Passing it on

May 25, 2022

*For the month of May, honoring Mental Health Awareness, the Center of Excellence for Integrated Care, a program of the Foundation for Health Leadership and Innovation, will host a series of blogs following Alex. These weekly journal entries from Alex begin in 2032 when Alex is 18 years old. Over the month Alex will reflect on the benefits gained from living in a system with preventive mental health policies as they grew up.

*Week 4 flashes forward to Alex reflecting on life moving forward with a new family.

“Life has been sooo busy lately. I barely have time to really sit back and appreciate all that has happened in my life. I guess the biggest update is that Frankie and I got married, and we are expecting a baby in the next five months. I can hardly believe I will have that level of responsibility – to actually take care of another human being and be responsible for that person…it feels a little overwhelming at times. My running and working out continues to help me when I feel overwhelmed. The other day I ran the farthest I have ever gone, and I am considering training for a marathon. I know it always helps me to have a goal to work towards, plus I have found some good friends in the running group I joined who also have young families. I don’t know how they find the time to train and take care of their families, but they are so encouraging and supportive that it seems possible.

Frankie has felt a little more stressed than I have, understandably so, but we are working through this change in our relationship together. We sought out a therapist who specializes in couples and family relationships just to help us navigate our expectations and this shift in our relationship. It has been helpful to talk about how we see parenting and how we balance the parenting responsibilities while maintaining our relationship as a couple. I have a feeling we will see our therapist a bit more even after the baby is born just to help with the adjustment. I have learned that talking about our relationship on a preventive basis really helps us just be the best we can be for each other and for the other people in our lives. I have watched co-workers go through separations and divorces and it just seems so hard. I learned so much growing up talking with Sam over the years, that I figure why not do the same sort of preventive work with my marriage and soon-to-be new family. I am also grateful to know that we have the support of a therapist when the baby is born who will be focused on our attachment and relationship dynamics with the baby, as well as each other, and who will also be there for the baby as they grow up. Knowing we have that support during those preventive mental health well child exams built into our life is beyond reassuring.

I am so glad our world is far beyond the days when going to therapy was such a big deal. It really has been an amazing help to me over my life and will pay dividend for years to come.” Later, Alex

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Press Release – July 2021

July 30, 2021

JULY 30, 2021

The Foundation for Health Leadership & Innovation Secures Funding to Improve and Advocate for Behavioral Health Needs of North Carolina’s Children and Adolescents

The new program, funded by The Duke Endowment, will be led by FHLI’s
Center for Excellence for Integrated Care team

CARY— The Center of Excellence for Integrated Care (COE) — a program of the Foundation for Health Leadership & Innovation (FHLI) — has received a grant from The Duke Endowment to lead a three-year program focused on child and adolescent behavioral health. The emphasis of the project is on advocacy for mental health check-ups for children, as well as on training for behavioral health professionals to provide pediatric and family assessments and interventions.

“North Carolina’s health care workforce is doing amazing work every day with well-child exams and preventative services for children and adolescents,” said Dr. Amelia Muse, COE’s Program Director. “However, after the hardships of the past year, it’s time to answer the call for more support for providers, families, and communities on preventative and interventive behavioral health care.”

With a dual emphasis on advocacy and workforce development, The Duke Endowment has provided support for this program that will include partners from the i2i Center for Integrative Health and the North Carolina Area Health Education Center (AHEC) Program.

The COE team will partner with i2i to convene a workgroup of family members, advocates in children’s welfare, and representatives of practitioners to develop a sustainability plan to embed annual behavioral health well-child checks into medical protocols and practices, with a focus on the need for insurance coverage. This additional focus on behavioral health during or in conjunction with the well-child check will bring North Carolina alongside other leadership states, who have worked to support pediatricians, children, and families with additional behavioral health emphasis.

“With our more than 34 years of collaboration and advocacy experience addressing behavioral, I-DD, SUD, and primary healthcare, i2i is well-suited to lead this advocacy effort,” said i2i Executive Director Ann Rodriguez. “We are thrilled to partner with FHLI, COE, and NC AHEC on this critical initiative. The pandemic and North Carolina’s Medicaid transformation efforts have created an opportunity to ramp up integrated, preventative care practices across the state and strengthen whole-child care.”

Simultaneously, the COE team will partner with North Carolina AHEC to address workforce development issues by offering a continuing education opportunity for a cohort of 45 licensed behavioral health providers and ten graduate student interns currently working with youth and families. The one-year specialized training program will focus on mental health and substance use prevention, assessment, and intervention for children and adolescents and their families.

The second year of the program will train a second cohort of behavioral health professionals, with the first cohort of graduates acting as peer supervisors to assist with oversight and case consultation. The training curriculum will be informed by evidence-based literature, as well as by information collected from regularly held workgroup meetings of child and family advocates, youth, family members and providers advising on policy to support child and adolescent behavioral health wellness.

“At the Foundation for Health Leadership & Innovation, we are committed to cultivating a culture of innovation, experimentation, and risk-taking,” said Kelly Calabria, FHLI’s President and Chief Executive Officer. “Given how COVID-19 has exacerbated an already-dire need for behavioral health services for all North Carolinians, we believe this work — led by our team behavioral health experts — is the type of innovative thinking that is needed. We thank the Duke Endowment for recognizing this need and for trusting FHLI to drive a solution.”

About FHLI’s Center of Excellence for Integrated Care
The Center of Excellence for Integrated Care (COE) — a program of the Foundation for Health Leadership & Innovation — supports the clinical, operational, and financial transformation of health systems to provide whole-person care. COE’s integrated care experts support communities in providing whole-person care and reducing the stigma of behavioral health for patients and providers. Learn more at

About the Foundation for Health Leadership & Innovation
The Foundation for Health Leadership & Innovation (FHLI) is a nonprofit organization that envisions healthy communities across North Carolina where everyone can flourish. FHLI develops and supports innovative partnerships that build a healthier North Carolina through collaboration and respect. With a long history in the state — and a deep understanding of its health care needs — FHLI scales solutions that benefit the entire state. FHLI staff are thought leaders and experts who bring communities together for a better, healthier North Carolina. Learn more at

About i2i Center for Integrative Health
The i2i Center for Integrative Health is a non-profit 501(c)3 organization whose mission it is to foster collaborative and evidence-based initiatives for improving the quality and efficacy of the behavioral health, intellectual and developmental disabilities, and substance use care and support service systems within a comprehensive system of whole-person care. Learn more at

About North Carolina AHEC
The North Carolina AHEC Program provides and supports educational activities and services with a focus on primary care in rural communities and those with less access to resources to recruit, train, and retain the workforce needed to create a healthy North Carolina. Learn more at

About The Duke Endowment
Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has distributed more than $4 billion in grants. The Endowment shares a name with Duke University and Duke Energy, but all are separate organizations.


For more information, contact:
Marni Schribman, Director of Communications & Public Relations
Foundation for Health Leadership & Innovation (FHLI)

Posted in Mental Health Awareness, Press Releases, UncategorizedTagged , , , ,

Oral and Behavioral Health Integration

May 27, 2021

Jamie: My background has always been in integrated care. From training through licensing, I lived, ate, and breathed integrated care! Coming from a rural community with limited healthcare services, behavioral health and physical health existing in the same space has always just made sense to me. But after a few years of my focus being on behavioral health integration in primary care, I became really curious about how these models of care were being implemented into completely different settings, like in allergist offices, pediatric obesity clinics, and complex care settings, for example. Again, this wasn’t surprising to me and just seemed like a common-sense way to improve patient care outcomes, as well as provider satisfaction. But I will never forget the day I saw a job posting for the role I have now! On one hand, I thought to myself, “Behavioral health integration at the dentist?! How is that going to work?” And on the other hand, I thought, “I’ve got to get in on this!”

Lisa: Oh, I am so glad I am not alone in my curiosity about integrating behavioral health care into oral health care! To be honest, when I first heard about integrating behavioral health into oral health I just wasn’t sure how it would work. At first I thought, well that would be helpful because personally I experience a lot of tension around going to the dentist. I am always up for someone talking to me and helping me feel more relaxed, so that was my initial take on the role of behavioral health in oral health. I thought, when I sit down and feel nervous about my procedure, or about what the dentist is going to say, a behavioral health person could help me manage that stress. But then I learned there was so much more and so many other reasons why behavioral health should be connected and integrated into oral health.

Jamie: Absolutely! At UNC we have done dentistry education without behavioral health for more than 50 years…so I don’t think you’re alone in feeling slight hesitation at the sound of “behavioral health in dentistry.” Changing the way teams are developed and work together, as well as the way patient care is viewed and delivered, is NO small feat. I had a dental colleague put this simply for me one day. He said to me that dentists are incredibly technically skilled professionals. For that reason, they historically have looked at patients and their needs with a 2mm point of view. They are using magnification tools to zoom in on that particular cavity, or that crown. As a behavioral health clinician, I am asking them to back that view up to about a 100-yard view of the patient and ask about their life, their health behaviors, and their own perspectives on their care. This is uncomfortable for most dental providers to think about in the beginning. But as I attend more morning huddles, discuss more patient cases with providers, and meet with more patients in the operatories, I see our dental providers — both learners and faculty — gain a greater understanding of how expanding their care to be more person-centered improves the patient’s experience, as well as theirs.

Lisa: That is very cool, Jamie. I am just fascinated with this whole movement of really connecting ALL of the parts of the body and mind. As an integration specialist, I really have always believed and advocated for whole-person care, but it took a bit of self-education and talking to others in the oral health field to understand the connection between the mouth, the body, and the mind more fully. It is almost a little embarrassing to say, but it also shows how entrenched everyone still can be in their silos, even if there is some overlap with those silos. It is exciting to hear about the work being done at the training level to tear these silos down and create a total culture shift.

I know Greene County Healthcare has been working with Medical Family Therapists in their dental clinics for a while now. In fact, the NC Oral Health Collaborative wrote a piece about the work of one of the MedFTs from Greene County and it was wonderful to hear the great work being done.

While I do think those in training right now — including behavioral health, dentists, and primary care providers — are getting more exposure to whole-person care, I think it is important to share with those currently practicing all of the many reasons that oral health and behavioral health intersect.

Jamie: When I explain the “why” behind integrating behavioral health into dentistry, I like to focus on specific patient presentations that dental providers will see in the dental chair. What we are seeing, especially in NC with the rise of the opioid epidemic, is that substance use and behavioral health can impact everyone, across all socioeconomic levels. So, regardless of where a dentist is practicing, if they came to me and said that they aren’t seeing behavioral health issues in their practice, or these issues are not impacting their patients’ care, I would kindly argue that they just simply aren’t paying attention. The mouth is the messenger for all sorts of things happening in the body, so if you aren’t receiving those messages, then you’re doing something wrong.

Some of the most commonly used substances in our state include cannabis, opioids, and methamphetamines. Cannabis can lead to increased risk of oral cancer and gum disease, use of opioids is associated with tooth loss and decay, and methamphetamine use can cause teeth grinding, tooth wear, and rampant decay. With that being said, poor oral health can also have an impact on substance use. Untreated oral pain can exacerbate factors that lead to substance misuse, or impede recovery from a substance use disorder. As for opioid prescribing patterns, oral health providers have been among the top prescribers of opioids in recent years, including for individuals 10-19 years old (this often happens after wisdom teeth removal). Another example of this is when we see people who are seeking care for oral health problems in emergency rooms being prescribed pain medications instead of receiving comprehensive oral care. Interestingly enough, we have actually seen a very rapid increase in recent years of dentists working in emergency rooms, with the goal being to provide more comprehensive urgent dental treatment in the ER setting.

As for mental health, one of the most interesting things I’ve learned since being in this setting is the significant impact of dry mouth on overall oral health. As you know, anti-depressants and anti-psychotics often cause xerostomia, or dry mouth. Saliva acts as a protective coating on the teeth, and when it is in scarce supply, the teeth and more susceptible to caries and decay. I’ve seen patients here who are high in socioeconomic status start a new anti-depressant medication and come in for their six-month cleaning with significant changes in their oral health. There is also ample evidence in the mouth for eating disorders (tooth erosion), bipolar disorder and OCD (patients get overzealous with brushing and flossing), and trauma or anxiety (habitual teeth grinding and clenching, TMJ disorders). There is also a lot of evidence that poor oral health can exacerbate cognitive decline and functioning, which was a new concept to me! The last connection I’ll mention won’t be a surprise to any behavioral health clinician. When patients experience tooth loss or poor oral health, they see multiple impacts on their quality of life. Their self-esteem is low, their relationships are impacted, it can be difficult to find employment, this list goes on and on.

Lisa: I have to be honest, before talking to you and doing my own research, I just had no idea about so many of these connections. Even though these connections are evident, I would imagine that whenever a new workflow or paradigm shift happens in healthcare, it can feel overwhelming to those practicing because of all that they juggle already to keep their operation flowing smoothly. Is there a framework that can help providers figure out where to start their change process to address some of these issues you’ve talked about?

Jamie: I really like this example framework below developed by the Center of Excellence for Integrated Health Solutions/National Council for Behavioral Health. This framework shows how even minimal integration — such as staff education or screening for needs — can be a big step towards improving patient care outcomes. I’m curious though…as an integration specialist, what are your thoughts on this framework?

Lisa: Well, change for practices, in my opinion, is not a lot different than change for people. We have to figure out where we are, start small, and evaluate the changes to keep moving forward. This framework reminds me of other integration continuum charts that can help providers figure out what part of the puzzle they can put into place in their practices. Even if a dentist is practicing in private practice with no behavioral health professional on site or nearby, and even if a behavioral health clinician is practicing in a traditional private practice, steps can be taken to help heighten the coordination and awareness of the relationship between oral health and behavioral health so that patients start feeling better both physically, orally, and mentally more quickly.

For example, oral health providers can receive mental health first aid training while behavioral health clinicians can receive training on oral health issues. On another deeper level of involvement, oral health providers could receive more intensive training about interventions such as motivational interviewing to help patients with brief interventions if it was clinically appropriate in their appointments, and behavioral health providers can include oral health questions about hygiene and utilization in their biopsychosocial assessments. Integrating behavioral health into oral health can certainly go as far as bringing in a behavioral health clinician into the dentist office, but I think it is a mistake to think that it has to be all or nothing. How would you encourage clinics to get started, Jamie?

Jamie: I agree with you completely on that! Students often ask me what they are supposed to do “in the real world,” meaning if they start their professional career in a setting where they do not have a behavioral health clinician on their team. There really is no wrong way to get started! Maybe I’m thinking a lot like a social worker, but I would say the key is to seek resources, resources, resources. If you are not the expert on your team, it is always good to acknowledge that and stay in your lane. Locate your local experts, or resources, like your local LME-MCO, Mobile Crisis Unit, Crisis Lines, Department of Social Services, 211, etc. Keep a flyer or binder of those resources at the front desk. Ask a staff member to be responsible for connecting with those organizations, learning about what they do, and periodically updating them if needed. North Carolina is fortunate in that it now has an easy-to-use, integrated, state-wide resource network called NCCARE360 that serves as an electronic one-stop-shop for all of the resources available within the local community. This way, you feel confident as a provider knowing that if you ask a patient a question about their behavioral or emotional health, or if a patient brings this up on their own, you know who to direct them to. No matter what type of healthcare you are providing, patients should be assured that there is no wrong door for accessing care and support.

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Systemic Change to Build Post-Pandemic Resilience in North Carolina Children, Adolescents, and Families

April 1, 2021

Children are amazing and resilient. Yes, children and adolescents can often handle more than we care to realize. However, 2020 and the beginnings of 2021 have been more than any of us could have ever imagined. Even the leaders running the world had no idea how much, how long, and how impactful the events of this past year would be to our country and our children. If someone had said a year ago that some children would be out of school for a full year, we would have said that there is absolutely no way that can happen. And yet, here we are.

Fortunately, there is finally a glimmer of hope on the horizon.

What often makes children’s resilience possible is the involvement of at least one caring and available adult. That caring adult can be a caregiver in the family, a family friend, a teacher, a youth group leader, a healthcare provider/therapist, or coach. This past year, as children watched for clues on how to handle all of the changes that were happening, the adults they normally turned to were likely trying to manage the chaos themselves. These adults, despite their best efforts, could very well have been emotionally unavailable due to their own stress, and quite possibly physically unavailable. We will not know the long-term impacts that this period of time has had on our children for a while; however, we do know that as the fog clears, it will be everyone’s responsibility to help ensure that resources are available for healing and recovery.

There is not a single sector of our society that can handle all of the needs of our children on its own. We cannot expect families to manage on their own. We cannot expect school systems to jump in and miraculously fill the entire gap. We cannot expect that regular visits to the pediatrician for sore throats and stomach aches will not be tangled up with the emotional turmoil that trauma can bring. We cannot expect to return to the status quo of how we have previously taken care of children in North Carolina.

The well-child exam is a natural place to provide an additional layer of support to children/adolescents and their families. For years now, this exam has been valuable in catching developmental warning signs, providing vaccinations, and addressing parental concerns. The concerns are often behavioral in nature, such as temper tantrums, developmental progress, attention deficit, and sleep hygiene, to name just a few. As childhood moves into adolescence, age-appropriate screeners transition into more adult questions focusing on substance use and sexual activity.

It is in these appointments that there is space and some time for patients and their caregivers to ask questions about mood, substance use, stress management, and coping with overall worries about life. It is in these appointments that we can be even more purposeful around our conversation with patients (and each other) around mental health and relational health to help nurture the whole child. Now is the time to capitalize on those valuable patient interactions in primary care offices to help provide additional support to these kids who have been through so much.

At the Center of Excellence for Integrated Care, we have been exploring system and policy changes that can integrate even more behavioral health support for children and adolescents than is already offered. Integrating behavioral health into practices not only helps provide a more robust offering of whole person care, but it also has been shown to help providers feel supported and improve their overall satisfaction with their work. It is time that our protocols and policies provide the support both our providers and our pediatric patients need in the aftermath of this past year. It was needed before now, but now it is undeniable. We look forward to sharing more as our partnerships around this idea evolve!

Posted in Uncategorized

Gratitude – The Helpers.

December 14, 2020

By Lisa Tyndall, PhD, LMFT

In moments when I am lamenting the dumpster fire 2020 has been, gratitude is often the furthest thing from my mind. And yet, in my more mindful moments, I truly believe gratitude offers the highest and best path forward.

I have always enjoyed the power of words and one of the things that gets me through some of the harder moments is remembering the inspirational and feel-good quotes I have heard in the past. Recently it was words of wisdom from one of America’s kindest souls. I think this quote has actually been found on many social media sites in the hard times of the past, but it bears repeating.  Mr. Fred Rogers said long ago, “When I was a boy and I would see scary things in the news, my mother would say to me ‘Look for the helpers. You will always find people who are helping.’” This wisdom was shared many years ago, but looking for the helpers is especially poignant now. As it so happens it doesn’t take a lot of time before I can find a “helper” who inspires my gratitude.

I have much gratitude for my many colleagues and friends in the healthcare profession. I have even thought of my own healthcare provider, a young mom of two toddlers, who has met with me in person and another time on the phone. During both times we met I could hear the sincerity, warmth, and professionalism in her voice and see them in her eyes above the mask.

I have gratitude for a friend who took on additional 12 hour shifts to help serve in the hospital drive up testing line, so that people would be able to follow guidelines before their holiday visits. I think of my friends who work in the local hospital, who have been there bent over patients already diagnosed with COVID-19 in the hospital, helping with intubation, holding hands, and saying prayers.

I have gratitude for so many of these healthcare professionals who likely never gave a thought that they would be working in such a high-risk environment and yet they have continued to go to work regardless of the associated danger.

These professionals, from the front desk to the clinician to the janitorial staff, dramatically changed the way they work from covering up in masks and shields that conceal their faces and impede needed human interactions, to delivering high quality care behind a cold flat screen. Each and every day they continue to show up and run what has turned from a sprint into a marathon for us.

I also have deep gratitude for the essential workers who keep our economy and our lives moving. At times during this pandemic, one of the only places I have frequented is the grocery store. I am always so grateful that the stores remain open and staff show up so that my family can purchase food. Then there are the bus drivers, the delivery men and women, the postal service employees, and the pilots and flight attendants all making sure that others can continue to quarantine, self-isolate, and when necessary get from point A to point B. As well as those who are in the places and facilities loved ones wish that they could be, filling the role of staff, but also the role of adopted family members providing comfort and care.

And I cannot think of things to be grateful for in 2020 without thinking of the teachers. Teachers had a difficult job before the pandemic with overcrowded and under-resourced classrooms, but now our communities are asking them to make a herculean effort to help all of our children succeed despite the obvious new and already existing hurdles that are now magnified. With several friends who are teachers, and my own mother-in-law as a middle school teacher, as well as my own two school aged children, I have seen and heard the exhaustion, sadness but more importantly the dedication of our teachers.

My mother-in-law, close to retirement age, has now completely re-tooled her educational belt to include online learning platforms, combat zoom fatigue, and risk her own health by being face to face with multiple people in a classroom during a pandemic.

A great deal of the sadness I hear from my friends comes because they know that for so many of the children the ability to carve out a quiet space to learn on a reliable computer on a reliable internet is next to impossible.

I see the notifications coming through the online learning apps on my phone at all hours of the night and weekends with my children’s teachers working tirelessly to keep up the juggle.  Every notification reminds me to be grateful for the helpers. 

Thinking about the helpers reminds me that I am quite grateful that my children are also learning about being a helper. I am grateful that they are learning even more about taking care of one another, which goes for those individuals inside our home but also our community as a whole. They are learning to look for the collective good rather than the individual bad.

There’s not much of 2020 left, a few more weeks, and 2021 will be here. I will still celebrate the hope of a new year, probably in a way I have not done in quite some time. I will have the power to choose the meaning I make around the year 2020. I plan to choose the good. I plan to remember the helpers and I plan to carry that gratitude for them and all of the kind moments forward in to 2021. I hope you can find something or someone to be grateful for as you look back on your 12 months, and I hope you can find a way in the next three weeks to be the helper someone else needs.

Posted in Uncategorized

Fall Integrated Care Learning Opportunity

September 29, 2020

Many of our sites and partners were excited about the momentum of the NC Integrated Care Symposium created last year. While this year is a bit different, we want to welcome last year’s attendees and future attendees to what we have in store for this November!

In the fall of 2019, the Center of Excellence for Integrated Care partnered with Wake AHEC to deliver a symposium on integrated behavioral healthcare. Based on the attendee reviews it was a great success! North Carolina has been on the integrated, whole person care journey for quite some time and it was clear the passion among our healthcare workforce for delivering the highest quality whole person care still runs deep.

With a focus on the clinical, financial, and operational aspects of team-based care, the stage was set for the planning of next year’s symposium for 2020. The Center of Excellence of Integrated Care was already in conversation with a fellow FHLI Program, the NC Oral Health Collaborative, to examine best practices around weaving together oral health, behavioral health, and primary care. Several awesome planning committee members joined our effort, and we were chomping at the bit to knock the 2020 symposium out of the park.

Notice the past tense. Because, 2020 had different ideas.

Yes, along with our amazing planning committee members, we decided after the impact of COVID-19 became clear, that 2020 was not well-suited to re-convene a large gathering. Out of respect for the discipline-specific conferences necessary for continuing education already being offered virtually, we thought it best to just pause and really assess the need.

What we were hearing from our work with clinics was that due to the necessity of teletherapy with patients being seen in the context of their homes and families, that there was an increased need for support around family work. So, we tagged an awesome clinician, Jasmine Williams, MSW, LCSW with the Tim & Carolynn Rice Center for Child & Adolescent Health, and are once again partnering with Wake AHEC to bring you a webinar on November 18, 2020 from 12-1:30pm, entitled, “Integrating the Family: Child and Adolescent Health.”

We hope you will join us for a lively presentation and discussion in November by registering at Wake AHEC online. Hope to “see” you there! Click this link to register.

Posted in Resources, Uncategorized

Experiencing Integrated Care

June 26, 2020

Welcome to the Team

In this story, Ricky Caliendo, LMHC, provides a narrative that describes the experience of integrated care from a patient’s perspective. The names of the patient and doctor are fictitious.

“Another night of lost sleep,” I think to myself as the screeches of a toddler travel into my bedroom. There he is. At the foot of my bed, with that look only a mother could read. It’s time for breakfast. My stream of consciousness continues as I move through the morning routine.

“Breakfast, pack a daycare bag, project for the office, take your medication…what am I missing?…ugh, doctor’s appointment today!”

Attempts at applying eye liner and mascara at a red light should mask the lack of sleep. I adjust the rearview mirror to find my three-year-old son’s face showing intense curiosity.

“You look like a clown, mommy,” he comments through his giggles.

Children are brutally honest and, despite my exhaustion, my mouth cracks a small grin when we lock eyes through the rearview mirror. It’s time for him to go to daycare and for me to push forward.

“Coffee, doctor’s appointment, work, kid, bills, dinner, call with lawyer…” I recite to myself on the way to the doctor’s office.

As I enter my primary doctor’s office, I begin to script my conversation with him.

“Sleep, aches, lack of focus, tightness in chest, diarrhea…ugh, he is just going to think that I’m crazy.”

After checking in and nestling into the waiting area, all of a sudden I am acutely aware of the weight of my recently applied mascara that now feels like it weighs ten pounds. In the exhausting fight to keep my eyes open, I notice a new poster in the waiting room.

We have a new member of the team! Carly Johnson, LCSW, is our new behavioral health clinician and works diligently alongside our doctors to serve your whole-person health needs!

“Okay, Carly, welcome to the team,” I say sarcastically in my head. With just a moment to be still, I feel the weight of my eyes again, and began to nod off to sleep.

“PAMELA? Is there a Pamela here?” exclaims a staff member.

Waking up, embarrassingly, I pull my head up to see Carly’s picture staring at me and I gather myself for the appointment.

Blood pressure. Temperature. Medication list. Paperwork. Hold on, I know this routine. But what is this new paperwork? My medical doctor is asking me about my sleep, mood, motivation, and whether I enjoy things anymore? I complete the questionnaire and interestingly the score does seem higher rather than lower. I am curious about what the score means.

Dr. Haffner enters the exam room in his white coat and I think to myself, “How do they always keep those coats so white? I can barely keep my boy’s church clothes clean.”

Lost in my preoccupation about his coat, I look up and recognize that Dr. Haffner is awaiting an answer to a question that was completely lost in my daydreaming.

“I’m sorry Doc, but I’ve been feeling a little out of it lately,” I say in response to the unknown question. It turns out he asked the fairly typical doctor question about what has brought me in today.

I recite the symptoms list as gracefully as it has been in my head. “I did it!” I silently reassure myself.

Dr. Haffner validates my feelings about my symptoms and discusses some of the paperwork that was completed prior to him coming into the exam room. He indicates that he is concerned about my lack of sleep, low motivation, high levels of stress, and complaints about stomach aches. He reassures me that he will order some blood tests. But, while we’re waiting on those results, he wants me to meet a new member of the team. I instantly find myself nervous and excited at the same time.

A woman in her 40s, dressed in business casual attire, enters the exam room offering a big, warm smile. She introduces herself to me…although I acknowledge her name before she’s able to get it out…Carly.

Dr. Haffner and Carly explain the clinic’s approach to whole-person care, describing the connection between a patient’s medical, social-emotional and spiritual experiences, and their health. With my permission, Carly excuses Dr. Haffner and I find myself, again, sitting across from Carly feeling the weight of my eyes. This time, she is not on a poster.

Carly’s approach is a harmony of kindness, professionalism, and compassion. We have a frank conversation about my experiences being a single parent, my recent financial and workplace stress, and how my life goals that historically excited me, now felt deflated.

“It simply feels like everything I was working toward just passed me by,” I explain. “Now, here I am looking at it as if it is a distant mirage.”

Carly provides a sense of understanding and normalizes my stress. She talks about the importance of self-care, building motivation, and breaking down goals into small steps.

For the first time in a long time, I begin to see myself again…even if it’s at a distance. I used to think that I was so strong and independent, that I had to be for my boy. I thought my needs should come last. But Carly’s intervention really helps me understand the importance of taking care of myself.

I quickly realize that Carly — once just a stranger on a poster in the waiting room — is now a part of my healthcare team. She has provided me with a source of comfort and motivation. She has normalized much of my experience and encouraged me to revitalize old coping skills, such as painting, nature walks, and meditation. She has provided resources so I can explore some new strategies, as well.

After setting my follow-up appointment for two weeks, and walking out of the office, I truly feel cared for.

Thinking about past medical appointments, and how stress has impacted my day-to-day life, I think I was always looking for help from my doctor, but speaking in a code at times. It was a code that I did not know how to break. But Carly opened up a conversation that I did not necessarily think about going into the appointment, and I am so glad she did. I was beginning to crack the code. My happiness and health are intertwined and partially dependent on my self-care.

Welcome to the team, Carly.

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North Carolina Integrated Care Symposium 2019

June 15, 2020

Center of Excellence for Integrated Care Symposium logo

In the fall of 2019, the Foundation for Health Leadership and Innovation’s Center of Excellence for Integrated Care, in partnership with Wake AHEC, hosted the North Carolina Integrated Care Symposium 2019: Inspire, Educate, and Connect. Aiming to bring together healthcare professionals from multiple disciplines, this symposium focused on educating the over 130 attendees on clinical innovation, operational/implementation necessities, and financial shifts in the healthcare system. In addition to this focus on the three-world view (Peek, 2008), attendees were treated to a morning plenary on team-based care by Dr. Eduardo Salas of Rice University as well as a lunchtime plenary on provider burnout and self-care by Dr. Clark Gaither. Continuing education events such as this, where whole systems are brought together, are necessary to continuing shifting the paradigm to true whole person care being delivered in North Carolina.

The 2019 Symposium was made possible in part with funding provided by:

  • Community Care of Western North Carolina
  • Foundation for Health Leadership and Innovation
  • Kate B. Reynolds Charitable Trust
  • Wake AHEC

Peek, C. J. (2008). Planning care in the clinical, operational, and financial worlds. In Collaborative Medicine Case Studies (pp. 25-38). Spring New York.

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