Catholic Health World - December 1, 2021 by Catholic Health Association

Road map to longevity 3 Executive changes 7 PERIODICAL RATE PUBLICATION

DECEMBER 1, 2021 VOLUME 37, NUMBER 19

Actions speak volumes: Doctors’ kids at front of line for pediatric COVID vaccine By LISA EISENHAUER

Dr. David Basel, Avera Medical Group vice president of clinical quality, didn’t hesitate when it came to getting his 8-year-old immunized for COVID-19. Basel had the system’s clinic manager text him when the first shipment of the Pfizer vaccine newly approved for children Basel age 5–11 arrived in early November. He took his daughter in pronto. He says that rush to vaccinate his own child is “probably the strongest piece of evidence I can give you about how I feel about this vaccine.” Dr. Michael Bolton, a pediatric infectious disease doctor with Our Lady of the Lake Children’s Hospital, saw that his daughters, age 11 and 8, got vaccinated the first Bolton morning the pediatric shots were available in Baton Rouge, Louisiana. The hospital is part of the Franciscan Missionaries of Our Lady Health System. “There were a few tears for the younger one, but once we went and got donuts right after, they were A-OK,” Bolton says.

Both Basel and Bolton have lead roles in overseeing the COVID vaccination process for their systems. “I know we don’t have millions of kids who have gotten it so far, but judging off the safety on the adult side and the safety that’s been studied so far in the older age group of kids, and the studies that have come out so far in this (5–11) age group, I feel very confident in the safety and efficacy of this vaccine,” Bolton says. He says his confidence is based on closely following the vaccine studies and the reports on them from the Centers for Disease Control and Prevention and its affiliated bodies. On Nov. 2, the CDC gave its long-awaited approval for use of the pediatric dose of the Pfizer vaccine in children age 5–11. Children age 12– 15 have been eligible for the adult dose Pfizer vaccine since midMay. Vaccine safety trials have begun in children age 6 months to 4 years.

Dr. Michael Bolton, a pediatric infectious disease doctor with Our Lady of the Lake Children’s Hospital in Baton Rouge, Louisiana, got his daughters, 8-year-old Georgia, and 11-year-old Caroline, in for the first of two doses of COVID-19 vaccines as soon as possible. He shared this photo on the hospital’s Facebook page in the same post in which the hospital announced that its clinics would be offering inoculation to all children age 5-11.

Benefits dwarf risks As with any vaccine, the doctors note, there is a potential for side effects. The most likely are the mild sort — arm soreness and short-lasting flu-like symptoms. The next highest risk is for an allergic reaction. Of the hundreds of thousands of COVID immunizations Avera has given to teens and Continued on 8

Nurses play essential role in efforts to advance health equity CommonSpirit Ministry nurses take on connects community vaccine hesitancy, maternal health disparities, care organizations to access gaps maximum effect By JULIE MINDA By LISA EISENHAUER

Since its beginnings, the Catholic health ministry has prioritized care of the poor and vulnerable. CHA and its members reaffirmed that commitment a year ago through the “We Are Called” initiative and the related pledge, “Confronting Racism by Achieving Health Equity.” As the largest bloc of health care providers in the U.S. and with a nearly ubiquitous presence across the care continuum, nurses have an essential and growing role in advancing health equity work, according

Family nurse practitioner and clinic supervisor Bridget Waldrup-Simpson examines Onita Sonnier at St. Bernadette Clinic in Lafayette, Louisiana. Waldrup-Simpson pursued an advanced practice credential in part to be better equipped to work to eliminate health care disparities.

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Lessons in trauma-informed care also can beneﬁt refugees, veterans and victims of domestic abuse By RENEE STOVSKY

Felice Zimmern Stokes, 82, has been a volunteer at Holy Name Medical Center in Teaneck, New Jersey, for 10 years, first working with children in the day care center and now assisting throughout the hospital. But one of her most important contributions to date may be the part she played in a new interactive, web-based training course, “Helping Survivors of Trauma,” that

Jeffrey Rhode/Holy Name

Holy Name teaches clinicians to take better care of Holocaust survivors

Felice Zimmern Stokes, right, and Deborah Buldo, simulation educator at Holy Name Medical Center in Teaneck, New Jersey, perform in a video simulation of a Holocaust survivor receiving compassionate medical care. Stokes was a toddler when her parents were murdered in Auschwitz. Filling out forms about her family’s medical history can make her feel sad and alone.

educates health care professionals on how to use a person-centered trauma-informed approach to care when treating Holocaust survivors, refugees, veterans and even victims of domestic abuse. The module was recently developed by Holy Name’s Russell Berrie Institute for Simulation Learning in partnership with The Blue Card, a national nonprofit organization dedicated to assisting Holocaust survivors in need. Stokes is herself a Holocaust survivor. Born in 1939 to a Jewish family in Walldürn, Germany, the infant girl was separated from her parents when they were deported by the Nazis to Camp de Gurs in Béarn, France, near the foothills of the Continued on 6

As system vice president of community health for CommonSpirit Health, Pablo Bravo oversees the system’s rollout of Connected Community Networks. The networks rely on a “trusted community convener” and a shared technology platform to link a range of community partners Bravo who help individuals with affordable housing, nutrition assistance, mental health counseling and other needs that factor into the social and economic determinants of health and health care outcomes. Bravo talked with Catholic Health World about how and why CommonSpirit is working to establish and expand the networks in select markets. The system launched the first network in Las Vegas in 2016. It has since shepherded 13 Connected Community Networks in five states. The interview has been edited for length. What prompted CommonSpirit to come up with the Connected Community Networks’ framework? We needed to find ways to address social determinants of health. One thought was Continued on 2

CATHOLIC HEALTH WORLD December 1, 2021

Community networks From page 1

You could develop specialty networks that ultimately could provide funding for a lot of these services.

to connect patients to community-based resources that help them stay healthy or manage an illness. My thought was, wouldn’t it be great to create a network of community organizations that can work together, that can refer to one another? Think of an individual going to a food bank and saying “Look, I need soft food because of a toothache.” What if the food bank worker could say, “I can connect you to a dentist”? I hired Ji Im, system director community health, to look at this potential for connectivity. And, it spun from there. I also thought that if social services and health organizations built and participated in a community network, they might stop challenging each other for grants. The competition is so great for the grants.

What investment was required by CommonSpirit to initiate the networks? Our investment in each of our communities around the Connected Community Network is significant, but we haven’t done this alone. There’s been other systems that we have partnered with, Kaiser Permanente and others. We have invested in this in the sense that we have provided technical assistance. We have funded the technology licenses for the community-based organizations and then we provided funding for some of the neutral conveners to get set up. We have put some money into development of the Connected Community Networks and also staff to technically assist their capability.

Is this a network of equals or have CommonSpirit hospitals taken the lead? This is a network of equals. We are a provider just like everybody else. I think the only difference has been that we have initiated the conversation. It is a partnership, it’s a network and we’re all equal. Do the networks all use the same technology platform? We started (in Las Vegas) using a oneway technology. It generated a referral from the hospital to local resources. Our goal was always to have a technology that made it possible for every participating organization in the network to refer to one another. Three years later on, Aunt Bertha and Unite Us and all these other technologies popped up, so it was meant to be. Right now, communities are choosing the technologies that are the best fit. We’re mixing and matching. Unite Us is definitely one of our primary vendors, but we are also looking at Aunt Bertha, Charity Tracker, etc. Were the first networks pilots for the others? They’re all still pilots. They’re showing major benefits across the board. There is a lot more work to be done, but the pilots are connecting patients to resources, helping us reduce hospital utilization. We’re definitely seeing a benefit to having a network of partners working with us to address access to resources, services and care. I know that our partners are also seeing that these pilots are demonstrating significant impact. The new IT solutions that we have in place make it possible for everybody to refer to one another and for us to record the referrals and some of the outcomes. The networks continue to grow and mature. In another year we can really take a look and see what the data is showing. How much organizational cooperation was there to begin with among the participants and how has that evolved? As anchor organizations in the community, hospitals have long-standing relationships with our community-based organizations. We didn’t come to the table and say: This is going to be our platform; this is going to be our network. We said: It is going to be all of us together; no one is the owner. I think everyone at the table was really excited to see something develop and see that it was going to be owned by everybody. Later on, the networks brought in a neutral convener. United Way fills this role in several Connected Community Networks. Are all the service providers in the network nonprofits? Will for-profits have a role in providing services that address social needs? The network is open to anyone. If you have a service that you can provide to the community that is going to address specific issues, come on in. We’re not the decider. The network is the decider. We hope that the networks will evolve even to a greater scale. It’d be great to have employers and I know in some places schools have stepped

A chart from Health.gov, a website under the umbrella of U.S. Department of Health and Human Services, identifies the social determinants that studies show greatly contribute to health, quality of life and life span. CommonSpirit Health’s Connected Community Networks facilitate collaborations between agencies that address various social needs within communities.

up to the plate to be part of the network. We would love the network to grow. For right now, the members are all communitybased organizations. Is this essentially a referral network resource, or will the network be instrumental in scaling community services to meet unmet needs? At this point, it could all go so many different directions. The idea is the net-

work will bring us all together, so services become orderly. Also, it would allow community-based organizations to specialize in certain areas, so they could potentially be getting paid for those services. For example, community-based organizations providing services for seniors could develop a small network of their own within the network, so if you have a payer or an organization that is looking for senior services, well, the specialty network’s right there.

How central is the Connected Community Network to CommonSpirit’s efforts to invest in initiatives that improve social determinants of health in order to get upstream of disease? The network is only one initiative within community health at the system level. There’s a lot of great work being done at each individual facility too, whether it’s programs around diabetes prevention, chronic disease management or response to cultural trauma. The list goes on and on. The days of providing an individual with a piece of paper saying, “After you leave us, call this number” (are waning); the followthrough is not necessarily there. With the networks, patients’ follow-through is not going to be 100%, but I believe that if the referral process is easy and folks don’t have to worry about having to make the appointments themselves, the compliance will be higher. leisenhauer@chausa.org

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December 1, 2021 CATHOLIC HEALTH WORLD

Saint Joseph Mercy pilots lifestyle medicine program for Trinity Health By LISA EISENHAUER

A lifestyle medicine program launched in the spring by southeastern Michiganbased Saint Joseph Mercy Health System is a pilot for the system’s parent company, Trinity Health. Working as part of a team of seven, Lisa McDowell, director of clinical nutrition and lifestyle medicine, helped develop the program. Its goal, she says, is “to provide support to individuals and teach them to hardwire best practices that optimize their own personal health and potential.” The team members McDowell — five dietitians and two physicians — are certified through the American College of Lifestyle Medicine, a professional society founded in 2004 that provides education, practice support and advocacy. The lifestyle medicine program includes individual assessments, nutrition therapy and group sessions that are based on six pillars: Whole food, plant-predominant diet. Regular physical activity. Restorative sleep. Stress management. Avoidance of risky substances. Positive social connections. McDowell says the pillars parallel researchers’ findings about the so-called Blue Zones of the world, five regions where residents on average live longer and healthier lives than elsewhere. The findings link the longevity to plant-based diets, physical activity and social connectedness. “If you look at the American lifestyle, it is so different than these Blue Zone pockets of success,” McDowell says. Many people in the U.S. eat meat- and calorieheavy diets, get too little sleep and exercise, ignore signs of stress and avoid social interaction. The pillars also reflect the practices McDowell has seen help elite athletes reach their peak performance in her work as a dietitian for both Olympians and the Detroit Red Wings professional hockey team.

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tunity that I couldn’t pass up.” Based on her individual assessment, Stark’s goals include getting more exercise, sticking to a more nutritious diet and finding more time for herself. Over the course of the program, she says she came to appreciate how beneficial getting sufficient sleep is to her overall sense of well-being. To relax and prepare for sleep, once she puts her children to bed, Stark is spending less time immersed in the apps on her phone and more time doing calming activities that don’t involve screen time such as working jigsaw puzzles. “It’s essentially been like a cascade,” Stark says. “I’m sleeping better so I’m able to wake up more refreshed, put better focus on what I’m eating. I have more energy throughout the day.”

Hillary Stark, a marketing specialist for St. Joseph Mercy Ann Arbor in Michigan, works on a jigsaw puzzle at her home. She says doing puzzles helps ease the stress of a busy life that includes two sets of young twins. Stark learned to prioritize restful sleep as a participant in the lifestyle medicine program being piloted at her hospital.

“We know that if an athlete is not sleeping well, or if they’re dehydrated, or they’re not getting the right food, or if they’re lonely, or if they’re abusing too much alcohol or relying on sleeping pills, they are not going to be their best,” she says.

Connecting the dots The idea for the lifestyle medicine program took root in 2020, McDowell says. She and some of her colleagues noticed that many patients were seeing a variety of providers to address separate health issues. The clinicians wanted to help those patients improve their overall health by making lifestyle changes. McDowell says sometimes lifestyle choices, rather than traditional medical care, can put patients on the path toward healthy lives. McDowell’s team works with patients to set personal goals to improve their wellness and to figure out how to move toward those goals. One of the options for patients is the Lifestyle Medicine Intensive Program, an eight-week course of group therapy. Par-

ticipants start with a private consultation with a dietitian and then engage in weekly group sessions that focus on specific topics such as stress management and the power of social connection. Because of the pandemic, the group sessions for now are virtual.

Cascading benefits Hillary Stark, a marketing specialist for St. Joseph Mercy Ann Arbor, says she had “zero awareness” of lifestyle medicine until she was assigned to market the program, but she was primed to make some changes to her stressful life as a working mother. This summer she joined a dozen other patients in the program’s first group therapy cohort. In December 2019, Stark had delivered her second set of twins. Her other twosome was just 3. When her maternity leave ended, the pandemic had begun, adding more stress to being a working mother with four very young children. “It was just like, man, I need a reset,” she recalls. “This program with everything that it covers seemed like a really great oppor-

Tough sell for insurers McDowell says lifestyle medicine follows established practices that have been proven to help keep patients healthier and prevent chronic conditions from worsening. Nevertheless, she notes that it has yet to win over many insurers. “Each insurance varies, but for the most part, what we’re finding is there is little reimbursement,” she says. Saint Joseph Mercy is incorporating lifestyle medicine into its programs for colleagues. For example, the system’s Nutrition Buddies Program pairs physician residents with kids from the community to learn culinary skills together. The focus on healthy choices also figures into the system’s community benefit efforts, which include free community clinics on nutrition. McDowell is hopeful lifestyle medicine will gain a wider embrace as the field draws more adherents and its benefits are backed up by further research. “I think that we have to collect data, we have to show outcomes,” she says. “I know everybody’s different, but I would much rather be empowered with the information to take care of my own health (and avoid preventable chronic illness) than to rely on a medicine or a procedure to try to reverse a disease or treat it.” leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD December 1, 2021

Nurses and care equity to a recent analysis by the National Academies of Sciences, Engineering, and Medicine (see sidebar). A sampling of nurse leaders from around the ministry say they felt compelled to take direct action to reduce health inequities. “We are the eyes and ears of health care, and we know what’s needed in the hospital and in the community, and we need to be at the table and in those conversations” about getting at intractable inequities that lead to poorer health Waldrup-Simpson outcomes, says Bridget Waldrup-Simpson. She supervises St. Bernadette Clinic, a free walk-in clinic run by Our Lady of Lourdes in Lafayette, Louisiana. That hospital is part of Franciscan Missionaries of Our Lady Health System.

Nurse advocates About eight years ago, WaldrupSimpson sought additional education and training beyond her R.N. credential. She joined St. Bernadette while studying to be a family nurse practitioner. Two and a half years after achieving that credential, she became the clinic’s supervisor. The clinic was established in north Lafayette to treat acute conditions in patients without insurance, most of whom are homeless. Many clinic patients have serious chronic conditions including diabetes and hypertension. The clinic pro-

Providence St. Joseph Health community nurse Kristy Capps vaccinates William Salgado against COVID-19 outside a mobile clinic in the Walla Walla, Washington, area. Salgado’s father was the first person in Walla Walla County to die of complications of COVID.

vides chronic care management for the months it can take staff to find the patient a permanent primary care provider. Many residents of north Lafayette are Black. The area lacks health care providers, particularly Black clinicians who would have an inherent level of trust among patients of the same race. Waldrup-Simpson says that her clinic also meets a vital need for medical, dental and mental health services in an area with a high level of socioeconomic need. Staff refer patients to community partners for help with housing, food, drug rehab and other social services. Because her patients lack timely access to specialists, Waldrup-Simpson advocates for health care equity locally and statewide. She meets with state legislators,

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‘Future of Nursing’ report says nurses are poised to lead on health equity

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urses have a critical role to play in promoting health equity, but in order to fully achieve their potential as leaders and influencers, they need robust education, a supportive work environment and autonomy. That is according to “The Future of Nursing 2020 – 2030: Charting a Path to Achieve Health Equity,” a report released in May by the National Academies of Sciences, Engineering, and Medicine. According to the authors, the nearly 4 million registered nurses across the U.S. are in a strong position to have an impact on health equity. They are present throughout acute care, community and public health settings and so can influence medical and social factors “that drive health outcomes, health equity and health care equity,” the report says. Nurses should serve as “bridge builders and collaborators, who engage and connect with people, communities and organizations to promote health and well-being,” the authors say. According to the report, in the interest of advancing health equity nurses should have a clear role in disaster response and public health emergency management. Health equity is relevant to disaster planning because pandemics and other health and environmental emergencies may have a disproportionately negative impact on communities of color. There are many barriers to nurses taking on wider responsibilities to advance health equity. They include a shortage of nurses and a growing number of unfilled positions, restrictions that prevent nurses from practicing to the top of their licenses and outdated payment systems that do not reward preventive health care. The report calls for states to lift restrictions on scope of practice regulations in order to allow nurses to apply the full extent of their training and education. The authors support value-based payments and other reimbursement structures that can give health systems more financial flexibility to engage in work that addresses social determinants of health and advances health equity. And the report calls for nurse education that prepares students to take on health care from a population health perspective and nurses to develop leadership and advocacy skills to advance health equity. Acknowledging the stress shouldered by nurses, the authors write that it is important to protect nurses’ health and well-being, particularly as they are taking on increased responsibility. The Future of Nursing is the second in a series of reports of the same name. It is the result of a study conducted by a committee under the National Academies. The committee undertook the study at the request of the Robert Wood Johnson Foundation and examined how to strengthen the nursing profession to meet the challenges of the coming decade. The AARP and the Robert Wood Johnson Foundation have launched the Future of Nursing: Campaign for Action to address recommendations covered in the study.

hospital administrators, community partners and insurance companies to lobby for improved care access. She supports the Louisiana Association of Nurse Practitioners’ advocacy on the state level for nurse practitioners to be able to practice to the full scope of their licenses. “As nurses we have big, giant voices and we are such advocates for our patients,” she says. Nurses should take that advocacy role beyond the bedside, she says.

Sheila Hager, reporter, Walla Walla Union Bulletin

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for withdrawal symptoms associated with neonatal abstinence syndrome. She’s put in place breastfeeding support and a hypertension management program in inpatient and outpatient care settings. She says she is driven to help women with substance dependence achieve sobriety by the fact that, during several years of her youth, her mother was incarcerated, although her crime was not related to substance dependency. “My passion for implementing the program is to help moms to rehab so they can be with their child. It was painful growing up without a mom. It was a huge hole in my life. “The majority of moms I see do not want to lose their children. The biggest reward to me is seeing these moms rehabilitate and take their babies home with them,” Welch says.

Boots on the ground Across the country, in Walla Walla, Washington, registered nurse Becky Betts has built from scratch the population health department at Providence St. Joseph Health’s Southeast Washington region. She came to the population health field having worked as a nurse in almost every departBetts ment of Providence St. Mary Medical Center. She says she’s seen patients whose noncompliance with medical orders led to frequent preventable readmissions and increased pain and suffering. She’s seen how poverty contributed to poor control of chronic disease. She felt limited in her ability to address such issues as a staff nurse and so she shifted her focus to population health. The department relies on community

‘Walk where they walk’ Sr. Mary Trinita Eddington, OP, began her career and ministry in Jackson, Mississippi, more than 60 years ago as a registered nurse at FMOLHS’ St. Dominic Hospital. For 35 years she held progressively more responsible administrative nursing roles at the hospital and its parent, St. Dominic Health Services. Longing to return to direct patient care, she earned her family nurse practitioner credentials in the late 1990s then opened the free clinic she’s run for 24 years. She now is preparing to turn her administrator duties over to a successor. The community in Jackson that the clinic serves is impoverished and has barriers to health care access. Sr. Eddington says evidence of systemic racism is pervasive there. Before she opened the clinic, she immersed herself in the community and built relationships to overcome people’s lack of trust in white medical providers. More than 80 percent of Jackson’s population is Family nurse practitioner Sr. Mary Trinita Eddington, OP, treats Sie Black or African Ameri- Lee Donalds at the free clinic she founded and heads in Jackson, can, according to the U.S. Mississippi. Census Bureau. “I knew I needed to walk where they walk and had to health needs assessments and data ana– build trust, I had to listen to them,” a mind- lytics to pinpoint health inequities. The analysis has shown great gaps between set that she’s maintained to this day. the health outcomes of Latino patients as compared to white patients. Betts has been ‘Window for change’ Patsy Welch is a nurse manager for labor hiring community health workers from the and delivery, and a lactation consultant Latino community and partnering with at the 57-bed Our Lady of the Angels, an community health workers from other FMOLHS hospital in Bogalusa, Louisiana. organizations to do outreach to medically About 30% of the population of that com- underserved Latinos. Many immigrants without legal immimunity is impoverished, according to the Census Bureau. gration status work in agriculture and meat Welch’s concern about the high per- processing in the Walla Walla area. Betts centage of expectant and new mothers and the health workers have taught memwith drug dependency, hypertension or bers of this vulnerable population how to other risky health conditions motivated access health care and protect themselves her to spearhead multiple initiatives that and their families from COVID-19. Betts says the work is having an impact she says are uncommon in small commuon health status. For instance, there has nity hospitals like hers. She started screenbeen a reduction in avoidable emergency ings and referrals in prenatal offices for substance dependency and for socioeco- department visits, increased medication nomic needs; social workers aid moms adherence and reduced hospital readmisneeding assistance. sion rates. Welch also implemented an “Eat, Betts says nurses have the skill set to Sleep, Console” program which makes the lead health equity work. “We are trained in mother an integral part of her newborn’s whole-person care, and we’re about taking care. The maternal nurturing can prevent care of family units.” the need for pharmacological treatment

December 1, 2021 CATHOLIC HEALTH WORLD

Clinical lens Ursula Wright is a nurse practitioner and vice president of clinical care and redesign at Chesterfield, Missouribased Mercy. In addition to provid- Wright ing hands-on care, Wright has been helping with systemwide efforts to recruit and promote colleagues with diverse racial and ethnic backgrounds. She co-chairs a committee that is working to provide mentoring, training and career ladders for minority clinicians and finding ways to meet the unique needs of diverse patient populations. Wright says nurses at Mercy have “become a critical component” in making changes at the system in a way that keeps patient needs at the heart of decisions, where they should be. “We’ve come up with new and innovative ways to approach patient care. And it’s part of our DNA as nurses to have that love of our patients and to have that concern to improve their health outcomes,” she says.

Providence launches national foundation to advance top priorities Focus areas include innovation, health equity, environmentalism By JULIE MINDA

Providence St. Joseph Health has started its first national foundation to generate funding for its top pressing goals and challenges. The Providence National Foundation will raise money to increase access to health care, to focus on pressing needs in mental health, sustainability, health equity, whole-person care and vulnerable communities across the seven western states where the system operates. Laurie Kelley, ProviKelley dence St. Joseph senior

vice president and chief philanthropy officer, heads the Renton, Washington-based foundation. Kelley says the new organization aims to raise between $3 million and $5 million within two years. Once it gains momentum, the Providence National Foundation hopes to raise more than $20 million annually. Its funding priorities include facilitating the continuing shift from the traditional health care model to a model that is more fully focused on whole-person care; advancing innovation through technology, data and research; leveraging facilities’ clinical expertise; addressing the social determinants of health; promoting health equity; and championing environmental stewardship. The national foundation will complement the efforts of the 40 foundations that operate in the system’s local markets. The national foundation’s fundraising “is

not at the expense of our local and regional foundation efforts. Providence is investing in its philanthropy teams, realizing that we have an opportunity to grow our results and thus impact more people,” she says. The national foundation will work with local ones to build stronger ties with existing donors and cultivate new donors. It will facilitate increased communication among representatives from these local foundations to foster the sharing of strategies and tools, especially when they have the same fundraising aims. For about two years, representatives from the system’s local foundations have come together monthly in subject matter expert groups to exchange ideas. The collaborative structure helps give Providence’s smaller foundations access to the tools and practices of the larger ones. Visit chausa.org/chworld for a list of the foundation’s board members.

Nursing schools help prepare students to advance health equity

ursing schools, including Catholic institutions, are equipping nursing students to play a central role in addressing health disparities. Sr. Rosemary Donley, SC, is a Duquesne University School of Nursing professor and the school’s Jacques Laval Chair for Justice for Vulnerable Populations. For Sr. Donley a dozen years she has organized an annual national symposium on health care justice. Among the attendees are nurses, nursing students and other health care providers. Sr. Donley says the curriculums of Catholic nursing schools in the U.S. including Duquesne incorporate coursework that exposes students to the human cost of health disparities in economically marginalized and vulnerable communities. She says nurses are taught to take the time to understand how well patients can care for their own health when outside the hospital walls, given their circumstances. For instance, nurses will want to know whether patients can realistically adhere to discharge instructions, whether they have access to the foods clinicians advise they eat, whether they have the facilities for the exercises clinicians advise them to do, whether they can afford the drugs they’re prescribed. This nursing mindset — looking at the practicalities of care adherence — naturally leads to a focus on social determinants of health and other health equity factors, Sr. Donley says. She says topics related to the social determinants of health and health equity are core to the Duquesne nursing school curriculum. She notes that the Pittsburgh school recently has been adding technology coursework to prepare nursing students to provide telehealth, which is proving essential for addressing health care access inequities affecting rural populations. The nursing school also has courses on ethics. Sr. Donley says she encourages beginning nursing students to pursue bachelor-level education and advanced certifications, including nurse practitioner credentials. Many nurse practitioners want to work in medically underserved communities, she says, and that commitment could improve care access.

A rendering of the hospital that will anchor the Lockport Memorial Campus of Mount St. Mary’s Hospital in Lockport, New York. Catholic Health plans to open the hospital sometime in 2023 with 10 inpatient beds and shelled space for quick expansion.

Catholic Health to build ‘neighborhood hospital’ in Lockport, New York By JULIE MINDA

Catholic Health of Buffalo, New York, expects to begin construction this month on a hospital in Lockport, New York, that will preserve health care services in that community. Lockport’s sole hospital is in bankruptcy proceedings and plans to close in phases when the new hospital opens, likely in the spring of 2023. The new hospital — Lockport Memorial Campus of Mount St. Mary’s Hospital — will be a campus of Catholic Health’s Mount St. Mary’s Hospital of Lewiston, New York. Lewiston is about 20 miles west of Lockport. The plans are the product of ongoing talks between Catholic Health and Eastern Niagara Health System. Catholic Health currently manages Eastern Niagara Health System’s Eastern Niagara Hospital. That not-for-profit Lockport community hospital has an emergency department, acute care, cardiac services, diagnostic imaging and an inpatient chemical dependency treatment unit. In a building it leases from Catholic Health, Eastern Niagara also operates an outpatient facility. When Eastern Niagara Hospital closes, Catholic Health will take over operation of the urgent care and ambulatory surgery center, occupational medicine and diagnostic services housed there. Eastern Niagara Hospital filed for Chapter 11 bankruptcy protection in November 2019, and its board subsequently agreed to partner with Catholic Health on a management agreement that will preserve services at Eastern Niagara Hospital until the new hospital, which the partners are calling a “neighborhood hospital,” opens. Joyce Markiewicz is Catholic Health executive vice president and chief business development officer. She says that Catholic Health will invite representation in facility governance for the new hospital from Eastern Niagara Hospital and it will employ staff from the hospital at the new Catholic Health hospital. Eastern Niagara has reduced inpatient

services and capacity over the years and the facility currently staffs 20 beds. The new Catholic Health hospital will be about 62,000 square feet and will open with 10 private inpatient beds. Shelled space for an additional 10 beds will allow for quick expansion based on demand. Markiewicz says if inpatient volumes rise, “Catholic Health will build additional inpatient rooms in the available space, saving time and providing the flexibility that is needed, resulting from the effects of the pandemic.” Markiewicz says Eastern Niagara Hospital will close in phases as the new campus opens. Lockport Memorial Campus of Mount St. Mary’s Hospital will function as part of a Catholic Health continuum that includes Catholic Health’s five hospital campuses. The new campus will have emergency, inpatient, imaging and laboratory services. It also will have medical office space for primary care, women’s health and specialty medical practices. In a press release on the hospital, Catholic Health President and Chief Executive Mark Sullivan says Catholic Health’s goal is to provide a state-of-the-art facility that will preserve health care for the more than 80,000 residents of the greater Lockport area. The New York State Department of Health’s Public Health and Health Planning Council approved the certificate of need for the new campus in July. The state health department has awarded Catholic Health and Eastern Niagara Health System $18 million in “vital access provider” funding. Sullivan says in a press release that the funding will help finance the redesign of the health care delivery system into a sustainable model for the long term, while also providing financial stability during that transformation.

An apple a day One of the parcels in the new campus is home to the locally popular Hall’s Apple Farm. Five generations of the family have lived and worked on the site and the patriarch is somewhat of a folk hero, says Mar-

kiewicz. The family will retain a portion of the land to operate a market and bakery. The call during which Catholic Health leadership and the Hall family discussed this arrangement was emotional “on all sides because the Hall family, like Catholic Health, was humbled and honored to play a role in creating something so vital for Niagara County residents on land that was such an important part of their family and the history of this community,” Markiewicz says.

Regional centers The Lockport investments come as Catholic Health jumpstarts a strategic plan it had put on pause when COVID hit. The system intends to create regional centers of excellence across Catholic Health’s Western New York footprint. The strategic plan includes: At Mercy Hospital of Buffalo: maintaining comprehensive cardiac and stroke services and growing neuroscience services. At Sisters of Charity Hospital’s main Buffalo campus: expanding vascular, bariatric and women’s services. At Kenmore Mercy Hospital of Kenmore: growing orthopedic services. At Sisters of Charity Hospital’s St. Joseph Campus: growing orthopedic services. St. Joseph Campus had experienced declining inpatient volumes and increasing ambulatory care volumes prior to coronavirus’ onset. Early in the pandemic the facility was reset as a COVID hospital. After COVID rates fell in late March, St. Joseph reopened the campus with a primary focus on ambulatory care and orthopedic surgery. St. Joseph reopened its emergency department in early June, but with no intensive care unit and few inpatient beds, emergency patients who require higher acuity inpatient care are stabilized and transferred to another Catholic Health hospital. jminda@chausa.org

CATHOLIC HEALTH WORLD December 1, 2021

Trauma-informed care From page 1

Pyrenees Mountains, in October 1940. Thanks to the efforts of Oeuvre de Secours aux Enfants, a French Jewish humanitarian organization that saved thousands of Jewish refugee children during World War II, she was placed with a Christian family — becoming a “hidden child” — until the war’s end. “I have no memory of my parents; I just know they were deported and killed at Auschwitz in 1942. But I was reunited with an older sister, who was also hidden, after the Germans surrendered. By then I spoke only French,” she says. The girls lived together in two different orphanages in France, and arrived in Newark, New Jersey, in 1951, where they grew up apart in several different foster homes. Eventually Stokes went to Stern College for Women — part of Yeshiva University. She worked for 40 years as an executive secretary at the Memorial Foundation for Jewish Culture in New York City. She married her late husband, Sherman Stokes, a chemical engineer, in 1980 and moved to Teaneck, where she’s lived ever since.

Lived experience Stokes says she does not suffer many of the scars of trauma that make so many Holocaust survivors, particularly those who survived concentration camps, hesitant to access health care. But she was happy to play the role of patient in the webinar to help educate nurses, doctors and dentists, especially younger ones, in how to promote well-being and avoid retraumatization of those who were once victimized by the Third Reich. “So many of the young nurses and medical residents I’ve met at the hospital know very little about the Holocaust except as a historical note in a book about World War II,” she says. “So, the more those who lived through it can still speak up about it, the better.” It’s estimated there are currently 80,000 Holocaust survivors — all at least 76 or older — in the United States, and about half of them live in the New York metro area. The Blue Card defines them as anyone who had at least one Jewish grandparent and lived under German occupation from 1933-1945. That includes prisoners in concentration camps, people who lived in ghettos, people who survived in hiding, lived under false identities or escaped to other countries, and those who emigrated later from the former Soviet Union. More than 30% of Holocaust survivors in the U.S. live in poverty, and many are at higher risk of developing heart disease, cancer, osteoporosis, joint disease and dental problems. Trauma survivors may have more difficulty in performing day-to-day tasks. And psychological scars also have an insidious affect — depression, anxiety, social isolation, nightmares, panic, paranoia, feelings of abandonment and fear of everyday activities, including routine medical visits that trigger past memories of persecution — are prevalent as well. Time is short “Time is running short for us to help heal this most vulnerable of groups,” says Shari Gold, program manager for grants at The Blue Card, which traces its origins to 1934 Germany, where Gold it provided assistance to Jews fleeing growing persecution there. (Its name came from the stamp and blue card donors received after raising funds for Jews who had lost jobs and businesses.) The organization relocated to New York in 1939 to continue aiding refugees resettling in America. Today it helps survivors in more than 35 states with everything from emergency cash assistance and educa-

compassionate medical providers, it is essential that we are aware and educated to avoid unintentional reinjury by instilling a sense of wellbeing and promoting healing in our patients,” she says. To help implement the module, Holy Name donated professional expertise to videotape interviewees, create and record simulated scenarios and incorporate historical photos. It also provided IT support. Despite delays due to the COVID19 pandemic, “Helping Survivors of Trauma” was completed last spring and has been available free and online since May. (To view Roll call at Buchenwald concentration camp, circa 1938-1941. Two prisoners in the foreground support a third man. the webinar, go to Helping Physical weakness made prisoners vulnerable to Nazi executions. SurvivorsOfTrauma.org.) An estimated 500 health care professionals got a lot of feedback, but we realized it was tional outreach to in-home care services. The origins of the Holy Name/Blue very labor intensive to organize in-person already have accessed the program, which Card training course can be traced to seminars for very busy people,” says Gold. involves watching videos and answering 2015, when the Jewish Federations of “So, in 2019 we applied for a second grant interactive questions. It takes 30-45 minNorth America received a grant from the for $225,000 to translate our presentations utes to complete, and doctors, nurses and U.S. Department of Health and Human into a web-based module.” dentists can receive continuing education Services Administration for Commucredits for the webinar. nity Living/Administration on Aging to Holy Name steps up develop innovations in person-centered It was obvious that Holy Name Medi- Universal application trauma-informed care for Holocaust sur- cal Center would be a terrific partner, says Sue McClain, a registered nurse at vivors. With that, plus additional contri- Gold. Based in Bergen County, it serves a Naples Community Hospital in Florida, butions, the Jewish Federations created large number of Holocaust survivors, par- recently viewed the module and says she the Center for Advancing Holocaust Survi- ticularly Russian Jews. And its institute for found it “very engaging.” “My biggest takeaway is that the patientvor Care and has since funded more than simulation learning, which teaches skills to medical professionals, centered trauma-informed approach to 400 programs. was an appropriate plat- care can be helpful for all patients. Instead In 2018, The Blue Card received a twoyear grant from the Jewish Federations form to house the train- of just asking them to sign consent forms for treatment, maybe we should routinely to advance person-centered traumaing course. informed training for medical profesJ. Cedar Wang, vice ask permission as well,” she says. “Many president of nursing patients, regardless of background, are sionals. With the help of consultants — at Holy Name, says the hesitant about everything from a routine including Eva Fogelman, a Manhattanmedical center is a per- blood draw to an EKG or an injection; we’ve based psychologist, writer and filmWang maker who pioneered the treatment of fect fit for the patient- seen this most recently with COVID-19 psychological effects of the Holocaust on centered trauma-informed care training vaccinations.” Stokes, who portrays an elderly patient survivors and their descendants; Dr. Bar- program. “We are known to cater to the prepping for an MRI in the program, says Jewish community here out of recognition bara Paris, director of the Department of Medicine, Division of Geriatric Services at of our shared Judeo-Christian values,” she her acting debut did bring up an uncomMaimonides Medical Center in Brooklyn, says. “We have a Sabbath elevator, serve fortable feeling she harbors as a Holocaust New York; and Dr. Rada Sumareva, a peri- kosher food when requested by patients, survivor. “I don’t hesitate to make an appointodontist in Cliffside Park, New Jersey, and and maintain things like a sukkah (a trapresident of the Russian-American Dental ditional temporary outdoor eating space) ment to see a doctor, and I don’t fear rouAssociation — it created and organized during the autumn harvest holiday of tine procedures, but I realized that filling presentations for doctors and dentists in Succot.” out forms about my family’s medical histhe five New York boroughs to improve Even more important, she adds, is that tory or identifying next of kin can make me treatments for this cohort. cultural competency and sensitivity are very sad,” she says. “I feel so alone at those “We put together a lot of learning and a cornerstone of care at Holy Name. “As times.”

Jump

Compassionate care of trauma survivors requires attention to sensory stimuli

hen you are a victim of trauma, any sensory-related stimuli — smell, touch, taste, sound — can spark re-traumatization. And for Holocaust victims, routine activities in a health care setting can set off flashbacks, irrational fears, sleep disturbances and more, according to “Helping Survivors of Trauma,” the person-centered trauma-informed care webinar for health care providers produced by Holy Name Medical Center in conjunction with The Blue Card. For example: Because Nazi doctors examined and then selected sick concentration camp inmates to be killed if they were unable to work, a Holocaust survivor might associate a routine checkup with serious illness and death. Filling out intake paperwork can cause extreme anxiety. Many Jewish children sent by their parents into hiding do not have a birth certificate. Others are unsure of their exact ages; in order to survive in concentration camps, they lied about how old they were to qualify as slave laborers rather than be murdered because they were too young to work. Being asked to undress and put on a hospital gown can be a reminder of concentration camp experiences. Survivors know that those who were selected to die were stripped of their clothing before

being forced into gas chambers; those who were selected to work were forced to wear prisoners’ uniforms. Health care providers in white coats who examine and treat patients without consent or adequate explanations can unleash memories of painful medical procedures that Holocaust captives experienced — the extraction of gold-filled teeth without anesthesia, injections of unknown substances, and horrific “twins” experiments. Loud noises from a dental drill, a dropped metal object or the banging of an MRI machine can cause extreme overreactions. Even receiving a hospital meal on a tray can bring memories of starvation.

Safety, courtesy, trust Now used to inform holistic care in many medical specialties, patient-centered trauma-informed care recognizes that mental health impacts physical health and vice versa. Practitioners of the approach promote the dignity of trauma victims by incorporating knowledge about the role of trauma in patients’ lives. The approach emphasizes: Safety. That includes providing well-lit spaces in health facilities, even in parking garages, and easy access to exam rooms and exits. Calm environments

promote feelings of well-being. Scheduling appointments for trauma victims on less busy days or times and moving patients to quieter areas can be beneficial. Trustworthiness. Make sure all communication — starting with receptionists on up through the physicians — is respectful and compassionate. All medical staff and support people should be trained in the principles of the approach and aware if a patient is a trauma survivor. Collaboration. Patients should have a role in planning and evaluating treatments and given choices if possible. Doctors and nurses should include not just family members but also patients — even those suffering from age-related dementia — in conversations. Engagement, not compliance, is the goal. Empowerment. Clinicians should ask the patient’s permission before beginning any exam or treatment, and always provide explanations before procedures. Sensitivity. Providers should be aware of cultural, gender and historical issues trauma victims may have. Questions about age, date of birth or family medical history can cause anxiety in Holocaust survivors separated from their families as very young children. — RENEE STOVSKY

December 1, 2021 CATHOLIC HEALTH WORLD

KEEPING UP

Cabezas

Kastner

Chu

Garrett-Ray

Dwaran

Anthoine

Aroh

Marotta

Waters

Gobler

PRESIDENTS AND CEOS CommonSpirit Health’s Dignity Health announced these changes in its greater Sacramento, California, market, effective Nov. 25: Edmundo Castañeda is departing as president and chief executive of Mercy General Hospital and Woodland Memorial Hospital to pursue a new opportunity in Houston. Dr. Brian Evans to president and chief executive of Mercy General Hospital in addition to his current role as president and chief executive of Mercy Hospital of Folsom. He will not continue as president and chief executive of Sierra Nevada Memorial Hospital. Dr. Gregory Eberhart to interim president and chief executive of Sierra Nevada Memorial Hospital. He is chief medical officer of Mercy San Juan Medical Center. Gena Bravo to interim president and chief executive of Woodland Memorial Hospital. She is chief operations officer and chief nurse executive. Dr. David Meiners to president of Mercy Hospital St. Louis. He replaces Steve Mackin, who is incoming president and chief executive of the hospital’s parent, the Mercy system. Meiners most recently was chief administrative officer for Mercy Clinic and surgery department chair in Mercy’s eastern Missouri region. Ed Smith will retire as president and chief executive of St. Anthony Regional

Hospital of Carroll, Iowa, in the summer. The St. Anthony board of directors is working to identify Smith’s successor. Organizations within Trinity Health have made these changes: Damien Cabezas to president at Mercy Care, a community health center in Atlanta. He was chief executive of Horizon Behavioral Health of Lynchburg, Virginia. He replaces Alan Bradford, who retired. Nancy Graebner-Sundling plans to retire in March as president of St. Joseph Mercy Chelsea of Michigan. A planning process is underway to name her successor. Steve Kastner plans to retire as president and chief executive of Trinity Health Senior Communities, effective June 30. The organization is undertaking a national search for Kastner’s successor. Thomas Leahy to interim president of Mercy College of Health Sciences of Des Moines, Iowa, following the departure of the previous president. Leahy is vice president of business and regulatory affairs.

ADMINISTRATIVE CHANGES Providence St. Joseph Health and organizations within that system have made these changes: Dr. Hoda Asmar to chief medical officer of Providence St. Joseph. Dr. Daniel Carey to chief medical officer of the Providence Physician Enterprise team, effective after Jan. 1, and Prasanna Mohanty to chief operating officer of that team, effective Dec. 6. Andy Chu to senior vice president of product and technology incubation at the Providence Digital Innovation Group. Providence Holy Family Hospital in Spokane, Washington, has made these changes: Susan Scott to chief operating officer and Adam Richards to chief nursing officer. Deborah Dage to chief financial officer of Saint Francis Health System of Tulsa, Oklahoma. Ascension has made these changes: Dr. Stacy Garrett-Ray to senior vice president and chief community impact officer; and Sally Hurt-Deitch to the newly

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created position of senior vice president of operations. Judith “Jodi” Naderhoff to chief financial officer of the Carmelite System at Germantown, New York, effective July 1. Covenant Health of Tewksbury, Massachusetts, and a facility within that system have made these changes: Vamsi Dwaran to system vice president of digital health for Covenant, and Debra Anthoine to executive director of philanthropy for the foundation of St. Mary’s Health System of Lewiston, Maine. Organizations within CommonSpirit Health have made these changes: Ron Yolo to chief nursing officer of CommonSpirit Health’s newly formed Southern California Division. Dianne Aroh to senior vice president and chief nursing officer for Virginia Mason Franciscan Health in Tacoma, Washington. Susan M. Marotta to general counsel of Calvary Hospital in Bronx, New York. Nikki Rivers to chief nursing officer of CHRISTUS Santa Rosa Hospital – New Braunfels in Texas. Keith Waters to chief financial officer — vice president of finance for St. Mary’s Healthcare of Amsterdam, New York. Breanna Bork to executive director of the PeaceHealth St. John Medical Center foundation. St. John is in Longview, Washington. Jane Gobler to director of the foundations of HSHS Sacred Heart Hospital in Eau Claire, Wisconsin, and of St. Joseph’s Hospital in Chippewa Falls, Wisconsin. Dr. Jeff Ciaramita to senior vice president and chief physician executive of Mercy Clinic, a medical group connected with Mercy health system of Chesterfield, Missouri.

ANNIVERSARY CHRISTUS Santa Rosa Hospital-Medical Center, San Antonio, 35 years.

GRANTS AND GIFTS The Mercy Medical Center Foundation of Cedar Rapids, Iowa, has received a commitment for a $1 million gift from John, Cindy and Bailey Bloomhall of Cedar Rapids and Naples, Florida, to support the Family Caregivers Center of Mercy. The donation will partially fund the salaries and benefits of two new staff positions at the center over the course of five years. The positions will support family caregivers who are aiding a loved one who is living with dementia or another chronic condition. Mercy Health, which is part of Bon Secours Mercy Health, has received an $18.8 million grant from the U.S. Department of Labor’s Office of Disability Employment Policy. Mercy will use the funding as a provider partner in the federal agency’s “Retaining Employment and Talent After Injury/Illness Network.” RETAIN providers are exploring return-to-work/stay-at-work strategies for workers who have nonoccupational illnesses or injuries. Mercy Health in Youngstown, Ohio, already had been taking part in an earlier phase of this pilot program through a partnership with the Ohio Department of Jobs and Family Services. The Children’s Hospital of San Antonio, part of CHRISTUS Health, has received a $5 million gift from philanthropist Harvey E. Najim, through the Najim Charitable Foundation. The gift will fund a pediatric surgical center at the facility. Najim founded Star Data Systems in 1980, renaming that organization Sirius Computer Solutions in 1991. He started the foundation with the proceeds of a 2006 deal with a private equity firm. The foundation aids children’s charitable organizations in the greater San Antonio area, including those focused on providing kids with food, shelter, clothing, medical treatment, and early childhood education.

CATHOLIC HEALTH WORLD December 1 2021

Pediatric COVID vaccine

despite its clear benefits. He notes that the speed at which scientists were able to develop the medications has been used as fodder for misinformation by some people instead of being embraced as a medical triumph. “I think we’re victims of our own success,” he says.

From page 1

adults, Basel is aware of three or four cases of severe allergic reaction. Those patients got a quick shot of epinephrine “and they’ve been just fine,” he says. Children are monitored for 15 minutes after each injection of the two-dose vaccines, just as teens and adults are, to check for an allergic response. The doses are given at least three weeks apart, for children and adults. The vaccine carries a slight risk of myocarditis or pericarditis, inflammation of the heart muscle or cardiac sac, in children age 12 and older and young adults, particularly males, according to the CDC. The risk of myocarditis and pericarditis is much lower in children age 5 -11, according to the CDC. A COVID infection also can trigger heart inflammation. Basel says there have been no documented cases of death from myocarditis associated with the vaccines and all cases have been resolved with treatment. The doctors say the overall benefits of vaccination for COVID far outweigh the risk of going unvaccinated, even for youngsters. Dr. Jerold Stirling is chair of the pediatrics department at Loyola UniStirling versity Medical Center in suburban Chicago. The academic medical center is affiliated with Trinity Health. Stirling points out that as of early November, more than 25% of all cases of the virus were in those 18 and younger and that unvaccinated children who got COVID had 10 times the hospitalization rate as those who had been immunized. “Our experience with COVID in children is the majoirity of time they do not experience as serious symptoms, but it is the eighth largest cause of death in children in the United States right now,” he notes. As of Nov. 17, the CDC reported that the deaths of 605 children involved COVID.

Anticipating skepticism Even with scientific evidence of their safety and efficacy and the endorsement of federal health agencies and medical groups, the doctors know the vaccines for young children will be met with skepticism by some parents. The physicians have prepped themselves and their clinician colleagues for those encounters in various ways, including by holding internal town halls for medical staff to get questions and concerns out in the open, sharing FAQ sheets and mailing and texting out synopses of studies.

Carrie Farr administers a COVID-19 vaccination to Eliana Genua at Mercy Hospital Springfield in Missouri in early November. The hospital made a video of Eliana and two other children getting their first doses and offering tips to other youngsters about the process. Eliana says: “If you’re calm, you won’t even feel it after.” The hospital shared the video on social media.

“I think pediatricians’ role is to educate and advocate for parents to do something for their kids to keep them safe and healthy,” Bolton says. “This is a vaccine that falls right in line with all the other vaccines that do that.”

Listen up Stirling suggests that doctors hear out vaccine doubters and address their specific concerns. “I think we really need to spend a lot of time talking to our patients’ parents, trying to understand their belief systems, where they got their information, and trying to address the information as best we can,” he says.

He recalls listening to the concerns of two “extremely dedicated” parents who he knew well and who were struggling over the decision of whether to vaccinate their three developmentally delayed children. He counseled them about how their own COVID risk went up if their children caught the virus. “I pointed out that if they got sick, there wouldn’t be anybody available to take care of their children as well as they are able to do that,” he says. “That really turned it around for them. They agreed to the vaccination after I put it that way.” Stirling says he is frustrated by how COVID vaccination has become politicized,

Sources: Dr. David Basel of Avera Health, Centers for Disease Control and Prevention and U.S. Food and Drug Administration

leisenhauer@chausa.org

Foundations of Catholic Health Care Leadership 2022

Facts about COVID-19 vaccines for age 5–11 The Pfizer vaccine, the only one approved for kids so far, is given in two shots at least three weeks apart. The pediatric dose is one-third of the adult dose. The formulation is the same as the adult version except for a different buffer, which allows for a longer shelf life. The vaccine was found in trials to be 90.7% effective in preventing COVID. The dosage in children was tested at 10 micrograms, 20 micrograms and 30 micrograms, which is the adult dosage. The tests showed the same antibody production at all dosages. The decision to go with the lowest dosage makes more of the vaccine available. The vials with children’s doses have orange tops; the vials for adult doses have purple tops. The vaccine can be safely administered to kids at the same time as other inoculations, such as for flu or tetanus.

Wide availability The doctors report that all of their systems have enough supply to meet demand and the shots are widely available in pharmacies, clinics and physicians’ offices. The systems will continue to do vaccine outreach to all eligible age groups in medically underserved communities. Loyola uses its pediatric mobile clinic for pop-up vaccination events in its service area. Franciscan Missionaries of Our Lady arranges vaccination events in partnership with the Baton Rouge mayor’s office and various nonprofit groups. It offers shots to students through school-based clinics. Basel says Avera will continue to collaborate with federally qualified health centers and county health departments to offer vaccine clinics across its footprint in the Upper Midwest. He doubts that the system will be able to do the same scale of outreach that it did when the first COVID vaccines became available. At that time, the system was just coming off a COVID surge and could shift staffers to focus on vaccination efforts, including phoning patients with chronic conditions and setting up vaccination appointments. With the pandemic dragging on and workers exhausted and new hires hard to find, he notes: “We’re just in a difficult spot with staffing right now.”

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