Fall 2021
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ARKANSAS HOSPITALS | FALL 2021 1 Independently Owned and Operated/Member of the Cushman & Wakefield Alliance
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B U I L D I N G H VA C , C O N T R O L S , & S E R V I C E • 8 7 7 . 2 7 4 . 7 1 2 7 • 2 FALL 2021 | ARKANSAS HOSPITALS
W W W. P O W E R S - H VA C . C O M
COVID-19: Changing Us All TOUGH CHALLENGES WE FACE: COVID-19 AND MENTAL HEALTH
12 Powerful Tools for Reaching Patients 18 The Growing Toll on Mental Health 23 Children’s Mental Health During the Pandemic 44 Mental Health and Frontline Workers 47 Rise in State Opioid Deaths
LONG COVID
39 Little-Known Illnesses in COVID Long-Haulers 42 Pioneering Clinic Learns about Long COVID
IN EVERY ISSUE
5 President’s Message 7 Editor’s Letter 8 Hospital Newsmakers 9 Event Calendar 31 Coach’s Playbook 34 Leader Profile: Chad Addudell 48 Where We Stand: Clinicians – Care for Yourself
ARKANSAS
HOSPITALS Arkansas Hospitals is published by The Arkansas Hospital Association
419 Natural Resources Drive | Little Rock, AR 72205 To advertise, please contact Brooke Wallace magazine@arkhospitals.org Ashley Warren, Editor in Chief Nancy Robertson, Senior Editor & Contributing Writer Katie Hassell, Graphic Designer Roland R. Gladden, Advertising Traffic Manager
BOARD OF DIRECTORS
Chris B. Barber, Jonesboro / Chairman Ron Peterson, Mountain Home / Chairman-Elect Peggy Abbott, Camden / Treasurer Darren Caldwell, Jonesboro / Past-Chairman Ryan Gehrig, Fort Smith / Director, At-Large Greg Crain, Little Rock Barry Davis, Paragould David Deaton, Clinton Marcy Doderer, Little Rock Kathy Gammill, Searcy Phil Gilmore, Crossett Vince Leist, Harrison James Magee, Piggott Mike McCoy, Danville Johnny McJunkins, Nashville Gary Paxson, Batesville Larry Shackelford, Fayetteville Brian Thomas, Pine Bluff Debra Wright, Nashville
EXECUTIVE TEAM
Robert “Bo” Ryall / President and CEO Jodiane Tritt / Executive Vice President Tina Creel / President of AHA Services, Inc. Pam Brown / Vice President of Quality and Patient Safety Lyndsey Dumas / Vice President of Education Debbie Love / CFO Melanie Thomasson / Vice President of Financial Policy and Data Analytics
Fall 2021
DISTRIBUTION: Arkansas Hospitals is distributed quarterly to hospital executives, managers and trustees throughout the United States; to physicians, state legislators, the congressional delegation, and other friends of the hospitals of Arkansas. Arkansas Hospitals is produced quarterly by Central Arkansas Media. Periodicals postage paid at Little Rock, AR and additional mailing offices. The contents of Arkansas Hospitals are copyrighted, and material contained herein may not be copied or reproduced in any manner without the written permission of the Arkansas Hospital Association. Articles in Arkansas Hospitals should not be considered specific advice, as individual circumstances vary. Products and services advertised in the magazine are not necessarily endorsed by the Arkansas Hospital Association. To advertise, email magazine@arkhospitals.org.
ARKANSAS HOSPITALS | FALL 2021 3
4 FALL 2021 | ARKANSAS HOSPITALS
PRESIDENT’S MESSAGE
Continual Caring
T
he Delta variant of SARS CoV-2 has thrown all of us for a loop. It reminds us how much our hospitals – their leaders, caregivers, and support staff – are juggling while managing the greatest uptick in patient levels we’ve seen in months. It humbles us to know just how much our fellow humans in the health care profession give to their communities every single day, often at the expense of their own health and wellbeing. So, I find that the AHA’s message, and my message, going into this second fall of the pandemic is one of profound caring. To our brave and dedicated health care professionals: We see you. We appreciate you. We honor you. We care about the mental, physical, and emotional toll the pandemic is taking on you. Words cannot express how grateful we are to each of you for your daily compassion, care, expertise, and gifts of self. The Delta variant ferociously shows us that receiving vaccination is, itself, a measure of caring. When people become vaccinated, they’re not just protecting themselves from COVID-19 and its most serious outcomes. They’re protecting their fellow Arkansans, their family members, their friends and coworkers, their children’s teachers, our health care workers, all of those with whom they come into contact in daily life. Vaccinated humans slow the spread of COVID-19, and they’re helping corral its ability to further mutate into more serious variants.
That's why the AHA took a stand this summer on vaccine mandates for health care workers. Yes, even before President Joe Biden mandated that all health care workers become vaccinated, AHA supported a similar mandate. We encouraged our hospitals to urge every person in their employ to become vaccinated. President Biden's vaccination mandate for the health care workforce affects all facilities that receive Medicare or Medicaid reimbursement. It is thought that requiring vaccinations in many U.S. workplaces will drastically slow the spread of COVID-19 and its Delta variant in our country. The vaccine, proven safe through years of research pre-pandemic, offers caregivers an important layer of protection from the virus, and in many cases lowers their ability to spread it to their patients and family members.
What better way to care for both caregivers and community? Delta also brought the association to a difficult decision in late August, as we regretfully cancelled this year’s Annual Meeting. We know how much it means to hospital leaders, managers, and professionals to come together, learn from one another, learn from experts, share best practices, and simply increase professional networks at these annual gatherings. We also know that Delta’s spike during the wider pandemic makes it impossible to gather together, impossible for leaders to leave their individual hospitals, impossible to travel at this precarious time. Caring for our hospitals, and for each of you serving them, led to our decision. We simply could not and would not convene when doing so could compromise our members’ health. We all hope that as more Arkansans become vaccinated and people continue to practice the public health measures that help stop the spread – especially masking and socially distancing – that we can come together once again in the fall of 2022. In this issue of Arkansas Hospitals, we introduce tools that acknowledge and can help people cope with mental health challenges during this pandemic. We look at Long COVID and offer suggestions on ways to spot some of its syndromes. The issues we cover are solemn, we know. But we offer them for one reason – because we care so deeply for you and the work you do.
Bo Ryall
President and CEO Arkansas Hospital Association
ARKANSAS HOSPITALS | FALL 2021 5
6 FALL 2021 | ARKANSAS HOSPITALS
EDITOR’S LETTER
The Power of
Human Connection
C
OVID changes everything, every single facet of our lives. We say this so often that the message has a numbing effect. In the spring and summer of 2020, the idea of a “new normal” grabbed everyone’s imagination. It helped us explain how fundamentally life was changing. But the profound truth didn’t really settle in until that “new normal” no longer felt new at all. We now realize: This is normal. Our shared pandemic experience includes grief resulting from specific, major loss – a family member, a home, a livelihood, hope. It includes sadness sparked by the constantly shifting sands of living in pandemic times. This much we know: We must support one another in attending to our mental, as well as physical, health needs. Nowhere is this truer than inside our hospitals. Health care workers live life immersed in the flux, fear, and uncertainty of the virus. Like each of us, they see the disease’s profound impact on their own personal lives, even while they actively care for those whose lives COVID is destroying. Our health care workers have been called upon to walk directly into COVID’s unknown, constantly adapting to and incorporating new care treatments as they emerge. Those who work at the bedside courageously guide patients and their families through that unknown. They shoulder the solemn weight of their role with all the dignity and respect one can muster. It takes a
toll that’s impossible to convey if one has not lived it. I have not lived it. I, like many, have worked from home during the pandemic. Like many (including our health care workers), I have experienced: virtual school, ordering groceries online, ordering everything online, wearing masks, missing grandparents, pandemic pregnancy, getting vaccinated, glimmers of relief, long-awaited reunions with loved ones, pangs of panic over the Delta variant, a return to in-person school – life changed by COVID. Our children suffer pandemic change uniquely. It upends their entire context for understanding how the world works – their social interactions, their routines, the way they learn and communicate. As for so many adults, it affects their mental health.
This issue of the magazine explores the mental health challenges we face as a society during the time of COVID, from loneliness and isolation to the necessity of self-care. We look at how COVID unsparingly disrupts our lives mentally, emotionally, and physically. For some, the physical impact goes far beyond COVID’s cycle – contracting the virus, quarantining, seeking treatment, returning to health. As more cases of what’s now called “Long COVID” emerge, we’re learning how much we do not know about the virus. Just as health care workers at the bedside are facing the unknown, so are these “long-haulers.” You’ll find articles sharing personal accounts of life with this new disease, offering ideas about how and where to seek help. We include physicians’ descriptions of syndromes to watch for when assessing Long COVID patients. It’s true that few things remain entirely untouched by the COVID-19 pandemic. As we share stories of what people face right now, in the eye of the storm, we issue this call to you: Ask for help when you need it. Support one another. Accept support when it’s offered. When the daily reality of COVID no longer holds us at this fever pitch of fear, devastation, and uncertainty, we will reflect upon what brought us through the darkest times. I trust that it will be the one thing that COVID simply cannot change: the power of human connection to heal us.
Ashley Warren Editor in Chief
ARKANSAS HOSPITALS | FALL 2021 7
HOSPITAL NEWSMAKERS AHA 2021 Annual Meeting Cancelled
The AHA Board of Directors and the AHA executive team regret to announce the cancellation of the 2021 Annual Meeting. At this time of rising COVID-19 cases, we know our hospital leaders want and need to remain in their communities, serving patients and supporting hospital workers in their facilities. The Annual Meeting is our opportunity to gather as a community, learn from one another, and reinvigorate our mission; but we believe that canceling the event is the right thing to do during these difficult times. AHA continues to do all it can to support our members in their work, as they continue to care for all Arkansans in the midst of this pandemic. In lieu of the in-person meeting, AHA will once again provide virtual education opportunities, hold giveaways, and find ways to recognize hospitals’ efforts over the last 18 months. White House Vaccinations Coordinator, Dr. Bechara Choucair, visited the AHA in late July to speak with state hospital leaders about strategies for increasing COVID-19 vaccination rates. Members attending, both in-person and virtually, discussed a variety of ideas for vaccinating people in a number of hospital settings. Dr. Hui-Ming Chang at the University of Arkansas for Medical Sciences (UAMS) is the recipient of a five-year, $3.5 million National Institutes of Health grant to study how dexrazoxane can protect the heart without hampering the anti-cancer chemotherapy drug doxorubicin's ability to fight cancer. Preventing heart damage is especially important for the long-term survival of cancer patients, especially breast cancer patients. Hospitals in Arkansas participating in The Chest Pain – MI Registry™ Performance Achievement Award program were recently recognized for consistency in meeting patient care guidelines for AMI patients. CHI St. Vincent Infirmary, CHI St. Vincent Hot Springs, Mercy Health System of Northwest Arkansas, NEA Baptist Memorial Hospital, and St. Bernards Medical Center earned Platinum Performance Achievement Awards. Baptist Health Fort Smith earned a Silver Performance Achievement Award. Taren Swindle, PhD, will lead a major new effort by UAMS to reduce cancer by addressing eating habits in early childcare and education settings. The project, supported by a five-year, $3.1 million grant from the National Cancer Institute at the National Institutes of Health, focuses on reducing cancer through the reduction of obesity in children. The project will reach about 5,000 children and 500 teachers across Arkansas and Louisiana. 8 FALL 2021 | ARKANSAS HOSPITALS
Washington Regional Medical System held a dedication ceremony and ribbon cutting in mid-July for its new J.B. Hunt Transport Services Cancer Support Home. The 9,800 square foot facility is designed to provide hope and comfort for those on their cancer journey. It offers overnight lodging with eight accessible guest suites, a wig and prosthesis boutique, and other support services. Patients receiving cancer care in the Northwest Arkansas area are eligible to utilize the facility free of charge.
Washington Regional Medical System
The Health Resources and Services Administration’s (HRSA) Small Rural Hospital Improvement Program in midJuly announced the release of $398 million for COVID-19 testing and mitigation from the American Rescue Plan Act. In all, 1,540 small and rural U.S. hospitals are receiving project funding; $9,043,160 will go to 35 small rural hospitals in Arkansas. Hospital leaders from all parts of the state gathered recently to meet virtually with U.S. Representatives Rick Crawford (1st District), French Hill (2nd District), Steve Womack (3rd District), and Bruce Westerman (4th District). The Congressmen were briefed on the COVID-related surge occurring in Arkansas hospitals; other key legislative topics were also discussed. IBM Watson Health recognized Baptist Health Medical Center-Hot Spring County and Mercy Hospital Northwest Arkansas on its Fortune/IBM Watson Health 100 Top Hospitals list for 2021. The list measures hospitals’ clinical outcomes, operational efficiency, patient experience, and financial health, as well as (new to award criteria this year) a measure of hospitals’ contributions to community health with a focus on equity. Baptist Medical Center-Hot Spring County is also one of 20 Top-100 Hospitals to receive the Everest Award, which honors hospitals showing the highest rates of improvement during a five-year period.
2021 Fall Calendar OCTOBER
AAHE Meetings
Arkansas Association for Healthcare Engineering, Inc. (AAHE) Meetings OCTOBER 1 | Virtual Event OCTOBER 22 | Virtual Event
Healthcare Law
OCTOBER 5 | Changes to Value-Based Care, Fraud, & Abuse Regulations Webinar
AHA Annual Meeting Workshop
(3.75 Hours Credit) A Three-Part Virtual Series OCTOBER 6 | Creating Focus OCTOBER 13 | A Winnable Game OCTOBER 20 | Creating Engagement Sponsored by AHA Services, Inc. See Highlight for Details
AHA Annual Meeting Awards Ceremony OCTOBER 7 | AHA 2021 Awards Ceremony Livestreamed Event
Compliance Event
OCTOBER 19 | CMS Hospital Surgery, Anesthesia, and PACU CoPs Requirements: Are You in Compliance? Webinar
340B Quarterly Meeting OCTOBER 19 | Virtual Event
2021 Admin Leadership OCTOBER 20 | Working as One: Bridging Generational Gaps Webinar
Quality Forums
OCTOBER 28-29 | Arkansas Healthcare Human Resources Association (AHHRA) Fall Meeting Virtual Event
NOVEMBER
Basics of Case Management Boot Camp
Governance
AAHQ Fall Conference
OCTOBER 15 | Arkansas Association for Healthcare Quality (AAHQ) Fall Conference Virtual Event
Now Offered FREE in 3-Part Virtual Series COVID-19 may have prevented the 2021 AHA Annual Meeting from convening, but it won’t stop us from bringing our members access to the full-day Leadership Workshop. Sponsored by AHA Services, Inc., the Workshop, “The Four Disciplines of Execution for Health Care,” will be offered as a three-part virtual series.
AHHRA Fall Meeting
340B Webinar
A Five-Part Webinar Series OCTOBER 12 | Session One OCTOBER 19 | Session Two OCTOBER 26 | Session Three NOVEMBER 2 | Session Four NOVEMBER 9 | Session Five
Annual Meeting Leadership Workshop
All Virtual OCTOBER 21 NOVEMBER 18 DECEMBER 16
Scholarship Trap Tournament
OCTOBER 7 | SUNRx 340B Webinar Series: Best Practices in Managing 340B Pharmacy Webinar
One-Time Member Benefit
NOVEMBER 5 | Arkansas Hospital Engineers’ Scholarship Trap Tournament Arkansas Game and Fish Foundation Complex, Jacksonville A Four-Part Webinar Series NOVEMBER 16 | Cyberthreats: Board Oversight of Information Security
DECEMBER
AHAWCSIT Board
DECEMBER 2 | Arkansas Hospital Association Workers’ Compensation Self-Insured Trust (AHAWCSIT) Board Meeting Virtual Event
Chris McChesney
Global Leadership Summit and World Business Forum presenter Chris McChesney will equip attendees to help their organizations improve strategy execution. He will explain the four principles of Focus, Leverage, Engagement, and Accountability and help us put them into action as manageable disciplines in the workplace.
McChesney, co-author of the bestseller The 4 Disciplines of Execution and Global Practice Leader of Execution for FranklinCovey Co., has led implementations of the 4 Disciplines at Marriott International, Kroger, Coca Cola, Lockheed Martin, Ritz Carlton, and Comcast, among others. Originally scheduled to lead AHA’s full-day Leadership Workshop, he graciously offered to bring this acclaimed program to AHA members in three “live” October virtual sessions. As a special benefit, AHA offers this program FREE OF CHARGE to employees of AHA member hospitals. 3.75 hours of continuing education are available to those who attend all three sessions “live.” The sessions are scheduled from 10 a.m.-11:15 a.m. October 6, 13, and 20. More information and registration details, including the accrediting bodies to whom the AHA has applied for continuing education credit, are available at arkhospitals.org (keyword search 2021 Annual Meeting). ARKANSAS HOSPITALS | FALL 2021 9
SPECIAL EVENT: We’re LIVE-STREAMING the AHA 2021 Awards Ceremony! No in-person AHA Annual Meeting this year? No worries! You’re invited to a special event: Our (virtual) AHA 2021 Awards Ceremony live and live-streamed straight to your device October 7, 12-1 p.m. AHA Board Chairman Chris Barber and AHA President and CEO Bo Ryall will introduce us to this year’s top award winners. You’ll meet the 2021 recipient of the A. Allen Weintraub Award, AHA’s highest honor, along with the winner of this year’s Statesmanship Award. Michael Givens, Arkansas’s ACHE Regent, will present the American College of Healthcare Executives’ Regent Awards for Early Career Healthcare Executive and Senior Level Healthcare Executive. Our speaker, professional football great and Arkansas favorite Keith Jackson, is set to offer words of inspiration during this trying time of COVID-19.
Congratulate (virtually) our hospital marketing teams as the 2021 Diamond Award winners are announced. The Diamond Awards annually recognize hospital marketing and public relations teams for program and project excellence. These winners are the best of the best, and their work showcases the quality, effectiveness, and impact health care marketing and public relations teams bring to hospital messaging each year. We will end by welcoming Ron Peterson as the incoming 20212023 Board Chairman.
Please join us October 7 | 12-1 p.m. CDT | Watch email for link
10 FALL 2021 | ARKANSAS HOSPITALS
A Growing Health System for a Growing Community
We are MAGNET RECOGNIZED Conway Regional Medical Center has achieved Magnet® designation— a reflection of our nursing professionalism, teamwork, and superiority in patient care. Only 8% of hospitals nationwide have Magnet Recognition status, and Conway Regional is now only the third hospital in Arkansas—and the first outside of Little Rock—to receive the honor. We also offer a new competitive pay structure for our team of distinguished nurses. At Conway Regional, we are blessed to have a bold team that is engaged, take pride in their calling, and work in unity to provide exceptional care. Visit ConwayRegional.org/Jobs or text “OneTeam” to 97211 for information on opportunities to join the Conway Regional family. We’re not just growing—we’re growing together. ARKANSAS HOSPITALS | FALL 2021 11
COVID-19 and Mental Health:
Powerful Tools for Reaching Your Patients By Bruce Trimble
T
he year 2020 was defined by the SARS-CoV-2 pandemic, arguably the worst pandemic the world has seen in 100 years. The illness affects nearly every aspect of life, from work and school to everyday activities like getting groceries – and even our wardrobes. Unfortunately, it also impacts the mental health of Americans.
12 FALL 2021 | ARKANSAS HOSPITALS
AMERICANS’ VIEW OF MENTAL HEALTH: PANDEMIC VERSION In 2020, Universal Health Services, Inc. (UHS), parent company of North Little Rock’s The BridgeWay Hospital, commissioned a national survey assessing and quantifying Americans' views and perceptions on mental health during the COVID-19 pandemic. Major findings of the UHS survey include: • 68% of American adults surveyed view COVID-19 as a severe or extreme crisis in the U.S. • 62% of survey participants report increased stress, anxiety, or depression. Of those feeling COVID-related stress, anxiety, or depression, 55% report these stressors are interfering moderately, severely, or overwhelmingly in their lives. • Nearly 25% feel COVID-related stress, anxiety, and depression most or all of the time. • Concerns about the economy, unknown duration of COVID-19 effects, no 'normalcy' in the near future, isolation from friends and family, and risk of virus exposure are the leading sources of stress, anxiety, and depression. • One in four surveyed are unclear what action to take if they had a mental health crisis. • Of those with COVID-related anxiety, stress, or depression, most are self-managing these negative feelings; only 15% used online tools and sought help from a licensed counselor or therapist. • Fear of virus exposure was the key barrier to mental health treatment during this time, followed by the cost of co-pay and a negative perception of telehealth. • Telehealth: About half of adults surveyed Universal Health Services, Inc., parent company of North Little Rock's The BridgeWay surveyed a national audience about views and perceptions of mental health used telehealth to treat a mental or physical Hospital, during the COVID-19 pandemic. condition, most of whom had a positive experience. • Nearly half of Americans expect to regain 'normalcy' within a few months; more than 90% are at least somewhat hopeful of their home life in the future.
62% of survey participants report increased stress, anxiety, or depression. Of those, 55% report these stressors are interfering moderately, severely, or
overwhelmingly in their lives.
ARKANSAS HOSPITALS | FALL 2021 13
GATHERING THE FACTS
Although many anticipated a return to normalcy within a few months, the virus persists. Sadly, many of its effects on mental health also remain. In 2021, Mental Health America (MHA) published its annual State of Mental Health report emphasizing the impact of COVID-19 on mental health, using results from the more than 1.5 million people who were screened through MHA Screening from January to September 2020. From these screens, MHA found: • Young people are those struggling most with their mental health. • Rates of suicidal ideation are highest among youth, especially LGBTQ+ youth. • The number of people looking for help with anxiety and depression is skyrocketing. • The number of people screening with moderate to severe symptoms of depression and anxiety increased throughout 2020 and remains higher than rates before COVID-19 hit. • More people report frequent thoughts of suicide and self-harm than have ever been recorded in the MHA Screening Program since its launch in 2014. • People screening as “at-risk for mental health conditions” are struggling most with loneliness or isolation. • People who identify as Asian or Pacific Islander searched for mental health resources more in 2020 than ever before. • While rates of anxiety, depression, and suicidal ideation are increasing for people of all races and ethnicities, there are notable differences in those changes over time.
AND WE CAN’T FORGET THIS… Due to 2020’s stay-at-home orders, alcohol sales and consumption increased. Neilson reported a 54% increase in national sales of alcohol for the week ending March 21, 2020, compared with one year prior, and online sales increased 262% over 2019. Also, in Arkansas, what was once a temporary rule change, spurred by the pandemic, allowing Arkansas restaurants, liquor stores, and breweries to deliver alcoholic beverages to consumers become state law in July of 2021. With increased access to alcohol, Americans are consuming more. For example, an October 2020 study published by the Journal of the American Medical Association revealed that alcohol consumption in the United States rose 14% during pandemic shutdowns. Also, women reported alarming increases in heavy drinking as early as the spring of 2020. Sadly, excessive alcohol use may lead to or compound existing mental health problems.
The 2021 State of Mental Health report, published by Mental Health America (MHA), says that more people reported frequent thoughts of suicide and selfharm than have ever been recorded in the MHA Screening Program since its launch in 2014.
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COMMUNICATING OUR MESSAGE INTERNALLY
COMMUNICATING OUR MESSAGE EXTERNALLY
To continue providing quality care during pandemic, The BridgeWay enacted numerous protocols to provide a safe environment for employees, patients, and their families. Internal communication was vital for conveying those protocols, which evolved over time as the pandemic wore on. Before the onset of the pandemic, we launched an intranet for employee use, which replaced the monthly print newsletter we published. The site serves to recognize employees for service excellence, announces policy and procedure updates, and spotlights messages from the CEO. In March of 2020, we added a new section under Infection Control to highlight COVID-19 updates. We promoted the site by conducting educational events and producing promotional items. In its first year, the number of individual clicks on the site was 3,665, an average of 10.04 hits per day.
Before March of 2020, we utilized telehealth, although not extensively. However, because of the pandemic and its limitation of in-person visits, we soon adopted Zoom to conduct mental health teleassessments. We found that most of the people who needed an assessment were not familiar with Zoom. It was awkward to ask people experiencing a mental health crisis to first download an app before being assessed. To overcome this barrier, we added a link to the Zoom app on our website connecting to our own electronic and printed poster with a QR code and instructions for using the app. In addition, we imprinted the QR code on the reverse of hospital staff business cards. As a result, teleassessments increased by 111% from April to January 2020.
CONNECTING WITH PATIENTS AND FAMILIES We first partnered with KATV (Little Rock’s ABC affiliate) and our UHS sister facilities, Pinnacle Pointe Hospital and Rivendell Behavioral Health, in 2020 to provide Therapeutic Thursdays, a weekly segment featured on Good Morning Arkansas social media. The features were designed to promote our ability to treat children, adolescents, and adults dealing with mental illness and substance use disorder. With the arrival of the pandemic, we shifted the focus of our topics from general mental illnesses to issues that arise during the pandemic’s unusual circumstances. Those topics included: • What Those in Recovery Need During a Pandemic. • Can Your Relationship Survive Lockdown? • Are People Reluctant to Admit to Mental Health Issues Due to the Pandemic? KATV Channel 7 and The BridgeWay, along with its sister hospitals Pinnacle Pointe Hospitals and Rivendell Behavioral Health, provide information, resources, and frank discussions about mental health on Therapeutic Thursdays.
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CONNECTING WITH EMPLOYERS AND EMPLOYEES According to a 2020 survey, two-thirds of employees reported that poor mental health undercut their job performance during the pandemic, and 40% of employees were battling burnout. As a result, employers began paying more attention to employee mental health. We have always treated employers and employees with a continuum of care that serves adults of all ages with mental health and substance use disorders. Yet, in 2020 we began to treat more employers who laid off employees or closed their doors either temporarily or permanently. These situations caused anxiety, depression, and suicidal ideation in the employers. To address these issues, we developed ads, articles, and posters that spoke to this audience. In support of the campaign, we embarked upon an outreach program to meet with employers and offer tips on how to provide self-care and support for employees. In addition, we developed a partnership with The Venture Center, called VCHealth. Working with Chenal Family Therapy, an outpatient provider, we conduct a monthly in-service on entrepreneurs' mental health and wellness resources. If these discussions trigger an emotional response among the attendees, The BridgeWay provides a licensed therapist available at no charge. The sessions are free and open to the public. It's been rewarding to see so many people interested in and recognizing the importance of mental health.
PROMOTING SELF-CARE Speaking of rewarding, one of the positive outcomes associated with the pandemic is that people are exploring self-care more than ever. A May 11, 2020, Tweet by Google Search Trends revealed that self-care was trending at an alltime high. According to Google Trends, the number of searches for "self-care" has more than doubled since 2015. Given the stigma associated with mental illness and the treatment thereof, it is encouraging that more people are considering their mental health.
The BridgeWay earned 2021 Diamond Awards for excellence in health care marketing and public relations for its intranet project and its collaboration with KATV on Therapeutic Thursdays. The Diamond Awards are sponsored by the Arkansas Hospital Association and the Arkansas Society for Healthcare Marketing and Public Relations. Bruce Trimble, MA, APR, is the Director of Business Development for The BridgeWay Hospital, a psychiatric hospital for children, adolescents, and adults in North Little Rock, Arkansas. An avid mental health advocate, he was appointed by the Governor of Arkansas to the Arkansas Suicide Prevention Council in 2015 when the council was commissioned, and he served as co-chair from 2015 to 2017. In 2018, he was instrumental in establishing a call center for the Arkansas Suicide Prevention Hotline. In 2021, he was invited by Stephanie Williams, Chief of Staff for Arkansas Department of Health, and Colonel Nate Todd, Arkansas Secretary of Veteran’s Affairs, co-chairs, to serve on the state’s Federal Veteran’s Affairs Governor’s Challenge to Prevent Suicide Among Service Members, Veterans, and their Families.
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COVID -19, Surge Two:
The Growing Toll on Mental Health By Lauren English Britton, LPC
M
any of us had active social lives before Covid-19 arrived on the scene. We dined out at restaurants. We attended large gatherings with family and friends without a care. I remember exactly where I was when the first Arkansas case was reported. I was attending a work conference in a large event space. Word spread quickly about that first case, and the energy in the room shifted almost instantly from carefree to tense. Many of us became painfully aware of any person who coughed or sneezed. The presence of COVID-19 launched a series of stressful life adjustments for many: Leave home only for essential reasons, like going to work or picking up grocery orders (perhaps placed online). Set up a home office space to accommodate daily Zoom meetings or online learning for students. Limit social gatherings to tiny groups and meet outdoors. Learn the public health practices of social distancing, sanitizing, and mask wearing. As for health care professionals, many of us found ourselves continually garbed in PPE, caring for patients receiving oxygen or on ventilators. We tested people for the virus. We cared for each other at work. We became stand-in families for too many patients separated from their loved ones while hospitalized. And we were devastated when so many patients didn’t survive. Today, the Delta variant is attacking full-force. Restrictions that began easing just three months ago are necessary once again. The toll on our mental health deepens. It sometimes seems like more than we can bear.
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THE WHIPSAW EFFECT
A few months ago, as vaccines became available and case numbers dropped, it felt as if we were approaching some sort of “normal.” People vacationed for the first time in a long time. They felt comfortable scaling back a bit on maskwearing. Health care professionals took the opportunity to breathe and hope for less daunting days. But, by June, virus variants had gained a foothold in the United States. In July, daily case numbers in Arkansas began reaching 3,000 or more for multiple consecutive days. Emergency departments became overcrowded with frightened – and often younger – patients seeking help, and our hospitals reported more patients requiring ventilator care than in past waves. Fear of the worst settled in even deeper, especially for already-exhausted frontline health care workers. As another school year begins, hospitals in Arkansas are overfilled with COVID-19 patients stricken with the highly contagious Delta variant, yet the rate of fully vaccinated individuals aged 12 and over in Arkansas stands near the nation's lowest at 50.8%. Arkansas Governor Asa Hutchinson makes frequent announcements about the dangerously limited number of ICU beds available in the state, and, in August, virus-related hospitalizations reached their highest point since the pandemic began. The nation’s mental health – the world’s mental health – is affected every day. And those at the front lines of the medical community are suffering greatly. Their daily workload is physically, mentally, and emotionally taxing, and then they go home to the common concerns affecting the mental health of nearly every person living today.
A SEVERE TOLL ON MENTAL HEALTH
Grief from loss of loved ones, extended isolation, financial insecurity, and job loss are continuing common psychosocial stressors faced by Americans during the COVID-19 pandemic.
Some hospitals provide support groups led by psychiatrists to help health care professionals manage symptoms caused by
anxiety, depression, and PTSD. While many wrestled – during the first wave and lockdown – with mounting stress and anxiety, the current wave, caused by the Delta variant, brings new questions about healthy survival. Stressors include: • Questions about being vaccinated. • Worry about family members’ vulnerability. • Concerns about others’ vaccination choices. • Dismay at the behavior of others. By now, most of us personally know individuals who have been hospitalized with the virus or its complications, have been placed on ventilators, or perhaps have even died of COVID-19. Scientists, learning from past pandemics, tell us that a disaster’s adverse mental health effects impact more people – and last much longer – than do its physical health effects. I’m a licensed professional counselor. It’s probably no surprise that those in our profession see an increase of symptoms and heightened levels of anxiety in clients as the pandemic wears on. Requests for appointments
with mental health therapists are dramatically rising; many people must wait months for their first appointment due to heightened demand. We’re all working desperately to meet people’s mental health needs. We know the need for mental health care is growing exponentially and will continue growing long after the infectious outbreak resolves.
ALL AGE GROUPS AFFECTED
A report published recently by the CDC found that ER trips due to suicidal ideations in teen girls (ages 12-17) has risen by 50.7% (3.7% in teen boys) since the start of the pandemic. 1 According to a metaanalysis published August 9, 2021 in the Journal of JAMA Pediatrics, one in four youth experiences symptoms of depression, and one in five experiences symptoms of anxiety, highlighting a startling truth: These mental health symptoms for young people around the world may have doubled since the COVID-19 pandemic began.2 The stresses associated with variant strains leave many people – parents, children, senior citizens, teachers, frontline workers, health care professionals, others – more anxious than ever. Arkansans who are vaccinated say they are now less concerned about being hospitalized if they get a breakthrough case of the virus, but that the high number of unvaccinated Arkansans is worrying. They’re concerned about contracting the virus and possibly spreading it to someone who is unable to be vaccinated at this time, such as children 11 and under. As a mother to a one-year-old son who is still too young to be vaccinated, I live with anxiety and fear every day, as many do, that I may unknowingly do something to expose my child to COVID-19. Parents of school-age children worry about health safety in classrooms.
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Nearly two years into the pandemic, constant debates still take place on social media, within families, and among friend groups about whether or not COVID-19 is a real threat. I marvel that becoming vaccinated and wearing a mask have become dividing lines in our society. Emotionally loaded discussions, disagreements, frustrations, even feelings of helplessness are affecting mental health in negative ways.
COMPASSION FATIGUE AND COVID-19
As a health care professional, do you at times feel like health care’s fight against COVID-19 is the most challenging group project in which you’ve ever participated? Are you frustrated when people refuse to take advantage of the tools designed to help us win that fight? You balance your work caring for others with genuine concerns for your own family and loved ones. The long work hours and increased demands are causing health care professionals to suffer overwork, exhaustion, and in some cases, burnout and compassion fatigue. Compassion fatigue is a state of chronic physical and mental distress and exhaustion. People with this fatigue often describe a negative shift in their world view; they seem to absorb the stresses of their traumatized patients. Compassion fatigue creates its own physical and mental stressors and can lead to burnout, affecting a caregiver’s ability to be effective in their job and relate to their loved ones and friends.
A disaster’s adverse mental health effects impact more people – and last much longer – than do its physical health effects.
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Health care workers experience stresses distinct from those in other professions. The pandemic only heightens this: They take care of patients making heart-wrenching phone calls to family members before going on life support. They educate patients about the COVID-19 vaccine, then deal with disappointment and frustration when many still refuse to take it. Many health care professionals report feeling less respected and supported than in the pandemic’s early days. Today there is little cheering from the parking lots or signs saying, “We Love Our Health Care Heroes!” We wonder: Are we really “all in this together,” as we heard so often in 2020?
PRIORITY ONE – TAKING CARE OF YOU
Health care workers are so used to caring for others that we often put ourselves last; the thought of caring first for ourselves seems almost foreign. Flight attendants remind us, ”In case of emergency, put on your own oxygen mask before helping those next to you.” This logical concept applies to everyone, perhaps even more to health care professionals in the midst of a pandemic. In today’s pandemic world, health care professionals can benefit from these practices: • Make self-care a priority: Despite your workload, do your best to make your health a priority. Focus on staying hydrated, sleeping as much as possible, eating nutritious meals, and getting exercise when you can.
• Boost your emotional resilience: Deep breathing, meditation, focusing on gratitude, and allowing yourself downtime to relax will allow you to better handle stress, setbacks, and crises. • Lean on social support: Connecting with supportive loved ones, friends, and colleagues can be a calming influence and shift your perspective on what you are dealing with every day. • Take pride in your profession: Your work is not only important, it’s a calling. You are caring for people during this ever-changing pandemic while giving them hope and strength. • Seek professional help: If you are experiencing distress and/ or symptoms of burnout for more than two weeks, help is always available at 1-800-273-TALK or by scheduling an outpatient appointment with a mental health professional.3 In addition to these self-care steps, health systems and hospitals should proactively ask doctors and nurses about their well-being, make the time and space to actively listen, and offer appropriate supports as needed for each staffer. Mental health care is as vital for health care professionals as are facemasks and other PPE. Support is needed to allow doctors, nurses, and other staff members the time and space to reflect and discuss the emotional toll of working through this pandemic and toward a post-COVID era. A promising sign: some hospitals provide support groups led by psychiatrists to help health care professionals manage symptoms caused by anxiety, depression, and PTSD. One lesson learned during the pandemic takes precedence: Take mental health seriously. Mental health is an aspect of overall health. The more we make the time to breathe and actively care for ourselves as caregivers, the more we will be able to help normalize an increased focus on mental health care. This moves society forward and helps us sincerely “all be in this together.”
Endnotes 1Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI: http:// dx.doi.org/10.15585/mmwr.mm7024e1. 2Nicole Racine, PhD, RPsych; Brae Anne McArthur, PhD, RPsych; et al. “Global Prevalence of
Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19, A Metaanalysis.” JAMA Pediat. August 9, 2021. http://doi.10.1001/jamapediatrics.2021.2482.
3Varun Choudhary, MD. “Compassion Fatigue and COVID-19.” Magellan Health Insights. https://
magellanhealthinsights.com/2020/03/17/compassion-fatigue-and-covid-19/.
Lauren English Britton, LPC, is a Licensed Professional Counselor and Business Development Representative working with Pinnacle Pointe Behavioral Healthcare System. She earned her Master of Science degree in Clinical Mental Health Counseling at Henderson State University, and her Bachelor of Arts degree in Mass Communications at Ouachita Baptist University. She has clinical experience working with children, adolescents, teens, adults, and families. You may recognize her from appearances on KATV Channel 7’s “Therapeutic Thursdays.”
SELF-CARE TIPS FOR CAREGIVERS THE 4–7–8 BREATHING TECHNIQUE FOR RELAXATION
1. Sit quietly, relax, and close your eyes. Place the tip of your tongue against the ridge on the roof of your mouth just behind your top front teeth. Your tongue should remain in this position throughout the exercise. 2. Exhale completely through your mouth, making a whooshing sound. It may help to purse your lips. 3. Close your mouth, and inhale quietly through your nose for a count of four. 4. Now hold your breath for a count of seven. 5. Exhale completely through your mouth, making a whooshing sound to a count of eight. 6. Repeat steps 2–5 three times, for a total of four breaths. In this technique, exhalation should take twice as long as inhalation. This ratio is the important part; the exact amount of time you spend on each phase is not important.
PROGRESSIVE MUSCLE RELAXATION
1. Get into a comfortable position. 2. Choose a muscle group (e.g., muscles in your feet or lower legs). 3. Breathe in and tighten the muscles in the group for 5 to 10 seconds. 4. Breathe out and release the muscles suddenly. Relax for at least 10 seconds. 5. Repeat the process with another muscle group. It often helps to progress from head to toe or vice versa.
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Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic
By Nirmita Panchal, Rabah Kamal, Cynthia Cox, Rachel Garfield, and Priya Chidambaram
C
hildren have experienced major life disruptions (e.g. social isolation, financial hardship, school closures, and gaps in health care access) resulting from the COVID-19 pandemic and necessary public health safety measures put in place to quell its spread. Rising numbers of parents report the worsening of their children’s mental health – in May 2020, shortly after the pandemic began, 29% said their child’s mental or emotional health was already harmed; in more recent research from October 2020, 31% of parents said their child’s mental or emotional health was worse since the pandemic began. Data collected since last fall indicate that number is increasing. Some children exhibit increased irritability, clinginess, and fear, and have issues with sleeping and poor appetite. Others show growing, severe symptoms. ARKANSAS HOSPITALS | FALL 2021 23
As mental health issues become more pronounced among children, issues with access to care may also be increasing. These access challenges can exacerbate existing mental health issues among children.
PRE-COVID BASELINES
Even before the pandemic, many children in the United States were living with mental health disorders. In 2018 and 2019, of children aged 3-17, an average of 8% (5.2 million) had anxiety disorder, 4% (2.3 million) had depressive disorder, and 9% (5.3 million) had attention deficit disorder or attention deficit/hyperactivity disorder (ADD/ADHD). Other mental health disorders among children and adolescents include obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders. Adolescents, in particular, in recent years have shown increases in poor mental health outcomes, such as persistent feelings of sadness or hopelessness and suicidal thoughts. Many mental health conditions develop by adolescence and, if unaddressed, can persist into adulthood and limit quality of life.
A BRIEF OVERVIEW
This article explores factors contributing to poor mental health and substance use outcomes among children during the pandemic, highlighting groups of children who are particularly at risk and barriers to accessing child and adolescent mental health care. Although data on child and adolescent mental health have historically been limited, where possible, we draw upon data from the National Survey of Children’s Health, the Youth Risk Behavior Surveillance System, and the National Survey on Drug Use and Health, in addition to surveys conducted during the pandemic. Key takeaways include: • Several pandemic-related factors may negatively impact children’s mental health. Social distancing and stay-at-home orders could lead to loneliness and isolation among children – these are known risk factors for poor mental health. Income insecurity and poor mental health experienced by parents during the pandemic may also adversely affect children’s mental health and may be associated with a possible rise in child abuse. • Adolescents, young children, LGBTQ youth, and children of color may be particularly vulnerable to negative mental health consequences of the pandemic. Even during the early part of the pandemic, more than 25% of high school students reported worsened emotional and cognitive health; that number is more than 66% today. More than 20% of parents with children ages 5-12 report their children are experiencing worsened mental or emotional health since the pandemic began. A recent survey of LGBTQ youth found that many LGBTQ adolescent respondents (ages 13-17) reported 24 FALL 2021 | ARKANSAS HOSPITALS
symptoms of anxiety (73%) and depression (67%) and serious thoughts of suicide (48%) during the pandemic. Although data is limited on children of color, research suggests that even before the pandemic, they had higher rates of mental illness but were less likely to access care. • Prior to the pandemic, many children with mental health needs were not receiving care, and it is possible that access to mental health services has since worsened. Data shows that there have been large declines in pediatric mental health care utilization since the pandemic began. Access to mental health care via telehealth has increased; however, access via schools – a commonly utilized site of care for children and adolescents – may have decreased due to school closures.
PANDEMIC-RELATED FACTORS: CHILDREN AND PARENTS Research broadly shows that loneliness is associated with anxiety and depression among children, and the long periods during which the pandemic forced education to go virtual resulted in extreme loneliness among children of school age. The duration of a child’s experience of loneliness is linked to mental health problems later in life. Pandemic-related isolation and quarantines may also lead to some children experiencing separation anxiety from their parents or caregivers and fear of themselves or family members becoming infected. Many parents report experiencing stress and poor mental health during the pandemic. This may be due to a number of factors, including parents balancing both work and childcare, and parents facing income insecurity (in late March 2021, 49% of households with children reported a loss of employment income and 61% reported difficulty paying for usual household expenses). The poor mental health of parents can adversely affect their children’s mental health. Media reports suggest that child abuse may have increased in light of the pandemic, although this is unclear based on available data. The pandemic’s negative impact on parents’ stress and mental health could be associated with the possible rise in child abuse. Child abuse can result in immediate emotional and psychological problems, and it is an adverse childhood experience (ACE) linked to possible mental illness and substance misuse later in life. Reports of child abuse have dropped since school closures began, and child abuse-related emergency department (ED) visits have decreased throughout the pandemic. However, the severity of injuries among these ED visits has increased and resulted in more hospitalizations; it is possible that due to school closures and stay-at-home orders during the pandemic, many cases are going undetected, since educators play a primary role in identifying and reporting child abuse. (Research found that cases of child abuse increased during the previous recession.)
$10.7 MILLION AWARDED TO EXPAND PEDIATRIC MENTAL HEALTH CARE ACCESS On August 27, the U.S. Department of Health and Human Services awarded $10.7 million from the American Rescue Plan to expand pediatric mental health care access by integrating telehealth services into pediatric care. The awards were made through the Health Resources and Services Administration (HRSA). The Pediatric Mental Health Care Access Program supports state and regional networks of pediatric mental health care teams. These teams provide tele-consultation, training, technical assistance, and care coordination for pediatric primary care and other providers to diagnose, treat, and refer children and youth with mental health conditions and substance use disorders. The expansion announced in late August broadens the program's reach from 21 awards in 21 states to 45 awards in 40 states, as well as the District of Columbia, the U.S. Virgin Islands, and the Republic of Palau. It also provides support to two Tribal areas – the Chickasaw Nation and the Red Lake Band of the Chippewa Indians. Currently, nearly 22% of children aged 3-17 in the United States are affected by a mental, emotional, developmental, or behavioral condition. Only about 20% of children with mental, emotional, or behavioral disorders, however, receive care from a specialized provider. "Primary care providers strive to address the many mental health challenges children and families are experiencing due to the pandemic, but they need more support," said HRSA Acting Administrator Diana Espinosa. "Expanding the Pediatric Mental Health Care Access program offers new opportunities for providers to offer families the mental and behavioral health services they need but that often aren't easily accessible." To learn more about HRSA's Pediatric Mental Health Care Access program, visit: https://mchb.hrsa.gov/training/ pgm-pmhca.asp.
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SUPPORTING MENTAL HEALTH IN THE WORKPLACE Nearly one in five adults lives with a mental illness. Employers can’t afford to ignore the financial impact mental health has on the workplace. Absenteeism, lost productivity, decreased retention = $$$$ The BridgeWay is here to assist you.
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*National Institute of Mental Health, 2019
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SPECIAL CONSIDERATIONS: ADOLESCENTS AND CHILDREN
Research during and leading up to the pandemic suggests that adolescents, young children, LGBTQ youth, and children of color may be particularly vulnerable to negative mental health consequences of the pandemic, including anxiety and depression.
ADOLESCENTS
Data show that throughout the pandemic, adolescents report increasingly poor mental health. Shortly after the pandemic began, more than 25% of high school students reported worsened emotional and cognitive health. A more recent survey found that only one-third of these students felt they were able to cope with their sources of stress, which include strained mental health and peer relationships. Private insurance data show that while all health care claims for adolescents aged 13-18 were down in 2020 compared to 2019, mental health-related claims for this age group increased sharply.1 The most frequently diagnosed mental health conditions in 2020 were depression, anxiety, and adjustment disorder. Some evidence shows that substance use disorders and overdoses among adolescents are on the increase during the pandemic. Solitary substance use, as opposed to social substance use, is increasing. An analysis of private insurance data found that, in general, claims for substance use disorders and overdoses increased as a share of all medical claims for adolescents aged 13-18 in 2020, compared to 2019.1 When substance use begins at younger ages, it is more likely to persist into adulthood and increase the risk of addiction.
Figure 1
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YOUNG CHILDREN
Parents report that their young children are experiencing worsened mental health during the pandemic. This may be due to pandemic-related disruptions in their routines and caregiving or stressful home environments. Forty-seven percent of parents with children who are not yet of school-age report they are more worried about their children’s social development than they were before the pandemic. Parents with children aged 5-12 report their children show elevated symptoms of depression (4%), anxiety (6%), and psychological stress (9%); and experience overall worsened mental or emotional health (22%) because of the pandemic. (Figure 1) Parents of children attending school online were more likely to report their children experienced overall worsened mental or emotional health than parents of children attending school in-person (25% vs. 16%, respectively). An analysis of private insurance data from 2020 found that claims for OCD and tic disorders increased as a share of all medical claims for children aged 6-12, compared to 2019.1 ADHD was the top mental health diagnosis for children aged 6-12 during 2020; however, claims for ADHD decreased as a share of all medical claims, compared to 2019. This decrease may result from teachers being unable to observe possible signs of ADHD as they typically would during in-person instruction.
Figure 2
LGBTQ YOUTH
Research suggests that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth may be particularly vulnerable to negative mental health outcomes during the pandemic. A non-probability survey of LGBTQ youth conducted in Fall 2020 found that large shares of adolescent respondents (aged 13-17) reported recent symptoms of anxiety (73%) or depressive (67%) disorder; 48% seriously considered attempting suicide in the past year. Prior to the pandemic, LGBTQ youth were already at increased risk for depression, suicidal ideation, and substance use. In 2019, 66% of lesbian, gay, and bisexual high schools students reported persistent feelings of sadness and hopelessness (compared to 37% of all high school students) and 47% reported serious thoughts of suicide (compared to 19% of all high school students). Larger than average shares of lesbian, gay, and bisexual youth also reported substance use before the pandemic.
CHILDREN OF COLOR
Poor mental health outcomes resulting from the pandemic may disproportionately affect children of color. Prior to the pandemic, children of color had higher rates of mental illness, but were less likely to receive care. They were also less likely than White children to have access to school health services, including mental health care. During the pandemic, these access issues can be further exacerbated as school services are suspended or limited. Asian children may be uniquely at risk of adverse mental health outcomes due to anti-Asian racism’s emergence during the pandemic; prior to the pandemic, they were more likely to face barriers in accessing mental health services than White children. Structural racism is associated with poor mental health outcomes.
Data show that during the pandemic, Black and Latino adults have experienced higher rates (than White adults) of 1) illness and death from COVID-19, 2) negative financial impacts, and 3) poor mental health outcomes, which may have adverse mental health effects on children from these communities.
ACCESS TO CARE DURING THE PANDEMIC
Prior to the pandemic, many children with mental health needs were not receiving care. Stated reasons include cost, a lack of providers, and limited insurance coverage. In 2019, 11% of children aged 3-17 received mental health care in the year prior. However, only one in five children with mental, emotional, or behavioral disorders were receiving mental health care from a specialized provider. Access to mental health care – access to all health services – became challenging at the onset of the pandemic. To slow the spread of coronavirus, many health care providers changed the way they deliver services, sometimes suspending service or operating at limited capacity. (Telehealth use has increased for many types of health services, but not necessarily by enough to offset the drop in in-person care.) Some data suggest there have been substantial declines in the utilization of pediatric mental health care during the pandemic. Among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries under the age of 18, the number of children receiving mental health services dropped by 50% from February to October 2020 (Figure 2). While utilization rates of other services – including child screening and dental services – among this population eventually began to rebound during these months, mental health service utilization rates lagged in comparison. Nearly two out of five children under the age of 18 in the U.S. are Medicaid or CHIP beneficiaries. ARKANSAS HOSPITALS | FALL 2021 27
Private insurance mental health care claims also decreased from 2019 to 2020.1 Despite a drop in the total number of mental health claims among privately insured patients, mental health care represented a larger share of total medical claims among these patients in 2020 than in 2019. Throughout the pandemic, many insurers and mental health care providers expanded telehealth services. Claims data from CMS show a significant increase in the utilization of outpatient mental health services via telehealth for Medicaid/CHIP child beneficiaries beginning in March 2020. Analysis of pediatric private claims data shows a similar trend.1 But a number of barriers may limit some children’s access to mental health care via telehealth during the pandemic, including lack of access to digital devices, internet, and privacy in speaking with a provider. Prior to the pandemic, many adolescents sought mental health care through their schools (3.7 million adolescent visits in 2019.) With pandemic-related school closures, children and adolescents perhaps faced limited or suspended health services, including mental health services, commonly accessed through school-based health centers (SBHCs). In focus groups conducted during the pandemic, many SBHC staff reported challenges in delivering health care and voiced heightened concern about mental distress among their students, including symptoms of anxiety, depression and suicidal ideation.
Surges of patients with severe COVID-19 have, at times, left hospitals at or above admissions capacity, and some have repurposed psychiatric beds for COVID-19 patients or have limited admissions in order to mitigate the spread of the coronavirus. Some financially hard-hit hospitals have closed inpatient psychiatric units entirely. Children in need of hospitalization for mental health disorders during the pandemic can be challenged to find hospitals with enough capacity.
POST-PANDEMIC NEEDS
Looking ahead, poor mental health outcomes and access to care issues among children and adolescents are likely to persist beyond the pandemic. The pandemic may also increase the risk of children having adverse childhood experiences, or ACEs, such as experiencing violence or being exposed to adult substance misuse, which can lead to long-term mental health and substance use issues. This article highlights the need for policymakers, providers, educators, parents, and researchers to consider the ways the COVID-19 pandemic may impact children’s mental health for the long-term. Endnote 1In this analysis by FAIR Health, medical claims refer to a service or procedure listed on an insurance claim. More information is available at: https://www. fairhealth.org/article/fair-health-releases-study-on-impact-of-covid-19-onpediatric-mental-health
REDUCED BED AVAILABILITY
Anecdotal evidence from numerous media reports suggests that the availability of psychiatric beds in hospitals and mental health facilities has decreased during the pandemic. This exacerbates an existing shortage of child and adolescent psychiatric beds, which are needed for individuals seeking emergency care during a mental health crisis. 28 FALL 2021 | ARKANSAS HOSPITALS
The authors originally wrote this article for KFF, a nonpartisan, nonprofit organization noted for its health policy analysis and health journalism. Their article is shared here with permission.
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COACH'S PLAYBOOK
Mental Health and Resilience in the Time of COVID-19 By Kay Kendall
A
nother day, another headline about hospitals with available beds but insufficient staff to care for patients. Today, it is Parkland Hospital in Dallas, Texas, which is experiencing huge spikes in infections, hospitalizations, and deaths due to COVID-19 and the surge of the Delta variant. Staff members become ill, or they transfer to other units because they’re physically and mentally worn out. Shortages in the COVID units and ICUs are critical. In the news feeds I follow on the internet, this is a recurring scenario in hospitals all over the country.
IT'S OK TO NOT BE OK For many people, not just those who work in health care, this pandemic has become a time of heightened anxiety with an upsurge of mental health issues. The notion of needing to take care of oneself and to acknowledge that “it’s okay to not be okay” has recently been at the cultural forefront of both women’s tennis and the Olympics. However, I’ve seen the media (social and otherwise) be very critical of, and even callous to, these calls for help and understanding.
ARKANSAS HOSPITALS | FALL 2021 31
STAFF MENTAL HEALTH IS ESSENTIAL TO ORGANIZATIONAL RESILIENCE The Baldrige Excellence Framework (2021-2022) introduces a new concept and core value in this most recent revision. The new section addresses “resilience.” Related to agility, which is more about “pivoting” in response to an unexpected situation or set of
circumstances, resilience focuses on recovery and bouncing forward. I wrote about this topic in the Summer 2021 issue of Arkansas Hospitals, but until now, in these days of staff shortages, I hadn’t really connected it with mental health and what we, as leaders, need to do to support our employees’ mental health and recovery. As someone who has experienced anxiety attacks and depression periodically in the past, I can tell you that a critical factor to getting help
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is trusting your health care provider and your workplace supervisor with your information. It’s challenging, in a workplace environment, to reveal that you’re having difficulties with mental health. We fear ridicule or judgment, and it’s possible such an admission could result in negative consequences affecting your employment. A recent business article revealed that Google pressured its employees, when reporting harassment or a toxic work environment, to avail themselves of free counseling through its Employee Assistance Program (EAP). This sounds helpful; but the company’s HR department sought to obtain the supposedly confidential records in order to fight lawsuits brought against the company in these areas. This is the antithesis of providing a safe, secure environment. As health care leaders, we must instill trust as we guard our employees’ mental health.
TOM PETERS AND THE IMPORTANCE OF “PEOPLE FIRST” One of my “gurus” is Tom Peters, whose recent book, Excellence Now: Extreme Humanism, brings the importance of “People First” as the overarching objective for anyone in management. What strikes me as I’m re-reading his book in the light of employees and pandemic-related mental health issues: How difficult it may be for employees to admit to their managers a need for mental health support. It’s highly likely that these same managers, prepandemic, never got to know their workers as real people with real lives outside of the hospital or the office. To bounce forward, or achieve resilience, our employees’ pandemic and postpandemic mental health needs will depend on intentional relationships; this is important for leaders to consider right now. Our organizations’ resilience is dependent upon theirs. As Arvind Govindarajan and Marco Vettori at McKinsey & Company put it, “In the longer term, businesses will learn that resilience is a capability they need to master, not an alarm button they hit after the fire has started.”
TRY THESE DAILY PRACTICES FOR LEADERS How well did you know your employees, prior to the pandemic? What can you do now if you genuinely want to provide mental health support at this critical time? The article, “Future Proof: Solving the ‘Adaptability Paradox’ for the Long Term,” was posted in early August by McKinsey & Company and offers daily practices designed to help leaders improve their performance in this era of constant change. These are, incidentally, great self-care practices that will enhance the mental health of all who try them. I excerpt their outline of helpful daily practices in three key areas below, with my own challenge to you:
BODY
• Sleep - Getting at least 7 hours of sleep at the same time each day. - Having a cutoff time for work/screens. • Exercise - Maintaining or increasing your weekly exercise goals. - Using a last-minute meeting (or virtual meeting) cancellation to get up and get out. • Nutrition - Modulating your daily caloric intake with your activity level.
SPIRIT
• Purpose - Regularly reflecting on how your work contributions connect to the organization’s higher purpose and to your own. - Finding ways to help others in your local community. • Renewal - Blocking time for your hobbies. - Participating in activities that bring you joy and lift your spirits. • Connection - Spending quality time each day – whether in person or virtually – with at least one person who is important to you. - Performing at least one act of kindness each day. (Access the complete article at McKinsey.com) As leaders, it will be important for you to personally model these behaviors and to encourage their practice with your employees. This is truly a time for you to teach self-care: “Do as I say, and do as I do.” Your relationship with each employee affects organizational resilience. Where will you start?
MIND
• Meditation - Building in 2 to 3 one-minute mindful breathing breaks throughout the day. • Introspection - Considering the use of a journal to express/ process your inner thoughts. - Honing your ability to not become distracted and to disconnect from technologies. • Perspective - Expressing gratitude. - Reframing negative mindsets to some that are more helpful.
The team at BaldrigeCoach would be glad to help guide your hospital’s quest for process improvement. As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award Criteria as a framework. Her team, working with health care and other organizations, has mentored 24 National Quality Award recipients. In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook. Contact Kay at 972.489.3611 or Kay@Baldrige-Coach.com.
ARKANSAS HOSPITALS | FALL 2021 33
LEADER PROFILE
How “Delta” Changes Caregiving By Nancy Robertson
T
he Delta variant of SARS CoV-2 is changing the face of health care in three ways: There are changes in the disease itself, a change in the ages of those being hospitalized with it today, and changes affecting caregivers and their caregiving. With Delta’s advance comes added concern for health care providers caring for COVID-19 patients. After more than 20 months working around the clock with desperately ill COVID patients, they are physically, mentally, and emotionally exhausted as hospitalization numbers, deaths, and cases of the virus continue to hit new levels, despite the availability of vaccines. “It’s hard to believe we’re still having discussions about COVID-19 all these months after vaccines became available,” says Chad Aduddell, Market CEO of CHI St. Vincent. “In April, after a few months of people receiving vaccinations, we saw the return of patients who had delayed care during the pandemic’s first waves. It gave us a glimmer of hope that things were changing. “But in May, we noticed a data blip, and another in early June, showing an uptick of COVID cases being seen in our clinics. It was, of course, due to the Delta variant making its way to Arkansas. Like other systems in Arkansas [and the South], our hospitalizations began to rise, and we continue to treat people who are very sick with the Delta variant today.” With fellow health care leaders the world over, Aduddell noted with alarm the Delta variant’s rise first in India, then in the United Kingdom, then in the United States first in the Branson/Springfield area of neighboring Missouri. With distressing reports of its more contagious nature and the effect it was having on younger adults and children, Aduddell and his team prepared in early summer for another long wave of COVID hospitalizations. “We were, and remain, thrilled with the numbers of older folks who chose to be vaccinated with the new COVID-19 vaccines,” Aduddell says. “In fact, we were very excited to offer the shots at large vaccination events throughout our system earlier in the year.” But adults under the age of 50 – not as highly susceptible to the early variants and less likely to choose vaccination – are the majority of adult cases presenting in late summer and early fall. Hospitals in the CHI St. Vincent system, like hospitals all over the South, are full. The vast majority of adult COVID cases are among the unvaccinated. And the numbers of children being treated are also growing. Aduddell simultaneously expresses confidence in his health care teams’ ability to care for those with the virus and his concern for their rates of exhaustion and frustration.
34 FALL 2021 | ARKANSAS HOSPITALS
STILL HEALTH CARE HEROES
“During the first waves of the pandemic, things were different,” he explains. “Yes, there were worries and concern as health care providers learned how to treat patients with this new disease. We dealt with shortages of personal protective equipment (PPE) including masks and eye protection. We worked around shortages of ventilators, of gowns … but we have gotten past these issues. So much has been learned about effective drugs and treatment methods. We’re better prepared and have more information about how to address the cases that present in our hospitals. Though fatigue affected everyone in health care during the first three waves, we looked forward to the day vaccines would be available.” When that day came, health care professionals around the world heaved a collective sigh of relief realizing that a slowdown in cases would follow. Which it did, for a short time. “Today’s concerns are turning to frustration,” Aduddell shares. “Health care workers are caring for very sick, mostly unvaccinated people in a time when only kids 11 and under are not authorized for vaccination. All around Arkansas and the country, we see people out in groups without masks and without socially distancing. This just should not be, with the Delta variant thriving.” Concerning the mental health of health care workers, there’s a vast difference between their treatment as heroes during the first waves of the virus and their treatment today. “Early on, people in health care felt very supported,” he says. “There was lots of attention to our Health Care Heroes from the community, the government, and various groups. Today, that external support for staff is nearly gone. Our health care workers are exhausted and feel alone. They’ve been dealing with tough schedules and little rest while caring today for more COVID patients than ever before. “The difference, now, is that we collectively feel these people are dying needlessly,” he continues. “We don’t see vaccination as adversarial or political…we see it as a life-saving mechanism. We’re just trying to take care of people, and to see so much death when vaccines are available is heart-breaking.”
SUPPORTING MENTAL HEALTH NEEDS
CHI St. Vincent is doing all it can to support its health care staff. Aduddell has brought in more caregivers to give the medical and nursing staff much-needed cycles of rest. “We also try to do little things every day, providing rest breaks, free meals at times, counseling when needed. There are also some area businesses that periodically bring in meals to surprise the staff. These all add up to help people feel supported. Sometimes mental health care doesn’t have to be complicated…we just need to show we care and that we’re doing things to help our staff members take care of themselves.” Mental health benefits have always been a part of the CHI St. Vincent employee package, but COVID has made making
The difference, now, is that we collectively feel these people are dying needlessly. We don’t see vaccination as adversarial or political… we see it as a life-saving mechanism. and keeping appointments with mental health providers easier through telehealth options. “The pandemic has rapidly increased the use of our virtual care platforms,” Aduddell says. “Our communications team creatively promotes these benefits in multiple ways throughout our multi-hospital system, internally through our co-worker newsletter, ‘Ask the Leader’ opportunities, and intranet information.” Leaders and administrators are not left out of the caregiving channels; they’re supported through special training sessions and leadership programming. Sessions on resilience are proving very useful during the pandemic, team members say. The system is also reaching out to patients in new ways during the COVID pandemic. Mental health services are expanding, and a new addiction recovery unit is now open to both inpatients and outpatients in partnership with Bradford Health. With the rise of drug and alcohol abuse during the isolation caused by the pandemic, this new unit is proving to be a huge asset to area patients seeking help. The system’s marketing group is active in getting information to the public, detailing CHI St. Vincent’s many areas of patient care, including mental health care and its new addiction recovery unit, through social media.
CHANGES GOING FORWARD What do Aduddell and his team see as changes to health care that will result from the pandemic? “For quite a while, those of us in U.S. health care have been shifting our focus from simply caring for people after they become ill to caring for them with the intention of preventing illness,” he says. “We ARKANSAS HOSPITALS | FALL 2021 35
are focusing on value-based care, which includes increasing access, improving quality, and decreasing cost and unnecessary utilization. We accomplish this by actively assessing our populations to identify risk factors, then intervening to correct those factors to protect health and wellbeing.” He notes that the workforce population separates itself into three groups: • Those who utilize health care as a means for preventing illness and increasing wellbeing. This is about 70% of the population. • Those who have some health issues and can benefit from interactive connections, including health coaches, personal calls after hospitalization or health care visits (to check on medication usage and questions as they arise, plans to keep impending appointments, etc.), and other means of communication. This is about 25% of the population. • Those who have advanced disease and numerous comorbidities, with little improvement expected in their prognoses. This is about 5% of the population. “Our focus going forward will really be on that middle group,” Aduddell says. “We want to get them the help they need to improve their health conditions while they can, while helping them be proactive in getting treatment. We’re connecting them with the resources they need to make real improvements in their health.” Challenges seen for health care, post-COVID, are not surprising. COVID and its toll on health care workers has substantially raised the cost of labor and has negatively affected the size of the health care workforce. “The cost of pharmaceuticals is also up, currently,” Aduddell says. “The nation will be looking at new options in this area as we move beyond the pandemic.”
TAKING COMFORT IN THEIR MISSION With the pandemic revealing the extreme need for additional health care access in many groups and demographics across the country, Aduddell and his team take comfort in the work they’re doing. “As we meet the needs of the poor and
vulnerable, we’re remaining true to who we are as a health system,” he says. “The Sisters of Charity of Nazareth started the CHI St. Vincent system with humble beginnings in 1888, meeting similar challenges for the poor and vulnerable even then. Today, we draw on that heritage every day to remind us of why we are here. We have more than 4,500 coworkers and over 500 physicians and health care providers serving the people of Arkansas, and it’s a part of our Catholic identity and ministry to accept all who need care. We’re proud to offer community clinics in particular areas of need and to offer bilingual staff where they’re needed.” CHI St. Vincent proudly points to three areas where its providers are recognized internationally and nationally for exceptional care. “Our Neuroscience Institute is unique in the United States, and it is gaining global attention as a center of excellence for those requiring care for neurological disorders and/or neurosurgery. The Heart Institute is known for the quality of results it achieves with patients, and it receives the highest ratings among thoracic surgeons. The breadth of the Heart Institute’s programs around the state gives Arkansans access to the state’s largest and most diverse network of heart specialists. And our Behavioral Health Program offers comprehensive behavioral health services including inpatient treatment and outpatient treatment programs. Whether it’s help through our new addiction recovery program, adult inpatient behavioral health care, or senior behavioral health care, we offer personalized programs for Arkansans’ behavioral health needs."
BEYOND DELTA Chad Aduddell doesn’t know where the Delta variant will take his teams and their patients as we move into the winter months. No health care leader can know that. But one thing is certain: He will continue to see not only that patients receive the best and most effective care but also that all employees in the CHI St. Vincent system, including the medical and nursing staff members, receive the support and care they need to maintain their personal health in the midst of this pandemic.
Chad Aduddell became Chief Executive Officer at CHI St. Vincent in 2015. As its leader, he oversees the system’s four hospitals (CHI St. Vincent Infirmary, CHI St. Vincent Hot Springs, CHI St. Vincent North, and CHI St. Vincent Morrilton, its Institutes, clinics, and service centers. For three previous years prior to being named system CEO, Aduddell served as Executive Vice President and Chief Operating Officer of CHI St. Vincent and President of CHI St. Vincent Infirmary in Little Rock. • He came to CHI St. Vincent from St. Anthony Hospital (sponsored by SSM Health Care, the first health care recipient of the Malcolm Baldrige National Quality Award) in Oklahoma City, Oklahoma, in 2012. At St. Anthony, Aduddell served as the President of the Bone & Joint Hospital and as Chair and Administrator of the Saints Heart and Vascular Institute. • He has experience in hospital operations and physician enterprise with CHRISTUS Spohn Health System in Corpus Christi, Texas, and in physician enterprise and physician residency program management with SSM Health Care in Oklahoma City. • Aduddell earned his Bachelor of Science with honors from the University of Tulsa and a Master of Business Administration in Health Care Administration with highest honors from Oklahoma City University’s Meinders School of Business. • He has served on the Little Rock Regional Chamber of Commerce Board of Directors, Arkansas Healthcare Transparency Initiative Board, the University of Arkansas at Little Rock College of Business Advisory Board, Healthy Active Arkansas, Arkansas United Soccer Club Board, and the Mount St. Mary’s Board.
36 FALL 2021 | ARKANSAS HOSPITALS
We Asked... What is the best advice you were ever given?
Feedback is the breakfast of champions – I learned this from my first boss and mentor at St. Anthony Hospital in Oklahoma City. The challenge is that feedback comes in different forms – compliments are feedback, and criticism is feedback. I have learned to take feedback for what it is, you can’t get too high or too low when you receive it. I try to use feedback to be better every day.
Do you have a favorite movie?
I can’t pick just one. The Lord of the Rings Trilogy: These were my favorite books growing up and were amazing on screen. Tombstone: Wyatt Earp really resonates with me. And Chariots of Fire: This is an incredible film. As a runner and huge fan of the Olympics, I am inspired by Eric Liddell’s story.
What’s on your music playlist?
I actually listen to this when I run: '80s rock, Hillsong United, Elevation Worship, Abba, the Spinners, and the soundtracks to Rocky and Rocky IV.
What is something people don’t know about you? I have four daughters, ages 12-20, and love to spend time with them, participating in their interests, activities, and sports.
What would you do if you weren't in health care?
I was blessed with great teachers, coaches, and mentors who have had an incredible influence on my life. I love to teach and coach, and I hope to do more of both in the future.
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Camden, Arkansas
Little-Known Illnesses Turning Up in
COVID Long-Haulers
By Cindy Loose
T
he day Dr. Elizabeth Dawson was diagnosed with COVID-19 in October 2020, she awoke feeling as if she had a bad hangover. Four months later she tested negative for the virus, but her symptoms have only worsened. Dawson is among what one doctor called “waves and waves” of “long-haul” COVID-19 patients who remain sick long after retesting negative for the virus. A significant percentage are suffering from syndromes that few doctors understand or treat. In fact, a yearlong wait to see a specialist for these syndromes was common even before the ranks of patients were swelled by post-COVID-19 newcomers. For some, the consequences are life altering.
LOOKING FOR ANSWERS
Before last fall, Dawson, 44, a dermatologist from Portland, Oregon, routinely saw 25 to 30 patients a day, cared for her 3-year-old daughter, and ran long distances. Today, her heart races when she tries to stand. She has severe headaches, constant nausea, and brain fog so extreme that, she says, it “feels like I have dementia.” Her fatigue is severe: “It’s as if all the energy has been sucked
from my soul and my bones.” She can’t stand for more than 10 minutes without feeling dizzy. Through her own research, Dawson recognized she had typical symptoms of postural orthostatic tachycardia syndrome, or POTS. It is a disorder of the autonomic nervous system, which controls involuntary functions such as heart rate, blood pressure and vein contractions that assist blood flow. It is a serious condition – not merely feeling lightheaded on rising suddenly, which affects many patients who have been confined to bed a long time with illnesses like COVID-19 as their nervous system readjusts to greater activity. POTS sometimes overlaps with autoimmune problems, which involve the immune system attacking healthy cells. Before COVID, an estimated three million Americans had POTS. Many POTS patients report it took them years to even find a diagnosis. With her own suspected diagnosis in hand, Dawson soon discovered there were no specialists in autonomic disorders in Portland – in fact, there are only 75 board-certified autonomic disorder doctors in the U.S. Other doctors, however, have studied and treat POTS and similar syndromes. The nonprofit organization ARKANSAS HOSPITALS | FALL 2021 39
Dysautonomia International provides a list of a handful of clinics and about 150 U.S. doctors who have been recommended by patients and agreed to be on the list. In January of this year, Dawson called a neurologist at a Portland medical center where her father had worked and was given an appointment for September. She then called Stanford University Medical Center’s autonomic clinic in California, and again was offered an appointment nine months later. Using contacts in the medical community, Dawson wrangled an appointment with the Portland neurologist within a week and was diagnosed with POTS and chronic fatigue syndrome (CFS). The two syndromes have overlapping symptoms, often including severe fatigue.
SYNDROMES COEXIST
Dr. Peter Rowe of Johns Hopkins in Baltimore, a prominent researcher who has treated POTS and CFS patients for 25 years, says every doctor with expertise in POTS is seeing long-haul COVID patients with POTS, and every long-COVID patient he has seen with CFS also had POTS. He expects the lack of medical treatment to worsen. “Decades of neglect of POTS and CFS have set us up to fail miserably,” says Rowe, one of the authors of a recent paper on CFS triggered by COVID.1 The prevalence of POTS was documented in an international survey of 3,762 long-COVID patients, leading researchers to conclude that all COVID patients who have rapid heartbeat, dizziness, brain fog, or fatigue “should be screened for POTS.” A “significant infusion of health care resources and a significant additional research investment” will be needed to address the growing caseload, the American Autonomic Society says in a recent statement. Lauren Stiles, who founded Dysautonomia International in 2012 after being diagnosed with POTS, says patients who have suffered for decades worry about “the growth of people who need testing and treating, but the lack of growth in 40 FALL 2021 | ARKANSAS HOSPITALS
doctors skilled in autonomic nervous system disorders.” On the other hand, she hopes increasing awareness among physicians will at least get patients with dysautonomia diagnosed quickly, rather than years later.
Every doctor with expertise in POTS is seeing long-haul COVID patients with POTS, and every long-COVID patient he has seen with CFS also had POTS.
of the American Medical Association’s Network Open found that 27% of COVID survivors ages 18-39 had persistent symptoms three to nine months after testing negative for COVID. The percentage was slightly higher for middle-aged patients, and 43% for patients 65 and over. The most common complaint: persistent fatigue. A Mayo Clinic study3 published in May found that 80% of long-haulers complained of fatigue and nearly half of “brain fog.” Less common symptoms are inflamed heart muscles, lung function abnormalities, and acute kidney problems. Larger studies remain to be conducted. However, “even if only a tiny percentage of the millions who contracted COVID suffer long-term consequences,” says Rowe, “we’re talking a huge influx of patients, and we don’t have the clinical capacity to take care of them.” Symptoms of autonomic dysfunction are showing up in patients who had mild, moderate, or severe COVID symptoms.
NO, IT’S NOT PSYCHOLOGICAL
RESEARCH IS COMING
Congress has allocated $1.5 billion to the National Institutes of Health over the next four years to study post- COVID conditions. Requests for proposals have already been issued. “There is hope that this miserable experience with COVID will be valuable,” says Dr. David Goldstein, head of NIH’s Autonomic Medicine Section. A unique opportunity for advances in treatment, he says, exists because researchers can study a large sample of people who got the same virus at roughly the same time, yet some recovered and some did not.
OTHER LONG-COVID SYMPTOMS
Long-term symptoms are common. A University of Washington study 2 published in February in the Journal
Yet even today, some physicians discount conditions like POTS and CFS, both much more common in women than men. With no biomarkers, these syndromes are sometimes considered psychological. The experience of POTS patient Jaclyn Cinnamon, 31, is typical. She became ill in college 13 years ago. The Illinois resident, now on the patient advisory board of Dysautonomia International, saw dozens of doctors seeking an explanation for her racing heart, severe fatigue, frequent vomiting, fever, and other symptoms. For years, without results, she saw specialists in infectious disease, cardiology, allergies, rheumatoid arthritis, endocrinology, and alternative medicine – and a psychiatrist, “because some doctors clearly thought I was simply a hysterical woman.” It took three years for her to be diagnosed with POTS. The test is simple: Patients lie down for five
minutes and have their blood pressure and heart rate taken. They then either stand or are tilted to 70-80 degrees and their vital signs are retaken. The heart rate of those with POTS will increase by at least 30 beats per minute, and often as much as 120 beats per minute within 10 minutes. POTS and CFS symptoms range from mild to debilitating. The doctor who diagnosed Cinnamon told her he didn’t have the expertise to treat POTS. Nine years after the onset of the illness, she finally received treatment that alleviated her symptoms. Although there are no federally approved drugs for POTS or CFS, experienced physicians use a variety of medicines including fludrocortisone, commonly prescribed for Addison’s disease, that can improve symptoms. Some patients are also helped by specialized physical therapy that first involves a therapist assisting with exercises while the patient is lying down, then later the use of machines that don’t require standing, such as rowing machines and recumbent exercise bicycles. Some recover over time; some do not.
Endnotes 1Petracek, L Suskauer, S Vickers, R Patel, N Violand, R Swope, R Rowe, P Adolescent and Young Adult ME/ CFS After Confirmed or Probable COVID-19 (29 April 2021) Frontiers in Medicine, Lausanne, Switzerland. 2Logue, J Franko, N McCulloch, D et al Sequelae in Adults at 6 Months After COVID-19 Infection (19 February, 2021) JAMA Network Open, Chicago, Illinois, USA. 3 Furst, J Fatigue, perceived cognitive impairment and mood disorders associated with post-COVID-19 syndrome (12 May, 2021) Mayo Clinic News Network, Rochester, Minnesota, USA.
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Dawson says she can’t imagine the “darkness” experienced by patients who lack her access to a network of health care professionals. A retired endocrinologist urged her to have her adrenal function checked. Dawson discovered that her glands were barely producing cortisol, a hormone critical to vital body functions. Medical progress, she added, is everyone’s best hope. Stiles, whose organization funds research and provides physician and patient resources, is optimistic. “Never in history has every major medical center in the world been studying the same disease at the same time with such urgency and collaboration,” she says. “I’m hoping we’ll understand COVID and postCOVID syndrome in record time.”
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Cindy Loose writes for KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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Pioneering California Post-COVID Clinic Learns about Long COVID From UC Davis Health
M
any Arkansas COVID-19 survivors and their physicians have questions about the emerging health phenomenon called “Long COVID.” The University of California Davis is pioneering clinical care for sufferers of Long COVID. In this interview, clinic director and pulmonary expert Dr. Mark Avdalovic of the new University of California Davis Post-COVID-19 Clinic in Sacramento, California explains the new clinic’s mission and how work at the clinic will eventually benefit people worldwide. Mark Avdalovic (pronounced av-DOLLoh-vich) is a specialist in pulmonary and critical care medicine and is Medical Director of the UC Davis Pulmonary Clinics. The system’s new Post-COVID-19 Clinic offers comprehensive care to patients who appear to have survived COVID-19 but still have long-lasting, worrisome symptoms. Here, he answers questions about the new clinic. Q: Why are you starting this new clinic? A: Our pulmonary care specialists, along with the hospital medicine and emergency medicine teams, have been on the front line taking care of patients in the hospital with COVID-19, where our focus was to save lives. However, as patients recover from the initial attack of the virus, physicians throughout the region are seeing more and more patients with ongoing COVID-related health concerns – like breathing issues, exercise endurance, headaches, tiredness, or concentration problems. We want to help them. The Post-COVID clinic will provide a centralized comprehensive approach to address patients’ wide array of symptoms. Q: How widespread is this problem? A: There are no precise statistics on the number of longterm COVID-19 patients – people who, in theory, have recovered from the worst impacts of the coronavirus, tested negative, but still have symptoms lasting weeks or months. The Journal of the American Medical Association, in a recent article, as well as a study from a team of British
42 FALL 2021 | ARKANSAS HOSPITALS
scientists, estimate that about 10% of COVID-19 patients fight these long-term symptoms. That’s in line with what UC Davis Health is seeing. Q: Are the people who were the most seriously ill with COVID-19 most likely to have these ongoing symptoms? A: No, that’s what is so interesting. Those ongoing symptoms aren’t necessarily associated with how sick someone was at first with the virus. We’ve seen people with mild cases and no previous health issues who are affected for months afterwards with on again, off again symptoms. In fact, recent publications have highlighted that some patients without symptoms during their acute infection appear to have evidence of inflammation in their lungs and heart. Q: Why is the clinic based in pulmonary medicine? A: With all patients, COVID-19 is a respiratory infection, and patients with ongoing symptoms will often continue
Coronavirus Also Affects Minds to experience respiratory complaints. COVID-19 can have long term effects on the airways, lung capacity, and the ability to exchange oxygen and carbon dioxide. Our experience in treating the patients in the hospital helps us have a thorough understanding of the potential long-term effects. The opportunity to see the patients in the clinic brings the care full circle. Q: What will you do in your clinic that isn’t being done elsewhere? A: First, we’ll be providing one place where patients can get answers to their questions and potentially start on a treatment plan. We have also partnered with specialists throughout our health system to provide timely consultations. Given what we have seen so far in patients, we expect to collaborate with cardiology, vascular, neurology and infectious disease-immunology specialists. Second, we’ll be gathering information for the benefit of COVID-19 patients throughout the world. There are just a few institutions like ours looking at the lifecycle effects of COVID-19 and setting standards for that longer-term care. We’ll be one of them.
That’s why we are available anytime from anywhere, offering all our services in the safest possible manner – Telehealth for: • Outpatient and school-based counseling • Kaleidoscope Grief Center group support • Methodist Behavioral Hospital physician services, family therapy, visitation through Arkansas Division of Child and Family Services, and court appearances • In-person psychiatric testing with plexiglass screen and PPE • Health screening admissions to acute, subacute and residential programs
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Q: What role will telemedicine play in the clinic? A: Our leadership in telehealth has been extremely useful for patient consultations during the pandemic, both for COVID-19 patients and our patients who have other tough lung conditions like asthma, COPD, pulmonary fibrosis, or cystic fibrosis. It will be helpful for the new clinic, too, especially for patients who can’t travel to Sacramento or who still test positive for the virus and shouldn’t be out in public. Q: What are the criteria for patients in the clinic? A: We are available for any patient who has tested positive for COVID-19, had their first symptoms at least 30 days ago and is concerned about health issues that weren’t apparent before the virus struck or who feel they are not back to their normal health. We are here to help.
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ARKANSAS HOSPITALS | FALL 2021 43
Addressing the Mental Health of Frontline Workers By Steve Chasteen
T
he pandemic has taken its toll on a vast number of individuals’ mental health, affecting people among every age group and demographic. However, frontline health care workers face increasing challenges to their mental health. Arkansas health care workers, especially nurses, regularly encounter high workloads, burnout, and exposure to psychologically traumatic events, each of which is a risk factor associated with the increased onset of mental disorders. The cumulative effects of repeated exposure to stressors may result in poorer mental health and functioning.1 Nurses experience symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety more frequently than the general population,2 yet current and sizeable sample data are lacking. When comparing medical and non-medical health workers, medical health workers exhibit a higher prevalence of insomnia, anxiety, depression, and fatigue.3 As groups, nurses, women, and frontline health care workers report
44 FALL 2021 | ARKANSAS HOSPITALS
more severe mental health symptoms resulting from the pandemic than do others.4 Because women represent the majority of the health workforce, as a group they remain at greater risk for contracting COVID-19 and suffering its emotional toll. Among those frontline workers experiencing clinically significant distress or impairment, individuals may exhibit distinct signs and symptoms: feeling overwhelmed with growing levels of anxiety and depression. Frontline workers cope with COVID-19’s stressors in varying degrees. Some adapt as anxiety, fatigue, and depression levels rise; in others, these conditions trigger mental disorders. The combination of fatigue and the pressure to continue working (despite the threat of contracting the virus) contributes to evolving mental health strain. It is likely that significant mental health challenges will emerge from the ongoing pandemic. Though frontline staff and direct patient care areas are highly impacted, the pandemic also adds concerns
and pressures to other areas within hospitals, as well. Particularly of note are departments focused on medical supply procurement, finances, and the epidemiology of this virus.5 After a recent, albeit brief, respite from the initial waves of COVID – a respite primarily resulting from vaccine availability and concerted efforts to get Americans vaccinated – mask mandates began to be relaxed and businesses returned to their prepandemic status. But the emergence of the Delta variant changes everything. Its presence once again plunges this country, and the world, into yet another viral wave that is quickly filling hospital intensive care units, depleting essential resources and supplies, and causing significant frontline staffing shortages. This resurgence has quickly moved this country from contingency planning to crisis management, and the peak of this second national surge in patients is still to come. Of concern should be the potential mental health issues for frontline health care workers that may emerge from this resurgence and being ready to provide treatment options and self-care activities that promote recovery. The primary source of anxiety reported by nurses and other frontline health workers during the initial COVID-19 outbreak was the fear of becoming infected or unknowingly infecting others. This fear is associated with decreased job satisfaction, increased psychological stress, and increased organizational and professional turnover among frontline staff.3 Chronic stress from fear of contracting the virus, fear of infecting
their patients and family members, real experiences of prejudice from the public, and distress that comes from dealing with inadequate supplies and resources can become overwhelming, leading to physical, mental, and emotional problems. Potential health policy implications include identifying groups, such as nurses and other frontline workers, who are at higher risk of developing depression, anxiety, or stress and providing them with early intervention. Also, it’s important to raise mental health awareness and educate medical teams toward mental health assessment. Helping nurses’ peers, managers, and administrators learn to address their workers’ mental health through early and adequate support measures is key. These measures include providing emotional support, fulfilling basic needs, and making working hours more flexible. Flexibility in the work schedule ensures sufficient breaks between rigorous pandemic shifts and itself provides psychological support. I’d like to share an example of health care administrators directly meeting the needs of their health care teams and frontline staff. This comes from Northwest Health, one of the largest health networks in Northwest Arkansas. Shanda Guenther, Chief Quality Officer at Northwest Health in Springdale, Arkansas, explains: “Our staff remain committed to providing quality medical care, and it shows in the way they care for our patients and their families. Each of our facilities continues to recognize both individual staff [members] and departments to show our appreciation for those at the bedside. Early on, we set up an
emotional support hotline called the ‘COVID Care Line’ for staff to call at any time to talk to someone confidentially about their experiences. Local area businesses have made donations to help set up relaxation rooms with massage chairs. We’ve also received many donations of meals and snacks for our frontline staff. We continue to utilize the resources that we have to find ways to help our teams through this difficult time in health care.” References 1Cavanaugh, C., Campbell, J., & Messing, J. T. (2014). A longitudinal study of the impact of cumulative violence victimization on comorbid posttraumatic stress and depression among female nurses and nursing personnel. Workplace Health & Safety, 62(6), 224–232. https://doi.org/10.3928/2165079920140514-01 2Mealer, M., Burnham, E. L., Goode, C. J., Rothbaum, B., & Moss, M. (2009). The prevalence and impact of posttraumatic stress disorder and burnout syndrome in nurses. Depression and Anxiety, 26(12), 1118–1126. https://doi.org/10.1002/da.20631 3 Sampaio, F., Sequeira, C., & Teixeira, L. (2021). Impact of COVID-19 outbreak on nurses’ mental health: A prospective cohort study. Environmental Research, 194, 110620. https://doi.org/10.1016/j. envres.2020.110620 4Lai, J., Ma, S., Wang, Y., Cai, Z., et al. (2020). Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https:// doi.org/10.1001/jamanetworkopen.2020.3976 5American Association of Critical-Care Nurses. (2020). Lack of PPE poses clear and present danger. https:// www.aacn.org/newsroom/lack-of-ppe-poses-clear-andpresent-danger
Steve Chasteen, MNSc, RN, CPHQ, serves as the Director of Practice Transformation at the Arkansas Foundation for Medical Care.
ARKANSAS HOSPITALS | FALL 2021 45
THANK YOU, HOSPITAL PARTNERS. We are grateful for the inspiring and compassionate care provided by all of our transfusion medicine partners during the COVID-19 crisis. We especially acknowledge the extraordinary efforts of the hospitals below who increased their yearly blood drive participation, in spite of the challenges presented.
Unity Health - White County Medical Center Baptist Health System Jefferson Regional Medical Center Conway Regional Medical Center John L. McClellan Memorial Veterans Hospital Eugene J Towbin VA Healthcare Center University of Arkansas for Medical Sciences (UAMS) Saline Memorial Hospital Ozark Health Medical Center DeWitt Hospital and Nursing With your outstanding support, we have been able to supply local patients with the steady stream of blood products they need, despite the immense challenges facing the blood supply.
46 FALL 2021 | ARKANSAS HOSPITALS
Rise in State’s Opioid Overdose Deaths: Pandemic + Fentanyl By Nancy Robertson
F
igures released this summer indicate that more than 94,000 people in the United States died of a drug overdose in 2020, up nearly 30% over 2019. While this figure is staggering, more alarming is data regarding Arkansas overdose deaths. Arkansas is one of 10 states predicted to show at least a 40% rise in drug overdose deaths for 2020 over the previous 12-month period, according to the CDC. Data for 2020 and 2021 are still being collected, but the prediction of the “at least 40% rise” is being watched in Arkansas, California, Kentucky, Louisiana, Nebraska, South Carolina, Tennessee, Vermont, Virginia, and West Virginia. The CDC says that several factors may be affecting the rise in overdose-related deaths, including the growing availability in Arkansas of fentanyl, a highly lethal synthetic opioid, and the stress people report relating to the COVID-19 pandemic. Provisional data released in July indicate that the predicted number of opioid-related deaths in Arkansas for the 12-month period ending in January 2020 was 367. The number predicted for the 12-month period ending in January 2021 was 514 – a 40.1% change upward. Data for these time frames are still incomplete. Kirk Lane, Arkansas Drug Director, says the rise in overdose deaths was not unexpected. “We were one of five states that actually reduced overdose deaths in 2019,” he says. “We have worked hard opening access to recovery programs, expanding Narcan programs, and increasing education. But when COVID-19 came along, things changed.” A number of resources for those in recovery necessarily shut down during the first months of the pandemic, and many in recovery
found themselves cut off from their support groups. Social isolation affected not only this group but also people who had not suffered with addiction prior to the pandemic. Rates of depression rose. At the same time, Arkansas experienced a great influx of illicit fentanyl in 2020. And Arkansas remains the state with the second-highest opioid prescribing rate – an average of 86.3 opioid prescriptions per 100 people, Lane says. (Only Alabama’s prescribing rate is higher. The national average is 46.7 opioid prescriptions per 100 people.) The combination of social isolation and easier access to opioids is proving lethal as overdoses increase. However, Arkansas continues its fight against overdose deaths. The Prescription Drug Monitoring Program (PDMP), enacted into law in 2015, provided a mechanism to stop multiple fulfillments of opioid prescriptions. Dual laws requiring co-prescriptions of overdose reversal drugs when opioids are prescribed and making it a felony to sell or traffic fentanyl are helping. So are the Arkansas Peers Recovery Together Program and the state’s 24-hour hotline, AR-CONNECT, that connects people fighting mental health issues or substance abuse to resources that can help them immediately. Another resource, launched during the pandemic, is TOGETHER ARKANSAS. The program is a partnership of the Arkansas State Chamber of Commerce, Walmart, the Arkansas Foundation for Medical Care, and Arkansas Blue Cross and Blue Shield. It helps employers connect employees struggling with addiction to programs that can help. More information about Arkansas’s multi-level fight against opioid and substance abuse can be found at artakeback.org. ARKANSAS HOSPITALS | FALL 2021 47
Clinicians: Care for yourself one small way each day Clinicians: Care for yourself one small way each day Find new ways to safely connect with family and friends, Find new ways safelyfeelings connect with family and friends, get support, andtoshare get support, and share feelings
Take breaks to relax and Take breaks to relax andmusic, unwind through yoga, unwind through yoga, music, gardening, or new hobbies gardening, or new hobbies
Take care of your body and get moving to les en fatigue, anxiety, or sadness Take care of your body and get moving to lessen fatigue, Take careorofsadness your body and get moving to lessen fatigue, anxiety, anxiety, or sadness
320352-G 320352-G 320352-G
Substance Abuse and Mental Health Services Administration Disaster Distress Hotline: call or text 1-800-985-5990 Substance Abuse and Mental Health Services Administration Disaster Distress Hotline: call or text 1-800-985-5990 Substance Abuse and Mental Health Services Administration Disaster Distress Hotline: call or text 1-800-985-5990
48 FALL 2021 | ARKANSAS HOSPITALS
Treat yourself to healthy foods Treat yourself to sleep healthy foods and get enough and get enough sleep
cdc.gov/coronavirus cdc.gov/coronavirus cdc.gov/coronavirus
Vaccinate the Natural State is an initiative to encourage all Arkansans to get their COVID-19 vaccination when it's their time. We’re working in collaboration with multiple business, healthcare and community organizations statewide — including the Arkansas Hospital Association — to educate and engage Arkansans in doing our part to help end the pandemic.
Let's work together to... Protect caregivers.
Protect families.
Protect communities.
Whether you are providing vaccinations, getting your workforce vaccinated, or encouraging your family and friends, everyone has a role in helping end the pandemic. Find out more at www.vaccinatethenaturalstate.com
In partnership with:
In collaboration with: ¡ Arkansas College of Osteopathic Medicine/ Fort Smith
¡ Arkansas Medical Dental Pharmacy Association
¡ Arkansas Faith Network
¡ Association of Federally Qualified Health Centers
¡ Arkansas Hospital Association
¡ Community Health Centers of Arkansas
¡ Arkansas Immunization Action Coalition (Immunize Arkansas)
¡ NYIT College of Osteopathic Medicine/Jonesboro
¡ Arkansas Pharmacists Association
10111 3/21
ARKANSAS HOSPITALS | FALL 2021 49
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