Stigma Reduction and Language for Clinical and Administrative Staff

Transcript (click here to view)

Stigma Reduction and Language for Clinical and Administrative Staff

ARIEL BOTTA: We’re very excited to provide this presentation for you today. My name is Dr. Ariel Botta, and I’m the Coordinator of Group Psychotherapy, and my dear colleague, Shannon Mountain-Ray, is the Director of Integrated Treatment in the Adolescent Substance Use and Addiction Program in the Division of Developmental Medicine at Boston Children’s Hospital.

And today, we’ll be talking to you about working with youth who use substances. We were brought to you by the TREAT ME Representatives in Maine. And TREAT ME stands for Treatment, Recovery, Education, Advocacy for Teens with Substance Use Disorder. The representatives reach out to the Opioid Response Network to develop a training on how to provide compassionate and inclusive care to youth who use substances.

We are brought to you today in partnership with the Opioid Response Network, and we want to thank ORN so much for funding us and for the opportunity to partnership. The ORN is a SAMHSA-funded initiative, which assists states, organizations, and individuals by providing the resources as well as the technical assistance needed to address the opioid and stimulant use crisis. The ORN supports evidence-based prevention, treatment, and recovery initiatives. The ORN connects local, experienced consultants, who work in prevention, treatment, and recovery, like Shannon and myself, to organizations, such as yours. The ORN accepts requests for education and training similar to the requests the TREAT ME representatives made for us to provide this training to you today. And each state and territory has a designated team led by a Regional Technical Transfer Specialist, who has experience and expertise in implementing evidence-based practices. Shannon and I have no financial interests or relationships to disclose today.

We have some pretest questions for you to think about as you hear the material we’re going to share with you today. And at the end of the presentation, we’ll ask you the same questions to determine if your views have changed. Number one, true or false, how a staff member interacts with patients and families on the phone or in-person can impact whether they continue to engage in care? Number two, the best way or ways to support patients and families while they’re waiting to receive care is to, A, have concrete resources readily available to offer them, B, have an identified person in the practice, who can respond quickly to immediate or urgent patient concerns, or C, both A and B? Number three, an example of Person-First language is A, substance abuser, B, addict, C, person who uses substances, or D, A and C? Number four, it is common for staff to have challenging feelings towards patients and families. When this happens, the best thing to do is, A, do nothing, the feeling will subside, B, express your frustrations to a colleague, or C, talk with your supervisor to get guidance and support. And lastly, number five is true or false, parental consent is required for patients under the age of 18 to receive treatment for substance use in the state of Maine.

The red thread that runs through our presentation today is that Shannon and I believe that every interaction is therapeutic, from start to finish. And what we know from research is that 4.5% of adolescents between the ages of 12 and 17 were diagnosed with a past substance use disorder. However, only 8.3% of them receive treatment. And this data really speaks to the two biggest challenges that we have in working with youth who use substances, which are engagement and retention.

Shannon and I really believe that people remember the first thing you say to them and the last thing you say to them. So as administrative assistants, your roles are crucial. You’re often the first point of contact for patients and families. And ensuring that they feel heard, understood, and cared for will increase the likelihood that they’ll stay engaged in treatment exponentially. And today we’re going to be talking about strategies for increasing engagement and retention. We’ll talk about how to create an inclusive environment, how to provide compassionate care, and how to lower barriers to care.

One of the requests made for this presentation was to address how to create an inclusive environment in which all people feel welcome. The most important thing to keep in mind when creating inclusive environments is to know your patients and client population. You may be working with individuals who are experiencing homelessness, immigrants, refugees, people who are undocumented in the United States, individuals who are experiencing economic hardship, and/or those who are experiencing oppression, or feeling disenfranchised due to other intersecting identities, such as race, ethnicity, sexual orientation, or gender identity, for example. There are many reasons why people can feel marginalized, and it’s crucial that we know the population with whom we work, and that we listen to the barriers to care that they identify. In this slide we’ll give a few examples of how to be inclusive with particular populations. And in the next slide we will share a few of the many resources that are out there that can guide you in your practice in creating an inclusive environment for all.

I often work with gender diverse and transgender youth. And so I’m very accustomed to asking what people’s chosen names and pronouns are. If I’m in-person, I often wear a pin with my chosen pronouns. And if I’m working virtually, you may see from my image, that I’ll always put my chosen pronouns next to my name and credentials. And by doing this, I’m letting people know we’re members of the gender diverse or transgender community, that this is an inclusive environment, and that everybody will be sharing pronouns, and we’re not just asking people who identify as transgender or gender diverse to do so.

Another great question is, what is the best way to contact you? And this really speaks to the fact that lots of youth who are using substances may be living– maybe transient, so they may not be living in the same place. It indicates to them that we’re not making assumptions that they’re living with their families of origin or always in the same place between visits. And also, we’re acknowledging that some youth may be experiencing homelessness. So Shannon and I are pretty accustomed to asking every single visit what the best way to contact our clients is, because that may change from visit to visit.

Another question is, do you need any immediate resources, and if so, what can we help you find and this is a great way to be doing an ongoing needs assessment. So rather than making assumptions about what our clients need we simply ask them, and then keep track of what they tell us and this will really help us figure out what the barriers to care are and what resources we need to be creating for our populations. It’s also helpful to have a wide array of visual representation and resources that focus on unique needs of various populations in your practice and to have them available in different languages whenever possible.

When thinking about the last point, in terms of representation and resources, here are some examples of helpful information and resources for different populations that your practice, program, or service may see. This is not at all a comprehensive list, but it is a start, and we suggest that you create a process to evaluate your own population to identify what they may need and how you may create an inclusive environment where all feel heard, represented, and cared for. The purposes of this presentation, I’ll just review the first three resources. And when you receive the slide deck, the links for each of the resources will be at the back of the PowerPoint presentation.

The New Mainers Resource Center is a Portland Adult Education program servicing immigrants, refugees, and employers in the Greater Portland Area, with the mission of supporting Maine’s economic development by facilitating the professional integration of immigrants and refugees and by meeting employers’ demands for a skilled and culturally diverse workforce. The website provides information for people seeking employment, employers interested in hiring, and other community resources that may be helpful for immigrants and refugees new to Maine.

The second resource, Stigma-Free West Virginia, is a free and easily accessible resource that provides four distinct ways that providers and practice staff can decrease stigma when providing care to those who are using substances. The four ways include changing our language and labels, which I’ll talk about in a moment, learning about the issue, which Shannon and I are here today to talk to you about, listening to people’s personal experiences rather than making assumptions about what they’re experiencing, and reviewing practices and policies.

And lastly, the pediatrician’s guide to an LGBTQ-friendly practice includes how to create a safe and affirming environment and the important role that front desk staff play. This website offers many tips and suggestions and includes brief, helpful videos to use in considering your practices and procedures. And Shannon and I are big fans of this website.

Part of creating an inclusive environment is knowing who can receive services. It is very important to note that any minor may consent to treatment for substance use disorder or for emotional or psychological problems in the state of Maine. And a minor is defined as anyone less than 18 years of age. There is no lower age defined in the state of Maine.

The statute varies between states. For example, in Massachusetts, where Shannon and I practice, the lower age defined is 12. And as you can see from this slide, in 2018, Maine’s legislature attempted to pass legislation to define a lower cutoff limit to consent, but it did not pass. So it’s important to remember that currently Maine patients under the age of 18 do not need parental or guardian permission to receive care.

In providing compassionate care, it’s important to use an empathic approach when interacting with patients. Shannon and I often say it’s important to put ourselves in their shoes. We also practice taking a non-judgmental stance and understanding that ambivalence is a normal part of the treatment process. It’s not a behavioral problem. And that no-shows are incredibly common, and should be expected, and it does not mean that a patient is not engaged in care. As we mentioned there are many barriers to care when youth are trying to access services.

And people may present in many different ways. They may come to visits or virtual visits under the influence. They may present to you unhoused or having not been able to be. And it’s important that we approach each person and their situation with compassion.

It’s also really important to be aware of both our verbal and nonverbal communication. How we act towards others is as important as what we say to them. And to recognize our own feelings judgments and biases. And to seek support from a supervisor when strong or challenging feelings arise with certain patients and families, and they will, because it’s natural, and we all have biases.

There’s a wonderful campaign called Language Matters. And it emphasizes the importance of using non-stigmatizing person-first language in all interactions related to patient care with people who are using substances. This campaign really emphasizes the importance of replacing old language, such as junkie, druggie, addict, substance abuser with person who uses substances. And rather than using substance abuse, saying substance use, substance misuse. Rather than the term clean, we say somebody is in recovery, remission, abstinent, or sober. Rather than referring to dirty urine, we say that someone had an unexpected test result. Rather than replacement therapy, we say someone is in treatment. And rather than saying someone’s born addicted, we say they were substance-exposed.

In terms of lowering barriers to care, if someone asks for support, it’s really critical to respond immediately to strike while the iron is hot. This is an absolute indication that they are ready for care. And readiness is everything when it comes to providing treatment for substance use.

It’s also important to make access to care as easy as possible and to alleviate client burden. This is, again, why we’re always listening really carefully for what the barriers to care are, so that we can break down those barriers. And to remember that navigating systems can be incredibly challenging, especially for adolescents and young adults, who don’t have experience doing this yet. And many young people don’t have support from parents, guardians, or other adults in their lives as they’re trying to navigate systems. Some practical ways to lower barriers to care are to talk to your team about creating a plan to support patients during wait times and to have concrete resources at your fingertips, like websites or internal resources. It can also be very helpful to identify a go-to person in your practice to get the right answers and responses when questions arise. And now, Shannon is going to demonstrate how creating an inclusive environment, providing compassionate care, and lowering barriers to care can be put into action by using some scripts that we’ve developed for you.

SHANNON MOUNTAIN-RAY: Thank you so much, Ariel. What we know is that one of the best strategies for ensuring that you provide compassionate and inclusive care is being prepared, and really trying to anticipate those different scenarios that may present themselves and have resources, and protocols, and some scripts in place for when that happens.

So we’re going to start by using an example of an introductory interaction. So this can be when a patient comes in or family comes into the office for the first time or calls the office. Or, maybe not even the first time, but presents with a new request or a new need.

So you, as the front desk staff person, may say, good morning. Thank you for calling general pediatrics. How may I help you today? And the patient may respond by saying something like, I’m really struggling with my alcohol and drug use, and I’m trying to find some help.

In order to present in a really compassionate way, you can say something like, I’m so glad that you reached out. My name is Ariel, and my chosen pronouns are she/her/hers. Let’s work together to see what your needs are and how we can provide support and guidance. First, can you tell me your chosen name, chosen pronouns, and your date of birth?

And the patient may respond, and say, my name is Charlotte Smith, and my date of birth is 7/11/2005. So you go into the system, and you attempt to look up the patient, but you’re not finding that patient in your system. So this can happen particularly in situations where a young person may be transgender.

And in this case, Charlotte was actually born male and under a different name. And so when you’re prepared for these kinds of things, you can minimize any kind of shock or reaction. And you can say, I’m not finding a patient of that name in our system. Could it be under another name?

And the patient might say, it might be under Charles Smith. And you may get the sense that they are prepared for a reaction. That they are defending themselves against some shock or some kind of judgment or bias.

And so you can say, thank you. I found it. I’ll make sure that your chosen name and pronouns are reflected accurately in our system. This may take some time, but please know that we are working diligently on this important matter. So you’re reassuring them that you understand how important this is, and that you’ll make sure that the situation is remedied.

And we might dive a little bit further. And we want to identify what are the needs or what is the need of the person that you’re talking with. It’s really important in these circumstances to have a protocol in place of how you address these needs ahead of time. So it may be a protocol where you have an identified person in the practice who you can refer patients to, like a triage nurse, or a resource specialist, or even providers in the practice. Or, it may be that you don’t have access to that kind of thing and you, yourself, may be the resource itself. And so you will want to, as Ariel mentioned, have a list of resources at your fingertips or have an easy way of accessing resources that you may not have readily available.

So you might say, do you have a sense of what you’re looking for, in terms of support? Sometimes patients will know exactly what they want, and they can be very specific. But other times, they just say no. I just know I need help.

And so you might respond, and say, OK, we’re here to help. You mentioned that you’re looking for help around your substance use. I’m going to connect you with our triage nurse to help you find what you need. If you have any trouble reaching them, please give me a call back, and I’ll help make sure you get connected to someone. So often when there are lapses in time, or there’s a need to call people back, or things like that, we lose the opportunity, so by inviting them to call you back in the event that they don’t hear from someone, or they don’t get what they need, or for some reason they get disconnected is really critical in letting them know that you’re there and you really want to help them. So again, as Ariel mentioned, providing resources, if there’s a delay in care. So again, often if it’s a situation where someone wants to see a provider in your practice, or program, or organization, or some other access to a resource where there might be a wait time, it’s really important that there’s a plan in place to help support them during that time.

So in a situation, for example, where they may request to be seen by one of your providers or it’s determined that they should be seen by one of your providers, but there will be a delay in services, you can say, currently, there may be a wait time to have you seen by one of our providers. I’m going to give you some names and numbers of programs and supports that might be helpful for you during the waiting period. What is the best way for me to– [AUDIO OUT] And back to Ariel’s point, about getting the most updated contact information, but doing so without having them to have to explain where they’re living, what they do and don’t have access to. So if you just check in, what’s the best way for me to reach you, They will tell you and they don’t have to explain anything about the circumstance.

So the patient may say, thank you. I don’t have a cell phone or access to email, at the moment, so giving them to me now would be the best thing. So again, having at least some resources available to you, in that moment, will be very helpful in these situations. And you might say, perfect, and provide those resources.

In some circumstances, you may have a patient who’s really, really struggling, in that moment. And they may say, I’m really worried, because I’m really struggling right now and not sure I can wait. So having a plan in place for how you respond to immediate needs or crises, in the moment, is really critical.

You might say, I’m so sorry that you’re having such a hard time. If you’re worried about your safety, we suggest calling 9-1-1, or going to your nearest emergency room to get immediate support. After you’ve been seen by the emergency room and a plan has been made, please call us back so we can continue to help support you. So again, this is a situation where some of the biggest challenges in our system of care is that when people transition between providers or different levels of care often people get lost in the system. So inviting them to make sure that they reach back out to you, and they tell you, this is where I’ve been, and this is what I need, and being available to help them in that way is really, really important. So as we talked about in the beginning, remember that every interaction is therapeutic. From the minute someone walks into the office, or calls on the phone, and the hello that you give them, all the way through identifying their needs and finding resources for support, every interaction you have is therapeutic.

In summary, first impressions matter. Engagement and retention begins with each of you. And creating an inclusive environment will help us to reach our most vulnerable patients. Remember, that youth are the identified patients and main contact. Parental consent is not required for them to engage in care. Provide compassionate care, and be aware of your own biases and judgments, and respond to youth needs expeditiously and guide them in navigating systems. This is a really wonderful website presented by the National Child Traumatic Stress Network and gives a lot of really wonderful tools and strategies for engaging adolescents in treatment. Again, this will be on the final slide with all of the resources.

When you’re working with your practices or programs or organizations to think about how you can create a compassionate and inclusive environment with low barriers to care here are some questions to consider. What resources do we have in place to support patients during wait times? Who do I talk to if I’m having challenging feelings towards a patient or a family? And what do we have or what do we need to create an inclusive environment?

Circling back to the pretest questions, after having gone through this presentation, hopefully these answers will come easily to you. But number one, true or false, how a staff member interacts with patients and families on the phone or in-person can impact whether they continue to engage in care? Number two, the best way to support patients and families while they’re waiting to receive care is to A, have concrete resources readily available to offer them, B, have an identified person in the practice who can respond quickly to immediate or urgent patient concerns, C, both A and B. Number three, an example of person-first language is A, substance abuser, B, addict, C, person who used substances, D, both A and C. Number four, it’s common for staff to have challenging feelings towards patients and families. When this happens the best thing to do is, A, do nothing, the feelings will subside, B, express your frustrations to a colleague, C, talk with your supervisor to get guidance and support. And lastly, number five, true or false, parental consent is required for patients under 18 to receive treatment for substance use.

We thank you all for being here today. And if you have a brief moment, please take time to fill out this survey. Your feedback is really important to us. Thank you.

ARIEL BOTTA: We’re very excited to provide this presentation for you today. My name is Dr. Ariel Botta, and I’m the Coordinator of Group Psychotherapy, and my dear colleague, Shannon Mountain-Ray, is the Director of Integrated Treatment in the Adolescent Substance Use and Addiction Program in the Division of Developmental Medicine at Boston Children’s Hospital.

And today, we’ll be talking to you about working with youth who use substances. We were brought to you by the TREAT ME Representatives in Maine. And TREAT ME stands for Treatment, Recovery, Education, Advocacy for Teens with Substance Use Disorder. The representatives reach out to the Opioid Response Network to develop a training on how to provide compassionate and inclusive care to youth who use substances.

We are brought to you today in partnership with the Opioid Response Network, and we want to thank ORN so much for funding us and for the opportunity to partnership. The ORN is a SAMHSA-funded initiative, which assists states, organizations, and individuals by providing the resources as well as the technical assistance needed to address the opioid and stimulant use crisis. The ORN supports evidence-based prevention, treatment, and recovery initiatives. The ORN connects local, experienced consultants, who work in prevention, treatment, and recovery, like Shannon and myself, to organizations, such as yours. The ORN accepts requests for education and training similar to the requests the TREAT ME representatives made for us to provide this training to you today. And each state and territory has a designated team led by a Regional Technical Transfer Specialist, who has experience and expertise in implementing evidence-based practices. Shannon and I have no financial interests or relationships to disclose today.

We have some pretest questions for you to think about as you hear the material we’re going to share with you today. And at the end of the presentation, we’ll ask you the same questions to determine if your views have changed. Number one, true or false, how a staff member interacts with patients and families on the phone or in-person can impact whether they continue to engage in care? Number two, the best way or ways to support patients and families while they’re waiting to receive care is to, A, have concrete resources readily available to offer them, B, have an identified person in the practice, who can respond quickly to immediate or urgent patient concerns, or C, both A and B? Number three, an example of Person-First language is A, substance abuser, B, addict, C, person who uses substances, or D, A and C? Number four, it is common for staff to have challenging feelings towards patients and families. When this happens, the best thing to do is, A, do nothing, the feeling will subside, B, express your frustrations to a colleague, or C, talk with your supervisor to get guidance and support. And lastly, number five is true or false, parental consent is required for patients under the age of 18 to receive treatment for substance use in the state of Maine.

The red thread that runs through our presentation today is that Shannon and I believe that every interaction is therapeutic, from start to finish. And what we know from research is that 4.5% of adolescents between the ages of 12 and 17 were diagnosed with a past substance use disorder. However, only 8.3% of them receive treatment. And this data really speaks to the two biggest challenges that we have in working with youth who use substances, which are engagement and retention.

Shannon and I really believe that people remember the first thing you say to them and the last thing you say to them. So as administrative assistants, your roles are crucial. You’re often the first point of contact for patients and families. And ensuring that they feel heard, understood, and cared for will increase the likelihood that they’ll stay engaged in treatment exponentially. And today we’re going to be talking about strategies for increasing engagement and retention. We’ll talk about how to create an inclusive environment, how to provide compassionate care, and how to lower barriers to care.

One of the requests made for this presentation was to address how to create an inclusive environment in which all people feel welcome. The most important thing to keep in mind when creating inclusive environments is to know your patients and client population. You may be working with individuals who are experiencing homelessness, immigrants, refugees, people who are undocumented in the United States, individuals who are experiencing economic hardship, and/or those who are experiencing oppression, or feeling disenfranchised due to other intersecting identities, such as race, ethnicity, sexual orientation, or gender identity, for example. There are many reasons why people can feel marginalized, and it’s crucial that we know the population with whom we work, and that we listen to the barriers to care that they identify. In this slide we’ll give a few examples of how to be inclusive with particular populations. And in the next slide we will share a few of the many resources that are out there that can guide you in your practice in creating an inclusive environment for all.

I often work with gender diverse and transgender youth. And so I’m very accustomed to asking what people’s chosen names and pronouns are. If I’m in-person, I often wear a pin with my chosen pronouns. And if I’m working virtually, you may see from my image, that I’ll always put my chosen pronouns next to my name and credentials. And by doing this, I’m letting people know we’re members of the gender diverse or transgender community, that this is an inclusive environment, and that everybody will be sharing pronouns, and we’re not just asking people who identify as transgender or gender diverse to do so.

Another great question is, what is the best way to contact you? And this really speaks to the fact that lots of youth who are using substances may be living– maybe transient, so they may not be living in the same place. It indicates to them that we’re not making assumptions that they’re living with their families of origin or always in the same place between visits. And also, we’re acknowledging that some youth may be experiencing homelessness. So Shannon and I are pretty accustomed to asking every single visit what the best way to contact our clients is, because that may change from visit to visit.

Another question is, do you need any immediate resources, and if so, what can we help you find and this is a great way to be doing an ongoing needs assessment. So rather than making assumptions about what our clients need we simply ask them, and then keep track of what they tell us and this will really help us figure out what the barriers to care are and what resources we need to be creating for our populations. It’s also helpful to have a wide array of visual representation and resources that focus on unique needs of various populations in your practice and to have them available in different languages whenever possible.

When thinking about the last point, in terms of representation and resources, here are some examples of helpful information and resources for different populations that your practice, program, or service may see. This is not at all a comprehensive list, but it is a start, and we suggest that you create a process to evaluate your own population to identify what they may need and how you may create an inclusive environment where all feel heard, represented, and cared for. The purposes of this presentation, I’ll just review the first three resources. And when you receive the slide deck, the links for each of the resources will be at the back of the PowerPoint presentation.

The New Mainers Resource Center is a Portland Adult Education program servicing immigrants, refugees, and employers in the Greater Portland Area, with the mission of supporting Maine’s economic development by facilitating the professional integration of immigrants and refugees and by meeting employers’ demands for a skilled and culturally diverse workforce. The website provides information for people seeking employment, employers interested in hiring, and other community resources that may be helpful for immigrants and refugees new to Maine.

The second resource, Stigma-Free West Virginia, is a free and easily accessible resource that provides four distinct ways that providers and practice staff can decrease stigma when providing care to those who are using substances. The four ways include changing our language and labels, which I’ll talk about in a moment, learning about the issue, which Shannon and I are here today to talk to you about, listening to people’s personal experiences rather than making assumptions about what they’re experiencing, and reviewing practices and policies.

And lastly, the pediatrician’s guide to an LGBTQ-friendly practice includes how to create a safe and affirming environment and the important role that front desk staff play. This website offers many tips and suggestions and includes brief, helpful videos to use in considering your practices and procedures. And Shannon and I are big fans of this website.

Part of creating an inclusive environment is knowing who can receive services. It is very important to note that any minor may consent to treatment for substance use disorder or for emotional or psychological problems in the state of Maine. And a minor is defined as anyone less than 18 years of age. There is no lower age defined in the state of Maine.

The statute varies between states. For example, in Massachusetts, where Shannon and I practice, the lower age defined is 12. And as you can see from this slide, in 2018, Maine’s legislature attempted to pass legislation to define a lower cutoff limit to consent, but it did not pass. So it’s important to remember that currently Maine patients under the age of 18 do not need parental or guardian permission to receive care.

In providing compassionate care, it’s important to use an empathic approach when interacting with patients. Shannon and I often say it’s important to put ourselves in their shoes. We also practice taking a non-judgmental stance and understanding that ambivalence is a normal part of the treatment process. It’s not a behavioral problem. And that no-shows are incredibly common, and should be expected, and it does not mean that a patient is not engaged in care. As we mentioned there are many barriers to care when youth are trying to access services.

And people may present in many different ways. They may come to visits or virtual visits under the influence. They may present to you unhoused or having not been able to be. And it’s important that we approach each person and their situation with compassion.

It’s also really important to be aware of both our verbal and nonverbal communication. How we act towards others is as important as what we say to them. And to recognize our own feelings judgments and biases. And to seek support from a supervisor when strong or challenging feelings arise with certain patients and families, and they will, because it’s natural, and we all have biases.

There’s a wonderful campaign called Language Matters. And it emphasizes the importance of using non-stigmatizing person-first language in all interactions related to patient care with people who are using substances. This campaign really emphasizes the importance of replacing old language, such as junkie, druggie, addict, substance abuser with person who uses substances. And rather than using substance abuse, saying substance use, substance misuse. Rather than the term clean, we say somebody is in recovery, remission, abstinent, or sober. Rather than referring to dirty urine, we say that someone had an unexpected test result. Rather than replacement therapy, we say someone is in treatment. And rather than saying someone’s born addicted, we say they were substance-exposed.

In terms of lowering barriers to care, if someone asks for support, it’s really critical to respond immediately to strike while the iron is hot. This is an absolute indication that they are ready for care. And readiness is everything when it comes to providing treatment for substance use.

It’s also important to make access to care as easy as possible and to alleviate client burden. This is, again, why we’re always listening really carefully for what the barriers to care are, so that we can break down those barriers. And to remember that navigating systems can be incredibly challenging, especially for adolescents and young adults, who don’t have experience doing this yet. And many young people don’t have support from parents, guardians, or other adults in their lives as they’re trying to navigate systems. Some practical ways to lower barriers to care are to talk to your team about creating a plan to support patients during wait times and to have concrete resources at your fingertips, like websites or internal resources. It can also be very helpful to identify a go-to person in your practice to get the right answers and responses when questions arise. And now, Shannon is going to demonstrate how creating an inclusive environment, providing compassionate care, and lowering barriers to care can be put into action by using some scripts that we’ve developed for you.

SHANNON MOUNTAIN-RAY: Thank you so much, Ariel. What we know is that one of the best strategies for ensuring that you provide compassionate and inclusive care is being prepared, and really trying to anticipate those different scenarios that may present themselves and have resources, and protocols, and some scripts in place for when that happens.

So we’re going to start by using an example of an introductory interaction. So this can be when a patient comes in or family comes into the office for the first time or calls the office. Or, maybe not even the first time, but presents with a new request or a new need.

So you, as the front desk staff person, may say, good morning. Thank you for calling general pediatrics. How may I help you today? And the patient may respond by saying something like, I’m really struggling with my alcohol and drug use, and I’m trying to find some help.

In order to present in a really compassionate way, you can say something like, I’m so glad that you reached out. My name is Ariel, and my chosen pronouns are she/her/hers. Let’s work together to see what your needs are and how we can provide support and guidance. First, can you tell me your chosen name, chosen pronouns, and your date of birth?

And the patient may respond, and say, my name is Charlotte Smith, and my date of birth is 7/11/2005. So you go into the system, and you attempt to look up the patient, but you’re not finding that patient in your system. So this can happen particularly in situations where a young person may be transgender.

And in this case, Charlotte was actually born male and under a different name. And so when you’re prepared for these kinds of things, you can minimize any kind of shock or reaction. And you can say, I’m not finding a patient of that name in our system. Could it be under another name?

And the patient might say, it might be under Charles Smith. And you may get the sense that they are prepared for a reaction. That they are defending themselves against some shock or some kind of judgment or bias.

And so you can say, thank you. I found it. I’ll make sure that your chosen name and pronouns are reflected accurately in our system. This may take some time, but please know that we are working diligently on this important matter. So you’re reassuring them that you understand how important this is, and that you’ll make sure that the situation is remedied.

And we might dive a little bit further. And we want to identify what are the needs or what is the need of the person that you’re talking with. It’s really important in these circumstances to have a protocol in place of how you address these needs ahead of time. So it may be a protocol where you have an identified person in the practice who you can refer patients to, like a triage nurse, or a resource specialist, or even providers in the practice. Or, it may be that you don’t have access to that kind of thing and you, yourself, may be the resource itself. And so you will want to, as Ariel mentioned, have a list of resources at your fingertips or have an easy way of accessing resources that you may not have readily available.

So you might say, do you have a sense of what you’re looking for, in terms of support? Sometimes patients will know exactly what they want, and they can be very specific. But other times, they just say no. I just know I need help.

And so you might respond, and say, OK, we’re here to help. You mentioned that you’re looking for help around your substance use. I’m going to connect you with our triage nurse to help you find what you need. If you have any trouble reaching them, please give me a call back, and I’ll help make sure you get connected to someone. So often when there are lapses in time, or there’s a need to call people back, or things like that, we lose the opportunity, so by inviting them to call you back in the event that they don’t hear from someone, or they don’t get what they need, or for some reason they get disconnected is really critical in letting them know that you’re there and you really want to help them. So again, as Ariel mentioned, providing resources, if there’s a delay in care. So again, often if it’s a situation where someone wants to see a provider in your practice, or program, or organization, or some other access to a resource where there might be a wait time, it’s really important that there’s a plan in place to help support them during that time.

So in a situation, for example, where they may request to be seen by one of your providers or it’s determined that they should be seen by one of your providers, but there will be a delay in services, you can say, currently, there may be a wait time to have you seen by one of our providers. I’m going to give you some names and numbers of programs and supports that might be helpful for you during the waiting period. What is the best way for me to– [AUDIO OUT] And back to Ariel’s point, about getting the most updated contact information, but doing so without having them to have to explain where they’re living, what they do and don’t have access to. So if you just check in, what’s the best way for me to reach you, They will tell you and they don’t have to explain anything about the circumstance.

So the patient may say, thank you. I don’t have a cell phone or access to email, at the moment, so giving them to me now would be the best thing. So again, having at least some resources available to you, in that moment, will be very helpful in these situations. And you might say, perfect, and provide those resources.

In some circumstances, you may have a patient who’s really, really struggling, in that moment. And they may say, I’m really worried, because I’m really struggling right now and not sure I can wait. So having a plan in place for how you respond to immediate needs or crises, in the moment, is really critical.

You might say, I’m so sorry that you’re having such a hard time. If you’re worried about your safety, we suggest calling 9-1-1, or going to your nearest emergency room to get immediate support. After you’ve been seen by the emergency room and a plan has been made, please call us back so we can continue to help support you. So again, this is a situation where some of the biggest challenges in our system of care is that when people transition between providers or different levels of care often people get lost in the system. So inviting them to make sure that they reach back out to you, and they tell you, this is where I’ve been, and this is what I need, and being available to help them in that way is really, really important. So as we talked about in the beginning, remember that every interaction is therapeutic. From the minute someone walks into the office, or calls on the phone, and the hello that you give them, all the way through identifying their needs and finding resources for support, every interaction you have is therapeutic.

In summary, first impressions matter. Engagement and retention begins with each of you. And creating an inclusive environment will help us to reach our most vulnerable patients. Remember, that youth are the identified patients and main contact. Parental consent is not required for them to engage in care. Provide compassionate care, and be aware of your own biases and judgments, and respond to youth needs expeditiously and guide them in navigating systems. This is a really wonderful website presented by the National Child Traumatic Stress Network and gives a lot of really wonderful tools and strategies for engaging adolescents in treatment. Again, this will be on the final slide with all of the resources.

When you’re working with your practices or programs or organizations to think about how you can create a compassionate and inclusive environment with low barriers to care here are some questions to consider. What resources do we have in place to support patients during wait times? Who do I talk to if I’m having challenging feelings towards a patient or a family? And what do we have or what do we need to create an inclusive environment?

Circling back to the pretest questions, after having gone through this presentation, hopefully these answers will come easily to you. But number one, true or false, how a staff member interacts with patients and families on the phone or in-person can impact whether they continue to engage in care? Number two, the best way to support patients and families while they’re waiting to receive care is to A, have concrete resources readily available to offer them, B, have an identified person in the practice who can respond quickly to immediate or urgent patient concerns, C, both A and B. Number three, an example of person-first language is A, substance abuser, B, addict, C, person who used substances, D, both A and C. Number four, it’s common for staff to have challenging feelings towards patients and families. When this happens the best thing to do is, A, do nothing, the feelings will subside, B, express your frustrations to a colleague, C, talk with your supervisor to get guidance and support. And lastly, number five, true or false, parental consent is required for patients under 18 to receive treatment for substance use.

We thank you all for being here today. And if you have a brief moment, please take time to fill out this survey. Your feedback is really important to us. Thank you.