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Caring for Healthcare Professionals: Strategies From the Field

April 13, 2020

From Stephanie Sundborg, PhD, Director of Research and Evaluation , Trauma Informed Oregon

Dr. Joan Fleishman, Behavioral Health Clinical Director for Family Medicine at Oregon Health & Science University (OHSU), talks with Trauma Informed Oregon’s Stephanie Sundborg about some of the strategies they are using at OHSU to care for the mental health and wellness of healthcare professionals. During a period of heightened response or crisis it’s important to focus on basic needs, resources, and mental health supports.

This video is 18:25 minutes.

Stephanie: Hello. I want to offer you a warm welcome and thank you for tuning into this vlog about caring for healthcare professionals. Today I have the distinct privilege to talk with one of Trauma Informed Oregon’s dear friends and colleague, Dr. Joan Fleishman. Joan is the Behavioral Health Clinical Director for Family Medicine at Oregon Health and Science University. She is an expert in trauma informed care and holds particular wisdom about trauma informed approaches in healthcare settings. In response to the COVID-19 crisis, Joan and her colleagues at OHSU have implemented strategies to care for the mental health and wellness of the frontline healthcare professionals. Joan has graciously agreed to talk with me today about some of the needs they are seeing, and the strategies they’re using to address those. Welcome, Joan, and thank you so much for being here. 

Joan: Thank you, Stephanie, and thank you for having me. 

Stephanie: Absolutely. So, to start out, I thought maybe you could say a bit more about your role at OHSU, and what your role looks like now due to COVID-19. 

Joan: Sure, so I am the Behavioral Health Clinical Director for the Department of Family Medicine at Oregon Health and Science University. What that means is I lead a team of 24 mental health professionals who are imbedded into our primary care clinics across the Portland Metro area and work in the primary care behavioral health model. And our work has, has pivoted a little bit during COVID. And I would say my work certainly has pivoted as a leader, leader of this team, but also as a, as a mental health and behavioral health leader in a very large institution that is trying to meet the wellness needs of not just our medical providers, but our entire staff. We have seventeen thousand, seventeen thousand employees across Oregon. And we’ve come together as a group of 13 people to form a wellness task force to try to meet these needs in this time of a pandemic here in Oregon. 

Stephanie: Wow. So, when you think about mental health and wellness for the staff, what types of things are you considering? 

Joan: So, I think we’re thinking about, first and foremost, meeting people’s basic needs, right? So, making sure that they are feeling safe, making sure that their biological needs are being met. And then we kind of start thinking about what are other resources that people need during this time, especially if they’re being called to work more hours or different hours, or as you all know, many, our entire school system is closed for the entire month of April and now looks like going into May. So now we have our kids at home. Our partners are working at home. We have households that are really disrupted. And so, we’re looking at other resources like childcare, transportation, laundry, those kind of things for our staff, as well as kind of the psychological and mental health needs that this is bringing up for people, and how do we meet those? What do we already have in place? And what do we need to put in place to meet our staffs needs around mental health? 

Stephanie: Wow, that’s really comprehensive. So, you mentioned several different areas of need and maybe we can talk about them individually a little bit. So, when you talk about basic needs, or essential needs, what specifically are you talking about? 

Joan: So basic needs, I’m really, really thinking about helping people, basically making sure people have food accessible to them, so that their blood sugar doesn’t get too low. We know that our thinking is much affected by low blood sugar, and also when our blood sugar is low, we see the production of cortisol and all of the stress response hormones as well. So, we really want to keep people in a regulated state. And there’s enough other stuff going on right now that put us in a dis-regulated state, an over taxing of our nervous system. So, we’re thinking healthy foods, not sugary foods. Not soda and chips and popcorn and cookies. So healthy foods. We’re thinking filtered water. You know, some people need to walk downstairs to another floor to fill their water bottles. So how can we allow for an efficient way for people to have water throughout the day? We’re thinking about, just as safety, so one of the things that’s come up a lot is around PPE. So, one of the things that we’ve been very clear about, which is part of our basic needs I think, is the timely and regular communication around our PPE sources and supply. And then Stephanie, were there other basic needs that you were thinking about? 

Stephanie: No. Actually, you’ve really covered them. I’m wondering what you mean though about the PPE and the supply. Can you say a little bit more about that? 

Joan: Yeah, I think what I’m actually talking about is the communication. So, the basic need is to feel safe and that someone has, has your back. And so, I think this message is really to leadership around how do you create regular pathways of communication that is predictable and reliable for accurate information to be disseminated to your staff. And that is kind of what I’m thinking about when I’m thinking about meeting basic needs with the information around PPE. So even though some of the information we had to share initially was alarming and quite, quite scary that we might have not had enough PPE. Now it looks like we will be ok, thank you to some generous donations from the community. That we, that we needed to share that information, even though it was uncomfortable. Because the lack of information itself can be, can be an activating factor for people. Does that make sense? 

Stephanie: Sure. Yeah, absolutely. What about resources? So, you talked about resources as well. What are some of the things that you’re thinking about in terms of that? 

Joan: Yeah, and I’m just going to, I’m just looking over here at some slides that I had made to just remind myself, you know, I think one of the things that we’ve thought about is what kind of support do people need outside of their workplace right now? So, do they need someone to go grocery shopping for them? Do they need someone to pick up a prescription at a pharmacy, or run an errand to drop off something at the post office? So thinking about creating a helping hands network of volunteers who you could match up to meet those, those needs. And just looking over here at my slide here, I also think about kind of is there an opportunity to help 

them with transportation? Perhaps they’re a one family, one car household. And they are used to riding public transit to get to work, but that’s not recommended right now. So, can you provide them taxi fare or ride sharing reimbursement? So those kinds of things I’m thinking about. And then one other intervention that we’ve put in place in our critical units in our hospital has been these wellness kits. And inside the wellness kit are all different kinds of tools to help down-regulate, so really regulate your nervous system. And all different items in that box and then people clean them off, of course, and sanitize them after use. 

Stephanie: Yeah. I’ve heard you refer to those as “what do I need most right now” kits, which I think is great because a lot of the items that I’ve seen are in those kits are really things that will help in the moment, like you said, to just stay regulated and maintain kind of some presence. The other thing that I’m thinking about when I hear you talk about resources, is how interesting it is to think about, so the basic needs are tapping into our survival mechanism, right? And our need to survive. And that some of the resources you’re talking about, like childcare or transportation, are really access issues that allow us to maintain whatever it is we’re doing in order to meet our basic needs. So, to be able to continue coming to work and continue earning some income so that we can buy food and have some of those basic needs met. It’s really interesting to think how that all kind of ties together. 

Joan: And I think, you know, one thing I didn’t mention was just we’re thinking through as a medical system, how to provide housing or living accommodations for staff who don’t feel comfortable going home after working in the hospital and fear of exposure to their families. And that goes back to safety and goes back to feeling like they’re being put in this situation by the nature of their employment. And so, I think those two things you’re really talking about, the basic needs and resources kind of coming together. And they support one another. And those two things for sure are symbiotic in a lot of ways. 

Stephanie: Yeah, that’s really great to understand. The third thing you talked about is the mental health support. Can you say kind of what you’re doing around that and some of the strategies that have maybe been initiated? 

Joan: Yeah, I think there’s this, this has been on my mind a lot, and for anyone watching this video, Stephanie and I work on other projects together, and have known each other for quite a while and have had many offline conversations about just where I’ve been sitting with this, personally as a mental health professional who works with frontline healthcare workers, and professionally as part of this wellness task force. Some of the things that we’re doing are creating essentially a wellness hotline, so Psychological First Aid Hotline where anyone can call in from 07:00 AM to 07:00 PM and talk to a live person. And that person’s job is just to kind of triage and figure out what does this person need right now? Anyone, any staff can call it. It’s not exclusive to just our medical providers. And then really that person’s job on the other end of the phone is to figure out what is it that they, what is it that they need, and get them connected to the right resource. We also are increasing our ability to do telemedicine, so tele mental health, and making that really accessible to everyone, which has been a heavy lift considering it takes equipment and it takes market, it takes kind of that, the push and the 

outreach to our folks. And then I’m again, just turning to my slides here of all the resources that we have. I think the other thing we’ve done is train our peers. So, we have a group of peers who’ve been trained in psychological first aid across the organization. And not again, not just frontline medical providers, but our environmental services staff, our staff who answer the phones, our staff who are working in some of the call centers. So, I think there’s a lot of, I think we think a lot about physicians, but we’ve really taken a staff approach to this. Well and let’s see. The other things would be the proactive text outreach that we have initiated that are not necessarily about mental health, but really, they’re just thought the outreach of like, hey, how’s it going and what have you, what have you done today for yourself? What do you need to do in the next couple of hours? And having a check-in system, which I think has been really helpful. We’ve already initiated with our leadership who have been working around the clock, so. 

Stephanie: Yeah, no, that’s all really great, really great stuff. So, in addition to all of that great work you’re describing at OHSU I also know that you and one of your colleagues, Dr. Christine Runyan from UMass Memorial, have been providing free weekly webinars about different topics related to this caring for clinicians. Can you say a little bit more about that and maybe tell us some of the topics that you’ve had? 

Joan: Sure, and full disclosure, this, these webinars that we have been hosting were truly just something from Tina and I’s hearts that we, we were not asked by our institutions to do this. We were not asked by anybody. We’re not being paid to do these. We really felt like there needed to be a space where clinician, the clinician community could really gather to ask the hard questions, talk about the relevant topics related to COVID-19. So, our first launch webinar, was about kind of an emotional survival guide. And we really focused on rounding and regulating the nervous system and practice some of those tools in our session. Our second session was about recommendations for staff wellness, so really building a staff wellness plan, and these three kind of bigger buckets that we just went over, Stephanie. And then this coming weekend we are really talking about moral distress. And we’ve titled the talk “Coping with Moral Distress”. And it’s really a, we have a panel of experts who are really just going to field comments and questions from the audience. And it’s not a didactic session, and it’s really a space for sharing stories and, and both triumphant stories and sad stories. So, does that answer your question about kind of what the intention was and what the platform is all about. 

Stephanie: Yeah, and I know that they’ve been really well received and I’m going to share, that should be correct. In my screen it looks like it’s backwards. 

Joan: It’s not backwards at all. I can see it very clear. 

Stephanie: And just so everyone knows, I will also put this in the text that is below the video link, so you can find it there. 

Joan: And Stephanie, correct me if I’m wrong, but one of the reasons why you are promoting these webinars here, on Trauma Informed Oregon’s site is because we are addressing a lot of, a 

lot of our content comes through a trauma informed lens. We incorporate a lot of mindfulness in our webinars, and also kind of through a mindfulness lens, and we speak to neurobiology and physiology of trauma in our webinars as well. So, it fits very well, and it’s been a pleasure partnering with Trauma Informed Oregon on so many other projects that this feels like a wonderful partnership as well. 

Stephanie: Yeah and having been someone that participated in watching these webinars, I know that you’re also really relying on the notion that social support and connection and coming together and relationship are really buffering in times of stress and trauma. And so again, thank you so much for the work that you and Tina are doing on that. And I know that it’s been hugely appreciated in the fields and very well, very well attended. 

Joan: It was very surprising to see 500 people log on to our very first webinar, and we’ve only grown from there. And I just want to share a quick anecdote about kind of what the platform is like. There’s a chat box, and we had a wonderful unexpected meeting of two attendees that somebody chatted in something, and another attendee saw the name and said, “is that you Judy from blah, blah, blah”. And she said, “well, yes, it is”. And it was unexpected, it was a beautiful connection that happened, and we hope that that’s exactly what we’re providing is a venue for folks to connect as well as participate in some really important conversations. 

Stephanie: Yeah, no, that’s great. Thank you so much for doing that. So, as we begin to wrap up our conversation, is there anything that you wish I had asked or brought up or left out? 

Joan: I think the one piece that’s been on my mind has been about how, in a time like this where there’s a lot of unknowns and uncertainty and fear, that that can trigger or activate old traumas for people. And then I think that there’s a lot of people who are feeling really activated, who, who don’t quite know why. It’s not, it’s not connected to any particular thing that’s happening in their life or incident, and it’s just this feeling of threat. And so I just want to leave that thought with you and those who are watching this, that, you know, I think we as a community need to be thinking about that as we interact with people, and realize that this might be bringing up some of our old demons, our old traumas, and that so much is stored in the body, and feeling things that we don’t quite understand. So, I would ask that you all just give yourself some grace and patience and check in with yourself about is it possible that some of the things that are coming up today are connected to things that have happened in the past? 

Stephanie: Yeah, oh that is just beautiful. Thank you for saying that. So again, thank you for your generous time. I know you’re being pulled thousands of directions, right now, so it’s greatly appreciated, and you are greatly appreciated. So, be well and thank you again for all the hard work you’re doing. 

Joan: And thank you Stephanie and thank you for Trauma Informed Oregon. Bye. 

Stephanie: Buh-bye.

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