Catholic Health World - March 1, 2022

Sensory-friendly vaccine clinic 2 Executive changes 7 PERIODICAL RATE PUBLICATION

MARCH 1, 2022

VOLUME 38, NUMBER 4

Pandemic takes heavy toll on mental health of children Ethicists make

By LISA EISENHAUER

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case for doulas in end-of-life care for most vulnerable

By LISA EISENHAUER

Karen Nickel shoulders the burden of St. Louis’ legacy as a nuclear dumping ground for herself, her family and her neighbors.

“I struggle some,” says Nickel, who has been diagnosed with lupus, Nickel psoriatic arthritis and fibromyalgia. “It depends on the day, but for the most part I still have the fight in me.

I have good insurance. I have access to the bloodwork and labs that I need. But I have

In the article “Unbefriended, Uninvited: How End-of-Life Doulas Can Address Ethical and Procedural Gaps for Unrepresented Patients and Ensure Equal Access to the ‘Good Death,’” ethicists Adele Flaherty and Anna Meurer make a case for formalizing the role of end-of-life doulas in the provision of optimal ethical health care for unrepresented patients and for Flaherty patients who are wards of the court and under public guardianships due to mental, physical or developmental disability.

Unrepresented patients are individuals who may not be capable of articulating health care decisions, Meurer and they have no one with the legal authority to speak on their behalf.

Rerigging the health care infrastructure to make a place for doulas in the end stage care of these vulnerable patients could be beneficial for patients, providers and health systems, the authors maintain. But before that can happen, the authors say, much work is needed in defining the training, the scope of practice and reimbursement structure for the supportive services of doulas.

Although some death doulas may be palliative care nurses who can provide clinical care under their nursing license, doulas are not licensed and do not have a clinical role in patient care. (Some professional organizations offer certifications for end-of-life doulas.)

Nevertheless, “As quasi-independent, non-medical members of the health care

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Karen Elshout/© CHA

Dr. W. Carson Felkel says emergency departments within the Bon Secours Mercy Health system have seen a surge of children and adolescents who have attempted or talked about suicide; who Felkel have injured themselves; or who are grappling with anxiety, depression or other mental illnesses during the pandemic.

Young patients with mental health struggles also are inundating the primary care, specialty and school-based clinics affiliated with the system, which operates in seven Eastern states.

As stressed as many young children and teenagers are now, he expects the situation will get worse once COVID-19 wanes and its aftershocks are fully felt.

“We’ve heard of several waves of the

Therapist Joseph Doney poses questions to a patient at SSM Health Behavioral Health Urgent Care at SSM Health DePaul Hospital in suburban St. Louis last May. Care providers say there has been a sharp spike in demand for mental health care for children since the start of the pandemic.

In an area marred by environmental calamity, SSM Health steps up

Persistent grassroots and health care activism brings modicum of justice to North St. Louis County

By KATHLEEN NELSON

Through Connection for Health and Healing, SSM Health is working to increase health care outreach and access in underserved areas of North St. Louis County. SSM Health launched the program in partnership with the local nonprofit IFM Community Medicine. Rachel Navarette, an IFM nurse practitioner, takes a blood pressure reading at a community health fair the partners held at an elementary school in November.

Giving to ministry foundations by new and repeat donors is strong during pandemic

By JULIE MINDA

While the pandemic caused significant disruptions in most of the usual channels that health care foundations use to solicit and process donations, giving has remained steady — and even increased — over the past couple of years. Community members, including many new donors, have been expressing their gratitude to health care providers for their courage and commitment during the pandemic through monetary and in-kind gifts.

Several executives from ministry foundations and from a health care philanthropy association told Catholic Health World that foundations had to find new ways of relating to major and casual donors as the pandemic interrupted their usual ways of courting philanthropic giving.

“The pandemic showed the world the importance of health care, and people are seeing how the work we do as foundations is essential, and that we contribute to

and support health care in communities,” says Fred Najjar. He is executive vice president and chief philanthropy officer of Chicago-based CommonSpirit Health and chair of the board of direcNajjar tors of the Association for Healthcare Philanthropy.

In mid-summer 2020, during a COVID-19 caseload peak, frontline health care workers at a Bon Secours Mercy Health hospital in Richmond, Virginia, express their thanks to all the donors who contributed cash and in-kind gifts. The money went toward the purchase of personal protective equipment, ventilators, UV disinfecting robots, and other equipment. Many donors brought meals, snacks and other comfort items for staff.

Personal touch When the pandemic shut down communities nationwide in early 2020, infection protocols prevented hospital foundation staffs from interacting with donors as they normally would.

Outreach to donors is very relationshipbased and before the pandemic there was much face-to-face contact, especially with major and repeat donors. Foundation staff host donors who contemplate big gifts at private lunches, give them VIP facility Continued on 8

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CATHOLIC HEALTH WORLD March 1, 2022

SSM Health-affiliated autism center hosts ‘sensory-friendly’ vaccine clinic People with autism may react poorly to the usual clinic setup

By JULIE MINDA

After 13-year-old Desmond Commo got his Pfizer COVID-19 booster injection at a vaccination clinic Feb. 5, he shot his dad a look that said, “Really, that’s it?”

His dad, Tyler Commo, says that was a calmer reaction than Desmond had to his first two vaccine outings. Desmond is on the autism spectrum, and his dad says the bright lights, mechanical noises, scary-looking equipment and potentially unpleasant procedures at health care appointments can be a recipe for disaster for a child sensitive to such stimuli. In fact, Tyler Commo says, one of Desmond’s first and worst “meltdowns” was at a dentist appointment.

Ahead of Desmond’s appointment at the vaccine clinic at the SSM Health Treffert Center in Fond du Lac, Wisconsin, his father filled out a form listing the teen’s sensitivities and offering suggestions for easing his anxiety. At Treffert, the nurse brought Desmond into a quiet room with soft lighting and gave him a fidget for distraction before administering the vaccine.

Tyler Commo says Desmond was in a great mood the entire time — in part because he had been at the Treffert Center multiple times before the pandemic and relished being back. The center offers supportive services for people with autism, behavior, and communication disorders.

Desmond was one of 29 people vaccinated at the Sensory-Friendly COVID-19 Vaccine Clinic sponsored by SSM Health, the Autism Society of Greater Wisconsin and the Autism Society of Southeastern Wisconsin. People age 5 and up could get their first vaccine and those ages 12 and up could get their booster. The autism center will hold at least one more vaccination clinic so those who require a follow-up dose can get it.

The center provided information to fam-

Desmond Commo, 13, gives a thumbs up after his COVID-19 booster shot at the Sensory-Friendly COVID-19 Vaccine Clinic at the SSM Health Treffert Center in Fond du Lac, Wisconsin. The clinic cares for patients with autism, who may be hypersensitive to noise and lights. Staff and the volunteer nurses adapted the vaccination experience to suit each patient.

ilies in advance of the clinic on how to prepare for the appointments, recommending a full night’s sleep and ample hydration. A family support specialist met each family upon arrival and accompanied them for the entire visit. Private rooms were available for those who wanted them. A sense of calm and quiet prevailed.

SSM Health nurses who volunteered for the clinic got instructions in how to distract and soothe their patients. In addition to fidgets, they used illustrated brochures to explain each step of the vaccination process in advance. The center spaced out appointment times so that the process

would not feel rushed.

Megan Puddy is a board-certified behavior analyst and therapist providing autism services with the Treffert Center, and Kirsten Cooper is executive director of the Autism Society of Greater Wisconsin. They helped to set up and coordinate the vaccination clinic.

Puddy says individuals on the autism spectrum are among the groups disproportionately harmed by the pandemic. She says she’s aware of families that delayed vaccination for their autistic children because of fears that the encounter would traumatize them. And she knows of families that had

failed attempts at inoculating their autistic children.

Cooper emphasized that adapting the vaccination experience to each individual patient is essential for people on the autism spectrum.

The clinic at the Treffert Center used an approach and resources made possible with the support of a grant from the Autism Society of America. Clinic organizers also got advice from the Autism Society of Minnesota, which had held a similar clinic.

Fond du Lac clinic organization benefitted from knowledge that Treffert Center staff has honed since the facility opened in 2016. Staff have guided numerous families through challenges including routine health care appointments for children with autism.

Puddy says the Treffert Center has plans to teach providers at SSM Health and beyond ways to make health care more individualized not just for people with autism but for all people.

Individualization is at the heart of the approach the late Dr. Darold Treffert championed when he worked with SSM Health’s Agnesian HealthCare to develop the Treffert Center on Agnesian’s flagship campus in Fond du Lac. The center provides multidisciplinary diagnosis and treatment of autism, behavior, and communication disorders in children and adults. Treatment includes in-home, center-based and community-based programs. Treffert was a guiding presence for the center until his death in 2020. jminda@chausa.org

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3

Medical educator has much to teach and much to learn from interns and residents Editor’s note: This story is part of an occasional series in which people talk about their jobs in the Catholic health ministry.

We invite readers to recommend themselves or colleagues for a profile that will help illustrate the diversity of jobs, skills and people that make the ministry vibrant.

To do so, send an email to jvandewater@ chausa.org with “At Work” in the subject line.

with on-site program coordinators, monitor and report the issues around compliance with Accreditation Council for Graduate Medical Education regulations.

Compliance can carry a negative connotation for Finley, for the facility program directors and especially for the participants.

“Sometimes the residents think we’re the bad cops,” he said. “But we have a tremendous amount of documentation to file every week to show how we’re making our residents safe, the environment safe and following duty limits for the residents.

We need to cross every ‘t’, every week.”

By KATHLEEN NELSON

CHRISTUS Health and Dr. Michael Finley believe that learning is a two-way street for its residents AT WORK and fellows. His job is to open the flow of traffic and ensure it continues to run smoothly in both directions.

Finley became system medical director and designated institutional official for CHRISTUS Health facilities in the United States in February 2021. As system medical director he coaches and mentors hospital clinical leaders in patient care delivery. The back end of his title means that he functions as liaison between CHRISTUS Health and the Accreditation Council for Graduate Medical Education. That nonprofit, private council oversees all internship and residency medical training programs for physicians in the U.S. Finley manages compliance for the medical education programs that CHRISTUS Health sponsors for residents at two family medicine practices and an emergency medical program, as well as graduate fellows in geriatrics, obstetrics and sports medicine. The programs include a combined total of 36 residents and graduate fellows. He works with onsite program directors to ensure the programs meet all guidelines and to standardize procedures.

Finley is the first to hold the title for CHRISTUS Health, which took over resi-

As system medical director and designated institutional officer for CHRISTUS Health facilities in the U.S., Dr. Michael Finley coaches hospital clinical leaders and manages compliance in medical training programs for 36 residents and graduate fellows. He is shown here with his wife Nancy at a car show.

dency and internship sponsorship from local foundations and medical schools about seven years ago. He had gradually assumed the work over the past six years while he was chief medical officer at CHRISTUS St. Michael Health System in Texarkana, Texas. His duties in medical education had expanded to take about 80% of his time when his title change became official.

“I like watching the residents and fellows grow into their next steps,” he said.

“You realize that everything’s a transition.”

A typical week Finley meets by videoconference twice a week to twice a month with the CHRISTUS Health Graduate Medical Education Committee, the CHRISTUS Health System Clinical Leadership Group and en masse

with the medical executive committees of the graduate medical education programs. He also checks in at least twice a week with program directors and his assistant designated institutional official, who is based at CHRISTUS Health headquarters in Irving, Texas.

“We huddle more than a football team,” Finley said. From the regularly scheduled meetings stem calls or videoconferences with a chief resident or other official with extra questions or issues to discuss. He texts the program directors “individually, on schedule” every two or three days.

Nearly every week also includes conducting an educational workshop or mock site visit modeled after a visit from an inspector from the accreditation council.

Finley and the three other members of the graduate medical education office, along

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The human touch Despite handling an abundance of paperwork, Finley is primarily a relationship-builder. Before the pandemic, he spent much of his time on the road. Working from his home base in Texarkana, he traveled to meet on-site with program directors, residents and fellows.

Though rarer throughout the pandemic, face-to-face interactions are the most rewarding for him. Last year, for example, he hosted three orientation programs in one week, two by Zoom, one in person in Corpus Christi, Texas.

He said the residents and fellows “want somebody to ask them how they’re doing, and they want somebody to actually listen to them and be interested.”

Last year, Finley traveled to San Antonio, where he met a first-year resident from a rural area. The resident expressed frustration that his rotation wasn’t giving him what he’d eventually need in a rural practice.

“I gave him some pointers on how to get some value out of the program, rather than waiting for the program to give it to him,” Finley said. “The whole thing about graduate medical education is that it belongs to you. You can go through rotations, take notes and go to the next rotation. Or you can dig deeper. You can ask for more.”

A few weeks later, the resident thanked Finley for the advice and said he was doing better since their talk.

“I can’t tell you how much that makes me feel that we got it right. And that makes me feel wonderful,” he said.

To strengthen the connection between residents, fellows and staff, Finley partnered with CHRISTUS Health’s health equity, diversity and inclusion group to conduct sessions with residents and faculty to explore their differences and commonalities. He said the sessions have proven “extremely rewarding.”

Percolating through the system The other part of Finley’s title — system medical director — flows from the first. His mission is to develop programs and procedures for residents and fellows “that will cascade into our hospitals and medical staff.” The partnership with health equity, diversity and inclusion has expanded in the residency programs to include a Diversity and Equity in Health Care workshop, which regional medical staff leadership will evaluate for including in their onboarding. Finley also hopes to expand throughout the system lessons he’s learned on physician well-being.

“The pandemic has greatly increased the need to revisit how we assess physician well-being and active ways we provide to maintain personal and professional positivity, outlook and a sense of accomplishment and satisfaction,” Finley said. “Physicians are experiencing higher rates of burnout, mental fatigue, depression and other stress-related issues, and we must accept the challenge to develop ways to address and help. We work very diligently with residents on this matter and are looking to pilot what we are learning to our medical staff.”

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CATHOLIC HEALTH WORLD March 1, 2022

convenient for patients, who will be able to pick up food while on campus for medical appointments. It is operated in partnership with the St. Louis Area Food Bank.

“A big part of this grant is bridging the accessibility gap,” Villaflores says. “There’s not always a lot of trust in health care, so we need to meet these residents where they are. Everyone is going to need health care.

So, let’s forge relationships early, get them the insurance they are eligible for and the services they need. We — and they — will be ready when they need us.”

SSM Health steps up From page 1

four kids and seven grandkids, and there’s been times they haven’t had access to health care. And even more important, the community is suffering.”

A co-founder of Just Moms STL, Nickel’s North Star for a decade has been easing the suffering of the community around Bridgeton, Missouri, 15 miles northwest of downtown St. Louis. After years of protests, advocacy, rallies and demonstrations that delivered promises, and fits and starts of progress, her cause is getting additional support from SSM Health Foundation, which recently received a five-year grant worth a total of $5.3 million to collaborate with St. Louis-based IFM Community Medicine on improving access to health care for her neighbors.

IFM Community Medicine is a nonprofit that works with community partners to set up clinics at shelters, schools, residential facilities, food pantries, senior centers and other points of need throughout metropolitan St. Louis.

“We were blessed to receive the grant,” says Dr. Herbert Villaflores, a psychiatrist at SSM Health DePaul Hospital in Bridgeton. He has taken on the role of physician Villaflores champion for the project known as Connection for Health and Healing. “But in my eyes, this is a community effort. Our goal is collaboration. Our partners know the community and can help us best address their needs.”

Dr. David Campbell, founder, president and chief executive of IFM Community Medicine, says SSM Health is leveraging his nonprofit’s experience starting clinics for the medically underserved in the St. Louis area to make health care more accessible to residents in portions of North St. Louis County.

and refuse companies that use it. The grant to SSM Health and IFM is the last and largest to be awarded to nonprofits that serve the residents of Bridgeton and adjoining communities.

Hand and glove SSM Health’s partnership with IFM initially developed more than a year ago, when they collaborated on a clinic at one of the neighborhood’s residential behavioral health facilities.

Dr. David Campbell, founder, president and chief executive of IFM, says, “DePaul came to understand what we do and said they had been looking for a partner” to bring service to the underserved around them. IFM was already doing some of that Atomic hangover work. “They were confident of their ability Nickel’s childhood stomping ground to do surgery and inpatient care but wanted and her current home bear the environ- to leverage our experience and insight into mental consequences of war work done by community programs,” he explains.

Mallinckrodt Chemical Works of St. Louis.

Villaflores describes the partnership as The company enriched uranium that was “a perfect and easy fit.” used to develop the bombs dropped on Both doctors emphasize that all resiHiroshima and Nagasaki. Toxic byproducts dents within a 4-mile radius of the landfill from the project ended up in both Coldwa- are eligible for services through Connection ter Creek, near Nickel’s childhood home, for Health and Healing whether they think and the West Lake they suffer from the Landfill in Bridgeton, effects of the landfill just 2 miles from her or not, whether they home of the past 23 have insurance or not. years in nearby MaryThe first goal is to open land Heights. People multiple points of who live near the entry for them: in elecreek and landfill have mentary schools, comreported dispropormunity centers, fire tionately high diagdepartments and faith noses of the chronic communities. The secconditions Nickel ond is to offer services contends with, as well to address physical as rare cancers, lung and mental health, as issues and a host of Christina Ehrlichman, operations manager for well as food insecurity. other health problems. Vision for Kids, assesses a child at a NovemVillaflores and The Environmen- ber health fair sponsored by Connection for Campbell agree that tal Protection Agency Health and Healing. the sprawling SSM designated the creek Health DePaul camand landfill Superfund sites in the 1990s pus can be intimidating. “That’s one of the and took urgent notice again in 2010, when barriers people in the community face,” a fire was discovered beneath the landfill’s Campbell says. “It’s easy to get lost. This surface moving toward the location where model takes services to people in places radioactive waste was buried. The landfill they are comfortable with, where they is near St. Louis Lambert International Air- already have roots.” port and about 2 miles from SSM Health DePaul’s campus.

Eyes and ears in the community Nickel and Just Moms STL co-founder IFM hit the ground running, hiring nurse Dawn Chapman became champions for practitioners, a community health worker, the residents of the working class neigh- and establishing three school-based clinics borhoods impacted by the contamination. in the earmarked area. Campbell says IFM Many of those people had lacked access to plans to add additional nurse practitioners basic health care even as they suffered or and community health workers in subsedied from rare cancers. quent years of the five-year grant.

The duo lobbied state, national and Both he and Nickel stress the imporlocal governments, mustering community tance of the community health workers support and activism. They staged dem- learning about the history of the landfill and onstrations and information sessions — the record of rare cancers in the catchment often with the help of SSM Health DePaul’s area for Connection for Health and Healing. founding congregation, the Franciscan Sis- The community health workers will listen ters of Mary. to what residents say they need, connect Their advocacy helped establish the them to health services and report back to Bridgeton Landfill Community Project SSM Health DePaul.

Fund, a $12.5 million settlement between “This will open the doors to so many the state of Missouri, the landfill operators doctors at DePaul, to get the residents the

help they need,” Nickel says.

Villaflores says SSM Health DePaul Hospital also plans to increase its community health staff. He added that the hospital will use existing programs and infrastructure in novel ways to meet community needs.

Among the services being initiated or enhanced are: MOMS Line and MOMS Line Support Groups. These services, which connect new mothers with peer coaches, counselors or doctors, will be expanded.

Community outreach workers at SSM Health Behavioral Health Urgent Care on the DePaul campus will provide patients with insurance enrollment assistance, resources to address food insecurity, and referrals to DePaul’s network of primary care physicians and specialists.

In October, SSM Health DePaul opened the Bread Basket community food pantry on its hospital campus. In addition to addressing hunger in the area, it will be

Coming full circle The project kicked off by offering flu vaccines as part of a community health fair in early November at a neighborhood elementary school. Just Moms STL also shared its community health reports, and advisers provided assistance signing up residents for health insurance, Medicare and Medicaid.

Through similar events and clinics, SSM Health and IFM hope to reach 4,000 residents in the first year and gather baseline data to tailor the project to the needs of the 70,000 people living in the area.

“These types of partnerships between health care providers and nonprofit partners are on the frontier addressing community needs,” Villaflores says. “As the project progresses, we’ll see the patients coming through and be ready to offer more services.”

Nickel looks at the grant as a return to SSM Health’s roots. Collaborating with the sisters on vigils, advocacy and demonstrations, she learned the congregation’s history and came to rely on their spiritual strength when she grew frustrated.

“This grant, these services, are based on the foundation of the sisters’ mission, how they went out to serve the poor and sick where they were,” she says. “Now, we’re able to restart that legacy. We hope this is an umbrella that will cover so many things going on in this community.”

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March 1, 2022 CATHOLIC HEALTH WORLD

End-of-life doulas From page 1

team, (doulas) provide a balancing, advocating voice on behalf of the patient, and may also help reduce inappropriate treatment, delays in care, and the overburdening of the public guardianship system,” Flaherty and Meurer write in their article published online by the journal Clinical Ethics in November. Flaherty has a PhD in health care ethics from Duquesne University, where she is an adjunct instructor in the McAnulty College and Graduate School of Liberal Arts and the School of Nursing.

Meurer is the program manager for education for the Center for Bioethics at The Ohio State University in Columbus. She is pursuing a PhD in health care ethics at Duquesne.

The pair talked with Catholic Health World about their research and what they hope comes next. The interview has been edited for length and clarity.

Is there a growing demand for the services of end-of-life doulas?

Meurer: There is evidence that interest is increasing in the general population. There’s an increase of articles, there’s increase in conversations on Twitter and on death forums.

The International End of Life Doula Association and the National End-of-Life Doula Alliance have reported increases in membership and they’re having a higher demand for (training) events.

The International End of Life Doula

Association says doulas can help a dying person explore the meaning of their life and understand the process of dying. They can keep vigil at a deathbed. What other specific services do death doulas provide?

Meurer: Their services can take myriad forms. They can provide psychological and emotional support, and companionship.

When a doula’s working as a bridge or a translator from the medical team, they can contextualize what’s happening and then tie that into the patient’s and the family’s values.

Flaherty: In his really great book Finding Peace at the End of Life: A Death Doula’s Guide for Families and Caregivers, Henry Fersko-Weiss, the founder and president of the International End of Life Doula Association, identifies three stages of the services that an end-of-life doula can provide. In the planning stage, doulas can assist with writing advance directives, help set up practical household support services, and facilitate communication with family members and friends. In the second stage, the dying process, doulas can provide support to a patient and their family, running errands, helping with personal care — whatever is needed. In the third stage, they can help families navigate a scary and chaotic time, organize home wakes or funerals and facilitate healing and healthy grieving long after the client’s death.

How is the work of a doula different than what can be provided by a comprehensive hospice program that addresses mental and physical suffering and the resolution of spiritual suffering?

Flaherty: The allocation of time is an important distinction. Hospice teams, including volunteers, hindered by caseload and requirements, can provide only a few hours a week of face-to-face time for patient care.

Death doulas can provide the respite needed for families and caregivers overwhelmed emotionally, mentally and physically by the round-the-clock care needed once a patient begins to transition. Such services include assisting with activities of daily living that are out of the purview of hospice care.

While there are several organizations which have developed competencies and training programs for end-of-life doulas, there is currently no government or professional oversight or certification for them. What training do professional doulas need?

Flaherty: There are so many different ways that people approach and experience death. I do think motivational interviewing and mediation are essential skills. I also think cultural competency and understanding, both the history of death and cultural approaches towards death rituals, are very key. Beyond that, there’s a lot of room for input from people who are already doing end-of-life care, palliative care and hospice, to say: “These are things we’d like to see” as part of the skill set.

In those places where doulas are in use, who pays for their services?

Flaherty: It varies. Here in the United States, mostly it’s the patients or their fami-

Let’s reunite for Assembly 2022

5

lies paying for doula services. In some countries where there’s a national health system, especially in Australia, there is more of a push for integration and a concerted effort to centralize training and access to services. The World Health Organization has called for state-funded health care systems to expand their palliative and hospice care services, and a lot of nations have, including by adding end-of-life doulas.

Your article advocates for exploring the use of end-of-life doulas for unrepresented patients. Are you aware of doulas being used anywhere for such patients now?

Meurer: I’m not. There are many conversations ongoing about decision-making and end-of-life care for unrepresented patients, but end-of-life doulas are noticeably absent from the academic literature.

Can you elaborate on how end-of-life doulas might be especially helpful for unrepresented patients?

Meurer: The trend for end-of-life care in general, but particularly for (hospitalized) unrepresented patients, is for drawn-out care, providing everything. But some of it may be unwarranted or unwanted, which can cause harm to the patient and distress to the health care team. We think by having doulas there as an expert who is in on the process, you’re going to avoid ethical and procedural pitfalls. We think it’s going to streamline the process, but also enhance the quality. End-of-life doulas can provide timely, just, resource-conscious value to care.

Flaherty: They can help the providers and the public guardians find that balance between not enough and too much care.

Do doulas have any legal authority to direct patient care for individuals unable to speak for themselves?

Meurer: The legal statutes don’t specifically name doulas as a decision-maker, but we do think some existing statutes make room for them. Doulas would not replace the legal guardianship system (which may give a court-appointed guardian the power to make medical decisions on behalf of their ward), but they could supplement it.

What we’re saying is that the system at the moment is overburdened. Doulas could be transformative to end-of-life care but the work to support it just hasn’t been done.

Who could do the work on what you suggest?

Meurer: Hospitals could do it, insurance companies could do it. There’s a lot of groups and areas of health care that we feel it would be beneficial to and it would be in their interest to connect with the doulas organizations and advocates, and bring them into their conversations.

And we know they’re looking for these solutions, we know there’s a recognition of challenges and high cost with end-of-life care. We know there’s a challenge in caring for unrepresented patients and it’s a growing population. We know there’s a challenge with moral burnout and distress with providers. So we’re saying everybody has an interest here, and you’re looking for solutions, here is one that should be explored.

We find that it’s morally justifiable.

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Does the work of end-of-life doulas align with the mission of Catholic health care?

Flaherty: End-of-life doulas can and do support that aspect of the mission that defends human dignity by providing a dignified death. They’re tending to the physical needs, the mental needs, the spiritual needs of the patients that they’re working with and their family.

To request copies of their article, email Flaherty at adele.renee.flaherty@gmail. com or Meurer at meurera@duq.edu. leisenhauer@chausa.org

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CATHOLIC HEALTH WORLD March 1, 2022

Youth mental health

the profession.

“What we’re seeing is that it’s really tough for kids to get into counseling,” Henderson says.

The mental health crisis in children has reached the point in Oregon that she has seen statistics showing suicide is now the leading cause of death for adolescents.

The state has yet to officially release figures beyond 2019, but historically accidents have taken more teenage lives than any other cause.

From page 1

pandemic, but there is going to be a tsunami of mental health and addiction concerns that follows this pandemic,” predicts Felkel, a psychiatrist who is Bon Secours Mercy Health system medical director for behavioral health.

Felkel’s observations and concerns are shared by mental health care leaders and providers at other Catholic health ministries. They also are reflected in several reports and advisories from public health officials and health care organizations.

National emergency In December, the U.S. surgeon general issued an advisory called “Protecting Youth Mental Health.” It cites alarming increases in certain mental health challenges prepandemic, such as that in 2019 more than one-third of high school students said they had experienced persistent feelings of sadness or hopelessness in the past year that kept them from participating in their regular activities, a 40% increase over 2009.

The pandemic appears to have made an alarming trend worse, the advisory says. For example, it notes that figures from the early months of 2021 show emergency department visits for suspected suicide attempts were 51% higher for adolescent girls than the same period of 2019.

“The pandemic era’s unfathomable number of deaths, pervasive sense of fear; economic instability, and forced physical distancing from loved ones, friends, and communities have exacerbated the unprecedented stresses young people already faced,” the advisory says.

The report urges a national response, including ensuring that every child “has access to high-quality, affordable and culturally competent mental health care.”

In October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association jointly issued a “Declaration of a National Emergency in Child and Adolescent Mental Health.”

An illustration from “Protecting Youth Mental Health,” a public advisory issued by the U.S. surgeon general in December, lists factors believed to be impacting the mental health of children and teenagers.

That communique calls on policymakers and child advocates to demand action, including an increase in federal funding for evidence-based mental health screening, diagnosis and treatment.

Waiting for treatment Dr. Robin Henderson, chief executive for behavioral health at Providence St. Joseph Health Oregon, says the youth mental health programs offered by her regional system can’t keep up with the Henderson demand for care. Those programs include inpatient and outpatient

services and partial hospitalization programs in which patients spend their days in treatment and go home at night.

“Across the board everything we do in this space has a wait list,” Henderson says.

“Sometimes those wait lists are weeks, sometimes those wait lists are longer.”

The waits are in spite of expansions of some of the programs in recent months.

Once young patients complete the treatment regimens, which typically last six to eight weeks, Henderson says finding continuing care for them is a challenge because few providers are accepting new patients. Additionally, as is happening across the board in the workforce, she says many mental health providers are leaving

Vulnerable affected most Like Felkel, Henderson expects the full impact of the pandemic’s disruptions on the lives of children to unfold for several years. While older kids might be experiencing depression and other conditions with immediate effects, she notes younger children might have developmental delays such as speech challenges that add stress to their lives and can take years to overcome.

The surgeon general’s advisory mentions that in recent years, suicide rates among Black children younger than 13 have risen rapidly, with Black children nearly twice as likely to die by suicide as white children.

It also notes that socioeconomically disadvantaged children and adolescents — such as those growing up in poverty — are two to three times more likely to develop mental health conditions than others.

Breakdowns of patient data based on race and other factors aren’t yet available for the pandemic timeframe, the mental health care executives and providers say, but anecdotally what they are seeing confirms that children from families with fewer resources or in vulnerable populations are exhibiting higher need for care.

Michelle Schafer, SSM Health vice president of behavioral health for the Schafer St. Louis region, says the youth patient population in recent months reflects a rise in need for care across all

Health systems expand and stretch pediatric mental health resources Providers train and deputize teachers to respond to crisis-level demand

M

ary Weatherford, a clinical psychologist at SSM Health Cardinal Glennon Children’s Hospital in St. Louis, had never used telehealth to counsel patients before the COVID-19 pandemic.

Weatherford Nowadays, much of the therapy she provides to her young patients is via screen.

“This has been wonderful in creating access for our patients who previously had difficulty coming in for appointments because of lack of resources,” she says.

Transportation was an issue for families without cars, and many people were reluctant to have their children come to in-person sessions because of the heightened infection risk, explains Weatherford, who has been in practice for 31 years.

Michelle Schafer, SSM Health vice president of behavioral health for the St. Louis region, says in addition to the wider use of virtual tools, SSM Health has expanded its hospital-based behavioral health programs for youth where possible. In the St. Louis region, it has added inpatient beds for patients of all ages and flexed those beds among adult and youth units to match demand.

Dr. W. Carson Felkel, system medical director for behavioral health at Bon Secours Mercy Health, says his system also has greatly increased its use of telehealth for treating emotional, mental and addiction-related illnesses for patients

of all ages. Pre-COVID, he easy to succumb to all the other says, there were a few distractions. It just is less effective.” hundred virtual sessions a As much as possible, Providence year; since then they have Oregon has kept its youth mental completed over 70,000 health services in-person and it has sessions. expanded those services when it has In addition, Felkel says the resources. It has, for example, that at the school-based relocated its eating disorders partial clinics the system partners hospitalization program to increase with, clinicians have in capacity by six and opened a second recent months put an adolescent psychiatric partial hospiemphasis on teaching talization program in which about 20 instructors to identify patients spend their days in treatsigns of mental illness in ment and go home at night. students and get those Henderson is also chief clinical students into treatment. officer for Work2BeWell, a ProviThe system is building dence initiative that offers educaon its strategy of integrattional resources and peer-to-peer ing all forms of treatment, support on youth mental health. The including behavioral health initiative’s weekly Talk2BeWell podcare, he says. Almost all cast, available on the streaming serclinicians at its integrated vice Spotify, has focused on several care clinics screen patients pandemic-related topics in recent The Work2BeWell program, an initiative of Providence St. Joseph Health, uses for behavioral health months, including the disparities in visual elements like this one on social media to share the topics of discusissues, and the system is care available to some populations sions featured on its Talk2BeWell podcast. The initiative provides peer-tofocused on seeing that and low-income families. peer support programs and free educational resources on youth mental those who are identified The initiative also provides curhealth issues. with potential illnesses are ricula material for educators. The treated or referred for mental health care. social workers can connect the patients latest additions to that curricula offer “We are making that pivot to ensure and their families to behavioral health teachers and coaches advice on how to that when a pediatric patient screens services. work with kids from minority populations positive (for depression or other mental Dr. Robin Henderson, chief executive for to support their mental health needs. health issues), we are also delivering the behavioral health at Providence St. Joseph “All those pieces of curriculum are best evidence-based care to them through Health Oregon, says while her regional sysavailable free and that’s where all my hope primary care,” Felkel says. tem offers telehealth, virtual care doesn’t goes to,” says Henderson, “doing what In addition, he says Bon Secours Mercy serve all children in need of mental health we can to support schools where kids are Health facilities have added social worktreatment well. six to eight hours a day in better being ers to medical teams in areas like pediatric “Kids have a lot of Zoom fatigue. Their able to identify and address mental health gastroenterology and neurology where school is online. Everything we’re doing is issues.” children with chronic co-occurring physical online,” Henderson says. “So then when — LISA EISENHAUER and emotional issues often are seen. Those your therapy’s online too it becomes very

March 1, 2022 CATHOLIC HEALTH WORLD March 1, 2022 CATHOLIC HEALTH WORLD

gender, socioeconomic and racial categories. And, she says, there is a continuation of the pattern for kids from racial minorities and poorer families and those who identify as LGBTQ to be overrepresented.

Disruption cuts lifeline Schafer and others say factors brought on by the pandemic — the deaths and illnesses, social isolation and financial hardships — have weighed especially heavily on those populations. She cites the closing of schools as a major disruption in the lives of vulnerable youth that left them with few social outlets and cut off their access to trusted and supportive adults.

“The pandemic drove us to move away from something that is such a significant foundational element for children and adolescents in their growth and emotional development,” Schafer says. “We just took the rug right out from under them and with that rug lots and lots of resources were taken away from them as well.”

Felkel says that just as closing schools caused distress for many students, reopening them has caused anxiety for others, such as those who deal with bullying or social anxiety often presenting as an upset stomach or headache. In some cases, that has prompted parents to keep children at home.

“When children are able to avoid stressful situations, do not have the skills to cope, and are not able to have the resource of therapy to process these difficult emotions, over time kids frequently get worse,” Felkel says.

An aspect of behavioral health treatment that impacts kids more so than most adults is that home dynamics usually also need to be addressed, the mental health care leaders say.

“Sometimes a kid gets better but the family remains dysfunctional,” Henderson says. “When we’re not able to work with the family as a system, I don’t think we’re able to be successful in the long term.”

Just as care options for children are stretched thin by the overwhelming demand and the shortfall of programs and providers, she and others say the same is true for family therapy.

Reducing the stigma The mental health care leaders see reasons to be hopeful, even amid a crisis that they believe has yet to peak. They note that the publicity around the upsurge in demand for care has led many people to advocate for increased funding and services. They also say the upsurge in need has led to a more open discussion about the importance of mental health care and that conversation is reducing the stigma around mental illnesses.

“We need to talk about it,” Henderson says. “We need to use every avenue we’ve got whether it’s print media, social media, podcasts, whatever. We need to normalize conversations about mental health.”

At SSM Health, Schafer and her colleagues are asking policymakers for more funding for programs in the Midwestern states the system serves. In the St. Louis region, they also are trying to build partnerships with other mental health care providers and community groups to devise a coordinated approach to the surge in demand for youth mental health care and to ongoing needs.

“It’s incredibly concerning and worrisome that we’re in this situation, but if we all come together, we could be a pretty powerful force to be able to address it and to help children get through this and then to send them on a very fulfilling life path,” Schafer says. leisenhauer@chausa.org

7 7

Rodgers was powerful advocate for health care for vulnerable As chief of the advocacy department at CHA and in his earlier work, Michael Rodgers devoted his career to shaping and advancing health policy that would benefit those who are poor and vulnerable, including the young and the old.

“I think of the many, many things that he played a role in, he would be most pleased and proud of the fact that we were instrumental in helping to get the Affordable Care Act and then able to protect it when Congress and the White House tried to destroy it,” said Sr. Carol Keehan, DC, retired CHA president and chief executive officer.

Rodgers died Feb. 13 at age 73. He had retired as CHA’s senior vice president of advocacy and public policy in February 2019 after almost 20 years with the organization.

Prior to coming to CHA, Rodgers was senior vice president of government relations and advocacy for the American Association of Homes and Services for the Aging, now called LeadingAge. He’d worked at that organization for 14 years helping develop legislative strategies to restore federal funding for nursing facilities after cuts related to the Balanced Budget Act of 1997.

Before that, he was staff director of the Subcommittee on Housing and Consumer Interests for the Select Committee on Aging of the U.S. House of Representatives and a member of the senior professional staff of the U.S. Senate Special Committee on Aging.

Rodgers was a past board chair of the charitable organization Support Our Aging Religious.

In addition to helping lead CHA’s work to support passage of the ACA, which was

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The Catholic health ministry is the largest group of nonprofit health care providers in the nation comprised of more than 600 hospitals and 1,600 long-term care and other health facilities. To ensure vital sponsorship and a vibrant future for the Catholic health ministry, CHA advocates with Congress, the administration, federal agencies, and influential policy organizations to ensure that the nation's health systems provide quality and affordable care across the continuum of health care delivery.

CHA is seeking candidates with a minimum of seven years relevant and progressively responsible experience in communications, marketing, and project management.

Experience in Catholic health ministry, nonprofit organizations, and/or the health care industry desired. Knowledge of Catholic tradition desired. This position requires a bachelor’s degree in English, communications, journalism, or related field; graduate coursework preferred or equivalent experience. To view a more detailed posting for this position, visit the careers page on chausa.org.

Cara Brouder, Sr. Director, Human Resources Catholic Health Association 4455 Woodson Rd. St. Louis, MO 63134 Phone: 314-253-3498 Email: HR@chausa.org

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Rodgers

enacted in March 2010, Rodgers was a major force behind the association’s effort to secure, and then protect, funding for children’s health insurance expansion.

Sr. Mary Haddad, RSM, CHA president and chief executive officer, said of Rodgers: “God gifted Mike with deep faith and a passion for justice, and he always put those gifts in service to others.”

Sr. Carol said that Rodgers was not rigid or sanctimonious in how his devotion to Catholicism guided his work. “He had an incredibly deep faith, but it was a warm faith, and it was a faith that took the very best of teachings of the church and applied them so well to the realities of life and how

we all want to do the right thing,” she said.

Sr. Patricia Talone, RSM, retired from CHA in 2016 as the vice president of mission services. She said Rodgers “loved meeting new people and making connections and it was that personality trait in him, that outgoingness, that I think made him so good in advocacy.”

Lisa Smith, who reported to Rodgers and then succeeded him as CHA’s vice president of advocacy and public policy, added: “Mike’s health policy expertise and charisma made him a well-known leader in Washington, but it was his sincerity and kindness that built the relationships to move important legislation through Congress. He was a true statesman.”

Julie Trocchio, CHA’s senior director of community benefit and continuing care, said Rodgers was “a born networker.”

“He was very popular on the Hill, and with consumer organizations and with provider organizations,” Trocchio said. “There aren’t too many people you can say that of.”

Sr. Carol recalled: “On an ordinary day, he made life a lot more fun. On a really tough day, he made life bearable and workable.”

Rodgers is survived by his wife, Mary– ellen, and five children and their families.

KEEPING UP PRESIDENTS AND CEOS Sue Anderson to regional president of SSM Health Wisconsin. She was executive vice president for Virginia Mason Health System and president of Virginia Mason Medical Center in Seattle.

AMITA Health has made these changes: Christopher Shride to president of AMITA Health Saint Joseph Medical Center Joliet, from president of AMITA Health St. Mary’s Hospital Kankakee. He replaces

Herb Buchanan, who is departing as the Joliet hospital’s president to become chief operating officer for AdventHealth Midwest Region. Karen Gallagher will take on the new role of administrator, now the lead role for the Kankakee hospital. She will report to Shride. She was chief nursing officer and vice president of operations. AMITA Health is a joint operating company formed by AdventHealth of Altamonte Springs, Florida, and St. Louis-based Ascension.

8

CATHOLIC HEALTH WORLD March 1, 2022

Donors keep giving

dence St. Joseph Health and Trinhospital two Cub Cadet ATVs. The ity Health say their foundations’ vehicles are used to cart staff and staff played an integral role in comsupplies around the campus. tours and visit them in their homes to find ing up with ways to enable hospital Laurie Kelley is chief philanout where the donor’s philanthropic goals leadership, clinicians and other thropy officer of the Providence intersect with health care programs and experts to quickly and efficiently National Foundaresearch. provide the vital information that tion, which directs The calendar included donors and the broader commugiving by Provilectures, golf tourna- nity wanted. dence St. Joseph ments, parties and Working with other hospital Health and helps lunches for other donor departments, foundation staff coordinate the groups. All such in-person arranged virtual town halls and work of other hosactivity came to a hard question-and-answer sessions. pital foundations Kelley stop in the late winter They sent out broadcast emails in the system. KelKoder and early spring months and texts. CommonSpirit’s Paul ley says many donors funded the of 2020, says Tim Koder, Richardson, system senior vice purchase of essential medical equippresident of the Bon president of philanthropy engagement, including ventilators.

Secours Mercy Health ment, notes that while the system’s Ayres says much of this type of Foundations. foundations continued to use Mercy Health Chief of Police Everett Wehrly boards one of two allneed-based giving was from “criDuring that first phase the postal sys- terrain utility vehicles gifted to a Bon Secours Mercy Health – Toledo, sis donors” who jumped in to help. of the pandemic, says tem for outreach Ohio, hospital.

While the foundation executives Alice Ayres, it was in questhroughout the say they and their staffs have been tion whether it was even pandemic, they used it “Donors view them- working to build relationships with these Ayres appropriate to reach out judiciously and as part of selves as investors in our new donors, they do not yet know whether and continue to make asks in the midst of broader, coordinated outsystem and facilities, they’ll evolve into long-term givers. the confusion and fear. Ayres is president reach campaigns. many of them feel close The ministry executives note that and chief executive of the Association for CommonSpirit and to our medical staff and one area of their foundations’ work that Richardson Healthcare Philanthropy. other systems’ foundaleaders, and many of them remained consistent throughout the pantion staff posted online tours of their faciliwere interested in the demic was their grant-seeking, which Information conduits ties to give viewers an idea of what it was Petonic well-being of our staff and often is done in concert with other hospiBut, Ayres says, foundations’ staff quickly like on their campuses while visitation was wanted to know how they tal departments. They say their foundarealized the pause of business as usual was restricted, and they made available video could help them,” Petonic says. tions secured valuable grants, including an opportunity to build closer relationships interviews with caregivers. new pandemic-related funds from federal with donors, personally and around health While in most cases any community PPE and an ATV agencies. Koder says at Bon Secours Mercy care’s mission. member could take part in the virtual Across the U.S. grateful community Health, grant revenue has nearly tripled in Koder says Bon Secours Mercy Health events, view the online resources and sign members expressed their support for clini- the past two years. foundations’ staff started calling donors up for the email communiques, mem- cal staff, who cared for patients battling early in the pandemic to check in on them bers of the hospitals’ donor community complications from COVID-19. Commu- New normal and ask how they were doing and how the were particularly appreciative of getting nity members and local businesses rallied Petonic and Koder say foundations staff could help them, and “we learned that information in this way, says Fran Petonic, to provide masks and other personal pro- within their systems restarted active fundpeople just wanted information.” senior vice president of philanthropy for tective equipment. Says Ayres: “There was raising on some major capital and service Koder, Najjar, and executives with Provi- Trinity Health. a surge of giving right away because the line campaigns within about a half year of media was talking about the need for PPE the pandemic’s onset. and the dire situation of clinicians, so founOver the course of the pandemic, foundations saw a huge jump in in-kind gifts.” dation executives have been taking donors’ Ayres says foundation staffs had to develop cues about how best to communicate with supply chain expertise, and learn how to them. They’re resuming in-person vissafely receive and distribute the gifts to hos- its with large-scale donors as those givers pital staff and patients. express comfort with that, and sticking with Some Trinity Health sites set up an phone calls and emails when that is the preonline platform so community members ferred way to communicate. could purchase meals for clinicians and They say they’ve been reevaluating other staff. Donors paid for respite rooms social fundraising events, such as galas where emotionally exhausted hospital and golf outings, to determine which ones staff could decompress. Some donors to still make sense to do, and how to do them Bon Secours Mercy Health facility foun- safely. Some foundations have resumed The Panda Express restaurant chain and the Panda Cares Foundation donated 100 lunches and 42,000 dations gave chairs for staff lounges. Mid- select in-person larger-scale events, with surgical and N95 masks to Providence St. Joseph Health facilities in Oregon. Here, general managers for west Industries, a maker of outdoor power infection protocols in place.

Panda Express stores in Portland, Oregon, deliver some of the items to Providence St. Vincent Medical equipment and a seller of all-terrain vehiAyres says virtual fundraisers have Center in Portland. cles gave a Mercy Health – Toledo, Ohio, met with limited success. The foundation staffs that reimagined the events instead of making old events virtual have been most successful.

From page 1

Foundations meet needs of clinicians, frontline staff T

raditionally, one function of health care foundations has been to provide resources to meet staff members’ needs, and that role has proved essential during the pandemic.

Ministry executives say foundations within their systems have helped to pay for and in some cases secure personal protective equipment for staff. The foundations also funded well-being resources for staff and provided monetary aid to employees in financial distress.

Trinity Health Mid-Atlantic’s foundation worked with the Independence Blue Cross Foundation and the NeuroFlow mental health software company to create wellness resources for clinicians. Aimed particularly to nurses, the app-based program allows clinicians to log their mood scores, make journal entries, assess their sleep patterns, and access wellness information.

Additionally, during the pandemic, Trinity Health built out an online platform for staff to apply for emergency assistance funds.

Bon Secours Mercy Health’s systemlevel foundation provided associate hardship funds to the system. That money went to staff who were furloughed in 2020 when inpatient counts fell and ambulatory care visits plummeted as hospitals scaled back the services they

The historic, December 2021 long-track tornado that struck Tennessee and Kentucky caused catastrophic damage including in this Princeton, Kentucky, neighborhood. Bon Secours Mercy Health has come to the aid of employees whose lives and property were significantly impacted. The system’s foundation has provided them with assistance with temporary housing and rebuilding costs.

offered to free up resources to focus on their COVID-19 response.

The foundation paid for child care and eldercare for staff who remained in the active workforce but who had new dependent-care expenses. Early in the pandemic especially, it was difficult and costly to find such care, particularly with many child care and eldercare facilities shut down because of the pandemic, says Tim Koder, president of the Bon Secours Mercy Health Foundations at Bon Secours Mercy Health.

The Bon Secours Mercy Health system foundation bought meals for workers, and in some cases paid for hotel rooms for frontline staff who feared exposing family members to COVID-19. It gave about $42 million for such support.

The foundation once again came to associates’ aid late last year when tornadoes destroyed some associates’ homes and other property in Kentucky.

—JULIE MINDA

‘Good investment’ The Bon Secours Mercy Health, CommonSpirit Health, Providence St. Joseph and Trinity Health executives say that gifts to their foundations have remained steady or have increased during the pandemic.

Najjar of CommonSpirit says foundations in that system had one of their best fundraising years ever in 2020, raised even more in 2021 and are on pace already to have a strong 2022. Najjar attributes the success to continued giving by faithful donors, combined with the infusion of funds from new donors.

Petonic says fundraising flattened a bit at Trinity Health foundations at the start of the pandemic amid economic uncertainty but then increased as established philanthropists returned to active giving. Koder of Bon Secours Mercy Health says giving in almost all categories increased during the pandemic. This includes grants to the foundations as well as planned, corporate and annual gifts.

And Kelley of Providence says that system’s foundations saw some of their best fundraising levels ever during the pandemic. “People saw us as a good investment” because of all that health care providers were doing during the pandemic, she says. jminda@chausa.org