:57,159 --> 00:03:59,099 And they all immediately got on board, 109 00:03:59,639 --> 00:04:01,914 and we're really excited about the opportunity. So 110 00:04:01,914 --> 00:04:03,534 we really dove in. We learned 111 00:04:03,995 --> 00:04:05,215 about zero suicide. 112 00:04:06,074 --> 00:04:08,794 We traced the history of these handwritten caring 113 00:04:08,794 --> 00:04:09,935 contacts note cards. 114 00:04:10,314 --> 00:04:12,974 We did some benchmarking with the Children's Hospital 115 00:04:13,114 --> 00:04:15,860 Association and found out this wasn't being utilized 116 00:04:15,860 --> 00:04:17,779 in any sort of environment that we could 117 00:04:17,779 --> 00:04:20,419 uncover. We had an amazing practicum student that 118 00:04:20,419 --> 00:04:22,019 helped us roll it out. And I want 119 00:04:22,019 --> 00:04:24,259 to bring back to attention the timeline that 120 00:04:24,259 --> 00:04:26,259 we started this, which was fall of twenty 121 00:04:26,259 --> 00:04:28,875 nineteen. We had no idea what was coming 122 00:04:28,875 --> 00:04:30,334 in March. 123 00:04:30,555 --> 00:04:32,394 We had set a go live date of 124 00:04:32,394 --> 00:04:34,074 05/01/2020, 125 00:04:34,074 --> 00:04:36,154 which took us about six months to develop 126 00:04:36,154 --> 00:04:36,814 the program, 127 00:04:37,435 --> 00:04:38,954 to create what we thought would be an 128 00:04:38,954 --> 00:04:40,334 effective clinical intervention. 129 00:04:40,849 --> 00:04:42,449 And I'm really proud to say that despite 130 00:04:42,449 --> 00:04:44,930 the COVID pandemic happening, we did go live 131 00:04:44,930 --> 00:04:46,389 on May 1. 132 00:04:47,089 --> 00:04:49,430 And since that time, we just celebrated, 133 00:04:50,050 --> 00:04:53,889 five years. We have enrolled nearly 1,200 134 00:04:53,889 --> 00:04:55,349 patients into the program. 135 00:04:56,085 --> 00:04:57,685 And the best news of all is we 136 00:04:57,685 --> 00:05:00,004 have zero deaths by suicide in our patient 137 00:05:00,004 --> 00:05:01,705 population in this space. So, 138 00:05:02,085 --> 00:05:04,345 that's how it came about, a random article 139 00:05:04,564 --> 00:05:05,384 being read, 140 00:05:05,845 --> 00:05:07,545 that was used in the adult space. 141 00:05:08,550 --> 00:05:10,629 Wow. That's absolutely amazing. Thank you so much 142 00:05:10,629 --> 00:05:12,870 for sharing that. And you're now five years 143 00:05:12,870 --> 00:05:14,009 into the program, 144 00:05:14,310 --> 00:05:16,469 and, obviously, it's going really well. But what 145 00:05:16,469 --> 00:05:18,949 outcomes or trends have surprised you the most, 146 00:05:19,189 --> 00:05:21,689 especially in terms of patient response and impact? 147 00:05:22,629 --> 00:05:23,610 Oh my goodness. 148 00:05:24,044 --> 00:05:26,365 You know, our biggest hope as we as 149 00:05:26,365 --> 00:05:28,625 we went into this is that, 150 00:05:29,084 --> 00:05:31,264 we really wanted to reduce 151 00:05:31,805 --> 00:05:34,285 our kids that were returning to us, for 152 00:05:34,285 --> 00:05:37,185 repeat suicide ideation or suicidal behavior. 153 00:05:37,644 --> 00:05:38,384 We also, 154 00:05:39,519 --> 00:05:41,199 thought that it might give us a chance 155 00:05:41,199 --> 00:05:44,159 to decrease the number of kids who died 156 00:05:44,159 --> 00:05:44,899 by suicide. 157 00:05:45,439 --> 00:05:48,639 We thought it would help normalize mental health 158 00:05:48,639 --> 00:05:50,879 and needing to come in for support with 159 00:05:50,879 --> 00:05:53,279 our pediatric health care team, but also we 160 00:05:53,279 --> 00:05:55,745 thought there was potential for it to impact 161 00:05:55,745 --> 00:05:58,485 our community in a positive way. And 162 00:05:59,024 --> 00:06:00,644 just showing a token 163 00:06:00,944 --> 00:06:01,764 of support 164 00:06:02,144 --> 00:06:04,324 for these individuals. I wanna be really clear 165 00:06:04,464 --> 00:06:07,104 that we never intended to replace the needed 166 00:06:07,104 --> 00:06:07,604 steps 167 00:06:07,909 --> 00:06:10,169 for kids after they come in for 168 00:06:10,709 --> 00:06:12,329 suicidal ideation or behaviors. 169 00:06:12,709 --> 00:06:15,509 We always needed to encourage them on to 170 00:06:15,509 --> 00:06:18,709 go into inpatient care or to connect with 171 00:06:18,709 --> 00:06:19,449 an outpatient 172 00:06:19,750 --> 00:06:21,689 or intensive outpatient team. 173 00:06:22,245 --> 00:06:24,965 These were really, like, we met you, we 174 00:06:24,965 --> 00:06:26,725 care about you, and we're gonna continue to 175 00:06:26,725 --> 00:06:28,485 cheer you on in your journey. So the 176 00:06:28,485 --> 00:06:30,345 cards are written really carefully, 177 00:06:31,365 --> 00:06:33,465 so that they speak to that component. 178 00:06:34,519 --> 00:06:37,080 But really, magic started to happen, and it 179 00:06:37,080 --> 00:06:39,959 started happening right away when the kids started 180 00:06:39,959 --> 00:06:41,399 writing back to us. And I have some 181 00:06:41,399 --> 00:06:43,420 cards I could read you some quotes from. 182 00:06:43,879 --> 00:06:46,120 We had no idea that the kids, you 183 00:06:46,120 --> 00:06:48,675 know, unprovoked, would choose to write. We've had 184 00:06:48,675 --> 00:06:51,154 kids that have called, like, our our Children's 185 00:06:51,154 --> 00:06:54,274 Nebraska agency line and say, hey. We're trying 186 00:06:54,274 --> 00:06:55,814 to track down a social worker, 187 00:06:56,115 --> 00:06:57,955 you know, and we don't we only remember 188 00:06:57,955 --> 00:06:59,955 her frictioning with this. And they literally, like, 189 00:06:59,955 --> 00:07:01,795 ping ponged through our system and are leaving 190 00:07:01,795 --> 00:07:03,495 messages for those social workers. 191 00:07:03,949 --> 00:07:06,029 We had no idea that we would hear 192 00:07:06,029 --> 00:07:06,930 from their families, 193 00:07:07,470 --> 00:07:09,790 that families were writing us and sending us 194 00:07:09,790 --> 00:07:11,009 pictures of their 195 00:07:11,389 --> 00:07:14,290 child. We got one picture where it was 196 00:07:14,509 --> 00:07:16,990 the child on their on their bed with 197 00:07:16,990 --> 00:07:17,889 their comfort 198 00:07:18,375 --> 00:07:18,875 cat, 199 00:07:19,335 --> 00:07:21,895 and all of the handwritten note cards. We 200 00:07:21,895 --> 00:07:23,514 send six in that year. 201 00:07:23,975 --> 00:07:24,955 We're all hanging 202 00:07:25,415 --> 00:07:27,095 by the side of her bed, and the 203 00:07:27,095 --> 00:07:29,495 mom was saying, this is the most amazing 204 00:07:29,495 --> 00:07:32,214 thing. They're concrete. They're tangible. She reads them 205 00:07:32,214 --> 00:07:33,115 over and over, 206 00:07:33,979 --> 00:07:35,579 and I just wanted you to see this 207 00:07:35,579 --> 00:07:37,660 picture of my happier and healthier child than 208 00:07:37,660 --> 00:07:39,039 when you first met her. 209 00:07:39,500 --> 00:07:40,720 We also then 210 00:07:41,180 --> 00:07:43,500 really didn't know that we would begin to 211 00:07:43,500 --> 00:07:46,139 see our social workers that were doing this 212 00:07:46,139 --> 00:07:48,455 work no longer felt like it was a 213 00:07:48,455 --> 00:07:50,295 churn and burn or a one and done 214 00:07:50,295 --> 00:07:52,314 environment. They actually felt 215 00:07:52,694 --> 00:07:53,595 that empowerment 216 00:07:54,214 --> 00:07:56,235 to continue to support the patients, 217 00:07:56,855 --> 00:07:59,654 in this really profound way. So the retention 218 00:07:59,654 --> 00:08:02,100 rate improved for us with our emergency department 219 00:08:02,180 --> 00:08:03,000 social workers. 220 00:08:03,300 --> 00:08:05,459 I think since we started, we've lost only 221 00:08:05,459 --> 00:08:07,480 one or two to moving out of state 222 00:08:07,860 --> 00:08:10,660 or, different positions in our organization, and so 223 00:08:10,660 --> 00:08:12,600 it's really stabilized that team. 224 00:08:13,540 --> 00:08:15,399 And then as we began to share 225 00:08:15,865 --> 00:08:17,784 successes after we've run the program for one 226 00:08:17,784 --> 00:08:18,284 year, 227 00:08:18,904 --> 00:08:21,724 it we heard from our division chief, 228 00:08:22,104 --> 00:08:24,584 of our emergency department. He said, hey. None 229 00:08:24,584 --> 00:08:26,344 of my peers are hearing any you know, 230 00:08:26,344 --> 00:08:28,264 they're not doing anything like this. We need 231 00:08:28,264 --> 00:08:30,204 to start telling people about the results. 232 00:08:30,990 --> 00:08:32,350 And so we've done a bit of that. 233 00:08:32,350 --> 00:08:34,750 We created a replication kit, and we've been 234 00:08:34,750 --> 00:08:35,250 able, 235 00:08:35,629 --> 00:08:36,690 to share that, 236 00:08:37,070 --> 00:08:38,529 with over 70 different, 237 00:08:38,909 --> 00:08:40,610 health care systems so far. 238 00:08:41,149 --> 00:08:43,330 So that's been been really exciting. 239 00:08:44,674 --> 00:08:46,754 Yeah. Yeah. As of that definitely sounds exciting. 240 00:08:46,754 --> 00:08:47,575 And you answered, 241 00:08:48,355 --> 00:08:50,514 my next question a little bit, but, obviously, 242 00:08:50,514 --> 00:08:53,394 the program has expanded significantly with over a 243 00:08:53,394 --> 00:08:55,095 thousand patients, enrolled, 244 00:08:55,554 --> 00:08:58,355 and replication kids share with hospitals and schools 245 00:08:58,355 --> 00:09:01,279 nationwide. Can you explain what the adoption process 246 00:09:01,279 --> 00:09:02,960 looks like? And you say you share you 247 00:09:02,960 --> 00:09:03,360 have, 248 00:09:04,080 --> 00:09:06,899 over 70 institutions that have adopted the model? 249 00:09:07,680 --> 00:09:10,580 We've shared with over 70 institutions, Mariah, 250 00:09:11,040 --> 00:09:13,360 and we're really pleased to do that. We're 251 00:09:13,360 --> 00:09:17,325 happy. We've presented on this program to conferences, 252 00:09:17,465 --> 00:09:19,945 to larger groups, but we also get thrilled 253 00:09:19,945 --> 00:09:20,764 to meet with, 254 00:09:21,304 --> 00:09:22,285 health care institutions 255 00:09:22,665 --> 00:09:24,764 one on one and really talk through 256 00:09:25,144 --> 00:09:27,304 how we've lifted the program here. I mean, 257 00:09:27,304 --> 00:09:28,524 you've got things like 258 00:09:28,889 --> 00:09:31,769 HIPAA and compliance. Right? We need to get 259 00:09:31,769 --> 00:09:34,430 guardian permission to be sending these note cards. 260 00:09:34,730 --> 00:09:35,129 We, 261 00:09:35,930 --> 00:09:36,830 need to ensure, 262 00:09:37,290 --> 00:09:39,370 that the patient expects that these cards are 263 00:09:39,370 --> 00:09:39,870 coming. 264 00:09:40,570 --> 00:09:42,384 And so we have a ninety per ninety 265 00:09:42,384 --> 00:09:44,544 eight percent of our patients that we offer 266 00:09:44,544 --> 00:09:45,605 this program to, 267 00:09:46,065 --> 00:09:48,485 choose to enroll. So that's really amazing. 268 00:09:49,024 --> 00:09:50,544 But I will say I don't know how 269 00:09:50,544 --> 00:09:52,804 many who have chosen to adopt the handwritten 270 00:09:52,865 --> 00:09:53,365 part. 271 00:09:53,904 --> 00:09:57,179 We're really grateful to Children's Nebraska that we 272 00:09:57,259 --> 00:09:59,980 are able to allocate our social workers time 273 00:09:59,980 --> 00:10:01,200 to writing these cards. 274 00:10:01,659 --> 00:10:03,339 I know there are some other health care 275 00:10:03,339 --> 00:10:05,580 institutions that are doing some really neat things 276 00:10:05,580 --> 00:10:06,799 with regard to texting 277 00:10:07,179 --> 00:10:08,159 and those components, 278 00:10:09,019 --> 00:10:10,779 but we haven't been able to argue with 279 00:10:10,779 --> 00:10:12,320 the results of zero suicide. 280 00:10:12,815 --> 00:10:15,934 We also have a substantial decrease in kids 281 00:10:15,934 --> 00:10:17,855 that are in the program that return to 282 00:10:17,855 --> 00:10:18,995 the emergency department, 283 00:10:19,774 --> 00:10:22,975 with regard to any sort of suicidal thoughts 284 00:10:22,975 --> 00:10:24,034 or or gestures. 285 00:10:24,975 --> 00:10:25,475 And, 286 00:10:25,934 --> 00:10:27,934 actually, we begin to see more and more 287 00:10:27,934 --> 00:10:28,649 of our kids, 288 00:10:29,129 --> 00:10:31,129 that we are seeing if they do come 289 00:10:31,129 --> 00:10:32,970 back, are able to discharge home with a 290 00:10:32,970 --> 00:10:35,290 safety plan and lethal means counseling as opposed 291 00:10:35,290 --> 00:10:37,450 to going into a higher level of care. 292 00:10:37,450 --> 00:10:38,889 So all of those things have told us 293 00:10:38,889 --> 00:10:41,450 we've really that we aren't at this time 294 00:10:41,450 --> 00:10:43,450 going to change our process, and we're gonna 295 00:10:43,450 --> 00:10:45,274 stick with the hand written cards. 296 00:10:46,214 --> 00:10:47,575 Got it. Got it. Thank you so much 297 00:10:47,575 --> 00:10:49,894 for explaining that. And read it Renee, how 298 00:10:49,894 --> 00:10:52,294 do you maintain the personal and meaningful nature 299 00:10:52,294 --> 00:10:54,475 of the handwritten notes, especially as the program 300 00:10:54,534 --> 00:10:55,034 scales? 301 00:10:55,495 --> 00:10:57,894 Can you share any memorable stories or feedback 302 00:10:57,894 --> 00:10:58,554 that really 303 00:11:04,620 --> 00:11:07,179 importance of using innovation and text is great, 304 00:11:07,179 --> 00:11:10,059 and those things are wonderful tools. And I 305 00:11:10,059 --> 00:11:12,514 think what we've realized through this program, 306 00:11:12,815 --> 00:11:14,815 when you send that card and that child 307 00:11:14,815 --> 00:11:16,334 was able to connect with the person that 308 00:11:16,334 --> 00:11:18,674 they sat with during their most difficult moment, 309 00:11:18,815 --> 00:11:20,754 they're able to recognize that 310 00:11:21,214 --> 00:11:22,034 this connection 311 00:11:22,735 --> 00:11:24,820 is a sign of hope and healing, and 312 00:11:24,820 --> 00:11:27,860 they get these multiple reminders of that courage 313 00:11:27,860 --> 00:11:29,700 it took to reach out, the ability to 314 00:11:29,700 --> 00:11:32,120 trust their own inner wisdom, and work with 315 00:11:32,259 --> 00:11:34,580 the the the person that's shared their story. 316 00:11:34,580 --> 00:11:36,200 So I think those cards, 317 00:11:37,034 --> 00:11:39,454 themselves are really a testament to the importance 318 00:11:39,514 --> 00:11:41,914 of connection and that however we heal is 319 00:11:41,914 --> 00:11:45,214 usually through connection with our caring team. And 320 00:11:45,434 --> 00:11:46,654 I think that the 321 00:11:47,115 --> 00:11:49,355 I'll have Sabrina read a card to you 322 00:11:49,355 --> 00:11:51,195 of of what is said because I think 323 00:11:51,195 --> 00:11:53,809 that just is is a one card from 324 00:11:53,809 --> 00:11:56,450 a child touches hundreds of caregivers because we 325 00:11:56,450 --> 00:11:59,649 do share the exciting words and not sharing 326 00:11:59,649 --> 00:12:01,330 the identity of the child, but just the 327 00:12:01,330 --> 00:12:04,210 healing that happens. And that, like Sabrina says, 328 00:12:04,210 --> 00:12:06,529 is so healing for the our team to 329 00:12:06,529 --> 00:12:09,295 remember that this treatment actually works. People do 330 00:12:09,295 --> 00:12:12,335 heal from mental health conditions, and they do 331 00:12:12,335 --> 00:12:14,754 really respond to powerful visits, 332 00:12:15,055 --> 00:12:17,535 and it can be trajectory changing. So, Wendy, 333 00:12:17,535 --> 00:12:18,975 you wanna go ahead and read one for 334 00:12:18,975 --> 00:12:21,235 us? Yes. Yes. I'm happy to. 335 00:12:21,750 --> 00:12:24,330 So, Mariah, here's a card we got back 336 00:12:24,470 --> 00:12:26,789 from one of our patients, and she writes, 337 00:12:26,789 --> 00:12:29,049 thank you so much for sending that letter. 338 00:12:29,190 --> 00:12:31,029 I can't even begin to tell you how 339 00:12:31,029 --> 00:12:32,870 much it meant to me. I got the 340 00:12:32,870 --> 00:12:35,269 letter the day of my birthday and started 341 00:12:35,269 --> 00:12:37,665 sobbing in the car. I'm glad I know 342 00:12:37,665 --> 00:12:39,904 I have someone rooting for me. It was 343 00:12:39,904 --> 00:12:42,085 so kind of you to reach out. 344 00:12:42,945 --> 00:12:45,264 I'll take a moment to read another one 345 00:12:45,264 --> 00:12:46,644 that I think is really impactful. 346 00:12:47,264 --> 00:12:48,245 This is someone, 347 00:12:48,865 --> 00:12:51,105 who wrote back after all six cards had 348 00:12:51,105 --> 00:12:53,370 been sent for that first year. And she 349 00:12:53,370 --> 00:12:55,529 says, I have always meant to write back 350 00:12:55,529 --> 00:12:56,269 to you. 351 00:12:56,809 --> 00:12:58,730 The cards mean so much to me. Each 352 00:12:58,730 --> 00:13:00,649 one is hanging up in my room. I 353 00:13:00,649 --> 00:13:02,490 wanted to let you know how much of 354 00:13:02,490 --> 00:13:04,649 an impact the cards have and to know 355 00:13:04,649 --> 00:13:07,129 someone I met once cares so deeply for 356 00:13:07,129 --> 00:13:09,274 me. I'm doing the best I have been 357 00:13:09,274 --> 00:13:11,995 since a year ago. I never imagined this 358 00:13:11,995 --> 00:13:14,475 much happiness was waiting for me. There have 359 00:13:14,475 --> 00:13:16,075 been hard times, but I have been able 360 00:13:16,075 --> 00:13:18,075 to overcome them and become better in the 361 00:13:18,075 --> 00:13:20,394 end. I can never thank you enough for 362 00:13:20,394 --> 00:13:22,254 all you have done in my healing journey. 363 00:13:22,649 --> 00:13:24,490 And, again, that's just a reminder that that 364 00:13:24,490 --> 00:13:27,389 social marker met this patient once and six 365 00:13:27,690 --> 00:13:30,570 handwritten note cards. I mean, again, just a 366 00:13:30,570 --> 00:13:31,389 bit of magic. 367 00:13:32,649 --> 00:13:35,050 Yeah. Absolutely. Thank you so much for sharing 368 00:13:35,050 --> 00:13:37,855 those. And looking ahead, how do you envision 369 00:13:37,855 --> 00:13:41,215 caring contacts evolving with Children's Nebraska? Are there 370 00:13:41,215 --> 00:13:44,335 any plans at all to expand beyond behavioral 371 00:13:44,335 --> 00:13:45,154 health into, 372 00:13:45,535 --> 00:13:48,174 other areas of care where connection might also 373 00:13:48,174 --> 00:13:49,075 improve outcomes? 374 00:13:50,379 --> 00:13:52,459 Yes. And I'll I'll answer the being that 375 00:13:52,459 --> 00:13:54,799 somebody you weigh in. But I think, ultimately, 376 00:13:54,939 --> 00:13:57,019 it's very important to say that, you know, 377 00:13:57,019 --> 00:14:00,299 interventions for kids experiencing mental health conditions happen 378 00:14:00,299 --> 00:14:01,679 across our continuum. 379 00:14:02,139 --> 00:14:04,379 We are training within Jones Nebraska. We have 380 00:14:04,379 --> 00:14:07,054 a program called COPE, which is children's outreach 381 00:14:07,674 --> 00:14:10,475 and provider education. And we train pediatricians to 382 00:14:10,475 --> 00:14:13,434 treat mild to moderate conditions within, 383 00:14:13,835 --> 00:14:15,915 primary care. And I think there's opportunities to 384 00:14:15,915 --> 00:14:18,394 expand in those types of settings to bring 385 00:14:18,475 --> 00:14:20,839 to outreach to other hospitals and to continue 386 00:14:20,839 --> 00:14:23,019 to talk about the importance of that personalized, 387 00:14:24,360 --> 00:14:27,240 deep trauma informed connection that allows for that 388 00:14:27,240 --> 00:14:29,339 sense of hope, which we know is really 389 00:14:29,480 --> 00:14:31,639 the key to healing. So I think we 390 00:14:31,639 --> 00:14:33,074 plan to you know, Sabrina's 391 00:14:33,375 --> 00:14:35,534 excellent at being able to support and to 392 00:14:35,534 --> 00:14:38,014 continue to provide that implementation. And we are 393 00:14:38,014 --> 00:14:39,774 gonna be using it as we expand our 394 00:14:39,774 --> 00:14:40,274 services. 395 00:14:40,654 --> 00:14:42,414 We have used it in our behavioral health 396 00:14:42,414 --> 00:14:43,235 urgent care, 397 00:14:44,014 --> 00:14:46,495 out in Kearney, Nebraska and have found that 398 00:14:46,495 --> 00:14:48,320 the kids absolutely love it out there as 399 00:14:48,320 --> 00:14:50,559 well. And so it's it's just a very 400 00:14:50,799 --> 00:14:52,820 it's a tool that we'll continue to support 401 00:14:52,959 --> 00:14:54,959 and offer to others as well as inside 402 00:14:54,959 --> 00:14:57,600 of our, inside of our programs, that are 403 00:14:57,600 --> 00:15:00,000 not just behavioral health programs or behavioral visits. 404 00:15:00,000 --> 00:15:00,465 They're, 405 00:15:00,945 --> 00:15:02,785 treating behavioral health in other parts of the 406 00:15:02,785 --> 00:15:03,285 continuum. 407 00:15:04,384 --> 00:15:05,925 Yeah. Agree with that, Renee. 408 00:15:06,305 --> 00:15:08,325 We've really been on a robust 409 00:15:08,705 --> 00:15:12,144 journey with zero suicide, and caring contacts falls 410 00:15:12,144 --> 00:15:14,250 under the transition arm of that. 411 00:15:14,649 --> 00:15:17,129 But what it's also taught us is that 412 00:15:17,129 --> 00:15:19,629 ability to have a conversation with the family 413 00:15:19,769 --> 00:15:21,389 while they're with us in crisis 414 00:15:21,769 --> 00:15:23,850 and saying, hey, we're gonna continue to support 415 00:15:23,850 --> 00:15:25,610 you, and this is what it'll look like. 416 00:15:25,610 --> 00:15:27,450 And we've added some other tools to that. 417 00:15:27,450 --> 00:15:30,105 We've really created a robust lethal means counseling 418 00:15:30,165 --> 00:15:33,065 program. We're not only we providing the concrete 419 00:15:33,125 --> 00:15:36,325 objects like lock boxes and gun locks and 420 00:15:36,325 --> 00:15:38,325 those sorts of things, but we also teach 421 00:15:38,325 --> 00:15:39,845 them how to do a home sweep. We 422 00:15:39,845 --> 00:15:41,684 send them home with those materials so they 423 00:15:41,684 --> 00:15:43,559 know how to make their home safer for 424 00:15:43,559 --> 00:15:44,779 their child to return. 425 00:15:45,720 --> 00:15:46,860 We have adapted 426 00:15:47,320 --> 00:15:49,399 the safety plan and are using it in 427 00:15:49,399 --> 00:15:51,899 really unique ways across our entire continuum. 428 00:15:52,519 --> 00:15:55,019 We do universal screening for depression and suicide 429 00:15:55,240 --> 00:15:56,700 across our Children's Nebraska, 430 00:15:57,845 --> 00:16:01,204 programs on units and clinics, which helps us 431 00:16:01,204 --> 00:16:03,544 identify kids, who are at risk. 432 00:16:04,084 --> 00:16:07,065 And just over last year, we identified 433 00:16:07,605 --> 00:16:10,245 well over 100 kids who actively had a 434 00:16:10,245 --> 00:16:12,404 suicidal plan that we're here for some other 435 00:16:12,404 --> 00:16:12,904 reason 436 00:16:13,320 --> 00:16:16,360 besides mental health care. And I think those 437 00:16:16,360 --> 00:16:18,059 are the things that keep us motivated 438 00:16:18,519 --> 00:16:21,100 moving forward just like these really amazing responses 439 00:16:21,160 --> 00:16:23,240 we get from our patients in the caring 440 00:16:23,240 --> 00:16:24,139 contact program. 441 00:16:25,455 --> 00:16:27,375 Wonderful. Thank you so much for explaining that. 442 00:16:27,375 --> 00:16:29,335 And, Sabrina, Renee, before I let you go, 443 00:16:29,335 --> 00:16:30,815 the last thing I wanted to ask is 444 00:16:30,815 --> 00:16:32,115 beyond caring context, 445 00:16:32,575 --> 00:16:35,795 how is Children's Nebraska leading excellence in pediatric 446 00:16:35,855 --> 00:16:36,915 behavioral health? 447 00:16:37,375 --> 00:16:39,295 What's on the horizon for bringing hope to 448 00:16:39,295 --> 00:16:41,039 children and families right now? 449 00:16:41,759 --> 00:16:43,600 That's a great question. I love answering it. 450 00:16:43,600 --> 00:16:45,279 It's such an exciting time to be part 451 00:16:45,279 --> 00:16:48,240 of Children's Nebraska. In January, 452 00:16:48,240 --> 00:16:50,399 we will be opening a behavioral health and 453 00:16:50,399 --> 00:16:52,980 wellness center that's part of our hospital system 454 00:16:53,365 --> 00:16:55,764 that provides a full continuum of care of 455 00:16:55,764 --> 00:16:57,065 behavioral health services. 456 00:16:57,524 --> 00:16:58,745 And this building, 457 00:16:59,285 --> 00:17:00,965 as being part of our health care system 458 00:17:00,965 --> 00:17:02,725 is unique in that it is also no 459 00:17:02,725 --> 00:17:05,205 wrong door. So when, kids have a behavioral 460 00:17:05,205 --> 00:17:06,884 health crisis, they can walk in our front 461 00:17:06,884 --> 00:17:08,940 door and they can receive behavioral health urgent 462 00:17:08,940 --> 00:17:10,940 care so they can meet with a therapist 463 00:17:10,940 --> 00:17:13,019 and work on, you know, a crisis that 464 00:17:13,019 --> 00:17:14,700 is occurring. But they can go back home 465 00:17:14,700 --> 00:17:16,700 and see be with their family if they're 466 00:17:16,700 --> 00:17:18,299 stable and can return back home. But we 467 00:17:18,299 --> 00:17:19,519 also have crisis stabilization 468 00:17:20,220 --> 00:17:22,325 that is, twenty three hours and fifty nine 469 00:17:22,325 --> 00:17:24,085 minutes. Kids can come in and stay for 470 00:17:24,085 --> 00:17:26,184 a while to provide more stabilization, 471 00:17:26,565 --> 00:17:28,744 be able to see a psychiatric nurse practitioner, 472 00:17:29,045 --> 00:17:29,545 psychiatrist, 473 00:17:30,164 --> 00:17:33,205 get therapy as peer support, and be able 474 00:17:33,205 --> 00:17:35,525 to receive those services that also can hopefully 475 00:17:35,525 --> 00:17:36,025 stabilize, 476 00:17:36,580 --> 00:17:38,820 them back to go home. But if need 477 00:17:38,820 --> 00:17:40,440 be, they can also be, 478 00:17:40,900 --> 00:17:42,200 admitted to an inpatient 479 00:17:42,580 --> 00:17:43,080 psychiatric 480 00:17:43,460 --> 00:17:46,019 unit that will help to offer that higher 481 00:17:46,019 --> 00:17:48,360 level of care for for acute services. 482 00:17:48,815 --> 00:17:51,234 We also will have a day treatment program 483 00:17:51,535 --> 00:17:53,954 that provides mental health care, 484 00:17:54,494 --> 00:17:55,634 as partial hospitalization. 485 00:17:56,255 --> 00:17:58,815 And then we have our eating disorder program 486 00:17:58,815 --> 00:18:00,734 that will also be expanding. It's a partial 487 00:18:00,734 --> 00:18:02,115 hospitalization we have, 488 00:18:02,460 --> 00:18:04,380 but we'll be expanding. So we have 10 489 00:18:04,380 --> 00:18:06,460 patients that can be in that program. So 490 00:18:06,460 --> 00:18:09,019 just a really large continuum of care, behavioral 491 00:18:09,019 --> 00:18:11,019 health service, as well as we'll have primary 492 00:18:11,019 --> 00:18:13,740 care located in our wellness center too. And 493 00:18:13,740 --> 00:18:16,079 the goal is to really help, destigmatize 494 00:18:16,380 --> 00:18:19,025 care, recognizing that please reach out early. 495 00:18:19,565 --> 00:18:20,045 Please, 496 00:18:20,445 --> 00:18:22,205 come in the door. We'll help you navigate 497 00:18:22,205 --> 00:18:25,105 the system and really create that seamless transition 498 00:18:25,244 --> 00:18:27,085 depending on what the child needs that families 499 00:18:27,085 --> 00:18:28,765 don't have to figure out where to go. 500 00:18:28,765 --> 00:18:30,684 We have excellent services right now, but it's 501 00:18:30,684 --> 00:18:32,605 just gonna be so exciting to offer the 502 00:18:32,684 --> 00:18:36,039 this, full continuum in January. 503 00:18:36,740 --> 00:18:38,900 Wonderful. Wonderful. Thank you both so much for 504 00:18:38,900 --> 00:18:41,059 those final thoughts. It's definitely been a very 505 00:18:41,059 --> 00:18:43,059 informative discussion. So, again, I wanna thank you 506 00:18:43,059 --> 00:18:44,820 so much for coming on Becker's Healthcare and 507 00:18:44,820 --> 00:18:47,320 explaining that. And I look forward to connecting 508 00:18:47,380 --> 00:18:48,759 again with you both soon. 509 00:18:49,432 --> 00:18:51,052 Thank you so much. So much, Brian.