Health & Well-Being
20 9 Addison Independent
January 21, 2019
Addison Independent, Monday, January 21, 2019 • Health & Well-Being — PAGE 15
Hospital gives patients a voice in how they get medical care By JOHN FLOWERS MIDDLBURY — Porter Medical Center each year helps hundreds of patients improve their health. Now the hospital is hoping to improve its own health through advice from its patients. The Middlebury-based hospital, rehabilitation center and suite of physicians offices next week will launch their first-ever Patient and Family Advisory Council, a panel that will offer advice on how PMC could improve the patient experience in such areas as billing, clinical care and facilities. “We’re looking for folks who are interested in providing feedback and fixing things,” said Alison Wurst, Porter’s director of population health and care management. The Patient and Family Advisory Council will be introduced at a kickoff celebration on Tuesday, Jan. 29, at the Middlebury Inn. Porter officials are still accepting applications from prospective council members, being culled from the community and Porter staff who have also been patients. The application can be found online at portermedicalcenter.org. “We don’t have a perfect number (of members) in mind, but for right now we will keep it small,” said Stacey Dwire, PMC’s inaugural “patient experience and quality improvement coordinator.”
PORTER MEDICAL CENTER has established a new “Patient and Family Advisory Council” made up of former hospital patients who will provide feedback on their experiences in an effort to improve hospital operations. Pictured here, left to right, are: Alison Wurst, Porter’s director of population health and care management; Chief Medical Officer Dr. Carrie Wulfman; former patient and current council member Kim Farnham; Stacey Dwire, Porter’s patient experience and quality improvement coordinator; and Amber Bailey, director of quality and patient safety. Independent photo/John Flowers
As of last week, Dwire had signed up seven people eager to serve on the new panel, which will meet monthly and participate in occasional special projects aimed at boosting
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the patient/family experience at Porter. Council members will be unpaid advisors who are expected to: • Help improve the quality of Porter
Medical Center’s care for all patients and family members. • Give feedback to hospital officials based (See Council, Page 17)
PAGE 16 — Addison Independent, Monday, January 21, 2019 • Health & Well-Being
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Rice said that anybody can While there are centers find themselves struggling in Burlington, such as the with this issue because Adams Center for Mind eating disorders affect people and Body, Rice said it can regardless of age, gender, be difficult to travel there race or other factors. And with the frequency required the fact that we associate to treat an eating disorder. eating disorders with girls Rice said she is not sure and women means that boys why Addison County has and men often don’t receive so few treatment options. the treatment they need, she “We certainly have a added. ton of people who would “Boys and men can slide benefit,” she said. under the radar,” she said. Among those who would “They don’t come forward as benefit are high school much as girls and women, but students, who often face they are still there.” peer pressure about their Rice also sees patients of all bodies and struggle with ages, from children as young disordered eating. Kelly as six or seven years old, McGovern, the school to high school and college nurse at Middlebury Union Amy Rice students, to adults. For her High School, said she younger patients, Rice said encourages students who that poor body image can come directly from are worried that they themselves or a friend is comments made by parents. suffering from an eating disorder to reach out “Parents might talk about going to exercise for support as soon as possible. because they need to lose weight and it can “If students are feeling badly about plant seeds in kids’ heads about what exercise themselves physically they should reach out is and what food is and what healthy is,” Rice as early as possible and not get to a place said. where they’re in crisis,” McGovern said. This kind of talk is “There are a lot of people common in January as that want to wrap around parents make their own New and help you with whatever Year’s resolutions. A 2017 you need.” Gallup poll noted that three McGovern urged students of the top five most common not to be embarrassed, New Year’s resolutions in noting that many in their the U.S. relate to diet and age group specifically weight loss. Rice said that struggle with eating parents may not realize the disorders. Indeed, the impact this message has on National Eating Disorder their children Association estimates “I tell parents to really that approximately a halftry to be mindful about million teens across the the comments they make country currently struggle themselves, to try to avoid with eating disorders or dieting and if they want to disordered eating. do a healthy resolution to Despite these statistics, pick something other than January is full of messages weight loss as a goal,” Rice about losing weight and Kelly McGovern said. eating better. As diet season For those struggling with wears on, Rice recommends eating disorders, Rice said the most important trying to block out the extra noise about weight thing is to seek treatment. However, she also loss. She notes that this often means reducing acknowledged that Addison County does not time on social media or taking a break all have enough treatment options for those who together. exhibit concerning eating or exercise habits. “As much as possible try to turn your “We have great therapists and counselors blinders on and put your head down and try to but we don’t have enough of them. And we focus on your own happiness and well-being don’t have enough people who specialize in from inside versus what you see and hear from eating disorders,” she said. others,” she said.
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By SARAH ASCH struggling with or on the If students are feeling MIDDLEBURY — With brink of an eating disorder,” the month of January comes badly about themselves said Rice, who splits her New Year’s resolutions and physically they should time between a private studies show that Americans reach out as early as practice and working with often vow to lose weight. possible. There are a lot of clients at Middlebury Fitness While some people use this Community Wellness Center. time of year to fortify their people that want to wrap This diagnosis is a common efforts to take better care of around and help you.” one. The National Eating their health, nutritionist Amy — Kelly McGovern Disorder Association reports Rice said that the increased that 20 million women and 10 buzz about weight loss can million men in the U.S. will be harmful to those who struggle with eating have an eating disorder at some point in their disorders or body image issues. lives. Symptoms can include an unhealthy “The big focus that comes around the preoccupation with weight, food, calories, holidays and then with New Year’s resolutions a refusal to eat certain foods or discomfort is a huge challenge for people who are already eating in front of others.
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Addison Independent, Monday, January 21, 2019 • Health & Well-Being — PAGE 17
Council (Continued from Page 15) on their own experiences as a patient or family member. • Help plan changes for the hospital to improve delivery of patient care. • Work with the hospital for either short or long-term commitments, depending on the project. In addition, members will be invited to hear — and comment on — guest speakers’ commentary on patient-related topics. Porter Chief Medical Officer Dr. Carrie Wulfman said the council will regularly convey its findings and suggestions to the organization’s Patient Experience Committee. The information will then make its way to Porter’s Quality and Patient Safety Department, and then to the PMC board of directors, according to Wulfman. “This is something the senior leadership team here has wanted to see for a while,” Wulfman said. Amber Bailey, PMC’s director of quality and patient safety, said she and her colleagues currently get most of their patient feedback through surveys, emails and a specially designated phone line. Dwire takes a look at any complaints/ advice, contacts the source for additional details, and then reaches out to the pertinent physician or department manager, according to Bailey. Any threats of legal action are sent to PMC’s compliance and management division. ADVISORY COUNCIL EXPERIENCE Kim Farnham of New Haven is a member of the new Porter Patient and Family Advisory Council, and comes on board with
some valuable experience. She was already a family advisory group, which launched around member of the University of Vermont Medical three years ago and now counts approximately Center’s patient council. 150 members, according to Farnham. She’s pleased to serve in the same capacity In her role, Farnham occasionally gives for Porter. input to UVM Medical Center’s radiology “My journey started around two years and oncology departments, on matters ranging ago in this particular facility,” from facility improvements to she said. “I feel a tremendous how staff members are interacting amount of gratitude and love the with patients. We shouldn’t opportunity to come back and assume we know She’s spoken with medical talk to not only the medical staff what patients are students, nurses and administrators here, but any other people in the about what patients expect and (patient) situation, so they get to thinking. We are how their desires can be fulfilled. hear my journey — good or bad really quite biased Farnham is also a great — depending on the procedure from having worked advocate and spokesperson that took place.” during Breast Cancer Awareness in health care for Her journey as a patient took so long, and have Month (October) conferences and her from Porter — where she had thoughts that might other related activities. undergone for mammograms and a Wurst already has an assignment lumpectomy — to UVM Medical not match up with in mind for Farnham and her Center, where she underwent a what our patients colleagues. One of PMC’s stated bilateral mastectomy as part of and families are priorities is to ensure patients her breast cancer treatment. have good access to primary care. expecting.” “At that time, there were a — Alison Wurst, Porter “But what does ‘access’ really couple of things that didn’t go mean for a patient?” Wurst said. Medical Center well for me, and some that went “That might mean something very well,” Farnham said of her different than (administrators) experiences at both locations. think it means.” As a longtime school board member and Council members could help PMC mediator, she believed she could provide officials better define patient expectations by helpful feedback to both hospitals on the answering some basic questions, according to quality of care she received. Wurst, including: “What kind of solutions could I offer to • When you’re calling your (physician’s) try to make this experience a little better for office, what are you expecting? other people and their families, rather than • What do you want to hear? just being in ‘attack mode’?” Farnham asked • What feels reassuring? herself. • What leaves you with a bad taste in your That led her to joining the UVM patient and mouth?
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“We shouldn’t assume we know what patients are thinking,” she said. “We are really quite biased from having worked in health care for so long, and have thoughts that might not match up with what our patients and families are expecting.” ‘AHA’ MOMENTS Farnham has found her time on the UVM council very fulfilling, and anticipates feeling the same way about PMC panel. “It creates such a different form of communication with everyone; there’s an ‘Aha’ moment that takes place where everybody says, ‘That’s a very simple (solution) and it doesn’t cost a lot of money,” Farnham said. “That’s what we bring to the table — that positive piece of … how to make a person’s journey a little easier se we can learn from your experience,” she added. Typically, each patient/family council meeting includes a member recounting his or her personal patient experience, according to Farnham. That tradition will be adopted by the Porter Patient and Family Advisory Council. “I’m blown away by some of the people and what they’ve gone through — and what they continue to give back to a particular facility that worked for them,” Farnham said. Porter CEO Dr. Fred Kniffin is looking forward to seeing the council in action. “If we are going to make meaningful improvements in the patient experience, we need input from the patients who experience it,” he said. Reporter John Flowers is at johnf@ addisonindependent.com.
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PAGE 18 — Addison Independent, Monday, January 21, 2019 • Health & Well-Being
Primary care provider is now just a part of ‘your’ team By DR. NATASHA person who always cares Although this relationship WITHERS for you, who knows you the “Who’s your doctor?” For is still quite common best, the person you turn to generations, this question today, in many cases this in crisis and who helps you has been asked frequently role has evolved from a to navigate many of life’s in various situations (even important moments and single individual to a team socially). decisions. Today, that question has of individuals who work Although this relationship evolved to “Who is your together to take care of the is still quite common today, Primary Care Provider,” patient. in many cases this role as the practice of medicine has evolved from a single has changed to recognize individual to a team of the vital role of Advanced Registered Nurse individuals who work together to take care of Practitioners, Certified Nurse-Midwives, the patient. Physician Assistants and other clinicians. Increasingly at the national level and Historically we have identified our doctor medical institutions across the country people (or primary care provider) as one person; the are talking about “Population Health,” an
approach to medical care where a primary focus is keeping the patient healthy and out of the hospital and doctor’s office. This Population Health model is behind the shift to this team-based model of care where a team of providers “manage” the care of a patient in both sickness and in health. It’s not to say that providers ignored wellness before, but rather we were limited in our approach, resources and ability to help our patients stay well. In recent years, there has been a national shift in the healthcare payment model that moves us away from the traditional fee-forservice payment structure to a new prospective payment that provides a financial incentive to promote wellness. This “lump sum payment” is all the money a provider receives for the
year to take care of an individual patient. If it costs more to take care of the patient than the lump sum the provider was paid, there is no additional payment. Healthcare providers are now rewarded both professionally and financially to find ways to keep patients healthy, and the best way to do this is by having a team of people that can best address the broad spectrum of patients’ medical needs. While this transition to a team-based model has happened, it has been met with mixed acceptance from patients and providers alike. Perhaps part of the hesitancy to embrace this model is the lack of a formal agreed upon definition of “team.” Some think of the team model as an advanced practice provider (See Primary care, Page 23)
Porter to provide ‘Drug Deactivation Pouches’ to patients MIDDLEBURY — With the assistance of then-State Rep. Fred Baser, the UVM Health Network/Porter Medical Center this past summer received a donation of 1,000 “Drug Deactivation Pouches” which provide a safe and responsible drug disposal method. The donation was made possible through a donation partnership with Mallinckrodt Pharmaceuticals. “It is an ongoing priority and challenge to support our patients who have unused or expired medications and wish to dispose of them safely,” said Porter Medical Group medical director Dr. Natasha Withers. “We plan to distribute these pouches to our primary care practices with an information flyer which will help
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Administration, nearly 68 our providers explain to It is an ongoing priority percent of those who used patients how to use these pouches and help us ensure and challenge to support our prescription pain relievers that medications do not fall patients who have unused or non-medically obtained into the wrong hands,” she expired medications and wish them from relatives. “Our organization has added. to dispose of them safely.” a number of ongoing The drug deactivation — Dr. Natasha Withers initiatives to both educate pouches render chemical and support our patients compounds safe for landfills so that medications can safely be who wish to dispose of medications included in the household trash. According to correctly, and this donation and new resource the manufacturer, “up to 45,000 prescription for our primary care practices will make a pills could be destroyed safely if every pouch real difference in advancing this important donated to Porter is used to its capacity.” work,” according to Withers. According to a recent national survey by the Porter Medical Center is offering a kiosk Substance Abuse and Mental Health Services in the hospital where the public can come to
dispose of prescription medications, which has been made possible, in part, by funding from the Vermont Department of Health. “We all recognize that we are in the midst of an addiction epidemic,” says Renee Mosier, pharmacy director at Porter Medical Center. “Much research shows that many addictions start or are accelerated by ‘left-over’ medications in home medicine cabinets. We have had the goal of offering a safe and easy way to dispose of medications to the community for a long time, and through support from the Vermont Department of Health, and Mallinckrodt Pharmaceuticals we now have two options to offer the community at no charge.”
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PAGE 20 — Addison Independent, Monday, January 21, 2019 • Health & Well-Being
Get outside & enjoy winter on Vt. Free Ice Fishing Day
NORTH HERO — Vermont’s sixth annual Free Ice Fishing Day is Saturday, Jan. 26. The day is geared toward giving new ice anglers an opportunity to try ice fishing before purchasing equipment, but any angler may ice fish on any water body open to ice fishing statewide without a fishing license. To celebrate, the Vermont Fish & Wildlife Department is holding an Ice Fishing Festival at Knight Point State Park in North Hero. The festival will be held from 11 a.m. to 3 p.m. The event is free and open to all ages as well as families with kids. Vermont Fish & Wildlife staff, as well as instructors from Vermont’s Let’s Go Fishing Program, will be on-hand to teach ice fishing skills. These include knot tying, baiting and using an ice fishing rod, and most importantly, how to stay warm on the ice. They’ll also discuss fishing regulations and go over fish identification. Rooted in Vermont will also be there to talk about the importance of locallycaught fish as a sustainable source of food. And new this year, the Coast Guard will be performing self-rescue demonstrations through a hole in the ice! Department staff will operate a fish fry station to cook up participants’ catch, and there will also be other refreshments on hand including plenty of hot cocoa. There will be several warming huts available.
TO CELEBRATE FREE Ice Fishing Day, the Vermont Fish & Wildlife Department will hold an Ice Fishing Festival for kids and others new to ice fishing at Knight Point State Park in North Hero on Saturday, Jan. 26.
Vt. Fish & Wildlife photo/Tom Rogers
“Ice fishing is one of the most accessible forms of fishing and can be a great way to introduce people to how much fun fishing can be,” said Jud Kratzer, fisheries biologist for the Fish & Wildlife Department. “This festival will demonstrate that ice fishing isn’t just about catching fish. It’s also a great way to spend some time outdoors with friends and family. You can
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skate, sled, make a snow fort and have a cookout — all while waiting for the flags on your tip-ups to signal when you’ve caught a fish.” The Fish & Wildlife Department will lend equipment needed for this fun day on the ice, or participants may bring their own equipment. For more information, contact Corey Hart at 802-265-2279 or corey.hart@vermont.gov.
Registration can be completed online in advance at register-ed.com/events/view/132707 or people may register when they arrive, although registering in advance will enable participants to get on the ice faster. Free Ice Fishing Day and the Free Ice Fishing Festival are held annually on the last Saturday in January.
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PAGE 22 — Addison Independent, Monday, January 21, 2019 • Health & Well-Being
Families dream big and take on the Long Trail
MIDDLEBURY — Anyone who has hiked with their children know that it has its delights and its pitfalls. At the Green Mountain Club Breadloaf Section annual meeting on Thursday, Jan. 24, two families will tell the story of what happened when they decided to join forces and hike together. The presentation will follow the business portion of the meeting, which will take place at the Champlain Valley Unitarian Universalist Society at 2 Duane Court, from 6:30-8:30 p.m. In “Short Legs, Long Trail — Four Summers on the LT,” the McIntosh and Harrington hiking families, both of Ripton, will present a program on how their two families, each with their individual loves of backpacking, decided to try backpacking together. As they recently described it, “It started with a simple overnight with just the two oldest kids (then 6 and 7). That trip planted the seed from which our adventures were born. Starting small, dreaming big, and staying flexible kept us going. (That, and plenty of M&M’s)!” The Harringtons have lived in Ripton since 2003. Prior to settling in Vermont, Tracey and Jay had their own backpacking adventures: Tracey in parts of East Africa and South America, Jay as an Appalachian Trail thruhiker. Their children Baxter (12) and Mary (10) have lived in Ripton their whole lives and, in addition to backpacking, enjoy Nordic skiing, playing music and reading.
THE HARRINGTON AND McIntosh families spent four summers hiking the Long Trail with their kids. Hear about their adventures at the Green Mountain Club Breadloaf Section’s annual meeting and program on Thursday, Jan. 24.
Photo courtesy Harrington/McIntosh families
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Council report gives strategies for defeating opioids MONTPELIER — The Opioid Coordination Council late last month released its progress report for 2017-2018. The report, “Strategic Actions and Progress,” is a summary of statewide actions to date, in response to the council’s recommended strategies issued in January 2018. “The opioid crisis is one of the most complex challenges we have faced here in Vermont and across the nation,” said Gov. Scott. “Far too many people and their loved ones face the daily struggles and terrible toll that comes with opioid addiction. This report highlights the work of the council, in collaboration with many state and local partners, legislators and providers, to strengthen and advance a
cohesive statewide system to sustain recovery, and to of supports for prevention, Read the Opioid help people from starting treatment, recovery and Coordination Council’s down the road toward enforcement.” addiction in the first place. “Strategic Actions and The four-page report “If we are going to highlights programs and Progress” report online at: permanently bend the policy actions in areas healthvermont.gov/response/ curve on substance of primary prevention alcohol-drugs/governorsmisuse and addiction, in schools, intervention then a comprehensive and treatment, recovery, opioid-coordination-council. system for prevention enforcement and workforce and recovery is key,” said development. LaClair. “Vermont has already taken the first Drug Prevention Policy Director Jolinda important steps — from our Hub and Spoke LaClair said this progress report documents treatment system that’s become a national the path Vermont is taking to get people the model, to supporting schools with a substance treatment and wrap-around supports needed use prevention coordinator, adopting rules
governing prescriptions, and our opioid overdose and reversal program that’s provided first responders with 10,000 doses of naloxone and distributed over 25,000 rescue kits — helping to prevent more than 1,500 possible overdoses.” “These are important steps forward even though progress on this issue is never enough,” said Governor Scott. “Prevention programs should reach into every community for every Vermont child and adult, as we work to keep Vermonters healthy and safe from substance use disorder.” Find treatment and support information online at healthvermont.gov/alcohol-drugabuse/how-get-help/find-treatment.
the psychosocial aspects of a patient’s care. It might also include community partners such as home health, elder care, and counseling services. We also now have access to RiseVT, a statewide (and local) organization that is working to improve the health of our community. Some of these services did exist prior to the shift in the care delivery model, but they had not been seamlessly integrated. Under the ACO umbrella there is more community collaboration and accountability for the service areas. Also, there are now better resources to help identify patients in need and be able to meet them where they are, by allowing them access to the health care system through traditional and non-traditional
pathways. Porter Medical Center has adapted to this shift and is utilizing all of these new resources to the advantage of patients in our area, and is now able to offer many different types of medical visits. For example, the hospital has technology that allows doctors to do video visits with patients, greatly improving access. This is appealing to the busy working professional who might have previously used “I have no time” as an excuse not to seek out preventative care, as well as those patients who have transportation issues or may not live close by to their primary care provider. Care Managers also are a recent addition to (See Care managers, Page 25)
Primary care (Continued from Page 18) (Nurse Practitioner or Physician Assistant) matched up with a doctor who care for the patient together. Others view the team as the Primary Care Provider (advanced practice provider or doctor) and the specialists who care for the patient. In my opinion, “team” should be defined as all of the medical professionals who care for the patients. This covers the person that checks you in at the front desk, the medical assistant who brings you into the exam room and briefly reviews your history, the nurses who take your telephone call when you are seeking medical advice, and all of the other people who are available to you based on
your needs (pharmacists, nutritionists, social workers, home health, community agencies, specialists, etc.). Certainly, the leader of that team is your primary care provider. In short, the important relationship between you and your primary care provider has not changed, but rather the care you receive by your primary care provider and his or her team has been expanded and improved. Accountable Care Organizations, known as ACOs, are the vehicles that have allowed the care delivery model to change. Under this new model, primary care provider s are afforded the resources to provide wrap around, teambased care, care that might include help from a Care Manager, someone who can manage
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PAGE 24 — Addison Independent, Monday, January 21, 2019 • Health & Well-Being
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Mental illness and suicide are subject of talks at two libraries Between 1996 and 2016, the suicide rate in Vermont increased by more than 48 percent — the second highest increase nationally according to the federal Centers for Disease Control. This rising rate of suicide, paired with the social stigma attached to mental health problems, indicates a need for safe spaces for communities to learn and talk about issues of depression, anxiety, and suicidal thoughts. Recognizing these issues within their own towns, Charlotte Library and Carpenter-Carse Library in Hinesburg have teamed up to host “Mental Health Conversations: Risk and Resiliency” during the month of February, 2019. The public libraries will host two evenings of panel presentations with mental health professionals, and a separate event that features Pulitzer Prize-winning and Emmy Award-winning writer and critic Ron Powers, author of “No One Cares About Crazy People” at the Carpenter-Carse Library. The panel discussions will take place on (See Ron Powers, Page 25)
Addison Independent, Monday, January 21, 2019 • Health & Well-Being — PAGE 25
Care managers (Continued from Page 23) our team at Porter. They are able to address the social needs that impede a patient is receiving medical care. Those social needs may be a lack of housing, stable job or income, insurance questions, or poor family supports. Through the Blueprint for Health (the state-sponsored initiative), Porter is able to offer free visits with a nutritionist or a mental health provider. The hospital also has many self-management classes that are offered to help people in such areas as quitting smoking, managing or preventing diabetes, and improving emotional wellbeing. As a physician, a consumer of health care, a mother, and a wife, I am truly amazed and thankful for this shift. I am able to provide the very best care for my patients for all of their needs as well as receive it for my family. It is a true honor to work at Porter, a place that is
on the cutting edge of health care reform. So, I ask you to join me in embracing this new care model. I ask you to join me in letting go of the idea that there is one person and one person only who can handle your health care needs. If you have an urgent need, be open to seeing any provider that can see you at the moment you need to be seen. I ask you to embrace the enhanced definition of “team.” If you have a wellness question, consider booking a wellness visit with your primary care provider or even take advantage of Porter’s free services. Welcome to the team and I hope you can share in my excitement in being able to provide better care for you and our community! Editor’s note: Dr. Natasha Withers is medical director of primary care at UVM Health Network Porter Medical Center in Middlebury.
WELL-KNOWN LOCAL AUTHOR Ron Powers, who tells of his own family’s struggles with schizophrenia in the book “No One Cares About Crazy People,” will speak at Hinesburg’s Carpenter-Carse Library next month as part of a series of conversations on mental health.
Ron Powers resident, is a Pulitzer Prize winner and a (Continued from Page 24) Feb. 5 at the Charlotte Library, and Feb. 20 New York Times bestselling author who has at the Carpenter-Carse Library. Both panel published 16 books. His most recent book, presentations start at 7 p.m. The panelists “No One Cares About Crazy People: The will be Charlotte McCorkel, LICSW, project Chaos and Heartbreak of Mental Health in America,” offers an account director of Integration at the of the social history of mental Howard Center; Joanne Wolfe, Ron Powers will illness in America as well as his MA, M.Ed, licensed psychologist; and Eliza Pillard LICSW, family speak of his family’s personal story of his two sons’ battles with schizophrenia. At wellness coach at the Vermont journey with the library Powers will speak of Center for Children, Youth and mental illness as Families at the UVM Medical well as his research his family’s journey with mental illness as well as his research on Center. Themes will include on mental health mental health and the health care anxiety, depression, and suicide and the health care system. prevention. Discussion topics These discussions and will be what to look for (signs system. presentations are made possible and symptoms) and how to start a conversation with a loved one. There will be by the “All of Us” grants through the National time for questions and the libraries will provide Network of Libraries of Medicine. The online resources and a curated collection of Carpenter-Carse and Charlotte libraries will print and video materials for browsing and also receive iPads through one of the grants. The iPads will be loaded with reputable borrowing. In addition, the Carpenter-Carse Library medical resources, and then circulated at at 69 Ballards Corner Road in Hinesburg the libraries so patrons can browse a wealth will welcome Ron Powers on Feb. 12 at 6:30 of mental health information privately and p.m. Powers, a former long-time Middlebury securely.
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