Catholic Health World - April 1, 2020

For the latest on Catholic health care’s response to COVID-19, visit chausa.org/coronavirus and read Catholic Health World online at chausa.org/chworld PERIODICAL RATE PUBLICATION

APRIL 1, 2020 VOLUME 36, NUMBER 6

Providence public health expert warns public charge rule could worsen pandemic The fact that the new “public charge” rule has been put in place just as the COVID-19 pandemic is spreading across the country is bad not only for immigrants affected by the policy but also for the public at large, a population health expert at Providence St. Joseph Health warns.

The federal rule makes it harder for legal immigrants to gain permanent residency if they have had Medicaid coverage for 12 months within a three-year period, or federal nutrition or public housing benefits. The argument for the change was that people seeking citizenship should not be a burden on American taxpayers. Providence St. Joseph Health is among many health care providers and advocates who have taken stands against the public charge rule out of concerns that it could increase health disparities.

The coronovarus epidemic underscores that health is communal as well as a per-

AP Photo/Ted S. Warren

By LISA EISENHAUER

Judie Shape, center, who has tested positive for the COVID-19 coronavirus, visits with her son-in-law, Michael Spencer, left, and her daughter, Lori Spencer, right, on March 11. The family use phones to talk to each other at the Life Care Center in Kirkland, Washington. In-person visits are not allowed at the nursing home, which is a center of the outbreak of the COVID-19 coronavirus in Washington state.

sonal and that a higher number of uninsured who lack the resources to protect themselves or seek timely health care could have implications for the spread of the virus.

On March 13, the day President Donald Trump declared a national emergency related to the coronavirus, the U.S. Citizenship and Immigration Services clarified that it will not consider treatment or preventive care for legal immigrants related to COVID19 as part of a public charge inadmissibility determination.

Immigrants who lack legal status in the U.S. are not eligible for Medicaid coverage and the public charge rule does not apply to them. The Kaiser Family Foundation reported, based on 2017 data, that more than four in ten immigrants without legal status were uninsured.

Dr. Rhonda Medows is president of population health at Providence St. Joseph Health and chief executive of Ayin Health Solutions, a population health Continued on 4

Onboarding programs Cardinal Glennon helps train bystanders to defuse child/caregiver struggles between caregivers and children. engage, inspire, connect By KATHLEEN NELSON Among its founding partners and Awkward moments between caregiver sponsors are SSM Health Cardinal newcomers to mission and child are an everyday occurrence — at Glennon Children’s Hospital in St. a grocery store, movie theater or in a park — when a caregiver’s attempt to silence or discipline a child escalates in intensity.

As the family becomes stressed, bystanders become uncomfortable. Some have the urge to scold or glance sideways in disapproval. Others want to walk away. Still others want to step up to calm the situation but are unsure how to intervene without angering the parent or making the situation even worse. So, most do nothing.

A program called Support Over Silence for KIDS, however, provides positive options for defusing challenging situations

In a role play during a Support Over Silence for KIDS training session, program developer Nancy Weaver, center, plays a mom trying to get her child (the taller woman) to leave a cafeteria. Another member of the class will demonstrate how to engage with the mother and child to calm the situation.

Louis, which is training some of its employees in the techniques.

“It’s not designed to fix parenting but to address an immediate need in an acute situation,” Nancy Weaver, the program’s developer and director, said of the training. “It’s about listening, offering empathy – and maybe a little distraction.”

Research meets real life The spark for the program was struck four years ago, when Weaver Continued on 6

Trinity Health ministries tackle food insecurity Onboarding sets the stage for formation work in the health ministry. Here, leaders connect at a Providence St. Joseph Health’s Ministry Leadership Formation program in October 2019 at Palisades Retreat Center in Federal Way, Washington.

By JULIE MINDA

When ministry facilities hire new employees, they are not just bringing them into a job — they are inviting them to take part in mission-based work.

Catholic health systems and facilities are open about the centrality of their Catholic identity and intentional about how they recruit, hire, welcome and enculturate people into their new roles in the ministry, according to a sampling of mission and human resources executives.

“Associates must understand how our mission, vision and values relate to their role,” says Jim Ritchey, system vice Richey president for human resources operations for SCL Health. “We Continued on 5

By LISA EISENHAUER

did it at the market is that we were there, and the food was 10 or 20 steps away, so people could just go right to it,” said Angel Surdin, manager of community engage-

When St. Peter’s Health Partners set up community farmers markets on its campuses last year, the health system also established a means to ensure that some of the fresh produce went to people with limited means.

The community health and well-being division of the system, based in Albany, New York, budgeted funding for $10 vouchers to be handed out at the markets. Volunteers roamed the markets and did a two-question screening of anyone who was willing.

They gave a voucher to people identified Shoppers at the farmers market at St. Peter’s Hospital in Albany, New York, through the screenings were asked two questions by survey takers last summer and those whom as food insecure. the screen identified as being food insecure received a $10 voucher for “The way that we fresh produce .

ment for the division.

Over the course of six events, the volunteers handed out 217 vouchers; of those, 215 were redeemed. At the last five markets, the farmers weighed the purchases and found that, in total, people had used the vouchers to get 1,092 pounds of potatoes, tomatoes, apples, cabbage and other seasonal offerings.

St. Peter’s Health Partners teamed up with the Regional Food Bank of Northeastern New York on the farmers markets and the voucher program. Much of the produce came from the food bank’s own farm, which follows sustainable agriculture practices.

Money from the vouchers went to the farm.

St. Peter’s is part of the Trinity Health system and its farmers market vouchers are one example of food insecurity programs operated by at least 13 ministries within the larger system. The programs’ goal is to address a social issue that the U.S. Department of Agriculture estimated plagued 11% of households in 2018.

Screening for hunger Trinity Health expects that its ministries Continued on 7

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CATHOLIC HEALTH WORLD April 1, 2020

Ministry organizations promote advance care planning National Healthcare Decisions Day is April 16

Resources for National Healthcare Decisions Day

By INDU SPUGNARDI

On April 16 CHA and the Supportive Care Coalition, along with other health care, legal and religious organizations across the country, will recognize National Healthcare Decisions Day as part of a concerted effort to focus the public’s attention on the importance of discussing and documenting advance care decisions.

The initiative was launched in 2008 by Nathan Kottcamp, a lawyer who serves on hospital ethics committees and witnesses firsthand the confusion and conflict experienced by families when health care decisions need to be made for a loved one who can no longer communicate but did not make their preferences known beforehand. National Healthcare Decisions Day is now part of The Conversation Project, an initiative of the Institute for Healthcare Improvement.

In its 2014 report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, the National Academy of Sciences defines advance care planning as “the whole process of discussion of end-of-life care, clarification of related values and goals, and embodiment of preferences through written documents and medical orders. This process can start at any time and be revisited periodically, but it becomes more focused as health status changes.”

The decisions made in these discussions are documented in advance directives. These are legal documents that provide direction on life-sustaining treatments when an individual is no longer able to communicate (living will) and that specify the individual’s chosen decision-maker (health care power of attorney).

Advance care plans can be developed at any time, whether people are sick or well, and can be revised and updated throughout the person’s life as health status and living circumstances change, Dr. Joanne Lynn explained in comments for the Centers for Disease Control and Prevention’s issue brief, Advance Care Planning: Ensur-

PeaceHealth St. Joseph Medical Center in Bellingham, Washington, prominently displayed photos of staff and community leaders in the run-up to National Healthcare Decision Day 2019. This year, because of the coronavirus outbreak in the Northwest, the entire PeaceHealth system is hosting virtual events to promote advance care planning

ing Your Wishes Are Known and Honored if You are Unable to Speak for Yourself. Lynn is a geriatrician and hospice physician who heads the Center on Elder Care and Advanced Illness for Altarum, a nonprofit research and consulting organization that works to advance health among vulnerable and publicly insured populations. She wrote that advance care planning is about planning for the “what ifs” that may occur across the entire lifespan.

Disparities in planning In 2016 The Economist and the Kaiser Family Foundation polled people in America, Brazil, Italy and Japan about their hopes and worries related to their end-of-life care.

Over half (56%) of U.S. adults said they’ve had a serious conversation with a loved one about their own wishes for end-of-life medical care, though the responses varied based on demographic factors including: Age: 28% of adults under age 30 reported having had the conversation versus 73% of people age 65 and older.

Marital status: 69% of married adults versus 43% of unmarried adults had had a conversation focused on their end-of-life treatment preferences.

I’ve Got Mine!

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Complete your own Advance Directive!

Workshops

Every First Tuesday of the Month 4:00PM - 5:30PM St. Luke's Health Education Center, 3333 Squalicum Parkway

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Be an informed voice for yourself, your family, and your patients.

Get prepared to tell them: I'VE GOT MINE! To register: Hilary Walker, Advance Care Planning Coordinator 360 752 5267 hwalker@peacehealth.org

A poster advertises a monthly workshop on advance care planning at St. Luke’s Health Education Center, which is near the main campus of St Joseph Medical Center.

Race/Ethnicity: 63% of Whites, 58% of Blacks and 40% of Hispanics said they’d had a conversation with a loved one about their own wishes for end-of-life medical care.

The most common reason given by respondents of all races/ethnicities for not having had the conversation about end-oflife care preferences was the belief it was unnecessary for healthy people to do so.

The survey found significant age-related differences in the completion of written advance directives. Overall, only 27% of U.S. adult respondents said they have set out their end-of-life wishes for medical treatment in a written document. That ranged from just 8% of those under age 30 to 51% of those age 65 and over. Among the 72% percent who do not have their wishes written down, 49% said they had not gotten around to it and 27% said they’d never considered doing it.

The survey also found completion rates for advance directives varied by race and socioeconomic status (these differences also persist after controlling for age and other demographics): Race/ethnicity: 35% of Whites versus 15% for Blacks and 11% for Hispanics have advance directives.

Education: 33% of college graduates and 20% of those with a high school degree or less have advance directives.

Income: 33% of respondents with a household income over $90,000 versus 20% for those with income less than $40,000 have advance directives.

The 2016 study on end-of-life wishes also asked about advance care planning conversations with health care providers.

While just 11% responded that they’ve had such a conversation with a provider, 92% said they would be comfortable having the discussion. Denise Hess, executive director of the Supportive Care Coalition, sees this result as an opportunity for health care organizations. “This puts health care providers in a good position to raise awareness about advance care planning, as part of patient and community health education efforts,” she said, adding that these efforts should be tailored to reach groups that are completing advance directives at lower rates.

Awareness-raising efforts Many health care organizations use National Healthcare Decisions Day as an added opportunity to promote advance care planning among their employees, patient populations and in their communities. In the run-up to decisions day last year, PeaceHealth St. Joseph Medical Center prominently displayed a collection of photos of physicians, nurses, other staff and community leaders holding copies of their advance directives.

Daleash Hall, system director of hospice and palliative care for PeaceHealth, said the system has revised its plans for National Healthcare Decisions Day 2020 because

CHA and the Supportive Care Coalition resources for National Healthcare Decisions Day can be found at www. chausa.org/nhdd. The materials can be used by their members to promote the day on social media and to educate patients, staff members and the broader community on how to prepare an advance directive. The website nhdd.org offers many ideas and suggestions for health care providers, including communications toolkits and collateral materials that can be branded by the organization.

In addition to providing advance care planning resources to individuals and communities at theconversationproject. org, the Institute for Healthcare Improvement offers “Conversation Ready” resources to help health care organizations and clinicians provide end-of-life care that is aligned with patients’ stated goals, values and preferences. Resources include “Conversation Ready”: A Framework for Improving End-of-Life Care (2nd Ed.) and How to Talk to Your Patients about End-of-Life Care: A Conversation Ready Toolkit for Clinicians.

of the coronavirus outbreak, which has hit the Northwest region the health system serves particularly hard. Instead of community classes and information tables, the system will only hold virtual events, such as social media outreaches to guide the public to websites. A campaign on the system’s health app incentivizes PeaceHealth caregivers to talk about their goals and values, watch a video on advance care planning and commit to filling out their own advance directive and getting it in their medical record.

PeaceHealth has advance care planning coordinators in all its networks who lead classes on advance planning and it provides clinical training focusing on “communication skills and knowledge about the documents that support patients’ goals and wishes,” Hall said.

The Institute for Human Caring, a part of Providence St. Joseph Health, will make available to all 120,000 Providence St. Joseph employees a National Healthcare Decisions Day toolkit. It has both printed and digital versions. The toolkit includes an op-ed by Dr. Ira Byock, founder and chief medical officer of the institute; extended and short “EZ” advance directive forms in multiple languages; posters, tent cards and flyers. Digital versions of the toolkit also will have links to videos about advance directives.

Going deep and wide As health care organizations prepare their outreach efforts, the Supportive Care Coalition’s Hess stresses the importance of involving mission leaders, social workers, chaplains and ethics committee members to broaden the reach. Palliative care and hospice staff also have the training and background to help with outreach and staff education activities. Working with parishes and other faith communities can also extend the reach of the organization’s efforts into the community.

On The Conversation Project’s blog, Ashley Areyan, development and community engagement director at the Institute for Human Caring, discusses her efforts to engage faith leaders in her Los Angeles community. Her work with the Archdiocese of Los Angeles includes offering a twohour workshop called Care and Prepare at churches. She gives advice to parishioners on how to proactively seek the health care they want. An expert from the archdiocese speaks about the Catholic teachings on end of life.

“After every presentation, workshop, whatever it is, there are always people who come up and say how genuinely grateful they are to have had this conversation,” Areyan wrote. “Literally every single time.”

April 1, 2020 CATHOLIC HEALTH WORLD

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Ascension offers formation insights beyond its ministry through Mandorla

By LISA EISENHAUER

Ascension is tapping its formation programming and expertise for a new venture called Mandorla aimed at inspiring “spiritually centered leadership and living” beyond the bounds of the ministry.

The venture’s motto is “Inner work for the common good” and its mission is to help people explore internal spiritual resources to serve a larger purpose, said Celeste Mueller, vice president of ministry formation for the St. Louisbased health system and the president of Mandorla.

Its name reflects both the spiritual and community focuses of its mission.

Mueller In religion, mandorla is the almond shape surrounding the figure of a holy person; in geometry, it is the figure created by the intersection of two circles, as in a Venn diagram. Mueller said Mandorla will use spirituality centered programs to help people find, within the intersection of the individual and the community, “the sacredness in every part of ordinary life.”

While the programs are fully aligned with the Catholic faith tradition, they will be accessible for those who profess other religious beliefs or life philosophies, she said.

Cultivating spirituality Mueller said it had long been a vision of Ascension leadership to make broader use of the “deep riches in our own ministry formation department, but also deep riches in the spirituality centers created long ago by the sisters (who founded Ascension ministries).” Last autumn the vision fell into place and Mandorla officially launched.

Mandorla doesn’t have a dedicated staff and while it is based in St. Louis and Austin, Texas, its programs will be offered nationwide and to both religious and secular clients or communities. Executives,

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facilitators, practitioners, researchers and artists who are employed by or connected to Ascension will present the programs at Ascension sites and elsewhere.

Funding for the nonprofit effort will come from fees, donations and grants. “The business model is that we would charge fees for work for audiences who can pay those fees, and we also want to serve audiences who can’t,” Mueller said.

Patty Speier is executive director of Seton Cove, an Ascensionowned interfaith retreat center in Austin and senior director of formation for Ascension. She’s Speier also a co-founder of Mandorla and its vice president. She said Mandorla’s programs will build on those that have been popular for years at Seton Cove.

They include leadership training seminars and contemplative prayer groups.

“Over the years we have seen spirituality enter more and more into businesses.

There is a longing for deeper meaning and purpose as well as for an enhanced sense of community,” Speier said.

“Leaders can feel isolated in the hypercompetitive corporate world. There is a desire to move beyond competition to cooperation and collaboration. Seton Cove has designed and offered programs in contemplative and integral leadership for 25 years. Now seems like the right time to take our programs and expertise beyond Ascension into the marketplace.”

A greater source Seton Cove will now fall under the Mandorla umbrella along with six other projects. The goal of all of its parts, Speier said, “is to help people understand that there is a source greater than their ego, to give them practices to connect to that source and to hopefully have them operate from that source more often than not.”

In addition to Seton Cove, Mandorla encompasses the following projects: Presence Lab, which offers coaching, training, consulting and reflective practice to individuals, businesses and organizations who want an integrated experience of leadership formation rooted in character and meaning.

Cor Unum Leadership, which provides formation experiences that will draw on Catholic theology and spirituality. Latin for “one heart,” Cor Unum echoes Pope

A teenager stands in his troubled Baltimore neighborhood in a scene from the documentary Inherit the Earth. The film was one of the first projects by Mandorla Media, one part of Ascension’s new Mandorla venture.

Francis’ call for “integral human development of persons, communities and creation and service of the common good.”

Mystic Heart Wisdom School, a spiritual formation program exploring a diversity of faith traditions and what the world’s spiritual traditions have in common.

McPhee Symposia, an annual lecture and workshop series in Austin that began in 2002 and honors Sr. Mary Rose McPhee, DC, the founder of Seton Cove. It offers leaders in business, health care, education and community an opportunity to reflect on spirituality and work.

Sacred Journeys, guided pilgrimages to sacred sites around the world.

Mandorla Media, producer of podcasts, video interviews, short documentaries and other resources that explicitly serve the common good.

One of Mandorla Media’s first projects was a short documentary called Inherit the Earth that focused on several children grappling with the effects of poverty, drug dealing and family dysfunction in a gritty section of Baltimore.

Robert Fish, senior director of ministry formation at Ascension, was executive producer of that film and two others that are in the works as part of Mandorla Media. He said all of the media project’s output will be directed toward advancing human dignity and the common good. He hopes the media

project will allow emerging filmmakers to tell stories that are “inherently meaningful” for them and that resonate with wide audiences.

“One way to say what we’re trying to do is to take the spirit of Catholic health care into the world,” said Fish.

Higher cause Mueller said all of Mandorla’s offerings “come out of our experience of what we have seen happen in the lives of individuals and communities and organizations over these years of doing formation.” Formation has shown them how to develop deeper inner spirituality and outside connections, she said.

She is hopeful that by offering those insights beyond Ascension through Mandorla, the health system can help people find the best part of themselves and bond with others and the world around them.

“I think we have firm evidence that persons flourish when they are aware of the deepest part of their being, when they’re in touch with meaning, when they are building and being part of community, and when they’re able to use their gifts in service of a need or a cause greater than themselves,” Mueller said. leisenhauer@chausa.org

Upcoming Events from The Catholic Health Association International Outreach Networking Call

2020 Catholic Health Assembly

Mission in Long-Term Care Networking Call

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Catholic Health Association and The Task Force for Global Health Joint Global Summit

Human Trafficking Networking Call

April 29 | 3:30 p.m. ET

May 5 | 3 p.m. ET

What Counts as Community Benefit Webinar

June 7 – 9 | Atlanta

June 9 – 11 | Atlanta

May 19 | 2 p.m. ET

June 25 | 3 p.m. ET

July 17 | Noon ET

International Outreach Networking Call Aug. 5 | 3:30 p.m. ET

A Passionate Voice for Compassionate Care® chausa.org/calendar

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CATHOLIC HEALTH WORLD April 1, 2020

COVID-19 From page 1

CHA advocacy CHA, too, is concerned about the public charge rule’s potential to exacerbate the expanding health emergency around COVID-19, the coronavirus strain sickening tens of thousands around the globe.

“Among the many harmful aspects of this rule, CHA has made it clear to the administration that the new public charge determination will hamper efforts to combat public health crises like the current pandemic,” says Lisa Smith, CHA’s vice president for advocacy and public policy. “Given the tremendous challenges we are facing, our focus should be on expanding health coverage instead of restricting it.”

Though the public charge rule took effect on Feb. 24, Medows says there is a lack of clarity about who it applies to and how it should be applied, in part because the rule is laid out in hundreds of pages of complicated terminology. “For the immigrant population and for the population of people who support them and care for them, there’s a lot of confusion about who it is really directed at,” she says. “Whenever there’s confusion there also is generated fear.”

Medows says the people frightened by the rule are already at risk of being missed by the efforts to staunch the pandemic. Due to language challenges, they might not be aware of the threat level in their community and the best practices to follow to avoid infection. In addition to her concerns about immigrants who are here legally or trying for legal status, Medows says she worries about those being held in detention centers as well as marginalized Americans who are on the streets and frail seniors residing in long-term care facilities.

AP Photo/Andrew Selsky

management subsidiary of the health system. She says that even with the rule clarification for public charge determination, immigrants exposed to the virus are still likely to avoid needed care out of fear of jeopardizing their legal status or chance for citizenship so long as the overall rule is enforced.

“Its purpose is still to exclude people with limited resources or in need of assistance,’ she says.

“Immigrants may still be fearful of coming forward Medows especially if they have used other services.”

Medows says the enforcement of the entire rule needs to be put on hold.

People who are homeless crowd a sidewalk in downtown Salem, Oregon, March 3, in their encampment.

Some cities are making provisions so the homeless who contract COVID-19 have a safe place to be quarantined during their illness and recovery.

advocates are informed.

The USCCB also worries that immigrants who lack legal status will be afraid of facing deportation by federal authorities if they show up at hospitals or clinics, even though the U.S. Immigration and Customs Enforcement, and the U.S. Customs and Border Protection agency had previously issued memoranda establishing hospitals and other health care facilities as “sensitive locations” where immigration enforcement actions such as arrests, interviews and searches are to be avoided.

The USCCB wants the administration to clearly communicate that the protocol will be followed. “We want people to be accessing health services,” Feasley says. “Just from a community safety standpoint, that is vital.”

Unhelpful policies The public charge rule is just one of several public or private health care-related policies that Medows views as unhelpful in the midst of a public health crisis.

Another is the current attempt by several

states, with the support of the Trump administration, to have the U.S. Supreme Court strike down the Affordable Care Act. If successful, the challenge could end health care coverage for hundreds of thousands of people who have received Medicaid coverage under the ACA. It could also end the “essential health benefits” requirement in the law that mandates insurers cover preventive care and prescription drugs and a host of other health services.

Vice President Mike Pence, tapped

by Trump to lead the nation’s coronavirus response, has said that testing for the virus is specifically covered as an essential health benefit. “That means, by definition, it’s covered in the private health insurance of every American, as well as covered by Medicare and Medicaid,” Pence said at a press briefing March 4.

Care providers like herself, Medows says, have a duty to help educate the public on the risk of the illness and all the potential ways to get care, including through remote means such as telehealth and nurse advice telephone lines. She sees this duty as particularly important for providers affiliated with Catholic ministries like Providence St. Joseph Health that have a mission to help the voiceless and vulnerable.

“When we talk about the healing ministry of Jesus, that applies to everybody, there are not subgroups,” Medows says. “If anything, if you’re poor or vulnerable, it means we work harder. In the middle of a pandemic, it applies even more.” leisenhauer@chausa.org

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Resources on Catholic Health Care and the Social Determinants of Health H E A L I N G T H E M U LT I T U D E S

NEW! HEALING THE MULTITUDES

Enforcement concerns The United States Conference of Catholic Bishops issued a statement March 12 from the chairman of its Committee on Domestic Justice and Human Development, Archbishop Paul S. Coakley, head of the Archdiocese of Oklahoma City, urging lawmakers to be inclusive as they consider measures to provide relief and aid in addressing the crisis. “Special consideration is warranted for those most vulnerable: the poor, the elderly, the homeless, those in prison or detention facilities, immigrants and refugees, and those with severe underlying health conditions,” the statement said.

Ashley Feasley, policy director for migration and refugee services for the USCCB, says the organization’s concern that the public charge rule will keep immigrants from accessing services for which they are eligible is heightened by the current public health crisis. The USCCB is urging the Trump administration to repeal or suspend the rule in light of the health crisis.

In the meantime, Feasley says, the goverment’s declaration that immigrants with legal status can receive publicly funded care related to COVID-19 without imperiling their applications for visas or permanent legal status needs to be robustly disseminated in English and other languages so immigrants and their

Catholic Health Care’s Commitment to Community Health

HEALING THE MULTITUDES

Catholic Health Care’s Commitment to Community Health: A Resource for Boards

1

Addressing the root causes of health issues is part of the tradition of Catholic health care.

Our faith compels us to give special attention to our neighbors who are economically poor and vulnerable and to work for the common good.

CHA has developed a set of resources that explains why Catholic health care is called to take a leadership role in addressing the social determinants of health. This work is not new to the Catholic health ministry, it is part of our heritage, started by our founding congregations who often addressed the social needs of those in their care alongside the medical needs. It is also part of our future, as our knowledge of health and well-being evolves, so must our approach to carry on the healing ministry of Jesus.

ACCESS THEM ALL AT

CHAUSA.ORG/COMMUNITYBENEFIT

April 1, 2020 CATHOLIC HEALTH WORLD

Onboarding

SSM provides links to videos on its legacy and mission. Providence provides many of its legal forms electronically so that new hires can complete paperwork before their arrival and be freed up on their first official day to concentrate on orientation content focused on Providence’s mission.

From page 1

must ensure there’s alignment. And we want to create a joyful work environment.”

Deborah Simmen, SCL Health system vice president of ministry formation, adds that the onboarding process presents an opportunity to bring new employees on as “ambassadors, influSimmen encers and advocates” for the organization’s mission.

Common understanding Many ministry systems that span regions and states have standardized their onboarding programming to have clear and consistent messaging about their organization’s legacy, mission, vision and values.

Doing this right “is important because we really do believe the first thing we are is a ministry — we exist to continue the compassionate ministry of Jesus Christ,” says Thomas Morris, Bon Secours Mercy Health chief sponsorship and theology officer. “We want to create a space, where everyone (in our organization) can grapple with how they connect their day-to-day Morris work with their call” in the ministry.

Greg Till, Providence St. Joseph Health chief people officer, says in onboarding, “We want people to be inspired, to connect to our mission and heritage. We want to Till build a sense of connection between their work and their personal calling. This is part of our ‘secret sauce.’”

Secular society Diarmuid Rooney, CHA senior director of ministry formation, says recruits and

Welcome All the systems aim to make new employees’ first day a welcoming, even inspiring one. At Providence, a mission leader escorts new hires from the lobby to their orientation session.

It’s common to have group orientations for new hires. Mission leaders and/or top executives extend personal greetings and engage the audience in presentations that expose the organization’s heart, purpose and Ministry systems and facilities provide ongoing opportunities to connect staff with the organization’s mission. Here, culture. an SSM Health choir sings at an annual Mission Days event in June 2018.

Rooney notes that orientations are becoming less didactic new employees “have their sniffers up,” background, “the focus of our onboarding now and flow more like a twowith many concerned that a Catholic health process and continued formation strategy is way conversation with the new hires. facility will try to convert them. “We have to not so much to change our associates, leadOrientation presentations are heavy on show them the truth — we are not prosely- ers or care providers’ way of thinking, but to storytelling since stories facilitate learntizing; we are not trying to convert you. But strengthen their personal understanding of ing, impute meaning and engage emotions. we are extending an open invitation for you community, connection and loving kind- There are usually videos about the work, to join us” in the ministry’s healing mission. ness to others.” vision and legacy of the organizations’ Simmen acknowledges that SCL Health For instance, Simmen says, at SCL founding congregations, and testimonials has had to be very purposeful in how it Health’s weekly new associate welcome from staff and patients about what the orgainvites people into its ministry. In many of sessions, leaders of the sessions tell the nization means to them. the communities where the system pro- parable of the Good Samaritan, emphasizSimmen says also during employees’ vides health care, prospective hires may be ing the universally shared concept of the very early days at SCL Health and its faciliput off by overtly religious language. “neighbor” as it relates to human kindness, ties, leadership encourages them to conProvidence’s Till says some potential compassion and service to others. Present- nect with others. There are buddy matchemployees may have misperceptions about ers challenge the new employees to think ups, lunches and mentoring programs what it’s like to work in a faith-based orga- about what their role has to do with serving available to help people quickly build a nization; they might guess the environment others and how that relates to SCL Health’s support system. Till says Providence takes a is only comfortable for those with certain mission. similar approach, with the goal of promotbeliefs. “We want everyone to know they’re ing a sense of belonging to a community. included in our mission no matter what First impressions And all the systems are intentional about their background or faith tradition is.”

All who spoke to Catholic Health World checking in with new employees at set Simmen says regardless of employees’ agree — onboarding begins well before a intervals — at 30 days, 60 days, 90 days and new hire walks in the door. Rooney says at a year, commonly — to assess how neweven third-party recruiters as well as inter- comers are doing with their assimilation nal hiring managers and interviewers must into the organization and to provide addibe “missioned” and pres- tional mission-related information. ent a comprehensive picture of what the organiza- Sturdy foundation tion is and stands for.

According to the mission and human Patrick McCruden, resources executives, onboarding sets the SSM Health’s chief mis- foundation for formation and ongoing mission integration officer, sion programming. While each system has emphasizes that the hir- its own approach to formation and “misMcCruden ing process is a time when sioning” of staff, all have some type of forcandidates and hirers assess one another, mal formation curriculum that varies by and SSM aims to make an impactful what type of role cohorts have in the organiimpression from the start. zation be it clinical, nonclinical, executive, SSM makes its mission and values clear sponsor, or board member. during the interviewing process, McCruden All of the systems provide opportunities says, and hiring managers use standard- throughout the year for staff to take part in ized guides to assess how well candidates fit mission-related activities such as service with SSM’s culture. projects or brown bag lunches where a Before a new hire’s first day on the job, speaker presents a talk on a mission-related topic. Systems email reflections and prayers to all employees that illuminate the mission to them, To create the new resource, CHA to keep mission and spiriworked with a group of ministry tuality top of mind. members and with the association’s SCL Health’s Simmen 13-member Ministry Formation Advisays, “Onboarding is a sory Committee. continual process. We’re Sr. Mary Haddad, RSM, CHA presipartnering with our coldent and chief executive officer, said of leagues in developing our the new resource, “Leaders in Catholic enterprise. This includes health care have come to recognize ministry formation and the crucial importance of formation in online learning throughensuring the Catholic identity of our out people’s careers. ministries.

“All of this is so we “In response to member needs, CHA can grow our talent and is committed to expanding opportunikeep people engaged and ties for ministry formation and serving loyal,” she says. as a catalyst to strengthen the Catholic Visit chausa.org/ identity of CHA member organizations chworld to learn how Bon in carrying out the healing mission of Secours Mercy is estabthe Catholic Church in the world today,” During SSM Health’s Mission Days in June 2018, corporate employees lishing a unified culture, she said. assembled 450 personal hygiene kit for Great Circle, a nonprofit agency two years post-merger.

New CHA resource provides framework for enhancing formation programs C

HA has created a new resource to help Catholic health systems and facilities to create or enhance their ministry formation programming. The resource will be available later this month from CHA’s online store at chausa.org/store/ storefront.

The 57-page “Framework for Ministry Formation” articulates what ministry formation is, setting forth six foundational elements of ministry formation: vocation, tradition, spirituality, Catholic social teaching, ethics and discernment.

It provides a sample template for building out programming with those essentials.

The booklet also describes the competencies that mission leaders specializing in leadership formation should have. Those attributes include personal qualifications, leadership characteristics, theology background, spiritual grounding, health care ethics knowledge, organizational management abilities and facilitation and presentation skills.

The booklet is part of a suite of resources, programming and education around formation that CHA provides to the ministry. The association developed the booklet in recognition of the fact that ministry systems and facilities are prioritizing formation of lay leadership to a much greater degree now than in the past. The women religious who led Catholic hospitals in the past had been formed by their congregations, said Diarmuid Rooney, CHA senior director of ministry formation, adding, “Now it’s up to the ministry to form the leaders of the future.”

5

— JULIE MINDA

that provides behavioral health services and programs for more than 35,000 children and their families in Missouri each year.

jminda@chausa.org

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CATHOLIC HEALTH WORLD April 1, 2020

Speak up From page 1

was out for pizza with her family. Seated at a nearby table was a grandmother, growing increasingly frustrated by the behavior of her two grandchildren.

When the trio caught the attention of the patrons Weaver and staff, Weaver walked over to their table, “without a plan” and said to them, “It looks like you guys are struggling.”

The grandmother opened up about her frustration with work and outside responsibilities. After a few minutes of listening, Weaver helped fill up the kids’ plates from the salad bar and went back to her table.

The restaurant’s staff thanked her for helping calm the situation. But despite her background as a professor of behavioral science and health education at the Saint Louis University’s College for Public Health and Social Justice, Weaver wasn’t sure she had done the right thing. She polled her colleagues at SLU and FamilyForward, where she was a member of the advocacy board.

The latter organization assists at-risk children and families. No one could give her a definitive answer.

“I had found a void,” she said. “You love those moments when your life and science collide. They speak to your personal curiosity and research.”

She applied for and received a threeyear grant from the Missouri Foundation for Health to research and develop a bystander intervention, assembling a team that included colleagues from SLU, FamilyForward, Safe Connections and Dr. Timothy Kutz, director of the Division of Child Protection at Cardinal Glennon. Safe Connections is a crisis intervention and counseling agency that aims to reduce the incidence and impact of relationship violence including sexual assault.

After researching the effectiveness of bystander training programs designed for intervention in sexual assaults, Weaver’s group decided to tailor a similar training to defuse challenging situations between caregivers and their children. The training incorporates elements of trauma-informed care, which recognizes that people may have experienced trauma in the past. This approach can apply to both caregivers and children.

KIDS first The two-hour, in-person program was designed for a broad-based audience. It teaches bystanders how to quickly notice an event, decide what to do and provide support. The training offers several options, depending on the bystander’s own background and the nature of the incident.

The hallmark of each option is that it is empathy-driven and judgment-free. No sideways glances. No reproach. No scolding.

“A lot of people say they could never tell a parent what to do or that what they see makes them angry,” Weaver said. “We train them to realize that, manage it and offer alternatives.”

To recall the options quickly, Weaver and her team developed the KIDS mnemonic: K: Offer Kind words. Or, Keep to yourself if you notice an event and determine that the parent and child are handling it well/ sufficiently.

I: Intervene directly. Weaver’s action at the pizza parlor is a good example. Another example would be offering to call someone to help, such as another caregiver familiar with the child or children.

D: Distract. Drop an item from your purse or do something else to divert the attention of the caregiver or child or both.

If in a grocery store, ask, “Which cereal (or soup) should I get?”

S: Seek help. If the situation has escalated, there are times when the store’s management or other official can offer more effective assistance or can help one overcome personal barriers for intervening.

Just add empathy “It’s almost overly simple,” Weaver said.

“It doesn’t require complicated decisions.

Cardinal Glennon was very supportive of our approach because it was simple and based on empathy.”

Using Cardinal Glennon as a pilot, Weaver’s team employed the train-thetrainer model. They trained 30 employees, who were team leaders or directors in departments that included nursing, pastoral care, social work and other groups. This core group is now training members of their respective departments.

Among the core group was Rebecca Chambers, manager of the transitional care unit at Cardinal Glennon. She has trained about 20 of her fellow nurses. Chambers noted Chambers that she and her nursing staff often use distraction techniques with young patients but that they initially questioned whether these techniques would be as accepted outside the hospital.

“It’s been nice to learn that most parents are grateful for assistance,” she said.

In addition to Cardinal Glennon, Support Over Silence for KIDS has trained

SLU students and members of community groups. Following each training session, the trainers have interviewed the trainees.

Among their findings: 86% of participants felt that the program changed their attitudes about their role in the community.

90% said they feel confident that they can do something to help caregivers and their children.

95% said they will pay more attention to caregivers and their children.

“A lot of people say they could never tell a parent what to do or that what they see makes them angry. We train them to realize that, manage it and offer alternatives.”

— Nancy Weaver Chambers has used the training at work but found it more valuable away from work, “in public places where children are abundant but not happy.” She recalled waiting in line at the grocery store, where a care-

giver and child were at odds over the child’s demand for candy. As the exchange grew louder, Chambers dropped her keys.

“I’ve done a fair amount of distraction,” she said.

Scaling up Support Over Silence for KIDS has printed key cards with the mnemonic, so trainees can keep a reminder close at hand.

It also has developed a facilitators’ guide, users’ guide and evaluation tools and has beefed up its presence on social media.

“Now, we’re looking at ways to scale up,” Weaver said, adding that she has received inquiries from groups around the country who are interested in the training. Weaver said the training may be offered to other SSM Health facilities as well as employees of retail establishments, and members of church groups and nonprofit organizations that focus their services on families and children.

“The training helps you acknowledge that these are behaviors that shouldn’t happen to children and that it’s OK to feel uncomfortable when you see it happening,” Chambers said. “But then they give you tools to help. Everybody seems to come out with a positive experience.”

2 20 AWARDS

Recognizing Extraordinary Contributions to the Catholic Health Ministry SISTER CAROL KEEHAN AWARD

Jane Graf, President and Chief Executive Officer, Mercy Housing Inc., Denver

SISTER CONCILIA MORAN AWARD

Patricia Casey, Program Coordinator, Special Needs Tracking and Awareness Response System (STARS), SSM Health Cardinal Glennon Children’s Hospital, St. Louis

LIFETIME ACHIEVEMENT AWARD

Johnny Cox, RN, Ph.D., Former Sponsor, Providence St. Joseph Health, Renton, Washington and Chief Ethics Advisor, Alliance of Catholic Health Care, Sacramento, California

TOMORROW’S LEADERS HONOREES

Honoring young people who will guide our ministry in the future

Prub Khurana, Chief Strategy Officer, Providence St. Joseph Health, Irvine, California

Natalie Blum, System Director, Quality and Infection Prevention, PeaceHealth, Vancouver, Washington

Tiffany Parker, Director, Inpatient Behavioral Health, Addiction Services and Domestic Violence Services, St. Agnes Hospital, Fond du Lac, Wisconsin

For boldly championing society’s most vulnerable

For demonstrated creativity and breakthrough thinking that advances the ministry

For a lifetime of contributions

Lindsay Flannery, Vice President, Patient Care Services, Avera Sacred Heart Hospital, Yankton, South Dakota Wendy Gaudet, Director, Pharmacy, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana Morgan Griffith, Vice President, Digital Strategy and Transformation, Bon Secours Mercy Health, Cincinnati Karthik Iyer, MD, Chief Medical Officer and Medical Director Critical Care, Mercy Hospital Jefferson, Festus/ Crystal City, Missouri

Aaron Puchbauer, President and Chief Executive Officer, HSHS Good Shepherd Hospital, Shelbyville, Illinois Nathaniel Schlicher, MD, JD, MBA, FACEP, Regional Medical Director, Quality Assurance for Emergency Medicine, CHI Franciscan Health, Tacoma, Washington Bernardita Ureta, Vice President, Mission, Red de Salud UC CHRISTUS, Santiago, Chile

April 1, 2020 CATHOLIC HEALTH WORLD

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KEEPING UP PRESIDENTS/CEOS

Lutton

Brinn

Lorraine Lutton to president and chief executive of Mount Carmel Health System in Columbus, Ohio, effective April 6. She was president and chief executive of Roper St. Francis Healthcare in Charleston, South Carolina. Mike Englehart, who was Mount Carmel interim chief executive, will return to his role as senior vice president for medical

groups and ambulatory strategy for the Trinity Health system.

Kate Brinn to president of Bon Secours Maryview Medical Center in Portsmouth, Virginia, and Bon Secours Health Center at Harbour View in Suffolk, Virginia, effective March 1. She was vice president of service lines at Bon Secours Hampton Roads Health System.

Divine Savior in Wisconsin joins nine-hospital Aspirus Divine Savior Healthcare of Portage, Wisconsin, has joined Aspirus, a ninehospital, not-for-profit system based in Wausau, Wisconsin.

Under the arrangement, Aspirus last month acquired the 52-bed hospital called Divine Savior Healthcare along with its skilled nursing and assisted living facility, clinics, home health services, an ambulance service and other sites and services.

Aspirus is not releasing financial details of the acquisition.

The Sisters of the Divine Savior had founded the Portage hospital in 1917.

Under Aspirus’ ownership, the sisters no longer sponsor the hospital, and the hospital no longer is operated as a Catholic facility. The names of the hospital and related facilities will be changed.

However, according to information from Aspirus spokesman Andy Napgezek, Aspirus has “committed to maintaining certain practices important to both the sisters and Aspirus.” This includes maintaining a health care ethics committee;

continuing Divine Savior Healthcare charity care, community benefits and community outreach; supporting certain Sisters of the Divine Savior ministries; promoting the sisters’ charism and core values; continuing spiritual care offerings; retaining the chapel; and displaying crucifixes and Catholic artwork and iconography.

Divine Savior Healthcare is the second Catholic hospital to join Aspirus. In 2007, Aspirus acquired Langlade Memorial Hospital of Antigo, Wisconsin, now called Aspirus Langlade Hospital.

According to information from Aspirus’ Napgezek, Divine Savior Healthcare will continue to have its own board of directors, adhering to Aspirus bylaws. The number of seats on that local board will increase from 10 to 13. Most members of the legacy board will remain in place. The sisters now will appoint one member to the board, rather than the two they had appointed in the past. And, two physicians and two Aspirus members now will sit on the board. The Aspirus system board

holds certain reserve powers over the local board.

The Sisters of the Divine Savior had approached Aspirus because they wanted to join a larger system. According to information from Napgezek, there is strong alignment between Divine Savior Healthcare and Aspirus. He said that the congregation had founded health care ministries around Wausau that would later form Aspirus. Currently, Aspirus’ network includes hospitals and clinics and other outpatient sites in Michigan and Wisconsin. Aspirus has two hospitals within 80 miles of Divine Savior Healthcare.

In a press release on the acquisition, Michael Decker, president and chief executive of Divine Savior Healthcare, said that now, as part of a larger system, Divine Savior Healthcare will be able to bring new resources to the communities it serves.

Napgezek added that it is likely Aspirus will expand Divine Savior Healthcare’s workforce and services in the future.

From page 1

Waste not Ivonne Der Torosian, vice president of community health and well-being at Saint Agnes Medical Center in Fresno, California, said countering hunger and other nutritional issues is a way for Trinity Health to pursue its mission of improving health outcomes for people who are poor and vulnerable. She noted that poor nutrition can worsen conditions such as diabetes and heart disease.

In Fresno, Der Torosian said, almost 30% of adults self-report a body mass index — a measure of body fat — that exceeds the healthy range. “What we find is despite there being a high obesity rate, many of our residents are malnourished,” she said. “They don’t have access to nutritious foods.”

ADMINISTRATIVE CHANGES Facilities within the Mercy system of Chesterfield, Missouri, have made these changes: Ryan Geib to chief operating officer for Mercy Hospital Fort Smith in Fort Smith, Arkansas; Mary Beth Bulte to vice president of mission for Mercy Hospital South in St. Louis; and Cotton Chou to director of performance excellence for Mercy Fort Smith.

Facilities within Baton Rouge, Louisianabased Franciscan Missionaries of Our Lady Health System have made these changes: Ann Marie Marmande to president of Our Lady of the Lake Foundation of Baton Rouge and Lowell Stanton to chief financial officer of Our Lady of the Lake Regional Medical Center of Baton Rouge.

ANNIVERSARY Benedictine Health System, Duluth, Minnesota, 35 years.

GIFT Elizabeth Seton Children’s Center in Yonkers, New York, has received a $1 million grant from the New York Citybased Mother Cabrini Health Foundation.

The funds will help Elizabeth Seton to build the nation’s first skilled nursing facility for young adults with severe, medically complex conditions. Construction is expected to begin in 2021.

a thousand people and the feedback has been positive, she said.

“It’s a big part of our mission to address inequities in communities and there’s a huge inequity in people’s knowledge and experience and understanding about food,” Stuart said. “In our community health needs assessment we saw huge issues around food insecurity and the research shows that changes in people’s behavior and understanding around food can have major impacts on their health.”

Food insecurity will be able to identify and help even more people as the system rolls out its integrated Epic medical record system. The rollout started in January at all Trinity Health sites in Michigan, home of its headquarters in Livonia, and will continue in waves across the 22-state system. The rollout is projected to take up to two years. The health system customized its Epic records to include 12 screening questions for all patients on “social influencers of health.”

The medical records system is matching the answers to those questions with a community resource directory curated by Aunt Bertha, an organization that indexes social services by ZIP code. When a screening identifies a social need, Aunt Bertha points out the top three resources to address that need in the patient’s ZIP code.

“Through this process, our expectation is that every individual who comes into a Trinity Health facility will be screened at least once a year and those screenings will be reviewed when they return to see if their needs have been met or if additional needs have arisen,” said Jaime Dircksen, the health system’s vice president for community health and well-being.

Three of the screening questions focus on food insecurity.

Larry LeGrand to president of SSM Health Ministries, the public juridic person of St. Louis-based SSM Health.

Workers clean crates that are used to distribute unopened food packages from schools, restaurants and businesses to those in need through Fresno Metro Ministry’s Food to Share program. The program gets some of its support from Saint Agnes Medical Center in Fresno, California.

Another bit of irony for the Fresno region is that it grows much of the fresh produce sold across the nation, yet the 2019 community health needs assessment done by Saint Agnes cited food insecurity rates there that are higher than the averages for California and the United States.

One of the ways Saint Agnes is addressing the nutritional needs of the community is to partner with the Fresno Metro Ministry to support its Food to Share program.

The program recovers unopened packaged food from grocery stores, restaurants and schools to redistribute to low-income neighborhoods where grocery stores and other food outlets are scarce. Starting last July, Saint Agnes committed to providing financial support to the program for three years.

From July 1 through the end of January, the operators of the program collected 158,000 pounds of food and distributed it among 49 partner agencies, such as churches and food pantries. Der Torosian said recipients will be surveyed once a year to see if Food to Share has reduced their households’ food insecurity.

Healthy meals on a budget On the other side of the country in Hartford, Connecticut, Saint Francis Hospital & Medical Center has contracted with the nonprofit Cooking Matters to teach courses on preparing nutritious, low-cost meals.

The courses run six to eight weeks and are offered five to six times a year at community sites, including senior centers and libraries. As part of the contract, Cooking Matters staff do cooking demonstrations at a weekly farmers market in a low-income neighborhood.

“We’re providing the funding and then we do some data collection collaboratively,” said Mary Stuart, regional director for program integrity and community benefit compliance for Trinity Health of New England. Saint Francis Hospital & Medical Center is within that regional Trinity Health group.

Stuart said the data collection is meant to ensure that the classes reach the target audience of people who endure food insecurity and that those who get the lessons find them useful. So far, the courses and demonstrations have reached more than

Hydroponic produce In Springfield, Massachusetts, Mercy Medical Center has taken a different approach to reach a similar end. The hospital helped facilitate a $200,000 low-interest loan from Trinity Health’s Transforming Communities Initiative to the Wellspring Collaborative’s greenhouse project. The worker-owned for-profit business uses hydroponic techniques to grow produce for hospitals, schools, businesses and individual customers. The Transforming Communities Initiative supports strategies that address social influencers of health.

Doreen Fadus, executive director of community health and well-being at Trinity Health of New England, said the greenhouse is in an economically challenged neighborhood. The project will serve the dual purpose of providing jobs and producing healthy food options for locals.

Mercy Medical Center also is giving advisory support to the Springfield Public Schools Culinary and Nutrition Center.

The center, which opened a $21 million site last year, provides daily preparation, cooking and baking of fresh foods for 50 schools, training for students and jobs for the community.

Fadus said the commitment to addressing hunger and nourishment issues goes back to the founders of Trinity Health. “Previously they might have looked at growing food or providing groceries to people or providing meals through a soup kitchen or resource center,” she said. “We might be calling things differently and we might be delivering in a different way, but we’re still doing the same work.” leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD April 1, 2020

With ‘Keys to Me,’ Mercy clinicians meet needs of young patients with developmental conditions With lights dimmed,

By JULIE MINDA

B

orn a micro-preemie and suffering from gastrointestinal, feeding and other disorders all his life, 5-year-old Sam Tranen is no stranger to hospitals and medical offices.

But, until recently, visits to these facilities usually were a high-anxiety experience for him and his parents. Sam, who is nonverbal and autistic, communicates with hand gestures and through an assistive communication computer. He needs to be eased into new situations. He can become agitated by bright lights and can get frightened and upset in unfamiliar environments.

His mom, Dena Tranen, says “because of how he is wired, it can take Sam longer than other kids to adjust or feel safe in a new environment, which makes him more vulnerable to becoming dysregulated.” She says she and her husband “were often faced with the decision of whether to allow the staff to physically restrain Sam or to come back later — and that could take months to reschedule.”

The experience at Mercy Kids Children’s Hospital St. Louis was totally different, says Tranen. The Tranens were the first family in a 2018 pilot for Mercy’s “Keys to Me” program, which consults the parents or guardians of children — particularly those with developmental disabilities — on how to make the kids’ medical visits as comfortable as possible.

Sam was due for an upper endoscopy, and Mercy asked the Tranens several days prior to the procedure to fill out an online Keys to Me form. In the form, Tranen and her husband described Sam’s communication level and behaviors that indicate he is in distress, what rewards motivate him and what accommodations might help him — and them — to have a better experience during the visit. A Mercy Child Life specialist called the Tranens before the appointment to talk in more detail about the information they had supplied.

Tranen says the day of the visit, she and her son arrived to a hospital room with lights dimmed as Sam preferred, with “Sesame Street” on the television as he liked. “He just crawled into bed and sat calmly,” unlike in prior

as Sam preferred, with “Sesame Street” on the television as he liked, “He just crawled into bed and sat calmly.”

— Dena Tranen

When Sam Tranen, age 5, got into his room at Mercy Kids Children’s Hospital, “Sesame Street” was on the television and there was a pile of toys at the ready to make his experience as a patient less stressful. The preparations were made in line with the “Keys to Me” form his mother had filled out before his visit.

procedures can be stressful to any patient, and especially to children, and that may be doubly true for children with developmental and behavioral conditions. He says kids with such impairments often lack the ability to communicate their own needs and preferences.

At a hospital or medical office, children may be thrust into unfamiliar and scary situations where they are expected to submit to medical prodding and procedures they don’t understand and that may even hurt. A child’s mounting anxiety often triggers their parents’ anxiety. Add to that the stress of clinicians who may not have met the child before and do not know the idiosyncrasies or what triggers or soothes their patient, and “you have the perfect storm of escalation of negative

appointments, Tranen says. The whole visit went just as smoothly, Tranen says.

That and subsequent appointments were so successful that Tranen has since transferred all of Sam’s care from a different hospital system to Mercy. She says Keys to Me “is a game changer — it changes our ability to access care for our son.”

Tamping down anxiety Dr. John Mantovani is medical director of the Mercy Kids TherMantovani apy and Autism Center; Katherine Jennings is the center’s practice manager; and Tara Anders is a Mercy Child Life specialist. All three helped to create Keys to Me, which Mercy developed beginning in 2017, piloted in 2018 and launched formally last year.

Mantovani says the medical environment and medical

A key icon on a doorframe signals clinicians to consult the patient’s medical record for a Keys to Me profile.

Toys from Mercy bins distract young patients undergoing treatment at the hospital.

Before the Tranen family began receiving care at Mercy, son Sam would often try to escape from his medical appointments.

That has changed under “Keys to Me.”

interactions,” says Mantovani.

Jennings adds that it is common for children with developmental disabilities to have medical comorbidities, and so it is typical for them to be at medical appointments frequently. And, she says, children’s memories of stressful past visits can “amp up” their anxiety before they even arrive at an appointment.

VIP treatment Mantovani, Jennings and Anders are part of a multidisciplinary team of about a dozen Mercy St. Louis associates who created and operationalized Keys to Me. The team wrote the questionnaire parents use to describe their child. They input the parental responses into the patients’ electronic medical record.

Team members conduct inperson trainings and have created “microlearnings,” which are brief online education sessions about developmental disabilities in children, for Mercy associates.

The training teaches associates the basics about developmental conditions, potential accommodations that can be made and the Keys to Me approach. Associates throughout Mercy Kids Children’s and at Mercy Hospital St. Louis have received the training. Mercy Kids Children’s is on the campus of the 859-bed hospital. Mercy is

expanding the program next to its pediatric primary and specialty clinics in St. Louis. A gradual expansion throughout the Mercy system will follow with the goal of offering it through all its pediatric primary and specialty care clinics in Arkansas, Kansas, Missouri and Oklahoma as well as at its other dedicated pediatric hospital, which is in Springfield, Missouri.

When preparing to treat a child who has a Keys to Me profile, Mercy associates place a magnetic picture of a key on the doorframe of the room where the child will be. Before the patient arrives on campus, staff review the patient’s preference and behavior profile so they can anticipate and head off potential issues. For instance, staff may arrange for a child who is anxious in crowds to skip the waiting room. For children admitted to the hospital, staff may turn the TV in the room to a favorite show and bring in toys and games to have at the ready.

Culture change Although it was designed for children with developmental Anders disabilities, Mercy clinicians can use Keys to Me to make health care less stressinducing for neurotypical kids too. Clinicians Jennings can fine-tune the instrument, adding their own tips and learnings about individual patients in a clinician section of the Keys to Me segment of the electronic medical record.

Anders says clinicians, parents and kids are far less stressed — and even calm — about medical procedures as a result of the Keys to Me program.

Jennings says the changes happening under Keys to Me are inspiring widespread culture change at Mercy. “We’ve been very attuned to patient experience for quite some time but through this process, there’s been a new dimension added. We’re looking at what gives a person a good experience and what about that person makes them have different reactions to the care setting, and how to maximize the insights we learn.

“You can’t be certain about what might work unless you ask the people who know the patient well,” or in the case of older patients — the patients themselves, she says.

Mantovani says as clinicians learn more about the children they are treating, and have the tools to make their experience better, they are gaining more confidence and more joy in treating patients who formerly may have been considered “difficult.”

He says for everyone involved, “These positive experiences tend to build on themselves, and children who may have once been terrified now are more positive, and are more likely to have more positive experiences with medical care here going forward.”

To review the Keys to Me form, visit mercy.net/forms/ mercy-kids-keys-to-me/. jminda@chausa.org