YCSC State of the Department: Looking Ahead to 2024

Transcript

• 00:00Welcome to the first Grand Rounds of 2024.
• 00:03I hope your New Year is off to a good start,
• 00:07and on behalf of the entire
• 00:08Grand Rounds Committee,
• 00:09I think we'll hope for a happy,
• 00:10successful, but above all,
• 00:12a more peaceful year ahead.
• 00:14Now Doctor Mays has been very generous.
• 00:16She's given us a couple of moments to get
• 00:18us started with our Grand Rounds series,
• 00:20and we wanted to start with
• 00:22a few words of thanks.
• 00:23We wanted to start with gratitude.
• 00:25So our first word of thanks goes to you,
• 00:27the Child Study Center community.
• 00:29Thank you for supporting grand rounds.
• 00:31Thank you to everyone who's reached
• 00:33out with feedback about talks,
• 00:34invited speakers, suggested speakers.
• 00:36We really want to encourage more of that
• 00:39and Andrews will talk to you a little bit
• 00:41more about how you can get more involved.
• 00:43We want to make grand rounds
• 00:45the best that it can be.
• 00:46We wanted to contribute to the
• 00:48mission of the Child Studies Center,
• 00:49showcasing the best in clinical practice,
• 00:52cutting edge research and medical education.
• 00:54And to do so,
• 00:56we need your help.
• 00:58And the second word of thanks goes
• 00:59to our Grand Rounds Committee and we
• 01:02thought we would take this opportunity
• 01:04to introduce you to the committee.
• 01:06And so Andrews and I have the
• 01:08pleasure working with Julie Chilton,
• 01:10Mike Crowley,
• 01:10Tara Davila,
• 01:11Amanda Lowell and two of our newest
• 01:13members of our Grand Rounds committee,
• 01:15Jen Reyes and Sarah Sanchez Alonso.
• 01:18Sarah is doing some fantastic work
• 01:20looking at multimodal imaging
• 01:21and developmental neuroscience.
• 01:23And of course,
• 01:24Chen is doing wonderful work trying
• 01:26to assess the socio emotional quality
• 01:28of the early childcare environments.
• 01:30And so we're delighted to have
• 01:31them on board on the committee.
• 01:33These are the people that you need
• 01:34to reach out to if you want to give
• 01:37suggestions about grand rounds.
• 01:38And then our final word of thanks
• 01:40to Krista Marshizzo and to Una
• 01:42Casey for their tremendous support,
• 01:43without which grand rounds
• 01:45simply wouldn't happen.
• 01:46And so now I'll just ask Andreas to come up,
• 01:48just a moment to tell you how
• 01:49you can get more involved.
• 01:54I had three things to say,
• 01:55but we're such a well coordinated team
• 01:57that I only have two things to say because
• 01:59the you mentioned about suggestions.
• 02:01You can approach any one of us
• 02:03in the grand rounds committee,
• 02:04be it with a particular speaker
• 02:06you're interested in or a topic
• 02:08that you're interested in.
• 02:09We put a lot of work and effort as a
• 02:12committee to have a broad range of
• 02:15interests and topics and speakers
• 02:18and that leads to our schedule.
• 02:19We think we've put together a very
• 02:22nice rich schedule for the coming
• 02:23year and we invite you to tell
• 02:26you what's happening next week.
• 02:27It's going to be a very special one.
• 02:29We have Maya Adam from Stanford
• 02:31University who has been using
• 02:33cartoons and short animated videos
• 02:35to take messaging in healthcare,
• 02:38including mental healthcare around the globe.
• 02:40And many of these videos are
• 02:41done not in Hollywood,
• 02:42but in Africa and in the global South.
• 02:45So it's really important, interesting work.
• 02:48And my final point is about attendance.
• 02:49Thank you for being here.
• 02:51We love having you here in person,
• 02:53where you get coffee,
• 02:55and having you in Zoom where you don't
• 02:57get coffee, And wherever you are,
• 03:00we really encourage you to not only come,
• 03:03but to participate, to be active.
• 03:05There is no question that is a dumb question.
• 03:07Our speakers are here to teach us all,
• 03:10and whether you make your questions
• 03:12on the text or in person, it's great.
• 03:15And finally, as you heard,
• 03:18we have Cmes and CE us.
• 03:20Not this week, but usually we do.
• 03:22And thank you to Tara for her valiant
• 03:24effort in getting us to CEU Land.
• 03:27So without further ado, our chair, Linda.
• 03:28Sure.
• 03:35Thank you Andres and I also would
• 03:37echo gratitude for for so many,
• 03:39for all of you on Zoom and for all
• 03:42of you coming and let's get going.
• 03:45Let me just start.
• 03:47So first, I want to welcome
• 03:49everyone back from the winter break.
• 03:51However you celebrated the holidays,
• 03:53I hope that you've had a restful and
• 03:55really joyous time and most importantly,
• 03:57that you had a restorative time.
• 04:00As I've been reflecting on this
• 04:02particular time that we just came
• 04:04through and the meaning of the
• 04:06winter break over these these many,
• 04:09many centuries,
• 04:10I have some thoughts that I wanted to
• 04:13actually begin with that across cultures,
• 04:17this time of year,
• 04:19beginning with the winter solstice,
• 04:22actually represents a time of coming
• 04:24from darkness from the darkest day,
• 04:26which is December 21st,
• 04:28and then emerging into light.
• 04:31And really across cultures,
• 04:33people represent this time of year
• 04:37as a coming from dying into life,
• 04:40winter into spring, darkness into light.
• 04:44I think that is actually a
• 04:46really important metaphor for us.
• 04:49And the reason that I actually
• 04:50have the image of Stonehenge
• 04:53here is it turns out many,
• 04:56many centuries ago,
• 04:58somehow the people that put Stonehenge
• 05:01figured out the winter solstice.
• 05:03So the moment of the winter solstice,
• 05:05or at the time of the winter solstice,
• 05:07the sunset is actually reflected
• 05:09in the middle of the two stones,
• 05:12then the middle 2 stones.
• 05:13The sunset is centered there in the
• 05:16summer solstice.
• 05:17The sunrise is centered there.
• 05:20It's a remarkably enduring mystery of
• 05:23how centuries ago people figured this
• 05:26out and this particular metaphor of
• 05:29both mysteries and darkness into light.
• 05:31I think it's highly relevant
• 05:33to hear what we do,
• 05:35whether we do it in our clinical work,
• 05:37whether we do it in our research,
• 05:39whether we do it in our education,
• 05:41is we're trying to unpack mysteries.
• 05:44We're actually bringing people
• 05:45sometimes from the darkest moments
• 05:48of their life into some lightness
• 05:50by the clinical work that we do.
• 05:53We're bringing people who are in
• 05:55training from their moments of deep
• 05:58confusion perhaps into lighter moments
• 06:00and clarity and what they will do.
• 06:03So this metaphor of darkness into
• 06:05light in the winter solstice is one
• 06:07that I want us to hold in mind,
• 06:09and that I I really do hope you
• 06:11had a restorative break,
• 06:12but I also hope that you can
• 06:15begin to to get this idea of what
• 06:17we're moving into light.
• 06:19But the other piece I want to say
• 06:21about that is that we've also
• 06:24come through a pretty dark year,
• 06:26and we're saying goodbye to it.
• 06:28Actually, pretty dark year.
• 06:29A year that's been marked by the
• 06:32war in Ukraine,
• 06:32by the horrors of October 7th,
• 06:35by the war in Gaza,
• 06:37by unremitting climate change,
• 06:39the fires in Maui, the fires in Canada,
• 06:44earthquakes, political divisiveness,
• 06:46the hate that spreads across our country.
• 06:50But on December 30th,
• 06:53Nicholas Kristoff wrote an editorial,
• 06:57and the title of his editorial
• 06:58is this was a
• 06:59terrible year, but also maybe one
• 07:01of the best ones for humanity.
• 07:03And So what Kristoff reminds
• 07:05us is also important to this
• 07:07darkness and light metaphor.
• 07:09And that is that if we stay in
• 07:11the darkness, we stay paralyzed.
• 07:14If we remind ourself only of all the dark
• 07:16and terrible things that have happened,
• 07:19we actually stay paralyzed.
• 07:21But we need to balance,
• 07:23challenge and hope.
• 07:25And Kristoff actually remind us,
• 07:27I really do recommend this,
• 07:29that in 2023 there were remarkable reductions
• 07:32in infant mortality across the the world.
• 07:35There were there were reductions in
• 07:37children living in poverty across the world.
• 07:40Debilitating illnesses went down
• 07:42continue to go down in Illinois in
• 07:45incidents there were life altering new
• 07:47vaccines not just the COVID vaccine and
• 07:50there were changes in treatment for
• 07:52chronic conditions such as sickle cell.
• 07:54So this is what I want.
• 07:55Also,
• 07:56I realize the beginning in somewhat
• 07:58of a somber darkness into lightweight,
• 08:01but would actually like us to keep in
• 08:05mind managing this challenge between
• 08:08balancing challenges with optimism.
• 08:11So I'm going to come back to that metaphor,
• 08:13but here's where I'd like to go.
• 08:16First,
• 08:16I'd like to do some of the
• 08:18departmental snapshots,
• 08:19talk about our faculty and the
• 08:22overall community, our finances,
• 08:24and add something about the ABC's of
• 08:26fundraising and why in the world we do it.
• 08:28Though it may seem like an obvious
• 08:31question as to why we do it,
• 08:32remember I do this in September
• 08:35and do it in January.
• 08:37So I would like to ask the question
• 08:39of what's happened since September
• 08:42and give you an update on that.
• 08:44Come back to what are the systemic
• 08:46changes that are happening and the
• 08:48local changes that are happening,
• 08:50both of which we are involved in,
• 08:52one of which we have a bit more control over,
• 08:56Conclude with the question of what
• 08:58holds us together and then return
• 09:01to the theme of September,
• 09:03which is staying grounded amidst
• 09:06A tremendous amount of change.
• 09:08So the first part of the snapshot
• 09:11is what are we now?
• 09:13Well,
• 09:13now we are actually a community
• 09:16of almost 566 people.
• 09:17That made me actually quite a surprise.
• 09:21Over the times that I've been presenting,
• 09:23we've grown from 500 to 566.
• 09:26That includes all of our community,
• 09:29faculty, trainees, staff, etcetera.
• 09:32We're 185 faculty total.
• 09:34That does not include our community, faculty.
• 09:38And as a gender split across faculty,
• 09:43trainees and staff,
• 09:45we are typically more 3/4 women and then
• 09:48you can see the racial distribution across.
• 09:52We still have work to do to
• 09:54become a more diverse community,
• 09:56but we are getting there and
• 09:59glad to show you.
• 10:00Share these slides with you.
• 10:03I also want to do a closer look at
• 10:06promotion progress and this shows you
• 10:09Assistant to Associate to professors.
• 10:11We still have some work to do
• 10:13to even that out to make it a
• 10:15little bit more balanced across,
• 10:17but we're moving in the right direction
• 10:20in terms of our research track faculty.
• 10:22You can see the distribution there.
• 10:25And once again,
• 10:26we still need to be moving many of
• 10:29our associate research scientists more
• 10:31more aggressively moving them up.
• 10:35And then to remind you about
• 10:36our social work faculty,
• 10:38our instructor and assistant
• 10:40clinical professors,
• 10:40I always wanted to keep reminding
• 10:42us that we still need to make
• 10:44progression to the next level,
• 10:46but this is where we are.
• 10:48And there
• 10:51let me show you a bit about our finances.
• 10:55So this year, our fiscal year 23,
• 10:58we had a revenue of 52.2, 9 million,
• 11:03so that's a pretty sizable
• 11:05revenue and expenditures of 59.8.
• 11:07That gap is filled by Yale Medicine just
• 11:11to clarify that right now as you can see
• 11:16we have 169 grant proposal sent out,
• 11:18we have 142 active awards
• 11:21that's that's pretty remarkable,
• 11:23that's a lot of grants.
• 11:25And then our patient care,
• 11:26the Red Arrows demonstrate or show that
• 11:30while we have 12.1 million in billing,
• 11:33we only collect about 50% of that
• 11:36and that has nothing to do with
• 11:38in the inefficiencies.
• 11:40That actually has all to do with
• 11:42what I continue to talk about about
• 11:44the lack of parity and reimbursement
• 11:46for mental health services.
• 11:48We bill for what we should be paid,
• 11:51but what we collect is what the payers pay.
• 11:55So there you go,
• 11:57that's that's actually the profile.
• 12:00And then if you want to divide that
• 12:02between what you can see that actually
• 12:05our grants and contracts account for
• 12:07nearly half of our budget and then you
• 12:10can see the distribution that goes
• 12:12between contracts and other clinical sources,
• 12:15endowments,
• 12:16the income from the hospital patient care,
• 12:19we could do a lot to
• 12:21increase our clinical trials.
• 12:22Our clinical trials are a very,
• 12:24very, very small portion.
• 12:26We could certainly grow that,
• 12:28but I want to call your attention to
• 12:31the fact that our endowments plus gifts
• 12:33are now about a fifth of our total revenue.
• 12:37That is perhaps should have been the
• 12:39obvious answer for why we fundraise.
• 12:41But let me go into that just a little
• 12:44bit more in detail because I want
• 12:46what we've been showing and what
• 12:48I've shown to you here is basically
• 12:50what comes in and what goes out.
• 12:53But is there a question?
• 12:54And there should be a question of what
• 12:56are our reserves, what do we save.
• 12:59And so let me give you just a little bit
• 13:02on the ABC's for gifts and endowments.
• 13:05So when we get any gift,
• 13:07regardless of its size,
• 13:09it we ask these three questions.
• 13:13And initially off the top,
• 13:14there is a 12% assessment by
• 13:17the school on any gift.
• 13:19But the first gift question we ask is,
• 13:22does the donor want this to be an endowment,
• 13:25which means that it pays in perpetuity.
• 13:28So on $1,000,000 gift in perpetuity,
• 13:32we would get around 35 to $40,000
• 13:36a year and as that amount grows,
• 13:39because it's invested,
• 13:40you will get more.
• 13:42Or does the donor want it to
• 13:44be in current use,
• 13:45that is that you spend it down.
• 13:48We also then ask does the donor want
• 13:51it to go to an individual faculty
• 13:53project or to the department?
• 13:56And then the third question is
• 13:58this unrestricted that it can be
• 14:00used for any purpose broadly,
• 14:02child mental health being broadly or does
• 14:06it have to be restricted and targeted?
• 14:09Those are the three questions
• 14:11we ask about any gift
• 14:13that comes in with from our
• 14:15associates or our non associates.
• 14:18And then I want to show you actually
• 14:20the balances then that we have
• 14:22on current use and endowment.
• 14:24And fundamentally you can reduce this
• 14:27slide to This is why we fundraise.
• 14:30So in the department I'm showing you
• 14:33across fiscal year 21 through 23 and
• 14:36the end of parentheses for fiscal year
• 14:3823 is the percent that are restricted
• 14:41that is can only be used for one very,
• 14:44very specific purpose.
• 14:45So for the department,
• 14:47we have about 6% unrestricted,
• 14:50but we are incredibly fortunate
• 14:53that among the balances that are
• 14:57overall overseen by the faculty,
• 14:59we have nearly 70% unrestricted,
• 15:01which means that the faculty overseeing
• 15:04those things have great flexibility
• 15:07in being able to do what they do.
• 15:09That is really good.
• 15:11And that's why unrestricted gifts to
• 15:14the faculty or the department give
• 15:16us absolutely the most flexibility
• 15:19and that's why we fundraise and
• 15:21that's why we try to fundraise
• 15:24for unrestricted gifts.
• 15:25I am very glad to go through any
• 15:27of these things in more detail,
• 15:29but I wanted to,
• 15:30to give you that perspective
• 15:34now to go to the progress since September.
• 15:36And I'm going to cover each of these areas.
• 15:39I'm going to put clinical services
• 15:41and the last one because there's a
• 15:43number of things that will bring us
• 15:45back home to the themes of September.
• 15:47And remember, our theme of September
• 15:50was staying grounded amidst a lot of
• 15:52change and I will come back to that.
• 15:55So first to turn to organization and culture.
• 15:58Climate has been a lot happening,
• 16:01a lot happening since September of 2023.
• 16:04We've been continuing to work with Ingrid
• 16:07Kennedy of Cirque and we were very,
• 16:09very fortunate that Ingrid and pursuing
• 16:12an advanced degree decided to make the
• 16:15Child Study Center her case study.
• 16:18And so she's created a really nice
• 16:20document we'll be glad to share with
• 16:22you about service leadership and the
• 16:24progress we've made in the center,
• 16:26but also the things we need to do.
• 16:29And shown on the slide is one of
• 16:31her our infographics,
• 16:32but very glad to share that with you.
• 16:35Darren has brought together a wonderful
• 16:38leadership blog and I hope you will.
• 16:40If you haven't already listened or
• 16:42read the interview with Doctor Comer,
• 16:44I hope you will because it is a beautiful,
• 16:46beautiful statement not only about
• 16:48his career but about how he thinks
• 16:51about mentoring and leadership.
• 16:53And then we have our new leadership
• 16:55series which we inaugurated on
• 16:56October 30th with Pam Sutton Wallace
• 16:58from The Health System.
• 17:00Darren, being our second speaker,
• 17:02I mean, I hope you've noticed the subtle,
• 17:05maybe not so subtle Trojan Horse
• 17:07posters around that are to get this
• 17:10idea that leadership is not just me.
• 17:12Leadership are the skills are in all
• 17:15of us and that we really are thinking
• 17:18about this idea of service leadership,
• 17:20our responsibility to bring everyone along.
• 17:24Coming up in the leadership lecture series,
• 17:27we'll actually be the CEO of Gaylord
• 17:31Specialty Healthcare in February
• 17:33and then we'll be very grateful to
• 17:35have NI Addy from the Dean's office
• 17:38and Psychiatry in April.
• 17:40Other activities in this in this space,
• 17:44we'll have two leadership workshops from
• 17:47Cirque on 17th and 24th and Krista's been
• 17:51sending out announcements about that.
• 17:56Hold on, let me get the pointer
• 17:58back to where it should be.
• 18:00Tara is continuing her Friday focus
• 18:02sessions and having really a lot
• 18:04of people come, which is great,
• 18:06really delighted about that.
• 18:08And then the final update to look
• 18:11ahead is Amanda Calhoun has brought
• 18:13together a clinical case conference
• 18:16on clinical services for Black Youth.
• 18:19Very excited about that.
• 18:21We have over 100 people signed up for
• 18:24in person for next Tuesday the 16th.
• 18:26And so stay tuned,
• 18:28but this is really an important
• 18:30event for us and an important
• 18:32event to continue to push these
• 18:34discussions of diversity
• 18:38and these are just the goals
• 18:40that we shared in September.
• 18:42What I'd like to point out on a
• 18:46particular one is this one and I'd like
• 18:49to engage your your thinking on this.
• 18:52It's something of great concern for us as
• 18:54we advocate not only for the post grads,
• 18:57for for everyone coming in a
• 18:59junior position to our community.
• 19:02So here's the here's the issue.
• 19:05You may have seen that New Haven
• 19:08and Connecticut has become one of
• 19:11the most expensive places to live.
• 19:14Rents in New Haven are now quite
• 19:17out of proportion,
• 19:17and you can see how they relate
• 19:19to the national average.
• 19:21For Connecticut,
• 19:23this has created an equity issue
• 19:27so that individuals that might have
• 19:30support from their families or might
• 19:33have made a savings can choose to come,
• 19:36but those who don't,
• 19:38it's really hard for them to
• 19:41live in New Haven.
• 19:42At the same time, we're trying
• 19:45to advocate for raising stipends,
• 19:47which we need, which we have done,
• 19:49but we can't raise stipends to
• 19:52keep up with this rent escalation.
• 19:56This impacts post docs,
• 19:57it impacts pre docs, It impacts us across.
• 20:01It also impacts retention.
• 20:03We're having these conversations
• 20:05centrally with Central Campus and
• 20:07we're having these conversations
• 20:09here in the medical school.
• 20:11Are there things that we can do?
• 20:13Can we partner, for example,
• 20:16with landlords in New Haven
• 20:18to offer subsidized rent?
• 20:20Are there things that we can do
• 20:22to address this because it is an
• 20:24equity issue and it is impacting
• 20:26recruitment and retention,
• 20:28not just for us parenthetically
• 20:30but across the school.
• 20:33The other thing that I want to raise is
• 20:36that I am sure if you're reading the
• 20:38newspapers or reading and listening,
• 20:40you are aware that there is a national
• 20:44push about DEIV agendas and initiatives.
• 20:48These are just four head headlines
• 20:52taken only from the New York Times.
• 20:54If you got across, there are many, many more.
• 20:58I have these here that I want
• 21:01to reassure our community.
• 21:03I want to be aware of this.
• 21:05I want all of us to be aware
• 21:07of this national discourse,
• 21:09but also to reassure our community that
• 21:11we are not moving away from this agenda.
• 21:13We are continuing this agenda,
• 21:16but it behooves us to be aware of what
• 21:19the currents of the discourse are.
• 21:22But just to remind you that climate
• 21:25and culture is vital to us.
• 21:27Culture is what I think the values
• 21:29that we hold about equitable rent
• 21:32is an equitable issue about an
• 21:35inclusive culture,
• 21:35and the climate is what we do
• 21:38that reflects those values.
• 21:40And so all the trainings that
• 21:42I've just brought forward that
• 21:44are happening and have happened
• 21:46are devoted to that agenda,
• 21:47to create and to inculcate a culture
• 21:51of respect and inclusion which
• 21:53over time creates climate change.
• 21:56We're sticking to the course,
• 21:58but do be aware of the national
• 22:00discourse that is pushing increasingly
• 22:02and pushing us to be thought
• 22:07so. Our research mission,
• 22:09we could actually spend the
• 22:10rest of the time on this.
• 22:12It is so productive and so, so full.
• 22:15But I just want to give you a
• 22:17sampling that is probably about 10%
• 22:20of what's happened since September.
• 22:22I mean literally about 10% of
• 22:25what's happened since September.
• 22:26And I apologize for not including 100,
• 22:29but I just want to give you a sample that
• 22:32as you can see there have been books.
• 22:34There have been a number of really
• 22:38distinguished awards from Kasha to ****
• 22:39Aslan, Chris Cipriano, Uche, Jessica.
• 22:44And then there have been a high
• 22:47impact papers that are coming
• 22:48from all of our research groups.
• 22:51It would go on several slides,
• 22:53but this is really,
• 22:54it's really important to know
• 22:56that that and then grants,
• 22:57I haven't even put the grants on that.
• 23:00Our research is thriving
• 23:01and we're doing very,
• 23:02very well.
• 23:04These are some of the areas that
• 23:07in September we focused on as
• 23:10goals for this academic year
• 23:11and they're all moving forward.
• 23:13I want especially to call out the
• 23:16series that Kareem and Soraya have
• 23:18brought together for research and
• 23:20progress because I think that's
• 23:21another way of trying to integrate
• 23:23both our clinical and research
• 23:26activities and also just to make two
• 23:29points around the subject recruitment
• 23:31and the strengthening the base.
• 23:34We have a collaboration very
• 23:35productive now that Tom and Yong
• 23:37Sung have brought together between
• 23:39the Yale Center for Clinical
• 23:40Investigation and the J DAT team.
• 23:42And J DAT, if you in case you didn't know,
• 23:45stands for Joint Data Analytics team.
• 23:49And they have actually now made
• 23:51it possible for or going to make
• 23:53it possible for us to recruit
• 23:55subjects through my chart.
• 23:56That may not sound earth shattering,
• 23:59but it actually is earth shattering
• 24:02because there has heretofore been a
• 24:05resistance to recruiting subjects with
• 24:07behavioral health needs through my chart.
• 24:10So now we will be able
• 24:11to recruit through them,
• 24:12which is really a remarkable
• 24:15and important achievement.
• 24:17I also wanted to remind you just
• 24:20click through this that we have a
• 24:23strategic profile that tries to
• 24:26integrate our clinical and research
• 24:28and policy education efforts
• 24:30in these particular areas.
• 24:32And around this particular,
• 24:34this Oval shows the other themes
• 24:36of the child Study Center,
• 24:37our focus on normative development,
• 24:39translational science etcetera.
• 24:43But these are our areas,
• 24:44neurodevelopment and disorders,
• 24:46movement regulation disorders,
• 24:48mood and emotion regulation,
• 24:50trauma,
• 24:51HealthEquity and HealthEquity
• 24:53services that broadly define our
• 24:56research portfolio and how we
• 24:58integrate across the clinical.
• 25:00I think we're deeply in need actually
• 25:03to think about where are the gaps,
• 25:05there are some gaps and where
• 25:07are the gaps in this profile and
• 25:09what are the ways that we can
• 25:12actually continue to grow that.
• 25:13But this is,
• 25:15this is really our research strategy.
• 25:18Having mentioned gaps,
• 25:21let me just say that there are some
• 25:24emerging collaborations bridging to
• 25:25other departments and I think this
• 25:27is a really important theme for
• 25:292023 to 2024. What are themes
• 25:32that we can bridge with others?
• 25:35So, for example,
• 25:36climate change and mental health is
• 25:38becoming a very important issue,
• 25:40is very important,
• 25:41and there are colleagues in the
• 25:43School of Public Health that are
• 25:45actually very focused on this,
• 25:46but they don't have a
• 25:48specific mental health focus,
• 25:49they have a climate change health focus.
• 25:52So emerging collaboration there,
• 25:55the new Department of Biomedical
• 25:59Informatics and Data Science
• 26:01offers us opportunities to
• 26:03collaborate around mental health
• 26:06informatics and also around digital
• 26:08mental health interventions.
• 26:09Uche's work, for example,
• 26:11is around digital mental health
• 26:14interventions and Uche is now jointly
• 26:16appointed with this new department.
• 26:18So these are opportunities,
• 26:20these are gaps and I think that
• 26:23especially bridging to other
• 26:24departments is really important
• 26:26for our research mission.
• 26:29Turning to the education and
• 26:33professional development,
• 26:34these are the areas that in September
• 26:37we spoke about that we were trying
• 26:39to move forward just to call
• 26:41attention to the box at the top.
• 26:43We've had now a number of folks coming
• 26:46forward interested in professional
• 26:48development and so we'll be filling
• 26:50that position in the next month.
• 26:53But as you can read,
• 26:55we've tried to improve the educational
• 26:56climate for our training programs.
• 26:58Really important to develop a
• 27:02professional development program in
• 27:04child and family behavioral health and
• 27:07then consistent communication across
• 27:09to try and develop a department brand.
• 27:12So let me show you a few things
• 27:14that have happened.
• 27:16So Darren again has developed a
• 27:18a phase one about learning the
• 27:21insurance and outs of peer coaching
• 27:23for our trainees and our fellows,
• 27:26piloting it with child psychiatry fellows.
• 27:29And then phase two will be offering
• 27:32individual coaching sessions to the fellows.
• 27:34Again the idea of trying to help
• 27:37on emerging professional identity
• 27:38and trying to help in the culture
• 27:41climate of our training programs.
• 27:45We are now becoming a training
• 27:48institute or trainers for paediatricians
• 27:50in the reach training program.
• 27:53We are, we will be a training site.
• 27:55We're just finishing our train,
• 27:56the training and we have ongoing
• 27:59now in 2024 we'll be offering
• 28:02training to pediatricians.
• 28:03Idea of that is to increase the
• 28:06capacity of pediatricians and child
• 28:09behavioral health so that we can actually
• 28:12address that that continuum of care.
• 28:15And there was a really exciting conference
• 28:17here in this room on December 2023
• 28:21that Carter helped organize on the
• 28:24literate brain with our former Haskins
• 28:27now Child Study Center colleagues,
• 28:29Not former in any way,
• 28:30but present in the global literacy hub
• 28:33talking about how do we translate the
• 28:36science of reading into actual interventions.
• 28:39And they will be continuing that
• 28:42work and then very excited.
• 28:45Many of you know that in fact
• 28:48you sometimes grown.
• 28:49When I mentioned framing that we're actually,
• 28:53we're going to become a framing hub
• 28:56with our colleagues and frameworks
• 28:58because we're very focused on how we
• 29:01communicate about children's mental
• 29:02health and we want to become a framing
• 29:05hub to train other people in that.
• 29:07These are just some of the examples
• 29:10of frameworks work and framing
• 29:12child mental health.
• 29:14How do we talk about child mental
• 29:16health in a way that we engage people
• 29:19that we get them actually to think
• 29:21broadly about the questions rather
• 29:23than to say what do you do about that.
• 29:26I mean that really is a formal
• 29:29communication technique.
• 29:35There's two ways to think
• 29:37about professional development,
• 29:38and I want to just present that point here.
• 29:43Some of the things I've
• 29:44mentioned are external.
• 29:45Our REACH training is external.
• 29:48The webinar on the reading
• 29:50science of reading literacy,
• 29:52those are externally facing.
• 29:54Kasha offers each year a really rich
• 29:57conference on the state-of-the-art
• 29:59and infant toddler neurodevelopment.
• 30:02Wendy and Ellie offer about anxiety.
• 30:05Our YCEI colleagues offer a lot of
• 30:09professional development externally facing.
• 30:11We also have extra internally facing
• 30:15professional development as we think
• 30:17about mentoring for our faculty,
• 30:19the FDAC process.
• 30:22These these acronyms crop
• 30:24up leadership workshops,
• 30:26the workshops on managing research groups.
• 30:29What I would like to say that for
• 30:3120 the rest of this academic year
• 30:34is that we think about a unified
• 30:37training brand that is centered
• 30:39around how discovery inspires
• 30:41care that is our training brand.
• 30:43But we think about how do we present
• 30:45that whether it's external or
• 30:47internal and we have a consistency
• 30:49across all of our training.
• 30:53Let me just briefly talk about
• 30:55operations and communication
• 30:56and then we'll go to clinical
• 31:02In in September, we listed a number
• 31:05of goals and actually these are all
• 31:08in progress and in particular the one
• 31:13on clarifying job responsibilities
• 31:14so that we can actually incorporate
• 31:16that into the F TAC process.
• 31:19We can make much clearer about lines
• 31:22of accountability, all of those
• 31:24things that is now actively in place.
• 31:26There's actually a workshop right
• 31:28after this grand rounds.
• 31:30The other piece that's very much in
• 31:34play is again what I've mentioned,
• 31:36the series of leadership talks
• 31:38that Darren has put together,
• 31:40trying to bring this idea of
• 31:43service leadership very much
• 31:45into our culture and climate.
• 31:48But if you want to get tired,
• 31:51these are all the activities that
• 31:53have happened in the communications
• 31:55portfolio since September.
• 31:57It's pretty amazing.
• 31:58Thank you, Krista.
• 32:02We have regularly
• 32:06regularly updated the comms
• 32:07related guidance on the Internet.
• 32:09Hope you find it also made the Internet
• 32:11how to get to the Internet really clear.
• 32:14There's a button, push it.
• 32:18Krista has open office hours,
• 32:20there's ongoing news stories, the IBO,
• 32:22the integrated business office,
• 32:24regular updates so you know where to go to,
• 32:27who to talk to.
• 32:29Comprehensive list of committees,
• 32:32you can see the insider community
• 32:34surveys and then the upcoming second
• 32:37annual year in review replacing.
• 32:39For those of you who have
• 32:40been around for a while,
• 32:41you remember every year we did
• 32:43an annual report and there were
• 32:45it was printed and all that.
• 32:47This replaces that and it's much
• 32:49more vivid and much more available.
• 32:51So there's been a lot of progress
• 32:55in communication.
• 32:56But importantly,
• 32:57if you have other suggestions,
• 32:59Krista is very open to those.
• 33:01Communication to 566 people is
• 33:06an ongoing dynamic challenge.
• 33:09So how do we do it better?
• 33:11How do we make sure that everyone
• 33:13feels like you know what's going on?
• 33:16That is what we need to keep working on.
• 33:18And thank you again, Kristen.
• 33:21So to our clinical services,
• 33:25First off,
• 33:26what's the state of our clinical services?
• 33:30Well, you can see some updates here.
• 33:32And this is over the calendar
• 33:34year of January to December,
• 33:37we have a 7% increase in referrals,
• 33:4158,000 plus scheduled appointments
• 33:43over this year.
• 33:44All those 58 thousand 16,500
• 33:48were via virtual.
• 33:49So you can calculate roughly roughly
• 33:53a third greater than 3000 unique
• 33:56youth and families were served.
• 33:59The average age is about
• 34:0411.752% of the clients identify as female,
• 34:07so half And then the racial breakdown is
• 34:11as you see with 46% having a historic
• 34:15identity that has been historically
• 34:18marginalized that those numbers do
• 34:23not give justice to the tremendous
• 34:26amount of work that's happening.
• 34:30Just to drill down a little bit
• 34:32into that 7% increase in referrals,
• 34:34the peak that you see January 2021
• 34:38to December 2021, that was a very,
• 34:42very high point.
• 34:43But we have still we are still much
• 34:46higher than we were before that time
• 34:49as you see and that one of the reasons
• 34:52why referrals are up there continues
• 34:55to be tremendous need out there.
• 34:57We wonder if one of their leveling reasons,
• 35:01no way to test this is that the word
• 35:03is out about wait list and things like
• 35:06that which we don't know that fact,
• 35:08but we're still going up in terms
• 35:11of referrals.
• 35:12Just want to give you a sense about
• 35:15our hospital based services across
• 35:17fiscal year 19 through fiscal year 23.
• 35:21You can excuse me,
• 35:23you can see that the behavioral
• 35:24health Ed numbers children coming
• 35:26to the behavioral health Ed,
• 35:28they stayed relatively constant.
• 35:30But what has dramatically
• 35:33dramatically changed,
• 35:34it's the number of hours that children
• 35:37sit in the Ed waiting for some kind
• 35:40of disposition whether to get to our
• 35:43inpatient unit or to services elsewhere.
• 35:45Dramatic change in that and we're
• 35:47still waiting on the fiscal year
• 35:5023 data to be finally summarized.
• 35:52But I can assure you it's going to be
• 35:54roughly in the range of fiscal year 22.
• 35:58You can see the child, the inpatient service.
• 36:00And again,
• 36:02while the volume may be relatively constant,
• 36:05what is changed is the length of stay.
• 36:10Children are sicker,
• 36:11children are staying longer.
• 36:13There's also fewer services out
• 36:15there to get them to the breakdown
• 36:17in the continuum of care.
• 36:19And then the CL service not only
• 36:22again numbers relatively constant,
• 36:24but severity,
• 36:25severity and illness and children
• 36:28staying in the hospital longer and
• 36:30needing more is what has gone up.
• 36:36Just to go back to our outpatient services,
• 36:39to give you a little bit of
• 36:40a sense of the distribution,
• 36:42you can see that about 47% are
• 36:45on Youth Services assessments.
• 36:48Assessments are listed at 3.1.
• 36:50We hope to grow that and you
• 36:52can see the distribution across
• 36:54our others of our services.
• 36:56Our family based recovery
• 36:58interventions for children with
• 37:00AIDS intensive ICAP services is
• 37:03about 1/4 of our outpatient work.
• 37:12And then to look at our wait list
• 37:15and we define now our wait list.
• 37:18As the hospital defines a wait list,
• 37:21it is even if children have an appointment,
• 37:23if it's several months out,
• 37:25we consider them on the wait list or
• 37:27that they're waiting for an appointment.
• 37:29So right now for assessment that is our we
• 37:33have about 398 children on the wait list.
• 37:37You can see that it varies actually
• 37:39across the different kinds of services.
• 37:41Our assessment services have about 200
• 37:43waiting to be in some way across evaluated
• 37:48about 106 waiting for therapy and then
• 37:53their distribution across the rest.
• 37:55And you can see also the importance of
• 37:58breaking this down is that shows you that
• 38:00not the wait time is variable depending
• 38:04on the different kind of service.
• 38:07We are not unique.
• 38:08I just want to stress that while this
• 38:10is very important data for us to track,
• 38:13we're not unique.
• 38:14There are wait times and wait lists
• 38:16across not only the state of Connecticut,
• 38:19across the country reflecting shortages
• 38:22of providers and also reflecting increased
• 38:26severity of illness so that children
• 38:28are not moving through services as well.
• 38:34There's been a lot of progress in other
• 38:37things since 2020, September 2023.
• 38:39Very grateful to Cecilia for continuing
• 38:42to move the racially informed
• 38:45clinical formulation work forward.
• 38:47We had a consultation to our outpatient
• 38:50services in early 2023 from Doctor Kraft.
• 38:53We're making changes in workflow
• 38:55and workforce development building
• 38:56from some of the other efforts I
• 38:59mentioned this culture of respect.
• 39:01We're so excited to actually have
• 39:04been welcomed Veronica as our
• 39:06developmental behavioral pediatrician,
• 39:08the first person to help us
• 39:09continue to build now that program.
• 39:12And then there's new funds flow
• 39:14that I will talk about on how the
• 39:17funds come from the health system
• 39:19to support clinical services and
• 39:21I'll talk about that in a moment.
• 39:26Just to remind you that these are some of
• 39:29the clinical goals that we set for 2023-2024.
• 39:32I already talked about the workplace
• 39:35climate culture. We need to focus
• 39:39more on comprehensive assessments.
• 39:40That's where there's a tremendous amount
• 39:43of need as you saw from the wait list.
• 39:45We need to build that out more.
• 39:48We need to also build out more short term
• 39:51evidence based treatment so that we can
• 39:53help move children through the system,
• 39:55developing a self pay practice.
• 39:58We're continuing to grow our pediatric
• 40:01psychology program with Lori and
• 40:04Maggie and then I want to really
• 40:06focus on that last point there,
• 40:07professional development funds as we try to
• 40:12enhance everyone's opportunities to grow.
• 40:16That is really important that we
• 40:18develop a fund that is available to to
• 40:20actually all of everyone I would hope,
• 40:23but certainly everyone in practicing
• 40:25clinically that gives them the
• 40:27opportunity to learn new skills.
• 40:30Going back to my fundraising slide,
• 40:31This is why we fundraise unrestricted funds.
• 40:35So we're actively trying to fundraise
• 40:37for professional Development Fund that we
• 40:39can access and make available to everyone.
• 40:42It's a very high priority.
• 40:46These two of embedding developmental
• 40:48Pediatrics in child study center and
• 40:50the pediatric psychology reflect
• 40:52our really deepening collaboration
• 40:54with the Department of Pediatrics.
• 40:57Pediatrics is really one of our close,
• 40:59it is our closest sister department
• 41:01if you will and that collaboration
• 41:04is very much deepening.
• 41:06And I've already talked about
• 41:09professional development funds.
• 41:10So I want to take a step back now
• 41:13and I've been referencing September,
• 41:16but now I want to take a step back
• 41:18to a year from now or year past where
• 41:21I spoke in January,
• 41:22the same kind of talk in January of 2023.
• 41:27And remind you about three points
• 41:29that were salient or I hope we're
• 41:32salient in that talk at that time.
• 41:34The first being that we are a part
• 41:37of a system.
• 41:39We are a department in a School of Medicine,
• 41:41a School of Medicine existing
• 41:44in a university,
• 41:45but we are also a part of the
• 41:47Yale New Haven Health System.
• 41:49And the Yale New Haven Health System is
• 41:51not just this hospital across the street.
• 41:54It includes Greenwich,
• 41:55it includes Lawrence of Memorial,
• 41:58it includes Milford.
• 41:59It includes a number of
• 42:01hospitals across the the,
• 42:03the southern part of the
• 42:04state and up the shoreline.
• 42:06We are a part of that system and there are
• 42:10a lot of changes happening in that system,
• 42:12which I will talk about.
• 42:15The 2nd academic medicine is changing.
• 42:20The growth in the clinical research
• 42:23clinical versus the research mission
• 42:26in Yale Medicine and academic medicine
• 42:29generally is dramatically changed.
• 42:31The clinical mission now is by far
• 42:33the biggest in every academic Medical
• 42:36Center in the country, not just us.
• 42:40This particular graph shows you
• 42:42the change just through fiscal year
• 42:4422 of Yale medicines fees.
• 42:47But perhaps even more dramatically,
• 42:49which I showed you a year ago,
• 42:51is the actual proportionate change
• 42:54in the clinical income versus
• 42:57research over 10 years.
• 42:59Over 10 years, the clinical income
• 43:02proportion of the annual budget of the
• 43:04Yale School of Medicine grew by 1.2,
• 43:07whereas the research income grew by .3.
• 43:12Clinical enterprise is actually the
• 43:15driver now of academic medicine.
• 43:19That is really important and it's
• 43:21important because it shows you where
• 43:24the discussion and the emphasis is,
• 43:26but it also raises important questions
• 43:28for how we're a part of that.
• 43:31And then the Third Point,
• 43:35they said academic medical centers are no
• 43:37longer the only providers of expert care.
• 43:40It's a competitive market.
• 43:42And I realized that many of us who went
• 43:45into medicine never thought we would
• 43:47be using terms like market. We never.
• 43:49Certainly when we went into research,
• 43:51we never thought we'd be using terms
• 43:53like market, but this is a survey
• 43:58and there's many, many like it.
• 43:59But in this particular survey,
• 44:01they ask and patients have become consumers
• 44:06didn't think that would happen either,
• 44:08but they asked patients,
• 44:09would you pay more to receive your specialty
• 44:12care at an academic Medical Center.
• 44:15Half said no.
• 44:18And the data are on this graph as well.
• 44:20Actually, 58% said no for primary care,
• 44:25but half said no for subspecialty care.
• 44:30And then even more striking perhaps,
• 44:33is this is that 58% of patients I'm
• 44:37going to keep substituting the term
• 44:40surveyed said that they would choose a
• 44:42Community Hospital if it was associated
• 44:45with an academic Medical Center.
• 44:47Hence why the partnership with
• 44:49Yale New Haven is so important.
• 44:53And that argues for these
• 44:56kinds of partnerships.
• 44:57So Yale Medicine and all of us
• 45:00hearing that there's 33 changes
• 45:03coming out of those messages,
• 45:05those messages that we talked
• 45:07about a year ago.
• 45:08The 1st is closer alignment with
• 45:10our health system colleagues.
• 45:12Remember the last point,
• 45:14patients will come to an academic
• 45:16Medical Center if or Community
• 45:19Hospital if it's aligned.
• 45:20The 2nd is integrating clinical
• 45:23networks within and outside to
• 45:26form actually what are called
• 45:28clinically integrated networks.
• 45:29And then the third is a new
• 45:32approach to funding from a health
• 45:34system that supports clinical care
• 45:36delivered by the medical schools.
• 45:39So I want to go into each of those
• 45:41for first there is active effort
• 45:44of alignment between Yale New Haven
• 45:47Health System and Yale Medical School,
• 45:50very active and that is expressing itself
• 45:54in these areas joint strategic planning.
• 45:57There has never been a joint
• 46:00strategic plan between the health
• 46:02system and the medical school.
• 46:04They have never jointly strategically
• 46:07planned until this year.
• 46:10Joint infrastructure having a single IRB,
• 46:14so that if you're going to do a
• 46:16study in the hospital and a study
• 46:17in the medical school,
• 46:18you don't have to have two IR BS,
• 46:21one single credentialing process,
• 46:24joint clinical programming coming to decide,
• 46:27yes,
• 46:28we'll do that together and
• 46:30most importantly funds flow.
• 46:32But just to give you a hint,
• 46:34this was in October of 2023,
• 46:38this was the Children's Hospital preliminary
• 46:41strategic areas and for the very,
• 46:44very first time behavioral health was
• 46:48included and this was jointly created
• 46:51between the school and the health
• 46:54system and including us as a part of that.
• 46:58That's really,
• 47:00really important.
• 47:02And some of those things that are
• 47:03in that are about improvement,
• 47:04access to behavioral health services,
• 47:07behavioral health services across
• 47:08the care continuum,
• 47:09the kinds of things that we've
• 47:12been talking about.
• 47:13The second area that our colleagues
• 47:17all across the school and the hospital
• 47:20is this clinically integrated network.
• 47:23And while this may not sound profound,
• 47:26it actually is deeply profound
• 47:29that there is now going there.
• 47:30As of January,
• 47:31there is one clinically integrated
• 47:34set of outpatient services,
• 47:36Yale Medicine and the Northeast
• 47:38Medical Group.
• 47:39The Northeast Medical Group was the
• 47:42health systems outpatient services,
• 47:43Yale Medicines was the schools.
• 47:45These come together now as one entity
• 47:48including also some aligned community
• 47:51physicians or community practices.
• 47:53But that one entity is led by Doctor McGovern
• 47:57who is Yale Medicine and the hospital.
• 48:01Why is that important?
• 48:03You have one voice, 1 voice,
• 48:05one entity working together,
• 48:07all these kinds of clinical operational
• 48:10things that we talk about 1 entity
• 48:13and while the clinically integrated
• 48:16network or another acronym,
• 48:18the SIN is talked about a lot without,
• 48:22there will be pediatric practices
• 48:25with embedded child behavioral health
• 48:27in bed and then finally funds flow.
• 48:31A number of you in our clinical
• 48:33practice have heard a lot of our
• 48:35talking about funds flow and how
• 48:36funds flow it's going to impact us.
• 48:38And remember my first snapshot slide
• 48:40showing you the difference between
• 48:42what we build and what we collect
• 48:45and then our that our clinical gap.
• 48:49So let me just walk everyone through
• 48:51where we are on funds flow and this
• 48:54really is how funds come from the
• 48:57health system to support clinical
• 48:59care in the school.
• 49:01So this has happened since July,
• 49:03but we have much more data than
• 49:06when I presented in September.
• 49:08So the traditional past model is
• 49:11that our space cost we paid for,
• 49:14we paid an assessment to Yale Medicine,
• 49:16we paid that,
• 49:18we paid malpractice and the clinical
• 49:22income was based on whatever the
• 49:25insurance carrier would pay us.
• 49:27Now with the new funds flow model,
• 49:29all of those first three items go
• 49:31to paid by the health system and
• 49:34we're paid based on what's called
• 49:36an RVUA relative value unit that
• 49:39is we are paid for what we do and
• 49:42it is paid by the health system.
• 49:44It is.
• 49:45It is payer blind.
• 49:47You don't have to worry or think about this.
• 49:50This patient have insurance or not,
• 49:53are they on Medicaid?
• 49:54You don't have to think about any of that.
• 49:56It is pay or blind.
• 49:58There are some subtleties in this.
• 50:00I mean,
• 50:00so for example as the bottom
• 50:03lines that there's some services
• 50:05such as medical directors,
• 50:07our pediatric psychology program that
• 50:08are not RVU but are on a staffing model,
• 50:11but that's a subtlety.
• 50:13We are basically paid for what we
• 50:16do and the impact of this is this.
• 50:22Our deficit goes right now and there's a
• 50:25lot of still things that we have to work on,
• 50:27but drops from 6.9 to 2.6,
• 50:31we are generating actually more
• 50:33clinical income and all of those costs,
• 50:35those fixed costs that we had
• 50:37little ways to influence and now
• 50:39shifted away from our budget.
• 50:41So it's really important for us.
• 50:43We are doing really well even though I know,
• 50:46I know there's still an unpaid
• 50:48gap that we will work on that.
• 50:51Importantly,
• 50:53what does it actually mean for an
• 50:55individual clinician and this is
• 50:57what I think is really important
• 50:59for individual clinicians.
• 51:00You are seeing patients you're
• 51:03actually freed up in many ways
• 51:05not even having to worry about
• 51:07do they have insurance or not.
• 51:08You're seeing patients you
• 51:10are responding to need.
• 51:12The impact is really on the
• 51:14department that we have now are paid
• 51:17for what we do and all of those
• 51:19costs are covered that we couldn't,
• 51:21we couldn't address those
• 51:22fixed cost are covered central.
• 51:27So I want to talk about levels
• 51:29of change and I'm glad to take
• 51:31any questions about funds flow.
• 51:33We continuing to talk about talk about
• 51:37enduring mysteries and Stonehenge,
• 51:39it gets clearer, you know,
• 51:41month by month and I'm glad to talk about,
• 51:45but I want to talk about levels of
• 51:47change because it may not be obvious
• 51:49that I've actually been talking about
• 51:52systemic change and local change.
• 51:54And what are the things that we have
• 51:56tremendous input over and what are the
• 51:59things that we have less input over?
• 52:01So systemically,
• 52:04we're talking about being a part
• 52:06of the New Haven Health System.
• 52:08And I've given you 2 examples,
• 52:10funds flow and joint strategic planning.
• 52:13Our examples of strategic systems
• 52:15change that we are a part of and
• 52:18we can influence in some ways.
• 52:20But actually, it's happening and we,
• 52:23we have, we have the ability to influence,
• 52:25but we're not driving the change.
• 52:27We're a part of the change.
• 52:29And then local change is the ones
• 52:32that I've been talking about,
• 52:34such as expanding our assessments
• 52:36or changing our workflow,
• 52:38the things that we can actually
• 52:40do in our practice.
• 52:41And so it's important to keep those
• 52:43two levels of change in mind and
• 52:46we're working at both of those levels.
• 52:48But really important to distinguish them
• 52:54in the last few minutes though I want
• 52:56to now switch to this question and
• 52:59ask the question of what holds us
• 53:03together and ask this question because
• 53:06I'm very aware that in the last,
• 53:08particularly the last few minutes,
• 53:11I've been talking about things
• 53:13like Rvus and all of that.
• 53:15And I want to ask the question
• 53:17of did the implicit,
• 53:18often transactional expectations that are
• 53:22built into the system that we live in,
• 53:26the system that we work in.
• 53:29So they actually sometimes over shadow
• 53:31what are our common goals and purpose.
• 53:34And so let me just give you
• 53:36my thinking on this.
• 53:37So for example, if you're working clinically,
• 53:41we try not to.
• 53:42But I think there's a lot,
• 53:44a lot people are thinking about,
• 53:46am I meeting my benchmarks?
• 53:49If you're running a lab,
• 53:52I think you're thinking
• 53:53about grants and funding.
• 53:55How do I keep my lab going?
• 53:59If you're in the education
• 54:00part of our mission,
• 54:02you're thinking about training expectations,
• 54:04you're thinking about the burden of workload.
• 54:07But there is something that unites us that
• 54:10I think we need to be very cognizant,
• 54:12ah, across Those are the things
• 54:14that I think are the implicit kind
• 54:18of transactional expectations.
• 54:20But I think we're actually united by these.
• 54:24We're united by caring for patients,
• 54:26seeking out new knowledge that will
• 54:28actually improve our understanding of
• 54:30disease processes and change how we care.
• 54:32We're united by training the
• 54:34best clinicians that we can,
• 54:36best researchers that we can.
• 54:39Those are the more explicit things
• 54:41that bring us together and would
• 54:43suggest that that is why we say we're
• 54:46discovery inspires care that what we
• 54:49are held together is this excellence,
• 54:52this focus on excellence
• 54:54state-of-the-art care driven by research,
• 54:56education or clinical work for families.
• 55:01And it is extremely important that
• 55:03even as we are in the midst of these
• 55:06huge changes in the health system,
• 55:09local or systemic, that we keep that in mind.
• 55:13What are we united by?
• 55:15Even though there are a lot of
• 55:19implicit transactional expectations.
• 55:20Which brings me then to the final point.
• 55:24Why do we stay grounded?
• 55:26This was our theme for September
• 55:29and absolutely why staying grounded
• 55:31in this time of enormous change
• 55:34is absolutely critical because it
• 55:36is through staying grounded that
• 55:39it allows us to focus on that.
• 55:41Where discovery inspires care To
• 55:44perhaps stretch a metaphor too far.
• 55:47Staying grounded keeps us from not
• 55:49being swallowed up by the darkness.
• 55:52Helps us to keep a little bit of sense
• 55:55of where we're going in the midst of
• 55:58how such tremendous, tremendous change.
• 56:01So I want to thank you.
• 56:03I appreciate this opportunity to give
• 56:06another update for the department.
• 56:07Thank you for all the work you're doing.
• 56:09And I hope we have some time
• 56:11for discussion and questions.
• 56:13Thank you.
• 56:19You'll be monitoring on
• 56:20Zoom if there's questions.
• 56:22I'll just turn the mics on in the room
• 56:24for anyone who wants to ask a question.
• 56:30Thank you. Appreciate it. Any questions,
• 56:38we probably could summarize the
• 56:39whole hour by saying we're actually
• 56:41in good shape there's there's,
• 56:42there's a lot going on,
• 56:44but we're in good shape.
• 56:45That would've been simpler, wouldn't it,
• 56:51Richard Lynn, Grace. Yes, ****
• 56:55yes, Linda, thank you very much.
• 56:57Fantastic presentation and very encouraging,
• 57:00particularly with regard to the funds model.
• 57:04I I wonder if you could comment on what
• 57:09struck me as somewhat surprising with
• 57:12regard to sources of income and that's
• 57:15the the absence of clinical trials that
• 57:19that that that seems like an opportunity.
• 57:22I wonder if you could comment on that.
• 57:24I can comment by saying **** I
• 57:26couldn't agree more that I think
• 57:28that's a remarkable opportunity for us.
• 57:30The app that we need to build up our
• 57:32clinical trials. We really, really do.
• 57:34We have an opportunity to partner
• 57:36more actively with pharmaceutical.
• 57:38Dr. Block does a lot of that work,
• 57:40but the more actively with pharmaceutical
• 57:43companies we have, we really have the,
• 57:45we have the infrastructure,
• 57:47we have the science,
• 57:48we really have the it's a it's
• 57:50a missed opportunity for us.
• 57:51We need to grow that.
• 57:53Carla, when you say clinical trials,
• 57:54do you mean medication trials
• 57:56specifically not the NIH funded both,
• 57:59both but the but the small slice
• 58:02of the income is really from
• 58:05pharmaceutical sponsored trials.
• 58:07I'm not saying that should
• 58:08be our only clinical trial,
• 58:10but there is off there
• 58:12are opportunities there.
• 58:13Thank *** **** for the question.
• 58:15Other questions,
• 58:20were there surprises?
• 58:24Relief. Oh, really? Relief.
• 58:25We're in good shape. Oh, OK,
• 58:27good. OK, All right, good.
• 58:32Any other online questions?
• 58:35Yeah, actually I have a comment.
• 58:36Yeah. I don't know if the question is
• 58:38I was struck by we have
• 58:41to vote.
• 58:45I was struck by what you said about
• 58:47how a clinical revenue is driving
• 58:49the train now and that research
• 58:51funds are kind of staying the same.
• 58:53And I think that's partially because
• 58:55NIH hasn't raised running levels.
• 58:58And so it's true. We can't, we can't.
• 59:00I mean we can write more grants,
• 59:02but we're not going to get more
• 59:04money more than likely in that way,
• 59:05which is actually really problematic
• 59:07because even talking to program
• 59:09officers, they know
• 59:10we can't do the work we want to do with the
• 59:13RO one funding amount. So I,
• 59:15I I guess it's just I I wonder
• 59:18like how the system can, how
• 59:20the health system or how Yale can
• 59:22advocate for that. Yeah.
• 59:24So so Carl, that's a really important point.
• 59:28So what drives that is not just that we've
• 59:33done such a good job about educating
• 59:36everyone and you know cutting edge
• 59:38care that they can now go other places.
• 59:41The other thing that drives that is
• 59:43research has become more expensive.
• 59:45So it's become more expensive and
• 59:47and so it's grants just don't cover
• 59:49it as you're saying.
• 59:51And so that also drives the
• 59:53increase in clinical revenue,
• 59:54so that you can funnel that back into
• 59:57research the catch 22 for behavioral health.
• 01:00:01It's because we're not adequately reimbursed.
• 01:00:03We can't funnel it back into research.
• 01:00:06So that becomes really a
• 01:00:09particular dilemma for us.
• 01:00:11The solutions,
• 01:00:12So what I didn't talk about because it just
• 01:00:15would have gotten too far in the weeds,
• 01:00:16but we can go into the weeds is
• 01:00:19the funds flow model has another
• 01:00:22component to it and you can call
• 01:00:24it a shared risk component.
• 01:00:26In essence what the hospital or
• 01:00:29the health system has agreed to
• 01:00:31is that as clinical revenue is
• 01:00:34generated across across the practice,
• 01:00:36not just by individual departments
• 01:00:39as you get a clinical excess if
• 01:00:42you will or clinical profit,
• 01:00:44then that gets funneled back into
• 01:00:47the academic mission that gets
• 01:00:49funneled back into research.
• 01:00:51That's what they have agreed to.
• 01:00:52That is a part of the and how the the
• 01:00:54various details of how that works.
• 01:00:56All that has to be worked out.
• 01:00:58But it's it's an important agreement
• 01:01:00that across the practice as a whole
• 01:01:03not just by department when there
• 01:01:06is clinical surplus that that will
• 01:01:10come back to support the academic
• 01:01:11mission distributed evenly that's
• 01:01:13that's the detail to be worked out.
• 01:01:15I mean that's for not young child
• 01:01:17study you're in a deficit.
• 01:01:18No, no, no,
• 01:01:19no I don't I don't think that will
• 01:01:20happen actually frankly I don't
• 01:01:22think that will happen because
• 01:01:23that would not be equitable.
• 01:01:24And then there is also a real
• 01:01:27commitment and funds slow to be
• 01:01:29equitable on to not have these
• 01:01:31individual deals and all of that.
• 01:01:33So that's really important but but I
• 01:01:35think that you're going to see that
• 01:01:38happening across academic medical
• 01:01:39centers across the country that
• 01:01:41there will be a more explicit using
• 01:01:44of clinical revenue to fund the
• 01:01:46academic mission has to be otherwise
• 01:01:49it's not a sustainable model.
• 01:01:50Does that help?
• 01:01:52Yes,
• 01:01:52it does think
• 01:01:56I still think the government needs
• 01:01:58to increase. Well, I yeah I would
• 01:01:59agree with that too but but given
• 01:02:01our current political climate,
• 01:02:02I'm not going to have, not immediately
• 01:02:05that was great and and very transparent
• 01:02:08in the same way that that the hospitals
• 01:02:11reached out you know buying up the other
• 01:02:14hospitals and the other practices to
• 01:02:16to associate and to increase income.
• 01:02:19What what about you know us as we
• 01:02:21have been in the past and still are
• 01:02:24going more national and international
• 01:02:26with multi centre grants and efforts.
• 01:02:29I mean, I know people are doing them,
• 01:02:31but is there a department, you know,
• 01:02:33thinking with people together
• 01:02:34about how how we do that
• 01:02:36We could, we certainly should
• 01:02:38do that, think we should expand.
• 01:02:39Isn't that what we should?
• 01:02:41Just seems like we're right
• 01:02:42for some of that stuff.
• 01:02:43I agree. I agree. Yeah, I agree.
• 01:02:45Todd would not disagree in any way.
• 01:02:48Thank you. Sure. Oh, yeah.
• 01:02:50Oh, no question. No. OK.
• 01:02:54OK. I think we're just about a time.
• 01:02:55If there are no further questions,
• 01:02:57maybe we leave the last comment to George
• 01:02:59Gannon said perfectly extraordinary
• 01:03:00presentation of privilege to attend it.
• 01:03:02So thank you. Appreciate it. Thank you.