Catholic Health World - December 1, 2022

Well Being Trust turns inward 5

Brian Smith, mentor to many 7

With policymakers focused on mental health, care providers hope for real change

By LISA EISENHAUER

The federal government is allocat ing funding and drafting policy initiatives to address mental health and substance abuse at a rate that executives in the field within the Catholic health ministry extol as unprecedented, laudable and long overdue.

Even so, they are unsure if the cash infu sion and legislative action will end what they see as a crisis level of mental and behavioral health needs and they worry the current focus won’t last. They also say it’s unclear if health systems will be able to tap any of the expanded funding to sustain and grow their services.

Patty Morrow, operational vice presi dent for behavioral health at St. Louisbased Mercy, says the federal effort is direly needed to address gaps in access, especially for vulnerable and rural communities, and to improve the system of mental and

Continued on 4

By JULIE MINDA

Throughout the year, emergency room clinicians at St. Anthony Summit Hospital in the heart of a Colorado Rockies recre ation area stay busy tending to injuries of sportsmen and women whose adventures have turned into misadventures. Now that ski season is getting underway, the ER team is prepared for spikes in patients with traumatic head injuries and orthopedic injuries.

The hospital is in Summit County, where the highest peak tops 14,000 feet. It’s no surprise then that year-round, the hospital also cares for patients with altitude-related conditions, particularly high-altitude pul monary edema, the accumulation of excess

Continued on 8

School district gets a hand from SSM Health hospital to take on ‘period poverty’

By LISA EISENHAUER

Karen Green wasn’t familiar with the concept of “period poverty” before the issue came up at a community event along with the idea for SSM Health St. Anthony Hospital — Midwest in Midwest City, Okla homa, to fund dispensers to give away men strual hygiene supplies in the local public schools.

Once she learned about period pov erty — the condition of being disadvan taged due to menstruation — and the fact that even students in the blue-collar MidDel School District where the hospital is seated were affected, she was onboard with the suggestion that the hospital provide

Mercy in Baltimore pioneers alternate light sources as forensic tools

By LISA EISENHAUER

When the Sisters of Mercy equipped the forensic nursing team at the congregationsponsored Mercy Medical Center in Balti more with a top-of-the-line alternate light source unit about 18 years ago, Debra Hol brook says it put her and the hospital on track to become pioneers in the use of the technology.

Holbrook, the hospital’s director of forensic nursing, says the forensic nursing team, which was founded in 1994, was one of the first of its kind in the nation. When the team — officially the Forensic Nurse Exam

iners Program — began experimenting with the alternate light unit as they examined victims of violence, they found it could be used to detect injuries hidden by skin color and those that left no marks on the surface of the skin.

Holbrook credits that discovery with advancing the work not only of Mercy Med ical Center’s team, but of forensic nurses everywhere. “This is what changed history in medicine across the world, because I published the very first research ever link ing use of alternate light on victims of stran gulation to (the ability to see) latent wounds

Charlee Barks poses for a selfie in front of a dispenser of free period products just after it was installed at her school. Charlee is the daughter of Lindse Barks, whose request for funding from SSM Health St. Anthony Hospital — Midwest led to the dispensers being installed in grade and high schools in and near Midwest City, Oklahoma.

Debra Holbrook, left, director of forensic nursing at Mercy Medical Center in Baltimore, demon strates the use of an alternate light source device on forensic nurse Allyson Boss. The device emits light in wavelengths that can make wounds below the surface of the skin visible.

This training for a helicopter rescue was part of the programming at a recent search and rescue confer ence sponsored by Centura Flight For Life Colorado and the Colorado Search and Rescue Association.

Alternate light sources

From page 1

under the skin,” she explains.

The study she co-authored with Dr. M. Christine Jackson, medical director of the Forensic Nurse Examiners Program, was published in 2013 in the Journal of Foren sic Nursing. It found that of a group of 172 patients of various races who reported being strangled, 93% had no visible evi dence of external inju ries. However, through use of alternate light, injuries beneath the skin were found in 98% of the patients.

Holbrook went on to co-author two more stud ies that have added to a growing body of research that supports the effectiveness of alternate light source tech nology in documenting violent injuries. She travels the country to educate attorneys, police, judges, clinicians and others on the technology.

She is president-elect of the executive board of the Academy of Forensic Nursing. She has been named a fellow by the Ameri can Academy of Nursing, a recognition of her status as a leader in advancing the profession.

Calibrating the tool

Mercy Medical Center continues to take a lead role in research on alternate light source technology. The hospital is collabo rating with George Mason University on a rigorous controlled study of the reliability and effectiveness of the technology in iden tifying bruising and damage not readily visible. “It’s a National Institute of Justicefunded study that will standardize what we’re doing here at Mercy across the entire United States,” Holbrook explains.

In the controlled study, she says injuries like those documented by her team with alternate light sources are being recreated and examined by researchers to make sure the findings match. The full study will prob ably take another 18 months to complete, but Holbrook says one part that is finished confirmed findings from the strangulation study she co-authored in 2013.

Mercy Medical Center is the designated treatment center for sexual assault and interpersonal violence victims in Balti more. Its team of about 30 forensic nurses work with criminal justice and other agen cies across the city that assist victims of vio lence. Team members are available 24/7 to examine patients at Mercy Medical Center and other area hospitals and document injuries from assaults, neglect and other maltreatment.

Holbrook says that in addition to con ducting evidence-gathering examinations of assault victims at Baltimore-area hos pitals, team members are dispatched on

similar missions to prisons, nursing homes and military bases, including the U.S. Naval Academy in Annapolis, Maryland.

The forensic nursing team has two large alternate light source units that have a wide range of wavelength settings as well as several small, less expensive units that resemble flashlights and have a more lim ited wavelength range. All of the units are portable.

Alternate light source units use lamps that emit visible as well as ultraviolet and infrared color bands, which can’t be seen by the naked eye. Those color bands, or wave lengths, enhance the visualization of evi dence through fluorescence, which glows; absorption, which darkens; or oblique light ing, which reveals small particles or impres sions. Examiners wear goggles, which work as a filter and reveal what had been hidden from view. They document all wounds for potential use as evidence.

Holbrook says the use of alternate light source gives the nurses “another tool in our tool belt, not only for forensic adjudica tion in a court system, but to provide a lot of information to our medical care providers for their decision-making.”

Growing acceptance

When the forensic nursing team first started using alternate light to examine victims of violence and document injuries, Holbrook says the evidence they found faced skepticism from judges and attorneys. “A lot of people challenged us,” she says.

Holbrook and her team took it upon themselves to teach people working in the courts, in law enforcement and in the health care sector about the technology. They explained that alternate light source units are like glasses, X-rays or other tools that provide a new way to see things not vis ible under normal white light.

“Now it’s a staple in forensic medical assessment in Baltimore city and we’ve been able to share this across the world. We’re very proud of this coming from Mercy Medical Center,” Holbrook says.

While alternate light had forensic appli cations to gather evidence such as bodily fluids on clothing before Mercy Medical Center’s nursing team started using it, Hol brook says it was her team that found and documented its effectiveness in finding injuries hidden beneath the skin.

This type of unseen injury was known to be the norm in strangulation cases when the weapon is the hands, Holbrook says, because choking involves one broad sur face, the hands, applying force on another broad surface, the neck. The force of the pressure is so dispersed that the injuries are below the skin, or dermal, level. Those inju ries are visible, however, when the patients are examined with alternate light. Holbrook says exactly which wavelength will expose the damage depends on the depth of the injury, skin pigmentation and length of time since the assault.

A study published in 2008 in The Jour nal of Emergency Medicine showed the risk of homicide increases by 750% for women who are victims of domestic abuse who have been strangled compared to victims who have never been strangled.

Seeking justice

Many patients are referred to the foren sic nursing team to help gather evidence of injuries from violent assaults. Holbrook says that the evidence is used in various ways. Some victims pursue an order of pro tection, some seek criminal prosecution, and some use it to bolster assault com plaints in nonjudicial settings, such as at a college.

Sometimes, Holbrook says, her nurses document injuries to domestic abuse vic tims multiple times before those victims take the forensic findings to the police or before they accept help to change their situ ation. A victim's reluctance to act is often

due to fear of their assailant.

“Justice isn’t always in court. What’s justice to me might not be justice to my patient,” Holbrook says. “So, after we col lect our evidence and we do the medical care and treatment of that patient, it’s up to patients what they want done with this evidence.”

With more research and education efforts supporting alternate light technol ogy as a means to detect hidden injuries, Holbrook says it has gained wide accep tance. As an expert on the technology, she testifies on its reliability and efficacy.

“When I go to court and I sit on the stand and I’m asked, ‘Are your peers using this instrumentation?’ or ‘Is this respected tech nology within the industry in which you work?’ I’m able to say now, ‘Absolutely, yes.’ And I’m able to name cities that are using this across the United States and across the world,” she says.

leisenhauer@chausa.org

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Catholic Health World (ISSN 8756-4068) is published semimonthly, except monthly in January, April, July and October and copyrighted © by the Catholic Health Association of the United States. POSTMASTER: Address all subscription orders, inquiries, address changes, etc., to CHA Service Center, 4455 Woodson Road, St. Louis, MO 63134-3797; phone: 800-230-7823; email: servicecenter@ chausa.org. Periodicals postage rate is paid at St. Louis and additional mailing offices. Annual subscription rates: CHA members free, others $29 and foreign $29.

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© Catholic Health Association of the United States, Dec. 1, 2022

seven saints who represent the core commitments of CHA’s Shared Statement of Identity. Featuring original artwork

A series of huddle cards depicting the lives of

from Lydia Wood, a St. Louis-based artist.

Holbrook

Alternate light source technology can enhance the appearance of patterned wounds, like those pictured here from a belt. Alternate light devices can make the wounds visible even weeks after they were inflicted and are no longer able to be seen by the naked eye.

TRYATHLON

Seventeen children with physical challenges got a chance to experience the thrill of competition at the Meet Me at the Finish Line!

Youth Adaptive Try-athlon sponsored by HSHS St. Anthony’s Memorial Hospital in Effingham, Illinois. Athletes and their adult buddies splashed, pedaled and stepped through the race as a team.

The hospital’s physical rehabilitation and wellness team coordinated the event, held in late September at The Richard E. Workman Sports & Wellness Complex in Effingham. Many of the volunteers who supported the athletes were from HSHS St. Anthony’s.

Clockwise from top right: Megan Weichman, HSHS St. Anthony’s physical therapist, left, athlete Dalton Hildebrand, and Rose Borries, HSHS St. Anthony’s occupational therapist, are all smiles after Dalton got a medal, as all the athletes did. Scott Bales, left, and Tony Feeler, volunteers from the nonprofit AMBUCS, help athlete Olivia Clayton get ready for her ride on an adaptive bicycle.

With Dalton’s mom, Kristy Hildebrand, right, recording, Weichman and Borries accompany the youngster on the running leg of the event.

Jon Lankow, left, HSHS St. Anthony’s physical therapy assistant, volunteer Braden Magelitz, and Erica Magelitz, HSHS St. Anthony’s physical therapist, encourage Steven Cook on his swim. Jennifer Wagner, HSHS St. Anthony’s clinical educator, pushes athlete Adelaide Hastings, as Borries cheers them on.

Trinity Health expands reach in Iowa and Michigan markets

Trinity Health has acquired Com monSpirit Health’s share of MercyOne to become sole owner of the regional system. A subsidiary, Trinity Health Michigan, has added its ninth hospital system.

MercyOne was founded in 1998 through a collaboration between Catholic Health Initiatives, now CommonSpirit Health, and Trinity Health.

CommonSpirit Health’s exit from MercyOne brings the 18 hospitals plus the clinic, hospice, home care and infu sion locations of MercyOne exclusively under the Trinity Health umbrella, with MercyOne retaining its name and its Catho lic identity.

The regional system is based in Des Moines, Iowa. It has facilities across Iowa and in Nebraska.

Trinity Health is based in Livonia, Michi gan, and provides care in 26 states. It has 123,000 employees, including nearly 27,000 physicians and clinicians.

“With MercyOne now fully part of Trin ity Health, we are a stronger and more uni fied system that will strengthen MercyOne’s

ability to serve our patients, colleagues, and communities,” Mike Slubowski, president and chief executive of Trinity Health, said in a press release announcing the completion of the purchase.

Bob Ritz, president and chief executive of MercyOne, said in the release: “We are grateful to CommonSpirit for their support in the transition and for more than 25 years of successful partnership in Iowa. We look forward to further strengthening the mis sion of MercyOne.”

MercyOne, Genesis strategize

In a separate announcement, MercyOne and Genesis Health System said they have signed a letter of intent to develop a stra tegic partnership. MercyOne and Genesis Health said in a joint press release that due diligence related to the proposed partner ship will be conducted over the next several months. The release did not include any details about what the partnership might include.

Doug Cropper, president and chief exec utive of Genesis Health System, said in the

release that the system’s leaders wanted a partner “willing to make significant invest ments in Genesis that will enhance our abil ity to grow, thrive and deliver more seam less integrated care in our region.”

Genesis Health System is based in Dav enport, Iowa. It has about 5,000 employees and serves a 17-county region of Eastern Iowa and Western Illinois. The system oper ates five hospitals and manages a sixth.

Trinity Health Michigan expands

Meanwhile, Trinity Health Michigan acquired its ninth hospital system Oct. 1. North Ottawa Community Health System, which has been operating in Grand Haven, Michigan, since 1919, now is called Trinity Health Grand Haven.

The acquired system includes an 81-bed community hospital and an 84-bed skilled nursing and rehabilitative facility as well as outpatient and urgent care facilities.

Trinity Health Michigan and the Grand Haven system have been in a strategic alli ance since 2016. In March, the two systems announced their intent to merge and in

July the North Ottawa Community Hospi tal Authority unanimously approved the proposal.

According to a release, Trinity Health Grand Haven’s services continued with out interruption, and its 650 employees and providers remain on staff. Many of the Grand Haven system’s physicians and advanced practice clinicians joined Trinity Health Physician Partners in 2018.

Trinity Health Grand Haven continues to have a local governing board and its local leadership remains in place, including its president and chief executive, Shelleye Yaklin.

The system was secular. It now is Catho lic, adhering to the Ethical and Religious Directives for Catholic Health Care Services It remains a nonprofit.

In a release, leaders of Trinity Health Michigan and Trinity Health Grand Haven said there already had been care access improvements under the two systems’ alli ance, and now that they are merged there is more opportunity for enhancements and growth.

Mental health

From page 1

behavioral health care delivery.

She adds that to ensure the increased funding and revised policies address the crisis will require a “wellcoordinated strategic plan” that puts the resources behind proven approaches to meeting needs within communities. “It’s not just the dollars, but the planning around the dollars and the spend that I think is a really critical issue,” Morrow says.

Big money, tragic trends

The stream of federal funds pouring into mental and substance abuse pro grams includes $3 billion in block grants to states as part of the American Rescue Plan Act approved in 2021. The Bipartisan Safer Communities Act passed in June added $100 million for states to cover mental health emergency preparedness, crisis response, and services around the 988 Suicide & Crisis Lifeline, which went national in July.

The financial boost comes at a time when studies show many Americans’ men tal health is fragile and the scourge of sub stance misuse and addiction is worsening. The National Alliance on Mental Illness says 21% of U.S. adults, or 52.9 million peo ple, experienced mental illness in 2020 and 6.7%, or 17 million, had a co-occurring sub stance use disorder and mental illness. The Centers for Disease Control and Prevention says opioid overdose deaths hit a record of 80,816 in 2021, up 15% from the year before.

Last year, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Chil dren’s Hospital Association jointly issued a “Declaration of a National Emergency in Child and Adolescent Mental Health.” It cited “soaring rates of mental health chal lenges among children, adolescents, and their families over the course of the COVID19 pandemic.”

In October, the groups behind that dec laration along with CHA and 130 other orga nizations sent a letter to President Joe Biden urging him to issue a national emergency declaration. The letter said such a declara tion would “galvanize existing critical fund ing streams and support to help ensure that all children and adolescents can access the full continuum of mental and behavioral health care.”

Heightened needs

Thomas Otten, assistant vice presi dent of behavioral health at Avera Health, says stressors and dis ruptions related to the pandemic — such as grief, isolation, school closures and socioeconomic chal lenges — have led to a spike in the number of people with depression, anxiety and other mental and behavioral health challenges. He credits that increase for policymakers’ recognition of the impact of untreated mental illness on individuals and

communities.

“I would say it’s perhaps a silver lining of COVID that there’s been a lot more atten tion focused on mental health and the wellbeing of people,” Otten says. Historically, he says, mental health has been viewed by policymakers as “something different than medical care,” a view he hopes is changing.

Otten adds that Sioux Falls, South Dakota-based Avera has responded to an increased demand for mental and behav ioral health care in several ways. One has been to become a partner in and operator of The Link, a “community triage center” that opened in Sioux Falls in June 2021. The center is open to anyone regardless of abil ity to pay. It provides withdrawal manage ment for substance abusers, observation for people who are intoxicated, and crisis stabi lization for those with acute mental illness who don’t need hospitalization. It is open around the clock.

The Link’s annual operations budget of about $2 million is funded by Avera and three partners — the city, the county and another health care system.

Otten says he’s unsure if the partnership will be able to tap any of the newer federal allocations to fund The Link, even though such funding could help ensure the longterm sustainability of a program that is meeting a critical need and diverting many patients away from more costly emergency room care.

State discretion

The federal government appears to be giving states wide latitude in the use of the block grants for mental health and sub stance abuse programs. Morrow says states could use that discretion to direct the fund ing only to state-run programs and facilities and community-based programs, such as alcohol and drug treatment centers.

Those programs are vital, Morrow says, but so are the services that Mercy provides, such as inpatient and virtual behavioral health care, that don’t typically get state grants. “We will not necessarily be the recipients of this funding even though we have a significant mission-driven focus on serving people with mental health needs,” she notes.

Policy changes around mental health services have proven beneficial to Mercy and other health systems in recent years. Dr. Kyle John, Mercy’s clinical vice president of behavioral health, cites, by way of example, some of the temporary federal rules put in place because of the pandemic. One of those revisions has allowed men tal health care providers to expand virtual access to all Medicaid and Medicare recipients. Most private insurers have followed suit.

The rule change is set to end when the public health emergency declaration around the COVID pandemic does. Keep ing that revision and other pandemicrelated policies in place could go a long way toward making mental health services financially viable, John says.

Support

for integrated care Mercy also is advocating for states to

revise their Medicaid codes to cover the provision of mental health services in pri mary care settings. This is a model of care sanctioned by the Centers for Medicare and Medicaid Services, and most behav ioral health care is delivered in primary care settings, John says. Even so, he points out, fewer than half of states have revised their Medicaid billing codes to support this approach. Three states in Mercy’s four-state footprint — Missouri, Arkansas and Okla homa — are among those that have not.

Dr. Arpan Waghray, chief executive of Well Being Trust, says he would like to see some of the new federal funding allocated to support the kind of integration of mental health care into primary care settings that many health providers have been imple menting in recent years.

Well Being Trust is a foundation that was created with an endowment from Providence St. Joseph Health. It is focused on advancing mental, social and spiritual health. Providence is among the systems that have moved toward mental health and medical care integration, including screen ing patients in primary care clinics for signs of depression, anxiety and drug abuse and offering treatment.

Waghray says the lion’s share of behav ioral health resources are concentrated in specialty mental health services yet only about one-third of patients with mental health concerns receive care in that set ting. The vast majority of those with men tal illness, he says, get treatment in family, pediatric, maternity and other primary care clinics.

Counting on partnerships

Michelle Schafer, SSM Health regional vice president of behavioral medicine, says SSM Health has many partnerships with community organizations to address men tal illness and the social determinants that affect patients’ health. One such partner program is Places for People, a nonprofit in St. Louis that helps people with mental illness and people in recovery from substance use disorders develop skills to manage their conditions and lead meaningful lives.

Even if most of the direct federal fund ing bypasses SSM Health, she says it is likely to boost some of the system’s partners and help sustain their joint efforts with SSM Health.

SSM Health Behavioral Health Urgent Care, which the system opened in August 2020 on the campus of SSM Health DePaul Hospital — St. Louis, works with several community mental health agencies. These community-level providers promote cli ents’ use of the urgent care facility for epi sodic treatment, and they take referrals for follow-up care from the urgent care clinic.

Schafer says that if some of the increased federal funding flows to community-based programs for patients with mental illness, the investment will address patients’ needs upstream before their issues reach a crisis point and acute stabilizing care is more dif ficult and more costly to provide.

Schafer is co-chair of a statewide collab orative in Missouri that includes members

Comprehensive mental health package moves toward approval in Congress

Clay O’Dell, who tracks initiatives around mental health care as part of his work as director of advocacy for CHA, says a comprehensive package of mental health care legislation is being drafted by the Senate finance committee. The package will address a range of issues includ ing workforce, tele health and insurance coverage, but is unlikely to make it to the finish line in the current Congress. Nevertheless, O’Dell says the prospect for its passage is good.

“The long and short of it is, every body thinks, and I agree, that this work is going to continue into the next Con gress,” he says. “The good news is that all of the work that’s been done so far by the committee has been bipartisan.”

Several of the legislative propos als that the committee’s five working groups have released align with what CHA and its members have been seek ing, O’Dell says. Those requests are out lined in a policy brief created by CHA and posted on its website, chausa.org.

Among the working groups’ propos als are:

Removing the requirement for Medicare patients to receive an in-person visit with a provider prior to receiving mental health services through telehealth. The requirement has not been in force during the COVID19 public health emergency.

Allowing Medicare beneficiaries who seek treatment for mental health disorders to receive their care through audio-only services.

Providing incentives to states to use their Children’s Health Insurance Program to address behavioral health needs in schools, including through telehealth.

Allowing providers to receive Medicaid reimbursement for behavioral and physical health services delivered on the same day.

Issuing Medicaid guidance to states to clarify allowable payments, identify strategies to reduce adminis trative burdens, and improve access to mental health and substance use disorder services to children and young adults, including strategies to deliver services in home or community-based settings.

— LISA EISENHAUER

of the state legislature. The collaborative is taking a coordinated approach to deciding how best to meet the demand for behav ioral health services. She says the work includes evaluating funding, legislative initiatives, Medicaid’s structure and other factors with the goal of creating a coherent system of care that is effective and that pro vides access to anyone in need of mental or behavioral health care.

Schafer thinks unified efforts like this one along with the heightened federal focus and increased funding could bring needed change to how, where and at what point in a patient’s illness mental health care is delivered.

“We have a real window of opportu nity for the first time in my career, and I’ve been doing this a long time. I’ve been in this world for 30 years,” she says. “I don’t want us to lose traction. I don’t want our legisla tors to lose interest or to move on to a differ ent thing.”

leisenhauer@chausa.org

This room at The Link in Sioux Falls, South Dakota, is for people who are sobering up from alcohol and other intoxicants under the observation of staff. The Link is a center where people experiencing a nonviolent behavioral health crisis or needing care for substance abuse disorders can access immediate treatment and get referrals to follow-up services. It opened in June 2021 and is operated and partially funded by Avera Health.

Morrow Otten

John

Schafer

O'Dell

Providence shifts Well Being Trust’s focus inward

By LISA EISENHAUER

Dr. Arpan Waghray is leading a “strate gic pivot” of the focus of Well Being Trust to address more meaningfully the needs of the communities within the seven states where Providence St. Joseph Health has hospitals and clinics.

“Where our ministries are is where we felt our strongest obliga tion to make sure that, when people are trusting us with their care, we’re always showing up for them,” he says. “That required focus on our side. We could not be as effective overall if we tried to do too many things in too many places.”

Waghray, a geriatric psychiatrist, became chief executive of Well Being Trust in August. The trust is a foundation created with a $100 million endowment just after Providence St. Joseph was formed in 2016 by the merger of Providence Health & Ser vices and St. Joseph Health. The nonprofit’s mission is to advance mental, social and spiritual health.

Waghray says Providence made the deci sion to turn the focus of the foundation’s work from externally facing to inwardly fac ing as the harsh toll of the COVID-19 pan demic on the system’s workforce and com munities became clearer.

Providence communities, like most other parts of the country, had been underresourced in terms of well-being, men tal health and substance abuse care even

before the pandemic and the crisis exac erbated that situation, Waghray says. “It became harder and harder to live up to our promise to everyone we serve, which is, ‘I will know you, I will care for you and I will ease your way,’” he says.

The Well Being Trust will work to bolster and refine the system’s resources and programs, he adds, with a goal of providing appropriate treatment for all Providence staff, which numbers 120,000, as well as the 5 million people who live in the health system’s communities in Alaska, Washington, California, Oregon, Texas, Montana and New Mexico.

Waghray had been chief medical offi cer of Well Being Trust since its inception in 2017 as well as chief medical officer for behavioral health across Providence. Though he is officially losing both those titles, he says the work he did in his lead role

in behavioral health is being integrated into his new position at the foundation.

“This is the one mental health arm for Providence that will drive this change across all our communities, while simul taneously maintaining national partner ships,” he says.

Waghray says the foundation will be applying an equity lens to all of its efforts to ensure that they are addressing specific needs of vulnerable populations within Providence’s communities. “If there is any one who is impacted disproportionately by mental health issues or there are disparities in the way they receive care, then that goes against who we are as a healing ministry, and that becomes a part of our work,” he says.

The inward shift of Well Being Trust’s focus and resources won’t bring a halt to the foundation’s collaborations outside of the ministry to develop best practices, Waghray says. One example is a project to address suicide risk within the health care work force that the Well Being Trust, the Ameri can Hospital Association and other health systems are partnering on.

Waghray says the foundation is closely monitoring the impact of its programs and treatment with metrics such as case numbers of mental illnesses, suicides and overdoses in the communities where it has facilities. “Hopefully, we will share what we’re doing with others so that we all learn together and advance the field,” he says. leisenhauer@chausa.org

Waghray

“Where our ministries are is where we felt our strongest obligation to make sure that, when people are trusting us with their care, we’re always showing up for them.”

— Dr. Arpan Waghray

Period poverty

From page 1

assistance. So were her colleagues at SSM Health St. Anthony Hospital — Midwest who approved a grant of almost $38,000.

“Why wouldn’t we make it better for students?” says Green, who is regional director of mission inte gration at SSM Health St. Anthony, a network of hos pitals and clinics in and around Oklahoma City that is part of St. Louis-based SSM Health.

The hospital’s gift covered the cost of 207 dispensers of period products that were installed in girls’ bathrooms this fall. The district, with about 11,000 students, takes in a suburban region just east of Oklahoma City that includes Tinker Air Force Base. In 2018-2019, the poverty rate in the district was 15.3%, according to a state report. The U.S. Census Bureau puts the national pov erty rate at 11.6%.

Green says: “The founding sisters of SSM Health St. Anthony were dedicated to serv ing Oklahoma’s vulnerable and address ing the inequities of their time, just as we believe Mid-Del Schools is doing through this program today.”

Hidden need

The grant from SSM Health St. Anthony Hospital — Midwest came at the request of Lindse Barks, director of the Mid west City-Del City Public Schools Foundation. The nonprofit raises private supportive funding for the district.

Barks says she, too, was unfamiliar with period poverty until two years ago, when she was at an event where two teachers accepted a donation to purchase men strual hygiene products. The products were for baskets the teachers were keeping stocked in a couple of Del City High School bathrooms.

“As soon as I heard that, I knew immedi ately that this was something that the foun dation can jump in on and we can help,” Barks says.

Barks arranged a fundraising brunch that brought in $2,000 and a large haul of boxes of tampons and menstrual pads, which she donated to the district’s six sec ondary schools. Perhaps more importantly, the event drew the attention of District Superintendent of Schools Rick Cobb.

Cobb met with Barks to talk about the equity issues inherent in period poverty, such as that studies have shown that girls who are menstruating sometimes stay home from school because they can’t afford period products. (See sidebar.)

The superintendent pledged that, if the foundation raised the money to buy the dispensers, the district would cover the cost

When professor found no research on period poverty in U.S., she did her own

Anne Sebert Kuhlmann was helping to evaluate the impact that providing period products to students in Northern Ethiopia had on their school attendance when she and a research assistant decided to search for similar stud ies across the globe. The resulting systemic review, published in 2017, found no studies had been done in the United States or other highincome nations.

“There was no data about whether this was an issue or not,” Sebert Kuhlmann says of that search across academic publications. “It sort of planted a seed for us, thinking about, well, wouldn’t this probably be an issue for those here who are struggling to get by?”

Sebert Kuhlmann is associate professor and interim department chair of behav ioral science and health education at Saint Louis University’s College for Public Health and Social Justice. The finding about the lack of research into period poverty in the United States prompted her to set up her own study with funding from the St. Louis-based Incarnate Word Foundation, a charity affiliated with the Sisters of Charity of the Incarnate Word.

of keeping them stocked. Barks remem bers calculating, based on what the brunch brought in, that it would take as long as 10 years for the foundation to get the dispens ers into girls’ bathrooms in all of the dis trict’s elementary, middle and high schools.

With SSM Health St. Anthony Hospital — Midwest’s funding, Barks cut the time line down to a few months. In September, the Mid-Del School District became the first in the state to install free period prod uct dispensers. The products also are avail able in counseling offices at the schools. Previously, the schools did not have any period product dispensers.

The foundation chose to buy the dis pensers from Aunt Flow, a company that makes period products and dispensers, but only dispensers that give the products away free. Aunt Flow donates one product for every 10 sold to organizations that supply period products to women in need.

Addressing the stigma

Jennifer Gaines is program director of the Alliance for Period Supplies. Gaines says the nonprofit works to meet a significant need for period products across the nation. Founded in 2018 as an off shoot of the National Diaper Bank Network, the alliance supports 130 independent organizations that give away the products.

Gaines says that while organized efforts

SALES TAX TREATMENT OF PERIOD SUPPLIES BY STATE

The study focused on 184 low-income women in St. Louis who got services from any of 10 nonprofit organizations.

It found that almost two-thirds of them were unable to afford needed period products in the previous year and that one-fifth of them experienced this monthly. It concluded that menstrual hygiene supplies are a basic necessity that many low-income people lack.

“We published those results in January of 2019, and that was really the first data from the U.S. showing that this was an issue,” Sebert Kuhlmann says.

She since has collaborated on two pub lished studies on period poverty among female high school students in Saint Louis Public Schools and in a nearby district, both of which have a high rate of poverty. Some of her findings compared to what was seen in developing countries, such as the percentage who reported having trou ble affording period products and missing school because of their periods. Many of the students also said they would like more information and education regarding managing periods and personal hygiene.

While Sebert Kuhlmann is hopeful that

her research will lead to assistance for people who can’t afford period products, she says the studies also pointed to other needs related to menstruation that espe cially impacted those with little means. Many of those she studied, for example, said challenges such as managing cramps or accessing clean restrooms to practice good hygiene affected their lives.

In the few years since Sebert Kuhlmann began her research into period poverty in the U.S., she says much attention has been focused on the subject. Many organiza tions have begun to provide free products to those in need. Lawmakers have picked up on the issue, with some states and cities passing laws to make the purchase of period products tax free and to require that public places such as schools provide free menstrual products.

Sebert Kuhlmann often gets interview requests about her research, many of them from high school journalists.

She is hopeful now that a once-ignored topic is getting due consideration. “I think it’s actually been amazing to watch and to be a part of how much the discourse has changed in just a few years,” she says.

— LISA EISENHAUER

to alleviate period poverty are relatively new, the problem isn’t. “It’s always been this silent crisis because of simply the stigma of talking about periods and the stigma of not having enough money and living in pov erty and not being able to access the basic necessities that you need,” she says.

The Alliance for Period Supplies cites a 2021 study by period product maker Kotex that found two in five people who menstru ate have struggled to buy period supplies. (One of Kotex’s product lines, U by Kotex, is a founding sponsor of the alliance.) The study found that the rate is even higher for those who are Black or Hispanic.

The alliance gives organizations within its network technical support, such as advice on how to secure warehouse space and set up boards of directors, and devel opment grants for building websites, hiring staff and more.

The alliance also advocates for policies to address period poverty. Among the legis lation it encourages is removal of sales taxes on period products, requiring public places such as libraries and courthouses to supply the products at no cost, and mandating ageappropriate menstrual health education in schools. It also urges government funding to cover the cost of period products for lowincome people. The products are not cov ered by programs such as the federal Sup plemental Nutrition Assistance Program.

Gaines say she knows the needle is mov ing on awareness of period poverty based on the growing number of inquiries that the alliance gets from people who want to help with or to start product giveaway programs and because of the uptick in the passage of related laws. The alliance keeps track of those measures, such as the ending of the so-called “tampon taxes” in Virginia this summer. Only 22 states continue to have sales taxes on menstrual hygiene products, the alliance says.

When it comes to period poverty and menstrual equity, Gaines says, “I think in general we’ve just been seeing the envi ronment becoming a little more friendly to

bringing up the topics.”

Breaking barriers

At least one other Catholic health care system has launched a recent effort around period poverty. Mercy Health — Lourdes Hospital in Paducah, Kentucky, in August started a program to provide free feminine hygiene products. The products are avail able in “period starter kits” that the hospital is supplying to Mercy Health OB-GYN and pediatrics practices as well as to local public schools.

A grant from Mercy Health Founda tion — Lourdes funded 1,000 of the kits, which contain about three months’ worth of period supplies. The grant also covered books on women’s health that are available to students, teachers and coaches. Mercy Health — Paducah is part of Bon Secours Mercy Health.

In a news release about the program, Meghan Lee, Mercy Health — Paducah OB-GYN nurse practitioner, says: “Our aim is to promote broader self-esteem and selfconfidence as our young women transition into adolescence and also ensure that girls don’t miss school due to a lack of feminine hygiene products.”

Barks says she saw genuine excitement among teachers, administrators and stu dents at the pep rally-like event the Mid-Del School District hosted to announce that the period product dispensers were being installed. She also saw the delight in her own eighth-grade daughter, who sent Barks several selfies in front of a dispenser at her school.

Since the dispensers went in, Barks has gotten queries from representatives from other districts in the state including the two largest — Oklahoma City and Tulsa — about how Mid-Del School District succeeded.

She is tickled about the impact the proj ect she helped spearhead appears to be having. “We’re creating equity for our stu dents,” Barks says. “We’re breaking down walls and breaking down boundaries and that for me is a big thing.”

Green

Barks

Sebert Kuhlmann

Bags with period products await distribution at Mercy Health — Lourdes Hospital in Paducah, Kentucky.

Gaines

Brian Smith advanced the ministry’s Catholic identity through mission leadership at CHA

Brian Smith, 64, CHA’s vice president of sponsorship and mission services, died unexpectedly on Tuesday, Nov. 8, having fallen while on an afternoon walk near his apartment in suburban St. Louis. He was an influential thought leader in the Catholic health min istry and particularly dedicated to recruiting and mentoring the next generation of mission leaders for Catholic health care providers in the United States.

Smith joined CHA in 2012 as senior director of mission integration and lead ership development. In 2019 he was pro moted to head the association’s mission services department, which focuses on mission integration, leadership formation, theology and ethics, ministry formation and sponsorship.

His work over the years enhanced the quality of CHA programming for mission leaders, ministry executives and physi cian leaders. Among his contributions, he led the development of the CHA Ministry Identity Assessment, which sets out an elu cidating process and objective criteria that Catholic hospitals and facilities can employ to evaluate their effectiveness as ministries of the church and their organization’s fealty

to mission and faith. He also energized and advanced efforts in the ministry to pri oritize succession planning for key roles in mission, ethics and pastoral care.

He was a faculty member of the CHA Ecclesiology and Spiritual Renewal Program for Health Care Leaders, CHA’s spiritual formation retreat and immersive experience in Rome and the Vatican. The cur riculum deepens the knowledge of Catholic tradition and faith values among participating health care executive leaders, sponsors and board members.

Smith also helped shape programming that brought together chief executives, sponsors and senior mission leaders of the nation’s largest Catholic health systems for in-depth conversations about Catholic identity and institutional integrity at a time of rapid change and corresponding chal lenge in health care.

Before the pandemic, when physician burnout had become a significant concern in health care, Smith helped focus attention on the benefits of formation programming for physicians to increase their resilience and job satisfaction.

Recognizing the added emotional and spiritual burden the pandemic put on all

caregivers, Smith addressed the impor tance of refreshing body and spirit in an article titled “Mission — Back to the Basics.” It was published in the Spring 2022 edition of CHA’s journal, Health Progress. He urged leaders within the Catholic health ministry to remember they are part of a “ministry of love” with a sacred tradition of caring for the broken and frail that extends to their colleagues.

“We live as a community, caring for the members of our organizations so they know they are not alone and in turn, they can minister in the name of the commu nity,” he wrote. “And then, when the worst has passed and we can catch our breath, we make time for renewal and refreshment for ourselves and for our teams.”

Prior to joining CHA, Smith held posi tions in the Catholic health and social ser vice ministry related to theology, pastoral care, mental health and political advocacy. He was a vice president of mission integra tion at CHRISTUS Spohn Health System in Corpus Christi, Texas, and a vice president of system mission at Mount Carmel-St. Ann’s Hospital in Westerville, Ohio. He worked for 15 years in parish ministry and service at the Department of Special Educa tion of the Archdiocese of St. Louis.

Sr. Mary Haddad, RSM, CHA president and chief executive officer, said Smith was “a man of deep faith, caring spirit and had a loving heart for those in need. His commit ment to Catholic health care will continue to be known through the lives he touched. I will miss him as a colleague and a friend.”

Dennis Gonzales, CHA’s senior direc tor of mission innovation and integration, called Smith a “fierce advocate and believer in our ministry and probably one of the best leaders I’ve ever met.”

Diarmuid Rooney, CHA’s interim vice president of sponsorship and mission ser vices, said of Smith, “His contributions to Catholic health care cannot be overstated.”

In late October, just weeks before his death, Smith announced his plans to retire at the end of the year and give up his com muter lifestyle. His permanent home was in Columbus, Ohio. In a message to CHA staff, he said that the pandemic and the recent death of his father and other life cir cumstances had caused him to think about “how I want to spend the rest of my time on Earth.”

“My plans for retirement are still unfold ing,” Smith wrote, “I am counting on God to show me how I may be of service to others in new ways.”

KEEPING UP

PRESIDENT AND CEO

John Wagner to presi dent and chief executive of HSHS Sacred Heart Hospital in Eau Claire, Wisconsin. He continues as president and chief executive of HSHS St. Joseph’s Hospital in Chippewa Falls, Wis consin. He succeeds Andy Barth, who has departed as president and chief executive of HSHS Sacred Heart Hospital.

FOUNDATIONS

Leaders in Catholic health care recognize the crucial importance of formation in ensuring the Catholic identity of our ministries. In response to member needs, CHA is pleased to introduce Foundations On-Demand as a sister program to Foundations Live.

ADMINISTRATIVE CHANGES

Registration is now open for both programs.

VISIT CHAUSA.ORG/FOUNDATIONS TO LEARN MORE.

Daniel J. Barchi to senior executive vice president and chief information officer of CommonSpirit Health.

Dr. Oswaldo A. Grenardo to senior vice president and chief clinical officer of Centura Health of Centennial, Colorado. Common Spirit Health is a co-sponsor of Centura.

Uday Madasu to chief information officer of Covenant Health of Tewksbury, Massachusetts.

Jennifer Svihus to chief development officer for the PeaceHealth Oregon network, based in Springfield, Oregon.

GRANT

Saint Francis Hospital of Wilmington, Delaware, and Merakey are partnering to provide integrated primary and behavioral health care to people in northern New Castle County, Delaware, through a recently awarded $2.5 million grant from Dela ware’s Community-Based Mental Health Services Fund. Merakey is a developmental, behavioral health and education nonprofit. Through the partnership, Saint Francis is assembling a Wellness Recovery Team led by Merakey that will offer behavioral health care, including addiction recovery, eldercare and mental health services.

ANNIVERSARY

Saint Alphonsus Medical Center–Baker City in Oregon, part of Trinity Health, 125 years.

Smith

Barchi Madasu Svihus

Wagner

Mercy begins second phase of nearly $1 billion expansion in Northwest Arkansas

Mercy health system is beginning the second phase of a decade-long expansion of the services it offers in Northwest Arkan sas. The new phase will bring the invest ments in the region by the Chesterfield, Missouri-based health system to nearly $1 billion since 2016.

Phase two work will total about $500 million. Planned improvements include the addition of a cancer center and the expansion of the emergency depart ment and isolation rooms at Mercy Hospi tal Northwest Arkansas in Rogers.

Mercy also is building out shelled space in the hospital with the potential to increase the facility’s bed count to nearly 400 from 245.

Mercy plans to nearly double the num ber of primary care physicians and special ists in the hospital’s network throughout Northwest Arkansas and add clinic loca

Mountain-area hospitals

From page 1

fluid in the lungs which makes breathing difficult.

Dr. Marc Doucette, a St. Anthony ER physician, says the 35-bed St. Anthony in Frisco operates the only level 3 trauma center “in the heart of ski country.” Summit County boasts four internationally known ski resorts within a half mile of each other.

Doucette says, “the win ter ski season is our busi est time of the year in the St. Anthony Summit Hospital ED, though summer is also becoming increasingly busy given the boom of summertime visitors to the mountains.”

St. Anthony’s emergency department logged 15,265 visits in 2021. St. Anthony’s operates emergency and urgent care clinics at the bases of the Breckenridge, Keystone and Copper Mountain resorts. Emergency medicine physicians, nurses and support workers staff those locations.

Summer is the prime tourist season and tends to be the busiest time for agricultural and recreational injuries in the ER at St. Claire HealthCare. The 159-bed commu nity hospital in Morehead, Kentucky, is in the foothills of the Appalachian Mountains. Nature lovers are drawn to the Red River Gorge in Daniel Boone National Forest and Cave Run Lake.

Dr. William Melahn says during peak tourist season, the emergency department treats an influx of people injured from falls, boating accidents, copperhead bites and ATV and motorcycle accidents. Melahn, who is vice president of quality and clinical affairs and a fam ily medicine doctor with St. Claire of Morehead, is a member of the volunteer fire corps that responds to such emergencies.

Year-round, a significant and growing number of calls are in response to opioid overdose, says Melahn, who has lived in Morehead and practiced at St. Claire for 25 years. The 27 opioid deaths in Rowan County in 2021 were the second highest number reported by counties in a state with one of the country’s worst opioid abuse profiles.

Heart of ski country

St. Anthony’s parent system, Centura Health, operates the Flight For Life air and ground ambulance company. (Centura Health is a joint venture of CommonSpirit Health and Advent Health.) Flight For Life transports critically ill or injured patients throughout Colorado as well as parts of Arizona, Kansas, New Mexico and Utah.

tions in the region. This will increase access to primary care, neuroscience, emergency care, women’s and children’s services, orthopedics, gastroenterology and behav ioral health. Mercy also is adding more

urgent care and outpatient infusion and imaging services.

Mercy Northwest Arkansas has com pleted the first phase of the work. That included the construction of a seven-story

tower, an orthopedic and spine unit, and an inpatient rehabilitation unit, and expanded neurology care, all at Mercy Hospital North west Arkansas.

In Springdale, about 11 miles south of Rogers, Mercy built a multispecialty clinic that includes an emergency room.

In a separate project, the system expanded Mercy Hospital Fort Smith’s emergency room and added 26 inten sive care beds to bring ICU capacity to 64 patients. The hospital has a bed count of 257.

Elsewhere in the Fort Smith area, Mercy added a rehabilitation hospital and con solidated orthopedic services last year at an orthopedic hospital it had opened in 2014.

The U.S. Census Bureau has ranked Northwest Arkansas as the sixth fastest growing midsized metropolitan area in the nation.

a specialist or a subspecialist. The use of telemedicine is limited, he adds.

“For many members of our population, travel is very expensive,” Melahn says. If patients must be hospitalized at a higher acuity facility out of town, family members may be unable to visit for lack of reliable transportation. “In addition, I hear this over and over, they just do not want to go to the ‘big city.’”

Melahn says it is usual for primary care physicians like him to become a “one stop shop,” aiming to handle as much as they can locally. Referring patients elsewhere often is not an option, he says, because he knows many patients are unable to travel far to access care.

Melahn says he’s built lasting, deep relationships with multiple generations of patients in Morehead.

“I have delivered a mother’s daughter, then delivered her daughter’s daughter, and now take care of all of them and the other members of the family,” he says.

The service has bases at five of Centura’s hospitals as well as at Colorado airports for its fleet of five medevac helicopters, three fixed-wing airplanes and four ground ambulances.

Kathleen Mayer, director of Flight For Life Colorado, says the crews, which are made up of nurses, paramedics and pilots or drivers, respond to a wide variety of calls, including for winter sport injuries, ATV accidents and car accidents. They transport patients from accident sites and from rural hospitals to high-acuity hospi tals. Patients with life-threatening or limbthreatening injuries are taken to a Level 1 trauma center, those with less serious inju ries go to a Level 2 trauma center.

The Flight For Life helicopter ambu lance crews practice frequently with search and rescue teams, including with the teams’ avalanche dogs. The dogs are trained to remain calm and task-oriented even with the sound of the helicopters’ rotors near.

Mayer says avalanche transceivers in Flight For Life helicopters can detect ava lanche beacons activated by skiers in dis tress. The Flight For Life team always has a snow safety technician on board on an initial flight into the area. That person can advise on the risk of additional slides. Mayer says the helicopter team has never triggered additional avalanche sliding due to the rotor’s wash.

She notes that common injuries among avalanche victims can include bone frac tures from having tumbled in the debris field with rocks and trees. Hypoxia — or an oxygen deficiency — can be caused by being trapped beneath the snow.

Search and rescue

Flight For Life’s helicopters fly search and rescue teams into the backcountry and other remote locations landing as close as

possible to where a rescue will take place.

Centura recently hosted a conference in Breckenridge for search and rescue teams. About 150 rescuers came to learn about practicalities of the work and to practice rescue techniques in the wilderness.

Mayer says Flight For Life is a break-even service; maintaining it and hosting educa tional conferences for search and rescue teams are mission-based undertakings for Centura.

Sole provider

The catchment area for St. Claire hospi tal in the Appalachian foothills has a differ ent socioeconomic profile than the affluent ski basins of Colorado. Melahn says that the opioid epidemic is part of a constellation of stressors that give the region a high rank on social vulnerability measures. Poverty, a lack of transportation and no health insur ance cause people to delay getting health care before their conditions deteriorate.

But the leading health issue year-round is drug overdose. The incidence of overdose has been growing in recent years in Appa lachia and is now at crisis levels, Melahn says. St. Claire has secured several grants to improve its primary care clinics’ and behav ioral medicine clinics’ capabilities to treat patients with substance use disorder.

Melahn believes primary care physi cians should be trained to do more to aid patients who have become dependent on opioids for pain control. He notes that the community needs addiction specialists, but “attracting an addiction specialist to a small area like this is very difficult. We have tried and they have not lasted.”

Melahn says like other providers in rural areas, St. Claire is always attempting to recruit physicians specializing in pul monary medicine, nephrology, oncology, urology, gastroenterology, obstetrics and gynecology, pediatrics and neurology, who want to work in rural areas. Some patients have to travel a minimum of 60 miles to see

Visit chausa.org/chworld to learn about St. Anthony's High Altitude Research Center.

jminda@chausa.org

Upcoming Events

from The Catholic Health Association

Ministry Formation Workshop Series

Tuesdays | Dec. 6, Jan. 17, 2023, March 28, 2023, and May 16, 2023 | 1 – 3 p.m. ET

Virtual Series: Emerging Topics in Catholic Health Care Ethics — Futility in End-of-Life Discussions Dec. 7 | 1 – 1:45 p.m. ET

Virtual Seminar: “Jeopardy!” on the Road to Health Equity Dec. 13 | 1 – 2 p.m. ET

A climber scales a rock face in the Red River Gorge in east-central Kentucky’s Daniel Boone National Forest. The emergency room at St. Claire HeathCare in Morehead, Kentucky, gets busier in the summer with agricultural accidents and tourists’ mishaps driving added volume.

Mercy continues a major expansion of its heath care facilities and services in Northwest Arkansas. It plans to build a cancer center as depicted in this architectural rendering.

Doucette

Melahn

Mayer