1 00:00:00,080 --> 00:00:02,240 Welcome to the Becker's Healthcare podcast. I'm Chris 2 00:00:02,240 --> 00:00:03,839 Sosa, your host, and I'm thrilled to be 3 00:00:03,839 --> 00:00:06,319 joined today by doctor Kelly Sandberg, chief medical 4 00:00:06,319 --> 00:00:08,339 quality officer and a pediatric gastroenterologist 5 00:00:08,960 --> 00:00:09,939 at Dayton Children's, 6 00:00:10,320 --> 00:00:12,559 and his colleague, doctor Katie Winter, division chief 7 00:00:12,559 --> 00:00:13,219 of psychiatry 8 00:00:13,519 --> 00:00:14,500 at Dayton Children's. 9 00:00:14,814 --> 00:00:16,175 Kelly and Katie, thank you for joining us 10 00:00:16,175 --> 00:00:16,675 today. 11 00:00:16,975 --> 00:00:19,074 Pleasure to be here. Thank you. 12 00:00:19,614 --> 00:00:20,114 Wonderful. 13 00:00:20,654 --> 00:00:22,654 So for those in our audience who are 14 00:00:22,654 --> 00:00:25,214 maybe not familiar, could you please introduce yourselves 15 00:00:25,214 --> 00:00:26,574 and give us a little bit about your 16 00:00:26,574 --> 00:00:28,829 background? Kelly, let's start with you. 17 00:00:29,469 --> 00:00:31,949 Hi. I'm Kelly Sandberg. I've been a quality 18 00:00:31,949 --> 00:00:34,189 officer at Dayton Children's for the last, almost 19 00:00:34,189 --> 00:00:35,329 twelve years now. 20 00:00:35,710 --> 00:00:37,630 I've been involved in developing some of the 21 00:00:37,630 --> 00:00:41,090 infrastructure for quality improvement, process improvement, quality assurance, 22 00:00:41,629 --> 00:00:44,189 and, currently developing an institute of quality and 23 00:00:44,189 --> 00:00:44,689 safety. 24 00:00:45,175 --> 00:00:47,895 And Katie. Great. Hi. Thank you so much 25 00:00:47,895 --> 00:00:48,875 for having us. 26 00:00:49,335 --> 00:00:50,855 My name is Katie Wenner. I'm the chief 27 00:00:50,855 --> 00:00:52,954 of psychiatry here at Dayton Children's. 28 00:00:53,655 --> 00:00:55,975 My training is primarily in child and adolescent 29 00:00:55,975 --> 00:00:58,155 psychiatry and then also adult psychiatry. 30 00:00:58,719 --> 00:01:00,640 And most of my clinical time is spent 31 00:01:00,640 --> 00:01:02,820 on the inpatient mental health unit. 32 00:01:03,440 --> 00:01:05,120 Excellent. Thank you for sharing that, Kelly and 33 00:01:05,120 --> 00:01:07,040 Katie. So we have you on the podcast 34 00:01:07,040 --> 00:01:09,520 today to discuss everything. Well, maybe not everything, 35 00:01:09,520 --> 00:01:11,439 but the important things most important things Dayton 36 00:01:11,439 --> 00:01:14,625 Children's is doing in reducing mental health readmissions. 37 00:01:15,245 --> 00:01:16,444 So there are a lot of different ways 38 00:01:16,444 --> 00:01:18,704 we can go. But let's just start with 39 00:01:18,765 --> 00:01:21,424 what initiatives on that front have been successful. 40 00:01:21,724 --> 00:01:23,505 Kelly or Katie, just take it away. 41 00:01:24,365 --> 00:01:25,165 Alright. So, 42 00:01:26,420 --> 00:01:28,179 we have done a lot here at Dayton 43 00:01:28,179 --> 00:01:30,259 Children's. Things have really changed in the last, 44 00:01:30,739 --> 00:01:32,200 actually since 2019. 45 00:01:32,739 --> 00:01:35,879 That is when we opened our inpatient unit. 46 00:01:36,259 --> 00:01:38,739 And in that time, we realized pretty quickly 47 00:01:38,739 --> 00:01:40,099 that we did have a problem with the 48 00:01:40,099 --> 00:01:40,599 remissions, 49 00:01:41,055 --> 00:01:43,215 and kids kinda coming back and not getting 50 00:01:43,215 --> 00:01:44,814 what they needed out of the first time 51 00:01:44,814 --> 00:01:45,314 around. 52 00:01:45,935 --> 00:01:47,935 And so we actually did publish a paper, 53 00:01:48,255 --> 00:01:50,015 looking at some of our initiatives that we 54 00:01:50,015 --> 00:01:51,954 did in quality improvement on the unit. 55 00:01:52,415 --> 00:01:53,694 And so some of the things that we 56 00:01:53,694 --> 00:01:56,515 did here were, remission programming. So 57 00:01:57,609 --> 00:01:59,950 most inpatient units will do the same programming 58 00:02:00,010 --> 00:02:01,710 kind of over and over. We're like Groundhog's 59 00:02:01,770 --> 00:02:03,770 Day. You wake up. You go to groups. 60 00:02:03,770 --> 00:02:05,130 You do the same kind of groups. The 61 00:02:05,130 --> 00:02:06,570 next day, you wake up and do groups, 62 00:02:06,570 --> 00:02:08,990 maybe a little bit different, but similar topics. 63 00:02:09,365 --> 00:02:11,444 So what we looked at was trying to 64 00:02:11,444 --> 00:02:13,605 come up with a more individualized plan for 65 00:02:13,605 --> 00:02:15,685 the kids that came back to us to 66 00:02:15,685 --> 00:02:17,224 really be able to 67 00:02:17,844 --> 00:02:20,724 better understand what didn't hit the mark, what 68 00:02:20,724 --> 00:02:22,680 problems did we not address last time they 69 00:02:22,680 --> 00:02:24,360 were here, and then how do we make 70 00:02:24,360 --> 00:02:26,039 changes so that we're not doing the same 71 00:02:26,039 --> 00:02:29,340 thing over and over again expecting different outcomes. 72 00:02:30,759 --> 00:02:32,439 One of the other initiatives that we looked 73 00:02:32,439 --> 00:02:35,239 at were, follow-up phone calls. So this is 74 00:02:35,239 --> 00:02:37,914 something that is pretty simple, but when families 75 00:02:37,914 --> 00:02:39,375 are here on our unit, 76 00:02:39,995 --> 00:02:42,474 or in any hospital setting, they're in crisis. 77 00:02:42,474 --> 00:02:44,555 And so it is very challenging for them 78 00:02:44,555 --> 00:02:46,655 to be able to absorb all the information 79 00:02:47,354 --> 00:02:49,775 that and everything that's going on around them. 80 00:02:50,030 --> 00:02:52,030 So what we started doing was when a 81 00:02:52,030 --> 00:02:53,949 family leaves, we try to give them a 82 00:02:53,949 --> 00:02:56,750 call anytime between twenty four hours or seventy 83 00:02:56,750 --> 00:02:58,930 two hours after they leave just to review 84 00:02:59,310 --> 00:03:01,789 how, you know, the discharge information that they 85 00:03:01,789 --> 00:03:03,709 have. Can you make the follow-up appointments? Were 86 00:03:03,709 --> 00:03:05,009 you able to get your medications? 87 00:03:05,495 --> 00:03:07,174 Just to problem solve to make sure there 88 00:03:07,174 --> 00:03:09,094 are no issues that we might be able 89 00:03:09,094 --> 00:03:09,594 to 90 00:03:09,894 --> 00:03:11,834 address before another crisis, 91 00:03:12,534 --> 00:03:13,034 appears. 92 00:03:13,734 --> 00:03:16,555 We also looked at our group structure itself. 93 00:03:16,694 --> 00:03:19,574 So part of our quality improvement was collecting 94 00:03:19,574 --> 00:03:22,550 data of why are these kids coming in. 95 00:03:22,770 --> 00:03:24,229 And what we found was 96 00:03:24,530 --> 00:03:26,930 conflict. There was conflict at home. There was 97 00:03:26,930 --> 00:03:29,430 conflict at school. There was conflict with peers, 98 00:03:29,889 --> 00:03:32,449 teachers, and kids did not have the tools 99 00:03:32,449 --> 00:03:34,370 that they needed to be able to deal 100 00:03:34,370 --> 00:03:35,270 with that conflict. 101 00:03:35,715 --> 00:03:38,275 So we added conflict management into all of 102 00:03:38,275 --> 00:03:40,754 our groups for every child to ensure that 103 00:03:40,754 --> 00:03:43,474 they had the communication skills, the empathy, and 104 00:03:43,474 --> 00:03:44,294 anger management 105 00:03:44,675 --> 00:03:46,675 to try to better deal with what was 106 00:03:46,675 --> 00:03:47,894 going on in their lives. 107 00:03:48,599 --> 00:03:50,680 And then the last one that we really 108 00:03:50,680 --> 00:03:51,659 looked at was 109 00:03:52,039 --> 00:03:54,120 a remission checklist, and this was really just 110 00:03:54,120 --> 00:03:56,199 a way to standardize what we were doing 111 00:03:56,199 --> 00:03:57,960 and make sure that no matter who you 112 00:03:57,960 --> 00:04:00,360 got assigned to your treatment team, you got 113 00:04:00,360 --> 00:04:02,539 the same options for aftercare, 114 00:04:03,240 --> 00:04:04,300 available to you. 115 00:04:04,974 --> 00:04:06,495 Katie, thank you for taking us through all 116 00:04:06,495 --> 00:04:08,014 of that. And so I have follow-up question 117 00:04:08,014 --> 00:04:08,495 on that. 118 00:04:08,895 --> 00:04:11,295 Just given when you started in 2019, was 119 00:04:11,295 --> 00:04:12,034 there a certain 120 00:04:12,495 --> 00:04:15,375 model from another department, another health system, hospital, 121 00:04:15,375 --> 00:04:17,339 anything like that that you look to? Or 122 00:04:17,419 --> 00:04:18,860 tell us a little bit about how you, 123 00:04:19,339 --> 00:04:21,180 built that program with those four steps that 124 00:04:21,180 --> 00:04:21,839 you mentioned. 125 00:04:22,939 --> 00:04:26,220 Yeah. So, I will say our collaboration within 126 00:04:26,220 --> 00:04:28,399 mental health, we are a small group 127 00:04:29,435 --> 00:04:31,915 of mental health providers across the country. And 128 00:04:31,915 --> 00:04:34,654 so, there are children's hospital collaboratives 129 00:04:34,955 --> 00:04:38,574 that, we get together with. Ohio is wonderful 130 00:04:38,634 --> 00:04:41,595 and that we have five pediatric hospitals that 131 00:04:41,595 --> 00:04:43,935 we talk to on a pretty regular basis 132 00:04:44,074 --> 00:04:44,574 about 133 00:04:44,889 --> 00:04:47,230 what they're experiencing, how they did things. 134 00:04:47,930 --> 00:04:49,069 And so we 135 00:04:49,449 --> 00:04:51,610 we went to a lot of these hospitals. 136 00:04:51,610 --> 00:04:53,230 We observed what they were doing. 137 00:04:53,850 --> 00:04:55,629 We've reached out. We asked questions. 138 00:04:56,089 --> 00:04:58,350 And so we leaned very heavily on others' 139 00:04:58,410 --> 00:04:58,910 learnings 140 00:04:59,615 --> 00:05:01,774 and trying to make the best program that 141 00:05:01,774 --> 00:05:02,595 we could make. 142 00:05:03,375 --> 00:05:06,014 Makes total sense. Kelly, Katie, so next question 143 00:05:06,014 --> 00:05:07,555 I have for you is now that you've 144 00:05:07,615 --> 00:05:09,154 come as far as you have, 145 00:05:09,694 --> 00:05:11,615 how do you think Dayton Children's is going 146 00:05:11,615 --> 00:05:13,294 to be able to build on the success 147 00:05:13,294 --> 00:05:14,194 that you've had? 148 00:05:15,100 --> 00:05:15,600 So, 149 00:05:16,379 --> 00:05:18,459 obviously, as I mentioned, we started this back 150 00:05:18,459 --> 00:05:19,439 in 2019, 151 00:05:19,979 --> 00:05:21,899 and it has been a process. The world 152 00:05:21,899 --> 00:05:23,819 has changed quite a bit in that time 153 00:05:23,819 --> 00:05:24,319 period. 154 00:05:24,939 --> 00:05:27,099 And our families have changed, what the needs 155 00:05:27,099 --> 00:05:29,175 of the kids in our community have changed, 156 00:05:29,175 --> 00:05:31,274 and then the resources have also changed. 157 00:05:32,055 --> 00:05:32,555 So 158 00:05:32,855 --> 00:05:35,095 despite that, we are still doing pretty much 159 00:05:35,095 --> 00:05:37,194 every one of those initiatives, but we've expanded 160 00:05:37,254 --> 00:05:37,754 them. 161 00:05:38,134 --> 00:05:39,735 And so I'll take the phone calls for 162 00:05:39,735 --> 00:05:40,235 instance. 163 00:05:40,855 --> 00:05:42,855 The phone calls we started off on our 164 00:05:42,855 --> 00:05:46,209 unit, but now we do them throughout all 165 00:05:46,209 --> 00:05:48,370 of pretty much Dayton Children's. But one of 166 00:05:48,370 --> 00:05:50,529 the places that we really expanded to, first 167 00:05:50,529 --> 00:05:53,089 off, was our crisis center. And our crisis 168 00:05:53,089 --> 00:05:56,230 center is, kind of like a psychiatric emergency 169 00:05:56,370 --> 00:05:56,870 room, 170 00:05:57,605 --> 00:05:59,685 where two thirds of those kids actually go 171 00:05:59,685 --> 00:06:00,185 home. 172 00:06:00,964 --> 00:06:03,365 And so we are now calling them to 173 00:06:03,365 --> 00:06:04,665 make sure that they understand 174 00:06:05,285 --> 00:06:08,004 what discharge instructions, making sure that they're able 175 00:06:08,004 --> 00:06:10,004 to get into those providers so that they're 176 00:06:10,004 --> 00:06:11,464 not into another crisis. 177 00:06:12,759 --> 00:06:15,020 As we I already mentioned, the collaboration 178 00:06:15,480 --> 00:06:16,779 piece is is huge. 179 00:06:17,480 --> 00:06:19,899 We have been working with all of the 180 00:06:20,040 --> 00:06:20,939 Ohio hospitals. 181 00:06:21,560 --> 00:06:23,160 You know, how do we continue to move 182 00:06:23,160 --> 00:06:25,240 forward and make sure that we are taking 183 00:06:25,240 --> 00:06:27,509 ideas and sharing ideas when it works. And 184 00:06:27,935 --> 00:06:29,214 then I will say the other piece of 185 00:06:29,214 --> 00:06:29,714 this 186 00:06:30,175 --> 00:06:32,574 project that I feel like was really just 187 00:06:32,574 --> 00:06:33,795 eye opening was 188 00:06:34,175 --> 00:06:37,314 that it's not difficult to put quality improvement 189 00:06:37,375 --> 00:06:40,175 into pretty much every practice, routine practices. So 190 00:06:40,175 --> 00:06:41,955 it has now become part of 191 00:06:42,415 --> 00:06:43,235 our leadership, 192 00:06:44,199 --> 00:06:45,659 on the mental health unit, 193 00:06:46,439 --> 00:06:48,839 where we use things like the tools we 194 00:06:48,839 --> 00:06:50,300 had, the checklist, standardizations, 195 00:06:50,919 --> 00:06:53,079 and we built dashboards. That way, we can 196 00:06:53,079 --> 00:06:55,560 monitor and make sure we're running an efficient 197 00:06:55,560 --> 00:06:57,339 system that is providing 198 00:06:57,720 --> 00:06:59,419 the care that we need to provide. 199 00:07:00,175 --> 00:07:02,814 Chris, another thing, as we're talking about building 200 00:07:02,814 --> 00:07:04,975 on success, you know, Katie has talked a 201 00:07:04,975 --> 00:07:07,454 lot about inpatient, and she just mentioned the 202 00:07:07,454 --> 00:07:09,854 crisis center just a second ago. But she, 203 00:07:09,854 --> 00:07:12,014 of course, is in charge of a lot 204 00:07:12,014 --> 00:07:14,334 more than just those two areas as well. 205 00:07:14,334 --> 00:07:14,995 She does, 206 00:07:15,750 --> 00:07:16,729 intensive outpatient. 207 00:07:17,509 --> 00:07:19,750 They have an outpatient day treatment program. They 208 00:07:19,750 --> 00:07:22,569 have counseling services. They have other things. So 209 00:07:22,629 --> 00:07:24,169 part of the reason why, 210 00:07:24,550 --> 00:07:27,029 you know, there there's a broader system and 211 00:07:27,029 --> 00:07:30,089 a broader support in place that does support, 212 00:07:30,824 --> 00:07:32,264 the work that's going on in both the 213 00:07:32,264 --> 00:07:34,204 crisis center and the inpatient unit. 214 00:07:35,944 --> 00:07:36,845 I I think, 215 00:07:37,305 --> 00:07:40,185 also that and Katie, correct me if if 216 00:07:40,185 --> 00:07:42,425 I'm speaking out of turn here, but there 217 00:07:42,425 --> 00:07:43,339 are are plans 218 00:07:43,639 --> 00:07:44,860 to, expand, 219 00:07:45,319 --> 00:07:47,959 the mental health, beds. And so, you know, 220 00:07:47,959 --> 00:07:50,360 if we've been successful, then we should be 221 00:07:50,360 --> 00:07:51,020 able to, 222 00:07:51,800 --> 00:07:53,580 help the community by expanding, 223 00:07:53,959 --> 00:07:55,100 you know, that resource, 224 00:07:55,514 --> 00:07:58,314 as well as offering community additional resources with 225 00:07:58,314 --> 00:07:59,935 respect to mental health and, 226 00:08:00,634 --> 00:08:02,794 starting to tackle some of the social drivers 227 00:08:02,794 --> 00:08:03,694 of of health. 228 00:08:04,634 --> 00:08:06,235 Yes. I I agree that we have been 229 00:08:06,235 --> 00:08:09,480 able to expand, and and I don't wanna 230 00:08:09,480 --> 00:08:11,240 say there was every part of it was 231 00:08:11,240 --> 00:08:14,040 easy. But the actual patient care piece of 232 00:08:14,040 --> 00:08:16,040 it, the how to make sure that we 233 00:08:16,040 --> 00:08:18,540 are doing the same things in one location 234 00:08:19,079 --> 00:08:21,805 or with 24 beds versus 48 beds once 235 00:08:21,805 --> 00:08:23,884 we get there. I feel because we have 236 00:08:23,884 --> 00:08:26,845 become more efficient, it's become an easier system. 237 00:08:26,845 --> 00:08:29,564 So that expansion has not been taxing on 238 00:08:29,564 --> 00:08:30,225 the teams. 239 00:08:30,845 --> 00:08:33,264 It's been easier to ensure that we are 240 00:08:34,720 --> 00:08:36,080 doing, you know, the same thing and that 241 00:08:36,080 --> 00:08:38,000 we have fidelity in what we're doing. So 242 00:08:39,040 --> 00:08:41,860 I very much appreciate you qualifying and clarifying 243 00:08:41,920 --> 00:08:44,080 that, Katie. I'm sure thankfully, I don't think 244 00:08:44,080 --> 00:08:46,320 our listeners hear this and think, oh, this 245 00:08:46,320 --> 00:08:48,805 was easy. I think they understand very much 246 00:08:48,805 --> 00:08:50,825 so that any part of the job that 247 00:08:50,884 --> 00:08:52,725 that you both are doing and others in 248 00:08:52,725 --> 00:08:54,565 your position are doing is is very difficult. 249 00:08:54,565 --> 00:08:56,725 But I do certainly, you know, there there's 250 00:08:56,725 --> 00:08:58,004 much to be said for the way you 251 00:08:58,004 --> 00:08:58,825 laid it out. 252 00:08:59,205 --> 00:09:00,884 Katie, I do wanna follow-up with you on 253 00:09:00,884 --> 00:09:01,785 something. So 254 00:09:02,240 --> 00:09:04,079 obviously, no one can monitor all the phone 255 00:09:04,079 --> 00:09:05,839 calls that are happening and that I mean, 256 00:09:05,839 --> 00:09:07,220 between the two of you. But 257 00:09:07,600 --> 00:09:10,559 when you're taking in the feedback at Dayton 258 00:09:10,559 --> 00:09:11,059 Children's, 259 00:09:11,839 --> 00:09:14,720 what have you heard from patients that says 260 00:09:14,720 --> 00:09:16,399 to you, hey. This is really working for 261 00:09:16,399 --> 00:09:18,485 us and for them, more importantly. 262 00:09:19,345 --> 00:09:21,044 So I will say just today, 263 00:09:22,144 --> 00:09:23,044 I had, 264 00:09:23,504 --> 00:09:25,524 been reviewing. We we do, 265 00:09:26,304 --> 00:09:28,544 patients can, you know, review us and give 266 00:09:28,544 --> 00:09:30,944 us scores. And one of the comments actually 267 00:09:30,944 --> 00:09:32,485 was about the phone calls 268 00:09:32,789 --> 00:09:36,149 and how they felt so much wrap around 269 00:09:36,149 --> 00:09:36,889 from our 270 00:09:37,269 --> 00:09:39,350 team that they were calling just to check-in 271 00:09:39,350 --> 00:09:40,169 on their child 272 00:09:40,549 --> 00:09:42,230 and to make sure that they really had 273 00:09:42,230 --> 00:09:44,950 the tools available to them that they needed. 274 00:09:44,950 --> 00:09:46,945 And so it was really nice to just 275 00:09:46,945 --> 00:09:49,044 kinda see that full circle, 276 00:09:49,584 --> 00:09:52,304 that what we're doing does matter to the 277 00:09:52,304 --> 00:09:52,804 families. 278 00:09:54,065 --> 00:09:56,084 No doubt. No. That's wonderful to hear. 279 00:09:56,464 --> 00:09:58,945 Lastly, I simply wanna ask you both, just 280 00:09:58,945 --> 00:10:01,584 given your experience now since 2019 and and 281 00:10:01,584 --> 00:10:03,450 stretching back further if you prefer. 282 00:10:04,070 --> 00:10:05,669 What advice do you have for other health 283 00:10:05,669 --> 00:10:08,330 systems, other organizations who are looking to launch, 284 00:10:08,870 --> 00:10:11,269 similar initiatives? So, Kelly, let's start with you 285 00:10:11,269 --> 00:10:11,769 there. 286 00:10:12,549 --> 00:10:14,250 I think from a system standpoint, 287 00:10:15,384 --> 00:10:16,445 especially from, 288 00:10:17,144 --> 00:10:19,945 you know, the mental health standpoint, objectively listening 289 00:10:19,945 --> 00:10:21,085 to frontline leaders. 290 00:10:21,705 --> 00:10:23,945 And in that in this case, you know, 291 00:10:23,945 --> 00:10:26,105 it it's not just doctors and nurses, but 292 00:10:26,105 --> 00:10:28,745 it's also the therapists and the community health 293 00:10:28,745 --> 00:10:30,044 workers and others, 294 00:10:30,830 --> 00:10:31,490 to understand 295 00:10:31,790 --> 00:10:33,870 kind of the pain points and understand what 296 00:10:33,870 --> 00:10:35,410 it is that we're trying to do. 297 00:10:35,790 --> 00:10:37,470 And then, you know, at some point along 298 00:10:37,470 --> 00:10:39,149 the way, you know, I'm not a mental 299 00:10:39,149 --> 00:10:41,230 health provider, but yet I I can serve 300 00:10:41,230 --> 00:10:43,950 as a as a sounding board and someone 301 00:10:43,950 --> 00:10:45,410 to check assumptions against. 302 00:10:45,804 --> 00:10:47,184 So Katie had mentioned, 303 00:10:48,045 --> 00:10:50,304 you know, something about conflict management. 304 00:10:51,165 --> 00:10:54,205 That was not initially inherent until we had 305 00:10:54,205 --> 00:10:57,004 some robust back and forth discussions and questions 306 00:10:57,004 --> 00:10:57,665 and answers. 307 00:10:58,125 --> 00:11:00,950 And so having kind of, someone who's not 308 00:11:00,950 --> 00:11:03,690 necessarily a subject matter expertise, but perhaps, 309 00:11:04,389 --> 00:11:06,870 you know, an expert in quality improvement or 310 00:11:06,870 --> 00:11:07,769 process improvement, 311 00:11:08,549 --> 00:11:10,330 or safety can be really helpful. 312 00:11:11,029 --> 00:11:13,110 I think also finding the key stakeholders in 313 00:11:13,110 --> 00:11:15,875 the community, whether they be from other surrounding 314 00:11:15,875 --> 00:11:16,375 hospitals, 315 00:11:17,394 --> 00:11:20,355 in the community or as, Katie has mentioned, 316 00:11:20,355 --> 00:11:22,995 you know, the children's hospitals have a lot 317 00:11:22,995 --> 00:11:23,894 of great collaboratives. 318 00:11:24,355 --> 00:11:25,794 You know, a lot of us are dealing 319 00:11:25,794 --> 00:11:27,894 with the same challenges and the same 320 00:11:28,279 --> 00:11:28,779 restraints. 321 00:11:29,639 --> 00:11:32,440 And so just understanding what others are doing 322 00:11:32,440 --> 00:11:34,840 and listening and agreeing that we're here to 323 00:11:34,840 --> 00:11:37,320 take care of, you know, patients, take care 324 00:11:37,320 --> 00:11:38,059 of kids. 325 00:11:38,519 --> 00:11:40,759 Those, you know, key stakeholders in the community 326 00:11:40,759 --> 00:11:41,676 could also include, you know, organizations that support 327 00:11:41,676 --> 00:11:42,040 homelessness or group homes or seeing how, you 328 00:11:42,040 --> 00:11:42,540 know, 329 00:11:43,884 --> 00:11:44,384 homelessness 330 00:11:44,684 --> 00:11:47,404 or group homes or seeing how, you know, 331 00:11:47,404 --> 00:11:49,884 and understanding what their challenges are so that 332 00:11:49,884 --> 00:11:50,704 we could better, 333 00:11:51,164 --> 00:11:53,745 you know, work together for, for the kids. 334 00:11:54,284 --> 00:11:56,444 And then finally, you know, working with appropriate 335 00:11:56,444 --> 00:11:58,625 government leaders to ensure that they understand, 336 00:11:59,459 --> 00:12:02,279 the realities of of providing care, 337 00:12:02,819 --> 00:12:04,199 in 2026. 338 00:12:04,579 --> 00:12:07,620 It's an ever changing landscape and if they, 339 00:12:07,620 --> 00:12:09,799 you know, if the decision makers in government 340 00:12:09,860 --> 00:12:10,679 don't have, 341 00:12:11,220 --> 00:12:12,980 a clear line of sight into what's going 342 00:12:12,980 --> 00:12:15,164 on, especially in the mental health spaces, 343 00:12:16,264 --> 00:12:17,164 we're really, 344 00:12:17,625 --> 00:12:19,644 kind of a a two hit on that, 345 00:12:20,024 --> 00:12:22,024 where we're first hit from, you know, not 346 00:12:22,024 --> 00:12:24,264 having the need needed resources, but also not 347 00:12:24,264 --> 00:12:25,804 having the understanding when, 348 00:12:26,264 --> 00:12:28,205 you know, legislation is brought forward. 349 00:12:29,480 --> 00:12:30,919 Makes a lot of sense, Kelly. Thank you 350 00:12:30,919 --> 00:12:33,240 for laying out all those steps, on from 351 00:12:33,240 --> 00:12:36,200 the operational standpoint. It's very, very helpful. Katie, 352 00:12:36,200 --> 00:12:38,200 I'm looking forward to hearing what you add 353 00:12:38,200 --> 00:12:39,179 to this as well. 354 00:12:39,879 --> 00:12:42,764 Yeah. I I feel like my answer to 355 00:12:42,764 --> 00:12:44,925 kinda how to give advice to this, is 356 00:12:44,925 --> 00:12:45,425 probably 357 00:12:45,965 --> 00:12:49,165 very simple. It's sometimes just jumping in, finding 358 00:12:49,165 --> 00:12:51,644 something that you're passionate about, and then finding 359 00:12:51,644 --> 00:12:52,304 a mentor. 360 00:12:52,845 --> 00:12:55,644 So Kelly was the mentor in this. Kelly 361 00:12:55,644 --> 00:12:57,980 has been the cheerleader in this despite not 362 00:12:57,980 --> 00:12:58,480 being, 363 00:12:59,179 --> 00:13:00,879 a mental health, you know, 364 00:13:01,259 --> 00:13:04,779 practitioner. He has encouraged us to really, you 365 00:13:04,779 --> 00:13:06,860 know, jump in, look at the data, and 366 00:13:06,860 --> 00:13:09,980 really get together and think of what can 367 00:13:09,980 --> 00:13:10,720 we do. 368 00:13:11,084 --> 00:13:13,404 As he mentioned, resources aren't always available, but 369 00:13:13,404 --> 00:13:15,644 there are small changes, things like a phone 370 00:13:15,644 --> 00:13:18,544 call that don't take a lot of resources 371 00:13:18,764 --> 00:13:20,544 that you can make a difference. 372 00:13:21,164 --> 00:13:23,884 So I just encourage people to really just 373 00:13:23,884 --> 00:13:25,184 think about what 374 00:13:25,659 --> 00:13:27,419 problems they feel like they have in the 375 00:13:27,419 --> 00:13:30,059 system and see how, you know, even that 376 00:13:30,059 --> 00:13:32,879 small change might actually make a big impact. 377 00:13:34,059 --> 00:13:35,820 Excellent advice to be sure no one can 378 00:13:35,820 --> 00:13:37,500 do any of this all by themselves. And 379 00:13:37,500 --> 00:13:39,284 clearly, you guys have gotten a long way, 380 00:13:39,684 --> 00:13:42,164 looking not only to each other, but, other 381 00:13:42,164 --> 00:13:42,664 people, 382 00:13:43,125 --> 00:13:44,264 who have been very helpful. 383 00:13:44,725 --> 00:13:47,044 Kelly, Katie, thank you so much for being 384 00:13:47,044 --> 00:13:48,345 on the podcast today. 385 00:13:48,725 --> 00:13:50,324 Thank you very much, Chris. It's been a 386 00:13:50,324 --> 00:13:51,704 pleasure. Thank you.