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

Delirium and COVID-19 2 Ash Wednesday sans ashes 2 Dire conditions in Guatemala 3 PERIODICAL RATE PUBLICATION

FEBRUARY 1, 2021 VOLUME 37, NUMBER 2

Obstetrics ED is Ascension Wisconsin’s latest effort to address maternal crises By LISA EISENHAUER

One of the first patients at the new Obstetrics Emergency Department at Ascension St. Joseph hospital in Milwaukee was in drug withdrawal and having an

In the spotlight: Clinicians champion public health safeguards By LISA EISENHAUER

Until the COVID-19 pandemic hit, Dr. Bilal Naseer used his expertise as an infectious disease specialist and a critical care physician to treat his patients and advise his colleagues within the CommonSpirit Health system. In the months since the virus began to rage out of control, he has been sharing his knowledge on a much wider scale. On behalf of his health system, he has given interviews to local media and to major news organizations including the Los Angeles Times and The Wall Street Journal, fielding questions about why the virus is spreading and how best to control it. “I was a little bit reluctant, but once I spoke to one journalist, I realized that it actually is really good for the public and the journalists to hear directly from the doctors who are managing patients,” says Naseer, Continued on 7

Dr. Christopher Thomas, medical director of quality and patient safety at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, explains public health recommendations to slow the spread of COVID-19. His appearance on a local TV newscast in March was one of many interviews he’s given on the topic.

Systems supercharge employee programs to ease pandemic stress By LISA EISENHAUER

A sign points the way to the obstetrics emergency department at Ascension St. Joseph hospital in Milwaukee. The department opened in September.

acute mental health episode. She also was in labor; and, compounding the risk to herself and her baby, she had had no prenatal care. “The patient’s behavior was extremely difficult,” recalls Dr. Matthew Lee, who oversees obstetrics and gynecology statewide for Ascension Wisconsin and practices at Ascension St. Joseph. “She was in agony from both her mental health issues and her drug withdrawal.” She was, in fact, the sort of high-risk maternity patient Ascension leaders had in mind when they opened the OB-ED in early September in partnership with OB Hospitalist Group, a company that the health system has contracted with since 2012 for similar departments at its hospitals in New York, Oklahoma, Illinois, Continued on 4

Dr. Matthew Swartz, a hospitalist at Avera St. Mary’s Hospital in Pierre, South Dakota, takes a moment while caring for a patient with COVID-19 in October.

As the COVID-19 pandemic was easing its grip on parts of the country in midJanuary, many of the hospitals in the Providence St. Joseph Health system were experiencing their worst surge of the virus yet. Providence St. Joseph Health tapped frontline workers for extra shifts and moved staff between hospitals in response to patient loads. It contracted with outside clinicians to supplement and give some relief to weary staff. Greg Till, executive vice president and chief people officer for Providence St. Joseph Health, said the demand on the system’s staff has been staggering. “At the same time that we’re delivering vaccine to more people than we ever have before, we’re also caring for the highest percentage of COVID patients that we’ve seen and we’re also doing everything that we can to continue the routine care that we would

have delivered to folks that are having back pain, heart issues or other medical challenges,” he said. Despite the endurance challenge of the ongoing crisis, Till said a recent survey of caregivers did not find a significant spike in burnout or stress. In addition, turnover is at the lowest level in the seven years he has been with the system. “We think a lot of that has to do with how our leaders are caring for our caregivers, the benefits that we’re offering our caregivers and the availability of employee assistance program support,” he said.

Leadership, added benefits Providence St. Joseph Health leaders are joining staff on rounds to offer support and pitching in to administer vaccines to colleagues at some sites. Early in the pandemic, the system guaranteed pay for staff who were sidelined by the low patient volume when Continued on 6

Pandemic fuels domestic violence and makes aiding victims more challenging By MARY DELACH LEONARD

Domestic violence calls to police and crisis hotlines have risen during the pandemic, but it is impossible to know the full impact of shelterat-home orders and social distancing on victims who can’t escape dangerous situations, said Veronica Zietz Zietz, director of Catholic Health Initiatives’ North Dakota Violence Prevention Program.

“The pandemic has caused serious economic devastation and has disconnected people from resources and support,’’ Zietz said. “It has also created anxiety, stress and uncertainty. These risk factors can spark domestic violence in families where it wasn’t previously present and fuel violence in families that have a history of abuse.’’ The Council on Criminal Justice, a Washington-based nonprofit, found that domestic violence calls to police increased by 7.5% during March, April and May in 14 U.S. cities that had issued social distancing and shelter-in-place orders.

A clay sculpture modeled by a participant in a healthy relationship workshop for mothers of Head Start children. The women were asked to depict unhealthy and healthy relationships.

In North Dakota, some crisis hotlines are reporting a 30% increase in calls, Zietz said. Educating professionals and at-risk people about domestic violence has never been more important — or challenging. Professional training is now online, but as COVID-19 cases spiked in North Dakota, many health care providers have been too busy caring for COVID-19 patients to participate, Zietz said. “And we may not be reaching those who are most vulnerable because they’re living with their abuser and not allowed access to Continued on 8

CATHOLIC HEALTH WORLD February 1, 2021

Clinicians can prevent delirium with increased vigilance, says expert Warning signs can be missed as COVID caseloads rise By JULIE MINDA

COVID-19 outbreaks in many communities across the U.S. had meant spiking inpatient admissions for many hospitals and high caseloads at long-term care sites. The resulting strain on the labor force can increase the chances that patients with and without COVID will develop delirium, which is an acute and usually temporary state of confusion that has underlying, reversible causes. That is according to geriatric nursing expert Donna Fick. She has called for clinicians to be extra vigilant in watching for warning signs Fick of delirium during the pandemic. Fick is the Elouise Ross Eberly Endowed Professor at Penn State College of Nursing; director of its Center of Geriatric Nursing Excellence; and editor of the Journal of Gerontological Nursing. According to Fick, there is evidence that when COVID patient counts surge in hospitals and clinician focus necessarily shifts to lifesaving treatment for the sickest patients, some of the best practices to help prevent delirium can fall by the wayside. The findings are relevant when caseloads overtax staff at long-term care sites too, she said. She urges providers to watch for the warning signs of delirium, since the condition can have a highly detrimental impact on people’s short- and long-term health outcomes. Older patients are much more prone to delirium than younger patients, but patients of any age with any serious medical condition can suffer delirium.

Tough to spot In October Fick led a CHA webinar on the heightened risk for undiagnosed delirium during the pandemic. She told the audience that delirium comes on quickly. Poor attention, confused thinking, changes in physical functioning and sleepiness can be signs of delirium. In some cases, delirious people experience an altered state of consciousness. Sometimes, she said, when a patient has dementia, early symptoms of delirium can be easily overlooked or ascribed to dementia. Fick said some of the most common causes of delirium are medication side

effects, infections, dehydration, electrolyte imbalance, impaired oxygenation, severe pain and sleep deprivation. She said that if delirium is not prevented, or if it is not diagnosed and treated quickly, it can lead to complications such as falls, skin breakdown, immobility and death. Delirium’s direct health costs to patients may include functional decline, accelerated cognitive decline, stress, fear

comfort and communication, staff stress, use of protective gear that obscures faces and voices and minimized time with patients are all consequences of COVID restrictions and protocols at hospitals — and all can promote delirium, according to Inouye. Inouye wrote that hospital staff were so overwhelmed amid COVID surges that they felt they had no time to spare to calm

Geriatric nursing expert Donna Fick says clinicians should get to the root cause of delirium in individual hospital patients or nursing home residents. She used this slide during her CHA webinar on the heightened risk of delirium during the pandemic.

and falls. Delirium can raise the risk of imminent patient death and it is associated with an increase in long-term care admissions. The authors of a case study in the Institute for Healthcare Improvement’s “The Business Case for Becoming an Age-Friendly Health System” calculated a hospital’s average additional costs of care for a hospitalized patient who experienced delirium at more than $22,000. In a Nov. 16, 2011, article in the Journal of the American Geriatrics Society, researchers estimated that “the total direct one-year health care costs attributable to delirium range from $143 billion to $152 billion nationally.”

COVID-19 surges During her webinar, Fick cited “The Epidemic Within the Pandemic: Delirium,” an opinion piece by Dr. Sharon K. Inouye published in the May 10 edition of The New York Times. Inouye is a geriatrician at Hebrew SeniorLife in Boston, founder of the Hospital Elder Life Program and a Harvard Medical School professor. “If you could design a health care system that would generate delirium, you would design exactly the system we have with COVID-19,” Inouye wrote. Social isolation, deprivation of human

agitated seniors. Many resigned themselves to using strong sedatives and physical restraints to soothe patients. These practices, too, can worsen delirium. In the CHA webinar, Fick noted that a study of hospitalized COVID patients in Brazil had found that about one-third had delirium. She said that COVID has been linked to neurological disturbances in some cases and there could be some interplay between those COVID-related neurological disturbances and the development of delirium. A JAMA Network Open article posted on Nov. 19 found that 28% of patients who reported to an emergency department with COVID had delirium. The study’s authors wrote: “Mounting evidence supports the high occurrence of delirium and other neuropsychiatric manifestations with COVID-19.”

Vigilance Fick said the time-tested practices that help prevent delirium should be reemphasized now, particularly amid COVID surges in hospitals and nursing homes. Prevention begins with vigilance, said Fick, describing two assessment tools that have proven to be highly accurate when administered by frontline hospital staff. The “Two-Item Ultra-Brief Delirium

Screen,” or the UB-2, is a two-question test. If people miss either question on the UB-2, there may be reason to suspect delirium, and providers can administer the “Ultra-Brief Delirium Screen — Confusion Assessment Method” or UBCAM. Both can be administered verbally by a nursing assistant who has been trained to use the tools; each takes less than a minute to administer. Fick said if an older adult is positive for delirium, as determined by the UB-CAM, it is important to document it and use best practices for treating delirium, including by avoiding medications as possible, mobilizing the patient, looking for the cause of the delirium and finding out what makes the individual feel calm. Fick said addressing delirium involves removing or treating underlying causes, preventing or remediating complications, restoring cognitive and physical function and managing and understanding delirium behaviors. She said treatment should be rooted in the patient’s goals of care and recommended that those goals be determined in part by using the “4Ms” as described by the Age-Friendly Health System program. The 4Ms are: What Matters to the patient and the patient’s Mentation, Mobility and Medication needs. Upon evaluation, it often is possible to eliminate the use of medications known to put a patient at higher risk of delirium, or to reduce the dose or frequency, she said. To lower the risk of delirium, the patient should be mentally stimulated, including through conversation and mind exercises and activities. Mobility exercises should be part of every patient’s day, Fick said, to the extent the patient can move safely.

Advocacy Fick said that restrictions on visitation due to the COVID threat can be promoting delirium, and not just because isolation increases stress and disorientation and can have other negative impacts on cognitive ability. For instance, without visitors, patients have fewer advocates at the bedside to note behavioral changes, and this can leave patients more vulnerable to undetected delirium. In the summer and early fall, many hospitals and long-term care sites began to relax near-total prohibitions on visitors. But because of rising caseloads, many facilities have put restrictive visitor policies back in effect. Fick emphasized that delirium is a preventable condition — even amid a pandemic. jminda@chausa.org

Ash Wednesday without ashes? CHA offers resources for COVID-safe observances As mission departments in Catholic health care facilities are looking toward mid-February, they may be struggling to determine how best to mark the occasion of Ash Wednesday, a day when Catholics do penance as they ponder the certainty of death and the promise of Christ’s resurrection. Ash Wednesday, which this year falls on Feb. 17, opens the Lenten season of fasting and prayer. Many Catholics begin the contemplative journey by attending Mass and receiving an anointing with ashes to signify mortality. This year, with chapels at many hospital and long-term care facilities closed or with their Masses and observances significantly curtailed by pandemic-related restrictions, the mission departments of these facilities likely cannot mark Ash Wednesday in their traditional way. CHA has developed a collection of Ash Wednesday resources to help plan observances. The resources align with precautions for Ash Wednesday issued in mid-

January by the Vatican’s Congregation for Divine Worship and the Discipline of the Sacraments. The Vatican instructions say

that rather than addressing each person at a Mass individually with words of repentance and marking the sign of the cross on peo-

ple’s foreheads with ashes, priests should speak the words once to the congregation and then, after washing hands and putting on a face mask, sprinkle the ashes over congregants’ heads. CHA’s mission department created a service that includes readings, reflections and prayers for Ash Wednesday. It can be used in virtual or in-person services or emailed to patients and staff. A short CHA video symbolically replicating the application of ashes can be used as part of the prayer service or as a stand-alone devotion. Carrie Meyer McGrath, CHA director of mission services, was instrumental in creating the resources. She says, “Although we can’t mark Ash Wednesday in the usual way in this very unusual year, the faithful still want to acknowledge the powerful call to be prayerful as they embark on the season of Lent.” The resources are available at chausa. org/prayers/lent-reflections.

February 1, 2021 CATHOLIC HEALTH WORLD

Providence St. Joseph Health gift helps address basic human needs in Guatemala By LISA EISENHAUER

A gift from the St. Joseph Community Partnership Fund is helping the victims of what one aid worker calls the “neglected crisis” in Guatemala brought on by two hurricanes last fall. The fund makes strategic investments in the health and well-being of communities served by Renton, Washington-based Providence St. Joseph Health. The health system is also extending a partnership to assist the struggling nation. Category 4 hurricanes Eta and Iota left more than 200 dead when they blasted through Central America in November, according to news reports. They also caused a food and financial emergency for Guatemala’s 17 million citizens that is expected to last at least until September, according to the U.N. Office for the Coordination of Humanitarian Affairs. Medical Teams International is using a $50,000 donation from the St. Joseph Community Partnership Fund to meet the immediate needs of Guatemalans, thousands of whom lost homes, crops and livestock in the storms. The grant has helped fund 8,000 hygiene kits with items like shampoo, toothpaste and toilet paper for the hundreds living in shelters, and the building of latrines and stoves at those shelters. The devastation has been exacerbated by the COVID-19 pandemic, which has drawn much of the world’s attention and emergency resources this year, said Michael Chapman, director of global programs for Medical Teams International. “We’re looking at it as what we would call a neglected crisis, something that’s just not received the support and the attention that it really deserves,” he said. Gifts from the St. Joseph Community Partnership Fund and others have enabled the charity to provide emergency assistance and continue its long-running projects to improve the health of Guatemalans, Chapman added. Providence St. Joseph Health has been a partner in some of those projects since 2012. The health system most recently has provided volunteers and funding for com-

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The village of Campur was one of many in Guatemala that sustained major wind and flood damage from hurricanes Eta and Iota last fall. The food and financial emergency that the storms created for 17 million citizens is expected to last at least until September, according to the U.N. Office for the Coordination of Humanitarian Affairs.

munity health programs for mothers and children age 2 and under and for training of Guatemalan health workers on emergency obstetrics and integrated management of childhood illnesses. Joel Gilbertson, executive vice president

of community partnerships at Providence St. Joseph Health, said the system has coordinated and supported volunteer efforts in Guatemala for more than 700 of its associates. However, since the start of the pandemic, the system has halted associates’

Workers with Medical Teams International carry sacks of hygiene kits to a Guatemalan village inaccessible by road. A gift from the St. Joseph Community Partnership Fund helped cover the cost of the hurricane relief kits, which include items like shampoo and toothpaste.

international travel, so it isn’t providing direct manpower to help with the nation’s recovery. Still, the system wanted to continue to assist in a region where it has developed strong community ties. “The immediate thing we could do is to make sure that Medical Teams had the financial resources to go out and address basic human needs,” Gilbertson said. Providence St. Joseph Health plans to continue its pipeline of support to Guatemala, including resuming its volunteer program once the threat of the pandemic is over, Gilbertson said. “We have always had a belief that we have to stay engaged and we need to contribute to addressing global challenges,” he said. Chapman said that while the partnership Medical Teams International and Providence St. Joseph have forged is unique, the charity is open to other collaborations to advance its efforts to improve health in the poorest regions of the globe. Its website, medicalteams.org, has detailed information about its work. leisenhauer@chausa.org

Upcoming Events from The Catholic Health Association Sponsors and the Church, Local and Universal – Series One, Session Six Feb. 10 | 2 – 3:30 p.m. ET

Faith Community Nurse Networking Call Feb. 16 | 3 – 4 p.m. ET

Diversity & Disparities Networking Conference Call Feb. 17 | 1 – 2 p.m. ET

Virtual Meeting: Theology and Ethics Colloquium

Virtual Meeting: Sponsor Formation Program for Catholic Health Care – Session Three

Formation Leader Community Networking Call

March 4 – 5 (Invitation only)

March 10 | 11 a.m. – 6 p.m. ET (Invitation only)

March 11 | 1 – 2 p.m. ET

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

CATHOLIC HEALTH WORLD February 1, 2021

Obstretics ED From page 1

Indiana and Florida. OB Hospitalist Group is owned by the private equity firm Gryphon Investors. Founded in 2006, the firm had 145 hospital partnerships by 2018, according to its website. After the distressed mother delivered her baby at Ascension St. Joseph, the OB hospitalists turned her care over to clinicians at Ascension St. Joseph who could treat her mental illLee ness and substance dependency, Lee says.

Milwaukee’s first The OB-ED is the first of its kind in Milwaukee and the latest of several initiatives that Ascension Wisconsin is undertaking to address the disproportionately high incidences of infant and maternal morbidity and mortality among minority populations, especially those who are Black. According to data from the Centers for

Disease Control and Prevention, Wisconsin has the nation’s worst death rate for nonHispanic Black infants, at 15.58 per 1,000 live births in 2016. Nationwide the rate was about 12 per 1,000 live births. (In both cases the figures are much higher than the comparative ones for infants who are white.) The mortality numbers are also grim in Wisconsin for non-Hispanic Black mothers, who die due to childbirth-related complications at five times the rate of non-Hispanic white mothers. Ascension St. Joseph long has been known as a “baby hospital,” Lee says, because of the skill of its obstetrics department. The hospital is in north central Milwaukee in a ZIP code where census data identifies the population as 75% Black or African American and where the average annual household income is about $32,000 a year.

Exclusive focus The OB-ED is on the third floor of the hospital, right next to the obstetrics department and two floors up from the main ED. The OB-ED has four patient beds and is equipped

with technology to assess the health of both mother and fetus. It is staffed at all times by an obstetrician gynecologist with OB Hospitalist Group who works a 24-hour shift. “They have no duties other than seeing pregnant women who present there to the emergency department, or other emergencies that may happen within the labor and delivery sphere,” Lee says. The OB-ED specialists also pitch in when needed with noncomplicated births. The OB-ED is an example of the investment Ascension is making across its ministry to address maternal morbidity and mortality and reduce infant deaths, especially at its urban hospitals, Lee says. Ascension has added certified nurse midwives including one at Ascension St. Joseph last year to encourage healthy behaviors during pregnancy. It is hiring maternal health navigators to help pregnant patients access care and services, including programs that help with transportation, food and housing. “We’re really walking with these patients hand in hand and trying to help them overcome these barriers that they

have to access care,” Lee says.

Safer care, better access Just in Milwaukee, Ascension supports a program called Blanket of Love that works with expectant mothers from low-income areas of the city to promote good health practices for themselves and their infants before, during and after delivery. (See sidebar.) Julia Means, the founder of that program, sees the OB-ED as another way Ascension is backstopping a vulnerable population of women. Many of the young mothers she works with in Blanket of Love don’t have the knowledge or confidence to make their needs known to medical staff. She says the OB-ED, which has doctors trained to care for expectant mothers in highrisk situations, increases the prospect for better outcomes. “The fact that we have an OB-ED that is aware of our young ladies now, this is such a one-up,” she says. leisenhauer@chausa.org

Blanket of Love offers wraparound care to at-risk expectant mothers in Milwaukee

the older women are supposed to teach the younger women, and we do.” Salahadyn says she wishes she could have been part of Blanket of Love long ago. It might have prompted her to take better care of herself during her earlier pregnancies, prevented some of the health issues she deals with now and caused her to rethink some relationships that weren’t healthy. “But, listen, I’m grateful that they were there when they were,” Salahadyn says. “I think it matters the most for Zakkiyya Salahadyn, third adult from left, and other Blanket of Love mothers celebrate at a birthday party for their babies in me now.” October. Ascension Wisconsin sponsors the program, which offers assistance to dozens of teenagers and women each year The program has as one means to reduce infant mortality in the Milwaukee area. helped her manage her as proper prenatal care or what to expect Columbia St. Mary’s Women’s Hospital Milmental health and move on to a better during the first days, weeks and months of waukee, is Blanket of Love’s founder. She is life. She’s built a stable home for her famparenthood. Because of the pandemic, those so renowned in Milwaukee for her work with ily in the suburb of Waukesha and she’s meetings have moved online. expectant and new mothers that last year managing to juggle parenthood with two Mayor Tom Barrett proclaimed Oct. 22 as jobs and college classes. Little Rosemary Learning to pray “Julia Means Day.” Means is healthy, walking and learning to talk. Means says Blanket of Love is grounded serves on the city’s board Addressing infant mortality in Christianity and traditional family values. of health, advising officials Lasting connections Ascension Wisconsin sponsors the pro“The first thing that I teach the girls is, as a on policies and practices to Means calls the program’s pargram that enrolls dozens of teenagers and improve population health ticipants her “Blanket girls” and, like women each year as a means to reduce outcomes. Salahadyn, many have continued to come infant mortality in the Milwaukee area, Means says she started to meetings or reach out to staffers for with a special focus on Black residents. the program in 2004 after parenting support long after their babies Data compiled by the Milwaukee Health attending a conference are born. “That’s why we have kept going Department show that Black infants there Means convened by the Milwaukee Health Departwith the parenting program, because are three times more likely than white ment on how to address the city’s high infant they would not leave,” Means says. “Once infants to die before their first birthday. mortality rate among Black residents, despite they had the babies and the babies met The program uses an evidence-based not having any training as an obstetrics their first birthday, they still stayed conmodel to promote women’s and infant’s nected to us.” health before, during and after pregnancy nurse. She was so jarred by statistics shared at the conference, including that the rate of Means says many of the mothers and to improve the likelihood of good outdeaths for Black infants in the city was higher their families also stay involved with the comes. It is administered by a registered churches that came to their aid through nurse, social worker, community outreach than in some developing nations, she knew the Blanket of Love Sanctuaries program. coordinator and community health worker immediately that she wanted to act. The city department was about to join They join the choirs and Bible study who work with participants from pregIn this December 2019 photo, Zakkiyya Salahadyn a national effort to help expectant mothers groups and develop long-term nurturing nancy to their baby’s first birthday. holds her baby, Rosemary, then 4 months old. relationships with older members. Blanket of Love includes these services: considered to be at risk of poor outcomes. Support groups and networking Means says she and several of the volunteers While she can’t point to studies or she worked with through the parish nursing mother, you must learn how to pray. You are statistics to show that Blanket of Love opportunities. Case management of mothers and program were eager to join the effort, but going to be praying for the rest of your life for has lowered Milwaukee’s high infant this child. mortality rate, Means says that to her infants, including telephone consultations. they wanted it to be faith-based. That didn’t Personalized referrals to public and mesh well with the national program, Means “I do promote marriage. I promote knowledge all of the babies born to the normalcy of what a family is supposed to hundreds of mothers who have taken private community resources to help with says, so that’s when she came up with Blanket of Love. be, that this is your responsibility, God has part in the program have survived. She needs such as food and housing. Childbirth, safe sleep and breastfeedShe got training through the obstetrics blessed you with this child,” she says. also is unaware of any of the girls born to department at Ascension Columbia St. In its first years, most of the mothers-toher earliest Blanket girls becoming teening education classes. Mary’s Hospital Milwaukee and staffers there be in the program were in their middle teenage mothers themselves. Blanket of Love Sanctuaries, a parthelped her write a curriculum to guide young age years. These days, Means says most are “I don’t think or believe that it’s just nership between the program and 36 mothers through the self-care required for 19 or 20. Despite the participants being older, because of us. I believe that this prochurches and faith communities in the a healthy pregnancy. The program is now the problems that imperil their pregnancies gram is anointed and appointed by God, greater Milwaukee area, provides addioffered to women at 16 sites including hospiare just as complex. Many of the women and that God has covered our children tional resources such as meals, mentortals and churches in and around Milwaukee. are from low-income one-parent homes and because that is the prayer that we have,” ship and spiritual guidance to an estiPregnant women are referred by clinics and dealing with the effects of substance abuse she says. “We pray that our babies are mated 4,700 families annually. community groups. Normally, the expectand domestic violence. “Most of them don’t safe, and that they reach adulthood, and ant mothers meet in person weekly with come from stable homes and so they really be able to be excellent members of the Determined to help program staffers. They share a meal and then enjoy having older women near,” Means community.” Julia Means, a registered nurse with take part in group discussions on topics such says. “And I always say the Bible says that — LISA EISENHAUER the parish nursing program at Ascension t wasn’t until Zakkiyya Salahadyn was 39 and pregnant with her ninth child that she learned about Blanket of Love. She was at Ascension St. Joseph hospital in Milwaukee for prenatal care when she saw a flier for the program. “At that time, I was in recovery, having a history of addiction and mental health issues, and I was looking for a support group so that I could maintain a healthy pregnancy and continue to live a healthy life,” Salahadyn says. She called the number on the flier and was soon connected with a support group and a staff of experts who offered education on how to care for herself and her unborn child and tips on good parenting. They also made sure that she had access to prenatal care and healthy food. She credits the assistance and encouragement she got through the program for a healthy pregnancy that led to the uncomplicated birth of her healthy daughter, Rosemary, in August 2019. It also helped her get firmly established in a productive, addiction-free life that includes taking college-level courses toward her goal of becoming a social worker. “I really feel very strongly that I am in a very good place because of Blanket of Love,” she says.

February 1, 2021 CATHOLIC HEALTH WORLD

Ascension Saint Agnes promotes healthy feedings with musical pacifiers By JULIE MINDA

Whether because of health problems related to prematurity or congenital conditions, babies in the neonatal intensive care unit can struggle to get the nutrition and sleep they need to gain strength and to grow healthfully. To help NICU infants develop good feeding habits, and to calm them, Baltimore’s Ascension Saint Agnes is using musical pacifiers. These high-tech devices reward babies with soothing lullabies or other pleasing recorded sounds as they strengthen the sucking reflex that is key to effective eating. Deborah Christino, a nurse on the unit, said it is common for preterm babies to be intubated, and that sometimes causes them to have an oral aversion that interferes with usual development of sucking techniques. She said the pacifiers are helping preterm and other babies who are having trouble with feedings to develop more endurance in sucking, and this helps them ingest more nutrition. Babies suck to self-soothe, too. Kathy Goad, nurse manager of maternal child health and the Ascension Saint Agnes NICU, said, “When the babies are more calm, they have more of an energy reserve, which means that they can have more food intake, more weight gain, and more successful weaning” in the case of babies born dependent on drugs. “They then can go home sooner and also have a lower chance of readmission.” She said that when babies are less agitated and better fed, they also are better able to bond with their parents.

Rewarding progress Goad said she came across the musical pacifier idea in research literature several years ago. Developed around 2012 by researchers at Florida State University and manufactured by Powers Medical Devices, the Pacifier-Activated Lullaby device plays a lullaby or other selected sound when a baby sucks on it properly. A probe inserted in the pacifier measures the quality of the suck. Goad explained that there are good sucks that are strong and effective for bottle and breastfeeding and ineffective sucks that are weak and inefficient for drawing nutrition. The probe connects by wires to a machine that can be programmed to reward the baby for a less powerful suck then adjusted upward to motivate progress in the baby’s technique and sucking strength. The machine comes with a selection of lullabies, and parents can record their own music choices, or their voices, to be used as rewards for their baby’s sucking. The hospital’s foundation raised funds to buy the pacifier system principally through a Giving Tuesday social media pitch in 2018. The campaign push brought in $13,740, 94% of the funds needed to purchase the devices, and the foundation kicked in the remaining $915. (The drive was so successful that the philanthropy council of Ascension Saint Agnes’ parent company Ascension gave the foundation an additional $1,000 toward the pacifier program and $1,000 to the foundation for staff development.) The Ascension Saint Agnes NICU used the money to purchase five machines and 10 reusable probes that stay at the hospital. The individual pacifiers that attach to the probes go home with baby. The pacifiers can still play music, but cannot be programmed with custom music and sounds, nor can they be adjusted for different reward thresholds. Initial success The NICU began using the musical pacifiers in August 2019, and Goad is conducting research to measure their effectiveness. Goad said she is hopeful the pacifiers will benefit the growing number of NICU

patients with neonatal abstinence syndrome. These babies were exposed to illicit drugs in the womb and must be weaned off the drugs in the NICU before they can be discharged. Goad said babies with this syndrome often are prone to frantic, high-pitch crying and chaotic sucking that wears them down to the point that they cannot feed successfully. She believes the pacifiers will be an important tool in soothing these babies, promoting their healthy feeding and improving their scores on a developmental test that is used to determine readiness for discharge. Goad added that clinicians try to limit their use of pharmaceuticals with babies, when possible, and so this non-pharmacological intervention is a welcomed tool. She noted that the staff also will use the musical pacifiers to help parents learn about healthy feedings. The bonding that can result as parents learn to calm their babies is vital, Goad said, “especially for families who may not have good coping skills. This can help them to navigate” ways to nurture their babies’ development. jminda@chausa.org

Powers Medical Devices

Devices help improve babies’ nutrition, sleep

A neonate suckles a Pacifier-Activated Lullaby device that rewards healthy sucking with pleasant sounds.

Feb. 11 is World Day of the Sick

Illness lays bare our human vulnerabilities, which is the exact place God meets us. Let us pray for God’s healing presence in all the world’s ailments. For the sick and those impacted by coronavirus, For those who share in the sufferings of the sick, For those bound by injustice, For our fragile environment, For our own hard-heartedness, God of wholeness and hope, heal your people.

AMEN.

CATHOLIC HEALTH WORLD February 1, 2021

Support for employees From page 1

nonessential care was paused for weeks. It covered the cost of day care for caregivers’ children whose day cares or schools had closed. It also gave two weeks of emergency paid time off to staff who needed it. Till said the system, which has facilities in seven western states, also has supercharged its EAP Till offerings. For example, it has set up virtual “behavioral health concierges” that workers can use to schedule free tele-visits for financial, emotional and spiritual support. And the system has launched a campaign called No One Cares Alone that teaches caregivers how to spot stress and strain in their colleagues and respond with empathy. “Just like our caregivers are doing a fullcourt press to take care of everybody in our communities, we’re doing a full-court press to take care of them,” Till said.

Building trust Dr. Richard Vath is president and chief executive of Baton Rouge, Louisiana-based Francis- Workers at a Providence St. Joseph Health ministry mug for laughs as they show their gratitude to the community for its support during COVID-19. can Missionaries of Our Lady Health System. Vath Lori Popkes, the Avera solid foundation for resilience.” CHA well-being resources said FMOLHS has taken McKennan chief nursing Popkes said the staff’s spirits have been CHA has compiled a collection of many steps to ease the officer, said staff are grate- lifted by the rollout of COVID vaccines. resources on employee well-being includburden the pandemic has ful for that simple kind- “When the first vaccines started, I walked ing prayers of gratitude, reflections and put on staff. ness. It comes on top of a over to the place where they were giving guided meditation. Find them at chausa. Vath The system created a comprehensive assistance them (to staff) and it was like you could feel org/well-being. multidisciplinary task force at the start of program for Avera Health the hope in the air,” she said. the pandemic to set standard policies, clinicare providers that also By mid-January, the hospital was well Popkes cal protocols and visitation rules. The con- human resources officer, said in midincludes free counseling into its second round of vaccinations for sistency that engendered built confidence. January that CHRISTUS had brought in out- and well-being resources. Avera McKen- frontline staff and Popkes said the process “The staff felt comfortable that the people side clinicians to help staff for the patient nan created a buddy system to pair up co- was going smoothly. She expressed optitelling them what to do were people that surge. A state regional advisory council is workers to talk through their stress, it sta- mism that the worst of the crisis might be they trusted,” Vath said. providing additional nursing staff. The sys- tioned a deejay in a lobby to lighten the over, at least for South Dakota. Having systemwide policies also has tem also has relied on its staff to work extra mood, and it handed out gift cards and Avera’s assistance to workers scarred by made it easier to shift staff among facilities, shifts. “We have some associates who have thank you notes to frontline workers cour- the ordeal of the pandemic will continue. because no new training is required, and it delayed their scheduled vacations and cho- tesy of a hospital contractor. Popkes said plans are taking shape to set up has taken some of the burden off of manag- sen not to take days off throughout the pan“I think it’s been very good in that there a “stress hotline” with trained counselors at ers to make decisions on demic,” Webb said. has been support from leadership and the the ready to offer support to frontline staffthings like care practices “Just like our caregivers With that in mind, organization as a whole, support to one ers who, like soldiers returning home from and use of supplies. system leaders decided another as team members and then there’s battle, have lingering trauma. are doing a full-court Vath said FMOLHS in December to change been this tremendous community suphas taken steps to ease the policy for paid time port,” Popkes said. “That has built a really leisenhauer@chausa.org press to take care stress by letting staff off. The revision allows of everybody in our take paid time off that workers to carry time off they hadn’t yet earned hours over for up to one communities, we’re and then later waiving year. payback requirements. CHRISTUS ramped doing a full-court press The system has paid out up its assistance proto take care of them.” grams to ease the strain resilience bonuses to n early 2019, Maggie Jones noticed the stress that workers at CHRISTUS Santa Rosa frontline care providers on workers. One new — Greg Till Health System hospitals were under and suggested to senior mission leaders the idea and added in pay differbenefit offered through of hiring a chaplain dedicated exclusively to associate care. entials for those who have worked during a partnership with a company called Bright Jones, regional director of spiritual care, got approval for a chaplain COVID surges and accepted irregular shifts. Horizons provides backup childcare for devoted to addressing workers’ spiritual needs for 20 hours a week The system’s pastoral care team staffs when a school or day care suddenly closes for one hospital in San Antonio, where the regional system is based. a spiritual support hotline that’s available as well as discounts for childcare and tutorThe go-ahead came with the understanding that the initiative would 24/7 to all 17,400 FMOLHS employees. ing services. be on a trial basis for 18 months. For managers, Vath restarted semiStaff can check in online with counselors When the COVID-19 pandemic began its sweep a year later, the regular meetings that had been conducted as well as attend 30-minute virtual classes program already was so popular that the president of the hospital two or three times a year to provide encour- on mindfulness and how to manage stress. agreed that it was a needed ministry. By last summer, the chaplain’s agement and a backstop. The meetings The system created a well-being guide for shifts had been expanded to 15 hours a week at each of two hospitals. Jones In addition, the system last year added a slot for a second-year graduwere paused early in the pandemic. The leaders that lists resources and offers tips for ate student in clinical pastoral education to offer spiritual care to staff at The Children’s group has reconvened virtually for now. how they can build resilience in their teams. Hospital of San Antonio and a part-time chaplain for associate care at CHRISTUS Santa “We don’t focus on the issues that they’re “We’re just really trying to meet associRosa Hospital – New Braunfels, in that Texas city. dealing with as much as we deal with lead- ates where they are,” Webb said. “Maybe “They stay busy during their whole shifts,” Jones said of all the chaplains concenership and talking about resilience and how they don’t have as much time as they did trating on the well-being of CHRISTUS associates. we can support them,” Vath said. before, so we’re making it really easy for She said the chaplains are trained listeners. “We are not advice givers. We don’t try As Catholic Health World went to press, them to have access to emotional support.” to fix a person’s problems. We simply are there to listen and to share the burden.” FMOLHS planned to survey staff in late JanAll of the spiritual care providers for associates spread their hours across day, night uary to assess whether the incentives and ‘You’re awesome!’ and weekend shifts to be available in person to as many staff members as possible. support go far enough, given the grinding Last year, as the demand to care for And Jones encourages them to be creative in how they reach out to associates. One of demands of the pandemic and sacrifices patients with COVID was pushing Avera the chaplains has taken that to heart by crafting a lantern that she carries with her as she makes her rounds. The lantern fashioned with LED lights is a homage to Florence they have made. “While everyone is suffer- McKennan Hospital and University Health Nightingale who carried a lantern while visiting her charges. ing so much, we really want to get a handle Center beyond its normal limits, human Jones gives the chaplaincy program for associates partial credit for reducing nursing on how we might be able to help them,” resources staffers began wheeling a “sunturnover to 20% from 30% at one of the hospitals. Having a group of chaplains focused Vath said. shine cart” stocked with stress balls, water on spiritual care of associates frees other chaplains to concentrate on ministering to bottles, insulated cups, granola bars and patients. Stress test stickers with messages like “You’re aweIn addition to making regular rounds in the nursing units to meet with workers, CHRISTUS Health sys- some!” Workers at the Sioux Falls, South the associate-care chaplains leave cards and notes about how to reach them in break tem has hospitals in Texas, Dakota, hospital who had been putting in rooms and at nurse’s stations. Jones said that while the requests for spiritual care are Louisiana, New Mexico weeks of mandatory overtime help themheaviest among the nursing staff, the chaplains are also available for physicians, respiand Arkansas, all pan- selves to snacks and a conversational break. ratory therapists, security and housekeeping staff. demic hotspots at the start Often, hospital leaders tag along. “How “We’re here for everyone,” she said of the associate-care chaplains. “We’re trying to Webb make that known.” of the new year. are you doing?” and “What else do you — LISA EISENHAUER Kimberly King Webb, the system’s chief need?” the managers inquire.

CHRISTUS Santa Rosa has chaplains dedicated exclusively to care of associates I

February 1, 2021 CATHOLIC HEALTH WORLD

Trusted news source From page 1

who is based at Mercy San Juan Medical Center in suburban Sacramento, California. Naseer is among many care providers from Catholic health systems who are stepping in front of news cameras and answering queries from reporters in hopes of helping the public better understand Naseer and respond to the threat posed by the pandemic.

Myth busting Ken Nelson, chief nursing officer for HSHS St. Vincent Hospital and HSHS St. Mary’s Hospital Medical Center, both in Green Bay, Wisconsin, is a veteran of the media spotlight. He talks to reporters fairly regularly during flu season about Nelson the danger of the viral scourge and the importance of getting a vaccine annually. In the last year, demand from news organizations for his time and knowledge has spiked. He’s talked about COVID and its seesawing impact on his hospitals with reporters from local and statewide TV stations and newspapers and he was featured in a film clip shown on ABC’s “Good Morning America.” He makes it a point to bring up the trauma that the pandemic is wreaking upon patients and their families and on health care workers. “As part of being a nurse and being in health care, I believe that we really need to make sure that the public is aware of what’s going on, what could happen,” and the truth and falsehoods behind popular health beliefs, myths and urban legends, Nelson says. Gratitude and prayers Another motivation for his making himself available for news interviews is to pull the discussion away from the political realm, where advice about how to respond to COVID has not always been sciencebased. He wants the public to be aware that their own behavior affects the virus’s spread.

Dr. Aamina Akhtar gets the second dose of her COVID-19 vaccine in January. As an infectious disease specialist, chief medical officer at Mercy Hospital South in suburban St. Louis and a woman of color, Akhtar welcomes news coverage to set an example that the vaccine is safe. She is seen here in a Mercy video.

“Honestly, COVID-19 is not a political problem or issue. It’s not even necessarily a health care problem or issue. It’s a community issue. It’s a community problem,” he says. “It’s really going to take the community, working together, to help to solve it.” Nelson says he knows that his words are reaching a wide audience because of the feedback he gets. That feedback comes in many forms, including personal emails, reader comments posted to news stories in which he is quoted, and letters sent to the two Hospital Sisters Health System hospitals where he works. “I’ve received letters from all over the country, believe it or not, from people who have heard our story, and have just reached out with offering prayers, offering gratitude, people that don’t have any ties to this community,” he says. “I was very surprised that that happened.”

Pandemic point person Dr. Christopher Thomas is also something of an old hand at fielding media inquiries. As medical director of quality and patient safety at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, and a specialist in critical care, he’s been tapped by the hospital’s Thomas communications team many times to talk to reporters on medical topics. His expertise has never been in as much demand as it has been since the rise of COVID and especially since Loui-

siana became one of the pandemic’s early hotspots in March. At one point, he and his colleagues were taking turns making appearances on a local TV station several times a day to keep the public in the loop about the extent of the emergency. He’s talked to The Washington Post and The Wall Street Journal about the strain the pandemic has put on his hospital and he’s stood beside Gov. John Bel Edwards at a press conference urging public vigilance to keep the virus from spreading. Thomas has shared his insight about the evolving pandemic with staff and the community in internal and social media postings and in his news media appearances. He has been one of three point people within the medical center writing dynamic guidelines for pandemic response based on patient load, community incidence and reports from medical journals and information from the Centers for Disease Control and Prevention and other health agencies. Thomas says he has at times felt the same frustration that other medical professionals have expressed over the absence of a unified message about the pandemic from public officials. His hope is that his postings and appearances have helped present the medical community’s best advice and set an example for why medical and scientific advice should be the guide during any similar crises in the future. “I would like to see the public say, ‘If it’s a public health issue, I want to hear from the health professionals to tell us what to do,’” Thomas says. And then he would like the government to take its cues on how it responds from medical experts.

Mercy Medical of Canton, Ohio, to join Cleveland Clinic The 476-bed Mercy Medical Center of Canton, Ohio, will become part of the Cleveland Clinic health system under an agreement that was expected to close by Feb. 1. Under the arrangement, which is called a member substitution, the medical center’s current parent, Sisters of Charity Health System of Cleveland, will transfer its membership interest in Mercy Medical Center to the Cleveland Clinic Foundation, which is connected with the nonprofit multispecialty academic medical center. The Sisters of Charity of St. Augustine will continue to sponsor Mercy Medical Center through CSA Health System Ministries, which is the Sisters of Charity Health System’s public juridic person. Mercy Medical will maintain its Catholic identity and will continue to adhere to the Ethical and Religious Directives for Catholic Health Care Services. The Sisters of Charity Health System and Cleveland Clinic had announced the deal in September 2019. The organizations currently are not disclosing financial details of their definitive agreement. Sisters of Charity Health System said proceeds from the transaction will be used to further the mission and ministries of the Sisters of Charity of St. Augustine. The Vatican and the Catholic Diocese of Youngstown, Ohio, have approved the agreement, and the waiting periods required by antitrust regulations were

Mercy Medical Center of Canton, Ohio.

expected to allow for a closing by Feb. 1. Mercy Medical Center will be the second Catholic hospital to become part of Cleveland Clinic. The first was Marymount Hospital in Garfield Heights, Ohio. Mercy Medical has 2,700 employees. The transfer to Cleveland Clinic also will include Mercy Medical’s 10 outpatient health centers. Cleveland Clinic has a main campus near downtown Cleveland as well as 18 hospitals and more than 220 outpatient facilities in Ohio, Florida, Nevada and in Canada, the United Arab Emirates and England. Canton is about 60 miles southeast of Cleveland. One of Cleveland Clinic’s hospitals — Union Hospital of Dover, Ohio — is within 25 miles of Mercy Medical. Sr. Judith Ann Karam, CSA, is congregational leader of the Sisters of Charity of

St. Augustine. She said that the Sisters of Charity Health System had been considering many types of partners and partnerships as a way to expand and grow Mercy Medical’s services. “The Cleveland Sr. Karam Clinic emerged as the top choice” and the systems signed a letter of intent in September 2019. Sr. Karam said that capital investment from Cleveland Clinic will allow Mercy Medical to further its reach “and continue to provide the highquality, low-cost health care it is known for in the communities it serves.” Thomas J. Strauss, president and chief executive of Sisters of Charity Health System, said the Cleveland Clinic was attracted to Mercy in part Strauss because of Mercy’s strong clinical programs and staff. With the transfer of Mercy, Sisters of Charity Health System will continue to solely own one hospital, St. Vincent Charity Medical Center of Cleveland, as well as two skilled nursing and assisted living campuses, three grantmaking foundations and six health and human services organizations.

Who better to lead? Dr. Aamina Akhtar, an infectious disease specialist, was relatively new to her job as chief medical officer at Mercy Hospital South in suburban St. Louis, when the pandemic began to ravage the globe. “Within the first six to seven months Akhtar of my new leadership role, here comes a crisis,” she says, adding her appointment was serendipitous. “Who’s better prepared to help lead through some of this” than an infectious disease specialist? She’s sharing knowledge and best practices regarding COVID across the Mercy system through email, Webex and other internal platforms. Even as the pandemic has stretched her hospital to crisis capacity, she has routinely granted interviews to local media to discuss the steps the hospital is taking to address the emergency and to urge the public to adhere to basic precautions like masking and social distancing to avoid contracting or spreading the virus. While she is willing to have a high profile in the pandemic in order to share her medical knowledge, Akhtar says the fact that she is a person of color is also a motivating factor. She thinks that people are more accepting of medical advice if it comes from professionals who share their gender and race. “I think what’s important is when we deliver messages to the community, whether it’s about health care or anything, people want to be able to relate,” says Akhtar, who emigrated from Pakistan with her family as a child. “And so, I think by bringing in diversity, that is an additional asset.” As the pandemic dragged on in late 2020, Akhtar was eager to get a COVID vaccine so she could set an example both at the hospital and in the community for anyone worried about the vaccines’ safety, of which she is confident. “Anytime we are speaking about medical issues and we have patients or family members or co-workers who have concerns about a process, whether it’s the vaccine or mask wearing, I think we have to be compassionate to understand that their questions and concerns are always legitimate,” she says. “We have to be able to find the right means to answer those questions honestly and continue to be an advocate for what keeps our patients and our community safe.”

KEEPING UP

McKelleb

Lambert

PRESIDENT

Dr. Todd Strumwasser has assumed responsibilities for additional hospitals as president of the newly expanded Northern California Division of CommonSpirit Health. There are 13 Dignity Health hospitals and ancillary facilities in that division, including four hospitals in the San Francisco Bay area, three hospitals in the North State; and as of Jan. 3, six hospitals in the Sacramento area. Dignity Health merged with Catholic Health Initiatives in 2019 to form CommonSpirit.

ADMINISTRATIVE CHANGES

CommonSpirit Health of Chicago and a facility within that system have made these changes: Dr. Thomas McGinn to system executive vice president of physician enterprise. Jalyn McKelleb to chief nursing executive officer for Dignity Health – St. Rose Dominican San Martín Campus in Las Vegas. Kristen Lambert to system vice president of risk management and system privacy officer, for Covenant Health of Tewksbury, Massachusetts.

CATHOLIC HEALTH WORLD February 1, 2021

Domestic violence

“One of our trainers provided a community outreach workshop to her local ministerial association,’’ Zietz said. “A pastor was so moved she dedicated her Sunday service to intimate partner violence so that everyone could learn how to get help — and know that her church was a safe place for people experiencing violence.’’

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a computer,’’ she said. “Or they’re worried about their safety if an abusive partner finds out they’re participating in a class or trying to reach out for help.”

A crisis situation made more dire Even in normal times, incidents of intimate partner violence occur at an alarming rate in the United States. One in three women and one in four men have at some point experienced rape, physical violence or stalking by an intimate partner, according to the Centers for Disease Control and Prevention. In 2019, 6,330 incidents of domestic violence were reported to North Dakota crisis intervention centers, according to the state’s Council on Abused Women’s Services. Ninety percent of victims were women; 24% were under the age of 25. At least 4,999 children were directly impacted. CHI St. Alexius Health started the North Dakota Violence Prevention Program in 2015 in response to rising cases of domestic violence in the state. The program serves eight communities in central and western North Dakota. The program is based in Bismarck. While intimate partner violence is a problem everywhere, it can often go unreported in rural communities where there is a lack of services and resources, Zietz said. The victim has no place to go.

Focusing on healthy relationships Key to curbing future violence is teaching people, especially young people, about healthy relationships, said Jeannie Nasers, a social worker who serves as a trainer for the program. “They are at such a vulnerable time in their life, but they also are so receptive, and hopefully they can receive the information before they end up in a harmful relationThe North Dakota Violence Prevention Program partnered with a domestic violence shelter in Lisbon on a ship,’’ Nasers said. citywide public art project to raise awareness. Each pair of shoes represents a victim of domestic violence Healthy relationship workshops can in the community. be tailored to the participants, whether they are students, church and community Safe place related professions. Most of those trainings groups, at-risk clients in domestic violence “People are sometimes shocked by the were held in person before the COVID-19 shelters or men and women in the correcstatistics,’’ Zietz said. “I’ve had health pro- outbreak forced the switch to virtual work- tional system, she said. fessionals come up to me after a presenta- shops. The program’s community outreach Nasers recalled a memorable experition and say, ‘I never really thought about workshops have trained 3,209 profession- ence while teaching inmates at a correchow I would respond if somebody said they als since 2016. tional facility who had volunteered for the weren’t safe at home.’” “Basically, we are a ‘train the trainer’ training. In FY 2020, which ended on June 30, the program,’’ Zietz said. “We work with local “I could tell when I was giving them the program’s community outreach leaders people to be our boots on the ground. We information that it was brand new to them,’’ held 26 workshops attended by 461 pro- train them, and then they share with others she said. “No one had ever talked to them fessionals working in health care, ambu- in their community.’’ about healthy relationships and the approlance services, social services and educaThe program also taps into existing priate way to communicate with a partner.’’ tion, along with college students entering community networks, including churches. People who have attended the workshops frequently describe them as eye-opening. “I knew I was in a relationship that was abusive but did not realize that it was that bad,’’ wrote one participant. “The things I thought were nothing, weren’t nothing.”

To celebrate the 5th Anniversary of CHA’s Guiding Principles for Conducting Global Health Activities, CHA HAS TWO NEW RESOURCES!

A 5th Anniversary Edition of the Guiding Principles INCLUDES A MODERN DAY PARABLE ON PANDEMIC

An essay collection to help us rethink, reset and reengage in global health activities! Among the many influential voices in global health, authors include Cardinal Peter Kodwo Appiah Turkson, Prefect of the Dicastery for Promoting Integral Human Development, and Andrew S. Natsios, former Administrator of the U.S. Agency for International Development.

ACCESS THEM AT CHAUSA.ORG/GLOBALHEALTH

Pandemic workarounds Although virtual sessions might be the only option during a pandemic, Zietz has found them less effective for nonprofessional participants than in-person training. “One of the benefits of this programming is that it builds connections and support,’’ she said. “I don’t think this happens in the same way virtually.’’ The pandemic has prompted creative thinking for reaching people. The program has partnered with hospitals to share social media messages about resources and ways to manage stress. And it has worked with a food pantry to distribute treat kits for kids that include information on domestic violence. “We always have to be very careful so that victims aren’t jeopardizing themselves by bringing the information into their homes,’’ Zietz said. “But if it’s in pamphlets that come with your pick-up from the food pantry, it’s not singling somebody out.’’ The CHI Mission and Ministry Fund supports the program as part of the United Against Violence campaign, which was launched systemwide in 2008. Since CHI and Dignity Health came together in the 2019 merger that created CommonSpirit Health, the two organizations have continued their commitment to addressing violence as a Krausa public health crisis, said Laura Krausa, system director of advocacy programs at CommonSpirit. The missions of CHI’s violence prevention initiative and Dignity Health’s human trafficking response program are now aligned under CommonSpirit’s Violence and Human Trafficking Prevention and Response Program. A strength of the North Dakota program is that it is community-based and takes a holistic approach to preventing violence that could be replicated elsewhere, Krausa said. “We don’t always have to recreate the wheel,” she said. “It’s going to look different in every community, but the framework and expertise can be leveraged well.’’