The Oregon-based nonprofit LifeWorks NW began providing mental health services more than 60 years ago, long before the idea of providing mental health services in the community was recognized as a best practice. Today the nonprofit runs a variety of mental health treatment programs, including Adolescent Day Treatment and one of the state’s Early Assessment and Support Alliance programs. It’s also one of the three partners of the Bridge clinic at OHSU.
As a part of a new OPB series tackling some of the most pressing problems that Oregonians are facing, along with some promising solutions, we went to the LifeWorks NW Tigard site and sat down with those involved in receiving and giving mental health care.
Our guests were: Massimo Merolla, an Oregon State University sophomore; Occupational Therapist Kylie McDermott; Tamara Sale, director of the EASA Center for Excellence; Sara Cady and her dad Josh Cady; Family Therapist Becca Schweigert; and Karen Bos, OHSU assistant professor and medical director of LifeWorks NW.
Note: The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. We are coming to you today in front of an audience at the LifeWorks NW Center in Tigard. We are here for the first installment of a series of conversations we’re planning for over the course of this year. We’re going to be focusing on some of the most pressing problems that Oregonians are facing, along with some promising solutions. We’ve come here to LifeWorks because we’re gonna begin today with a conversation about youth mental health, and Massimo Merolla starts us off. He is a student at Oregon State University who is a client in the LifeWorks NW EASA program, that stands for Early Assessment and Support Alliance. It provides support for teens and young adults who are experiencing the early signs of psychosis. Massimo, welcome and thanks very much for joining us.
Massimo Merolla: Hi, Dave, thanks for having me.
Miller: My understanding is that, going back in time a little bit, the first time that you went to an emergency room due to psychiatric symptoms, it was because you had flagged down a car and you asked the driver to call 911 for you. What happened next?
Merolla: From there I had a… he basically told me to sit on the curb.
Miller: The driver did?
Merolla: Yeah. And from there I sat and I waited… basically a cop arrived and he had to do a few questions, preliminary stuff, and [he] just checked in with me, made sure, trying to assess the situation. And then from there he took me to the hospital and I don’t know, I felt very grateful for that. I still think kindly of him.
Miller: I think our audience knows that things don’t always end well when people in the middle of psychotic episodes interact with police officers. But for you, this worked?
Merolla: Yeah, I mean, he just had to do his checks and get through and it was nice. On the way there, he was asking me certain basic questions. “What’s your name? Are you at Oregon State? What are you doing right now?” And of course, for me, it’s always a complicated question. It’s like I’m here, but I’m not a student, I’m doing an internship.
Miller: What was, more broadly, what was going on in your life at that time? What were you experiencing?
Merolla: In that moment?
Merolla: At that time, the only thing that was really going on was the extreme paranoia. I had been losing sleep. The day prior I actually texted my mentor at the time because I was doing the internship and just let him know, “hey, I’m not coming in today, I need a mental health day.” And from there it kept spiraling. I sat on the couch, hours went by and I didn’t realize it was 6am to 6pm. And I was like, well, shoot, it wasn’t a mental health day and something’s going wrong. So, that night seemed to get worse. And when I left the building I no longer had the key to get back in and I didn’t have a phone on me. I couldn’t reach out to my parents. They were in another, they were on vacation at the time. So one thing led to another and it was just getting worse and worse and I realized how bad my memory was. And I figured at that point it’s probably time to get some serious help.
Miller: And then you were at the hospital.
Miller: Did you get helpful help at the hospital?
Merolla: Yes and no. It was a very interesting experience because I tried to describe… I’m like, “look, I know that things probably coming out of my mouth right now don’t make any sense.” But I’m like, it could be a lack of sleep or it could be on the psycho path, which at the time was kind of my narrative that stuck in my head with the paranoia.
Miller: How long was it before you ended up in the EASA program through Lifeworks NW?
Merolla: That wasn’t until much later. Postdoc, so come October, I had to go back to emergency services and then, [during] that time period, that’s right around when Kylie came along. Sometime after that for me, I can’t, the time around October to January is quite fuzzy for me.
Miller: Was anything helping you at that time?
Merolla: In between that time period?
Miller: Exactly, before you met Kylie, who we’re gonna meet in just a second?
Merolla: I was just along the ride, as far as between hallucinations and just trying to endure some of the stuff.
Miller: You mentioned Kylie. Kylie is an Occupational Therapist in the EASA program at LifeWorks NW. Kylie, what’s your starting point when you meet a client for the first time?
Kylie McDermott: One of the roles that I’ve had on the EASA team has been what we call the screener. I’ve been the person who will meet a family or a young person for the first time to see if they qualify and if they would be a good fit for what we do, and also receive the referral. When somebody’s asking for help, I’ll respond to that as soon as possible, within 24 hours or a business day. I don’t quite remember who I got the referral from. It might have been from Massimo’s mom directly, and I ended up calling and talking with Massimo’s mom and then finding out that he was in the hospital. So, then I figured out a way to go and visit Massimo and coordinate with the hospital there.
Miller: My understanding is that one of the things that you sometimes do when you go to a hospital, into a hospital room, is to turn the overhead lights down. Why do you do that?
McDermott: Yeah. In psychosis, actually, it’s really common that people have different sensory experiences. Oftentimes they’re highly sensitive to things like light, and sound, and movement around them. And when I came into the hospital room, I noticed that Massimo was laying in bed with his eyes closed and kind of frozen there with his arms outstretched. And so I wondered, hm, is the overhead light way too stimulating right now? So I turned off the light and it helped a lot.
Miller: Massimo, how much do you remember about that first meeting?
Merolla: Not too much. I can say that most likely happened and I have some vague memory of perhaps it being extremely bright, and then, “Now I’m not being blinded.”
Miller: Kylie, when you are talking with people who are dealing with psychosis, how do you handle the fact that what they are seeing or hearing feels very real to them, but not to you? How do you meet them where they are, and sort of honor their experiences when you don’t experience what they’re experiencing?
McDermott: Good question. Well, first off, I think that we all have extreme states. So every person, myself included, can be in a place where, for extreme grief or love or joy, where maybe other people aren’t going through the same thing. But we can connect with that and I can connect with that and to focus on empathizing. So, really listening and slowing down and looking for and listening for emotional content. If somebody is making a comment about, like, “how am I supposed to talk to you if you’re dead?” Like, wow, like that must be so hard and scary to think that I’m dead right now. So, yeah, naming those emotions and connecting with people there.
Miller: Massimo, for you, I mean, you said that one of the ways this would manifest itself was that, I think your word was that you thought you were a psychopath.
Merolla: I’m not sure, I just for some reason, the dots clicked as like, every action that I take, whether if it’s through goodness or whatnot, it’s through self intent because I don’t have to live a good life. You make other people happy and whatnot. So, I don’t know, somehow that got twisted and then it just stuck and, I don’t know, I just felt like I had done something wrong and just . . . At that point - Kylie had referenced - if someone, at least from my scenario at that point the hallucinations were so strong, I was just convinced I was like, “OK, reality is gone. I must be dead.” This is just what’s left of my memory or the afterlife or something.
Miller: Are there tools that you have gained from your time with Kylie that have been most helpful?
Merolla: Absolutely. But for that time period it’s more… I feel like afterwards it was a lot of help, I feel like Kylie gave us a lot of hope.
Miller: In what way?
Merolla: Reminding us that at least, giving us the hope that I can get back to doing what I love and doing all the things that I previously liked doing.
Miller: That you would get better?
Miller: Kylie, how do you do that? How do you give somebody hope?
McDermott: Name it, say it. “It’s really hard right now, but I have all the hope in the world that this will get better.” And naming examples of people in recovery that go back to school, people get jobs, people feel better, they feel happy, they have friends. They’re our community members and, yeah, just continually reinforcing that.
Miller: Because Massimo, at that time you didn’t think those things would happen. You didn’t think you’d go back to school or go back to the version of your life you’d had before?
Merolla: Potentially, yeah. I think once I was lucid again it was sort of like, wow. OK. A couple months have passed and at the time I was on so many medications I couldn’t keep my head up straight and couldn’t really watch TV. That gave me a headache. I couldn’t even listen to music for too long. That would also give me a headache and it’s like, going from that to… towards the end of the year, we got to travel a bunch. I got to learn how to sail, drive a motorcycle. Those are just things that I’m like, cool. It was a really fun year of recovery.
Miller: Kylie, what does it mean to be an occupational therapist in this setting? I think it’s possible that listeners may be more familiar with the idea of occupational therapy after a physical injury.
McDermott: Well, occupational therapy actually started as a mental health practice, and we focus on the activities that people need to and want to do in their daily lives. And the idea is that what we do day to day brings us health and wellness, including our mental health. So we start with activity, what are the activities that people want to get back to or are having a hard time with or want to do more of? And as much as possible, we engage in that activity and look at ways to modify it or change the environment or build skills to be able to do what we need to do, which we all struggle with from time to time. And that can look like things like, “I go and play pickleball.” With Massimo, for instance, we did things like searching on Craigslist to find housing in Corvallis or taking steps to return to school.
Miller: We have been talking about the EASA or Early Assessment and Support Alliance program that’s run through LifeWorks NW, talking with Kylie McDermott who is an Occupational Therapist for EASA and Massimo Merolla who has been one of the people she has helped. The program, through LifeWork NW, is one of a whole network of EASA programs in Oregon.
Tamara Sale helps organize them. She is the director of the EASA Center for Excellence and she joins us now. Welcome to the show.
Tamara Sale: Thank you.
Miller: What’s the big idea behind this whole set of programs?
Sale: The big idea is to be there when people need someone to be there in the way that they need them to be there, and to believe in them and to accompany them, and to help them get to where they need to go. And that includes the family as well, that we can’t do it alone and families need partners in the community who really understand that the young people are important and we need to be there quickly and follow through in a different kind of way than we have in the past.
Miller: What is the idea of focusing on this particular population? It’s a very specific population of teenagers and young adults who are dealing with the first onset of psychosis. Why is this population at this time so important?
Sale: Well, this is the point in time when people often start to develop psychosis for the first time. It’s an incredibly important developmental point in your life where you’re becoming an adult for the first time, figuring out who you are, becoming employed, having relationships beyond your family. Those are all incredibly important tasks. And there’s a lot of experience and research that’s shown that without early intervention programs, people often go for a year or more before they receive any kind of care. And then when they do get care, often it’s involuntarily, which means that the police get involved, sometimes in a very negative way. And fortunately, it sounds like your experience was more positive, but it can be extremely traumatizing for people and they lose their connections, their relationships, their roles, [and] they drop out of school. And that affects your entire adult life. So, it’s incredibly important that someone is there to support you through that process.
Miller: How do you measure the effectiveness of these programs?
Sale: It’s about continuity in the person’s life. Most of the time when someone comes to us, they’re either still in school or they’re just finishing high school, they’re figuring out what they want to do next. The continuity is really important, they’re continuing with what they had started or figuring out where to go next. Another thing that’s incredibly important is the connections to their family and to the people who care about them. We’re trying to preserve those, because people don’t automatically understand what’s going on unless they have someone else to turn to, who can help translate what those experiences are.
And then also teaching people both the skills and also kind of building that awareness that this is not an uncommon experience and that all the negative preconceptions that people have about these experiences are generally wrong.
Miller: What are examples of the preconceptions you’re talking about, that you’re saying we have wrong?
Sale: Terms like “psychosis” and “schizophrenia” have a lot of history. They’ve been in the media, they’ve been in the movies, and people… and also when someone is experiencing hallucinations or delusions or those changes in their thought process, that can be really scary and they start to worry about themselves and they take on all those negative attitudes that they’ve heard or seen around them. And that’s a lot of really old thinking that has to do with people’s fear of what they don’t understand. What we offer is a community of people who have lots and lots of experience with psychosis, and know lots of people and can tell all those positive stories and introduce people to each other so that they can see that, yeah, actually there is a way for me to get back to where I was.
Miller: Kylie, why were you drawn to this particular job?
McDermott: One of my best friends, when I was an undergrad, had his first episode of psychosis shortly after graduating, and I tried to help in the way that I could, but it just really meant a lot to me to be with him through that. It combined that care and that experience, and the meaning and that experience and the interest in sitting alongside of it, [along] with the type of engaged work that I want to do, [which is] getting to know people over a longer time, building relationships, doing together. It’s just really meaningful and beautiful.
Miller: What about the end of this, the work together? Because you’ve all three talked about the importance of these relationships, I mean, in kind of concentric circles, including family and friends, but also sort of closer in. But at a certain point, this particular therapeutic relationship ends. What is the intended end point? And how do you deal with that transition?
McDermott: Well, there’s some flexibility there. It’s like we close some doors, but there’s a window open still. So, still coming to groups or leading groups. Still coming to family gatherings, for instance. But there is that cut off of, we’re no longer your therapist, right? We are no longer your prescribers, and it’s often really sad and painful. And we process that together and involve the young person in making a choice about what they want to do next. And whether they want to continue on with a new therapist, or a new program and then working in the last six months to make those connections, or to send them on their way, sometimes they don’t want to be in therapy or need it anymore. And that’s OK too.
Miller: Massimo, where are you right now in that trajectory?
Merolla: We’re getting pretty close. In our last meeting, we actually asked that question, it was about eight months out. I’ve definitely made the statement that I’d like to come back and help when I can as far as giving back, and my family’s on board with that too, so.
Miller: Why do you want to come back, to give back?
Merolla: Because so much was given to me and I just feel like it’s easy to relate with somebody else that was there. Or if, maybe they don’t even need someone that has gone through the experience, maybe they just need someone that will accept them for what’s going on.
Miller: My understanding is that there are EASA programs in almost every county in Oregon right now. But that is not the same thing as saying that these programs are available to almost everybody in Oregon. What is the capacity right now compared to the need?
McDermott: We have programs in every community. Right now, the primary thing has been a workforce shortage. We have some positions open, including at LifeWorks NW.
Miller: What has the workforce shortage looked like for you, how has it impacted the services you hope to provide?
McDermott: COVID has changed a lot of things, there have been changes in people’s lives and turnover and people going to schools or other places to work. The state has had to invest additional money to help boost salaries and to provide signing bonuses and things, and that’s starting to really take hold. In fact, I was in a meeting today where there were three programs that didn’t used to have staff that now do. Tillamook, Clatsop and Columbia Counties all have programs again, which they had basically stopped operating.
Miller: And and you see that as a direct result of a state infusion of money, or just the system slowly working itself out of pandemic mode?
McDermott: Yeah, I think it is a combination of both, different communities have different challenges. Some of the coastal communities and the smaller communities just, not everybody wants to move there, right. So depending on the community, there are different challenges that they’re working through and that’s a big part of my job, is just to stay with the communities [and] to keep them working on the improvement. Most of our programs across the state are accepting people within a very short time. So, right now, it’s more the exception than the rule that’s not happening.
But one of the commitments related to EASA is a leadership commitment, at all levels. It includes the Oregon Health Authority. It includes the agency leadership, the county leadership, focusing on building the infrastructure needed for the population. So, not just building a small clinic that will take just a small number of people, but understanding how many people in the community are likely to develop psychosis and building the infrastructure, so we can respond in real time.
Miller: Massimo, you’ve been on the receiving end of different aspects of mental health care in the last couple of years, in the inpatient setting and outpatient setting. What do you think is most missing in our patchwork of mental health care in Oregon right now?
Merolla: That’s a difficult question. I can tell you the good things that are there. I don’t know if I can tell you necessarily what exactly was missing.
Miller: Well, you know what, then tell me the good things. I love to hear good news, too.
Merolla: Sure. From my time in the Mental Behavioral Health Unit, once I was starting to get more on the lucid side it was nice to be greeted with a few comforts, whether that was, for me, I like playing guitar. And so, even [with] the other people that were getting their meds adjusted or whatnot it was nice to have somebody to connect with over that. There’s many people that helped me that I probably couldn’t remember their name as far as in the Mental Behavioral Health Unit, but I recognize their face and it’s a warm, welcoming face.
Miller: Massimo, Kylie and Tamara, thanks very much.
McDermott: Thank you.
Miller: Massimo Merolla is a student at Oregon State University and a client in the LifeWorks NW EASA program. Kylie McDermott is an occupational therapist in the program. And Tamara Sale is the director of the EASA Center for Excellence.
We’re going to turn now to one family’s experience with the Adolescent Day Treatment Program here at LifeWorks NW. Sara Cady is 19 years old and graduated from the program here last year. She joins us now, along with her father, Josh and her former therapist here, Becca Schweigert. It’s great to have all three of you on this show. Thank you.
Josh Cady: Great to be here.
Miller: Sara, what’s it like to come back to this building?
Sara Cady: It’s weird. I would say it’s definitely brought back a lot of memories and a lot of, I think, just… not nostalgia, but I guess just a lot of comfort, as well. I think that comes from not just the people, but also the places that I’ve been and the things that have happened here and I think that really helps to kind of remember how well I did here and how much support I had.
Miller: Well, then I wanna come back to learn a lot more about why you speak so happily of this place. But I feel like for that to make sense, we should probably hear a little bit about what you experienced before. What were the kinds of attempts at help that you had been exposed to earlier and how were they different?
S. Cady: I don’t really remember too much in my early life of that kind of help, I guess, because probably it wasn’t there. And when I say that, I mean that… when I was diagnosed pretty young with autism and I didn’t receive any real help until things got very serious. When I say that, I mean I had a lot more intense mental health struggles and challenges, including depression and anxiety. And I don’t think it felt very real until real things started happening such as worse days, higher levels of depression, not wanting to do anything, [or] go anywhere.
Miller: Josh, what are your memories of the struggles that Sara had in those earlier years, say in middle school or maybe in high school, and your attempts to get her help?
J. Cady: Yeah, it was quite a journey, quite a journey. And many times, my wife and I felt like we were not equipped to help. Situations were really intense. Sara was really struggling and it was quite a challenge for her and she was relying on us to be responsive to that. And in many cases, we didn’t know what to do. And when Sara started getting into high school, went to a big high school; great people, great school, but it was way too big.
Miller: Beaverton High School.
J. Cady: Yeah.
Miller: One of the biggest in the state.
J. Cady: Right. And it was very loud, over-stimulative. It was not a good environment for somebody like Sara. She needed a smaller environment, more attention from educators and a little more support. We learned very early on in her freshman year that we needed to find that support. We went searching, and we got in touch with a lot of people that were already helping us and got in contact with new people that could help us down that road. And eventually, for her junior year, we found ourselves here at LifeWorks NW.
Miller: I mean, you just skipped ahead two years. Because you were talking about the real challenges freshman year, and two-plus years is a long time in anyone’s life, especially for a teenager.
J. Cady: After Beaverton High School, we went to another school, a smaller school, Pacific Academy; again, great school, great people. But it ended up, they were not equipped to help Sara with some of the challenges that she faced. And we had to go searching again. This time, we had to go outside of the Beaverton School District, which was a challenge in itself. And then eventually we were able to find LifeWorks NW and were able to be accepted into this program and that’s when she started to really flourish.
Miller: Sara, what was different about what you got here?
S. Cady: I would like to say everything, but I don’t know if that’s…
Miller: Say everything.
S. Cady: Yeah, I would say a big one was how open I was. I felt myself… at older schools, like Beaverton High School and Pacific and just throughout those two years before coming to LifeWorks, I felt very closed and people had to pry me open almost to get me to open up to them with my experiences and thoughts and feelings. And here it was like that, but I found a sense of almost, not immediate trust, but I think definitely a faster curve of trusting the people that work here with how I feel because when I think back to how I was two years ago or three years ago, I remember how difficult it was to open up and no one should ever have to feel like that. I just think that being at LifeWorks, it was a lot easier to find support because I felt as if they did want to help me. And at other places, like Beaverton or Pacific, the focus was elsewhere or it just wasn’t there at all. And that was really hard for me to kind of see, especially as someone who felt like I needed more support at the time.
Miller: Although, when you first arrived here, having had those, if not negative - and I appreciate you both being careful to not throw earlier places under the bus - but did you just think, oh, this is gonna be one more place? It’s not gonna serve me, when you first arrived, or did you immediately think this was gonna work?
S. Cady: I remember my screening meeting very, very well. I remember my thoughts and feelings going into it. My initial mindset was, this is just gonna be like the last school I was at. I’m not gonna open up to them, I don’t think that they can help me. It’s not gonna be worth my time. And I remember I didn’t say very much in the screening meeting. I think it was due to lack of hopefulness and that was something that really made the transition period a lot longer. But I think that was a blessing in disguise because I was able to take that time to kind of reflect on why I might not have been getting the help that I needed earlier.
Miller: Becca Schweigert is with us, as I mentioned earlier, who I guess was your therapist here, [but] no longer. Becca, I imagine that you’ve had a lot of first meetings with clients here. What do you focus on in that very first meeting?
Becca Schweigert: In those first meetings, kind of just humanizing myself is important, I think, because a lot of times you have been through a lot of different systems and I think there’s varying degrees of humanity coming from the people that you’re meeting, not that people are trying to be robots…
Miller: But humanize yourself as opposed to what, like professionalizing yourself?
Schweigert: Yes. Feeling, I guess more Freudian and sitting behind a desk and being like, oh yes, I’m the one who knows everything, all of the time. Making sure that it’s more of a comfortable, you can tell us stuff, because we’re gonna ask you a bunch of really hard things right now. I wouldn’t want to tell it to somebody who seemed like they were just sitting there judging me, from an iron tower or an ivory tower. Spending time just making sure that you know that this is a safe space, and giving the opportunity to take breaks and utilizing, there’s a really great team here in the day treatment program. Showing that we’re all in this together and we’re here for you because at the end of the day, the family and our clients are the ones who know the most about themselves. So kind of letting them know that they can take the reins more and that we’re here for them and to not be just judgy.
Miller: What kinds of coping skills or tools were you able to offer Sara, in particular?
Schweigert: Sara might be able to speak a little bit more to that because it’s been, it’s been a minute. I know just a lot of working on understanding your emotions is a really big thing, especially as a teenager. Getting to know yourself. It’s very hard sometimes to also know your emotions, or there’s not a lot of opportunities to get to know those things. The biggest thing at first is recognizing how you’re feeling, and then knowing how to advocate for yourself. Again, teaching clients how to know themselves so that they have those opportunities for advocacy and to have, [to] be the front runner of their own story.
Miller: Sara, what, what do you most remember? What has most stayed with you, that you learned from your time here?
S. Cady: That’s a really good question because I actually did learn a lot. I don’t really know off the top of my head, but something that really stuck out to me would be how I can help other people. That was something that didn’t really come up until the end of my time at ADTP, but it was something that I always knew was important, but I never thought I was capable of doing it until obviously, like right now, I’m sitting here and talking to you about it. But I think a really important part of that was I was getting so much help and support from so many different people here that I felt like everyone deserves that. It was something that I really felt was important and something that if every school, if every job, every setting had it, people would be a lot more happy and we probably wouldn’t have this mental health challenge.
Miller: How different do you think our conversation right now would be if we were having this before you spent a couple of years here? How different are you now, I guess is what I’m asking, than before?
S. Cady: Honestly, we probably wouldn’t be having this conversation, because I was so different, but I think that’s because it comes from how developed I was and how much I was exposed to. When I started high school, I came from a K-8 school. I was with the same group of people every day, and [there were] not a lot of differences in day to day school life and it was a smaller school, a smaller middle school, so small groups of classes. And it was towards the end of my time, unfortunately there, it was a negative experience because I experienced bullying and I experienced teachers [that] weren’t as helpful as I thought they would be.
When I finally got to high school, I was so used to being in small groups of people and I guess I was so dependent on my parents, because I guess I didn’t have anyone else I felt like I could depend on. But I think at the two year mark, around when I started at LifeWorks, I realized if I’m gonna do this, I do need support and it’s gonna be hard to open back up because so many times I had been opening up and [was] ignored or hurt or whatever it may be. I think that’s something that I really wanted to come here with.
Miller: Josh, I’m curious from the perspective that you have now and in a lot of ways it seems like having come through something and arrived at a much better place, what do you see now as a better way that the system could be set up so you could have, as a family, gotten here earlier?
J. Cady: Great question. I think thinking back, the diagnosis was tough to begin with.
Miller: In what ways?
J. Cady: I think we now have a much better understanding of autism and are in a better position to diagnose it, but…
Miller: Did gender play into that?
J. Cady: I believe so, and that’s what we’ve heard from the professionals that we’ve worked with. I think that was, that’s a big part.
Miller: That girls on the autism spectrum are less likely to be diagnosed than boys?
J. Cady: Yes. And then once we finally had that diagnosis… that was a very difficult thing to get. We suspected, we were told, but then you [have] got to take a certain test with the right professional, in order to get the official diagnosis. And then that starts to open up more doors, but it doesn’t open up everything that you need. You still have to go searching for all those different services and people to connect with. It took us a long time to get here but once we got here, we were having weekly sessions with Becca and it was not only helpful for Sara, but it was helpful for my wife and I as well.
Miller: In what ways?
J. Cady: Because she helped us think through some of the challenges that we felt like we were not equipped to deal with.
Miller: Sara, you said that one of the things you’ve realized relatively recently is that you can actually, you can help people who were in your situation. If you came back here and talked to a 17 or an 18 year old, a 16 year old, who’s just arrived, what would you tell them?
S. Cady: I already did that. I actually came back here two weeks ago on Friday and I did a little speech. Yeah, I had a little presentation and just kind of talked to all the kids in the ADTP program, both new and old, about how I utilized LifeWorks to get the most out of it. And I think it was really helpful for them, because there was a lot of good feedback from them. But also I could tell that they were listening and they did want to hear what I had to say. And that was also very important to me.
Miller: What was it like for you to be able to do that?
S. Cady: Honestly, it felt really good because, not only because it does feel good to give back to a community that you love so much, but also that I felt like if it could make one difference in one person’s life, that’s enough for me. It is hard because I don’t know what everyone’s thinking at the time. And I also, I don’t know everyone’s story, but I try to relate on a general level and keep it at least somewhat entertaining.
Miller: Sara and Josh Cady and Becca Schweigert, thanks very much.
S. Cady: Thank you.
J. Cady: Thank you.
Miller: Sara Cady is a graduate of the LifeWorks NW Adolescent Day Treatment Program here. We also heard from her father, Josh. Becca Schweigert is a family therapist here.
We’re gonna end today with Karen Bos. She is the Medical Director of LifeWorks NW and an assistant professor at OHSU. She helped create something called the Bridge Clinic, recently. It’s in partnership with OHSU and the Care Oregon CCO. Karen Bos, welcome.
Karen Bos: Thanks for having me.
Miller: What was the big idea behind the Bridge program?
Bos: I think we’ve heard a lot today about challenges and getting access to care for youth and families, and how do we help families when they’re at a really vulnerable time, when they really need timely, quick access to the right mental health services? That’s the idea behind Bridge Clinic, is how do we do better at kind of getting those quick connections for families? Bridge Clinic serves families who often are youth or teens who come into the emergency room for significant mental health problems like depression, anxiety, self harm, suicide attempts. Or youth who are maybe in a higher level of psychiatric care, like an inpatient hospitalization and are ready to be discharged, but don’t have outpatient care.
We know that if we can get those youth and families connected to good outpatient care, they’ll do better. They’ll have better health outcomes, they won’t return to the emergency room as often. But our system doesn’t often have a lot of those resources in place. It can be challenging if you’re a teenager in the emergency room, after maybe a suicide attempt and trying to figure out what can the emergency room staff offer you, what resources can we get in place quickly? We have a lot of shortage in Oregon for hospitalization level of care or residential level of care.
The Bridge Clinic is really about getting outpatient levels of care quickly for those families. The emergency room team can send in a referral to our Bridge Clinic team at LifeWorks NW and we get those families, those patients scheduled quickly - often within like days to weeks, kind of in that time frame - so that they can come in and see one of our child psychiatry fellows and get a really good evaluation and assessment [and] get a lot of time to ask questions and get everything answered. Then come up with a treatment plan including medications, if that’s appropriate. And then our Bridge Clinic will stay with those families until they get connected to longer term mental health services.
Miller: And this just started within the last year, right?
Bos: Yeah, just in July.
Miller: So, without this program, where might those young people have ended up?
Bos: I think the reality is, often it just takes a long time without services. Families might be on waitlists for different services, often on multiple waitlists, but it can take a long time. And when I say a long time it can be months even, to get that kind of service.
Miller: So, somebody ends up in the ER or potentially in an inpatient psychiatric facility and then they’re discharged back to home, with no plan in place for them to actually get good mental health care for months?
Bos: I think everyone tries in the system to get those good plans in place. But it can be really challenging when we just don’t have the openings, the slots, so we don’t have the availability. It might be that, maybe their pediatrician is covering their psychiatric meds for a while because they aren’t able to get in with a specialist, or maybe kind of piecing together different things. We get a lot of family feedback from the Bridge Clinic and some of the feedback that we get from families: one of the families wrote [that] one of the things they really appreciated about Bridge Clinic was having us there because there were no other openings for care for their child. And a lot of families give similar feedback, but it just feels really frustrating that they’re trying and people in the system are trying to help them as well, but there’s just very often limited resources for child psychiatry in Oregon.
Miller: Are you adding capacity? Are you adding new health care practitioners or are you just - I don’t say just as if it’s not significant, but - or are you primarily creating a new way to hook up patients in need with existing practitioners?
Bos: Yeah, it’s both. One of the really exciting things about the model that we set up with Bridge Clinic is this collaboration, like you said, between Care Oregon, OHSU and LifeWorks NW. And what we do is our Bridge Clinic is staffed by OHSU Child Psychiatry fellows, that means there are psychiatrists who are specializing in child psychiatry and are just finishing up the last stages of their training. And I think that’s really important.
I know we spoke earlier today, we heard a little bit about different workforce shortages for the EASA program and how that can affect availability of services and how we’re gonna fix that down the line. I think one of the strategies is to get people interested in community mental health and community psychiatry. And the way to get people interested, I think, is to get them exposure during training to a really positive setting in community mental health. That’s what got me interested in community mental health in my job, in my career trajectory, was really getting exposed to it when I was in medical school and residency.
Miller: What was it that you were exposed to that made you follow this as a career?
Bos: I focused on community mental health at different stages in my med school training. And then I went to a residency that focuses on community mental health as well. I think that gave me the opportunity to see what it’s like. A couple of things that I think are really important is, it’s a very team based approach, which I think we heard about today and in many different ways at LifeWorks NW we are very team-based. I think we also have the opportunity, it’s a really rewarding field to be in, [and] it’s doing really meaningful work. And I think that’s something that for trainees to see that, when they’re thinking about, what do I want to do when I’m done with training? What kind of setting do I want to practice in? It’s really important to be exposed to that.
Miller: There’s been an, almost just by necessity, we’re talking in Tigard and there has been throughout this conversation, a Portland metro area focus, whether it’s Portland, or Washington County. And my understanding is that the Bridge Clinic is also largely for young people in the Portland Metro area. But we’ve heard from our health reporter at OPB, Amelia Templeton, and others that rural Oregon, because of the distances and the lack of providers, they have their own very specific version of a mental health crisis. So what options are there for something like Bridge Clinic in the rest of Oregon?
Bos: Yeah, it’s a great question. I think it’s one that’s on a lot of people’s minds in the mental health and [the] psychiatry world is how can we… there’s such a need for this kind of vulnerable moment, right, of connecting people who maybe went into the emergency room or are having a kind of crisis level. How do we not just treat the crisis, but how do we get them connected to ongoing care that’s really gonna help stabilize them?
Bridge Clinic is something that I know we’re thinking about a lot and how to expand it. The population we serve at the LifeWorks NW Bridge Clinic is focused, it’s a youth population, but there’s a need for this for adults as well. And then, as you mentioned, also geographically, there’s a huge need for this across the state. I think one thing we’re thinking about in psychiatry is how do we use telehealth as an option to help support families and youth who are not in the metro area or in areas where we don’t have as many psychiatrists? And I think there’s a lot of potential for that as well.
Miller: Karen Bos, thanks very much.
Bos: Thank you.
Miller: Karen Boss is the medical director of LifeWorks NW and an assistant professor at OHSU. Thanks very much to the Oregon Community Foundation for making this series possible. The next installment of this series of conversations about significant issues that Oregon is facing and potential solutions is gonna focus on treating substance use disorder.
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