Staying Grounded In the Midst of Change: Looking Ahead to the New Academic Year

September 13, 2023

Information

YCSC Opening Grand Rounds September 12, 2023

Linda Mayes, MD
Chair, Yale Child Study Center

ID10704

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00:04What I want to bring us in
00:05is to the theme for this year
00:07that I really, really want us.
00:09I hope to take to heart,
00:11and the thing was in the title,
00:13was the idea of being grounded.
00:16And grounded is a term that
00:18actually appeared in the 14th
00:20century to mean to be based firmly,
00:22to be based firmly and on something,
00:25whether it's a body of knowledge,
00:27whether it's a place.
00:28But to be based firmly
00:30psychologically in our world,
00:32it means to continue to have a
00:34clear and focused mind even when
00:36things are dramatically changed.
00:38To maintain to apparently,
00:40but I underline the last line is to
00:43stay true to the ones of entity or
00:46I would argue to the departments of
00:48entity even in times of greater people.
00:52And we have an identity in this department.
00:55One of our identities is to invoke the
00:57state of being grounded is actually
00:59focuses on what is most meaningful
01:01to us in terms of excellence in
01:04our clinical care and our teaching
01:06and in our research and also in
01:08how we care for each other as well
01:11as how we care for our patients.
01:14The 2nd is that insane grounded in our
01:17values and I really mean those is our values.
01:20We more easily imagine the world that will
01:23be for those who will come after them.
01:25For those that we have welcomed here in July.
01:29We imagine that going and that that thing
01:32that theme of generativity of imagining
01:35the world after was 2022 as well.
01:38So I want to make the connection back,
01:41but being grounded lets us be more generative
01:45and lets us actually build stronger,
01:47healthier things.
01:48And I reminded you of this
01:51actually in last year,
01:52that there is actually literature
01:55that being more generative,
01:57thinking about those who will come after
02:00actually does make teams not develop it.
02:03But at the same time, at the same time,
02:06we actually need to be very aware that
02:09more change challenges are grounded.
02:12But when there's change all around us,
02:14which I'm going to talk about,
02:16we actually tend to,
02:18as human beings,
02:19innately pull into what is most
02:23important to us, the individual,
02:25to focus on that individual needs.
02:28So we have to pay a lot of
02:30attention to this partner.
02:31We have to pay a lot of
02:34attention to that trough there,
02:36because that's what pulls the
02:37scenario you're going to need back.
02:41So in the spirit of this,
02:42how in the world do we do this?
02:44How do we stay grounded?
02:46And I would say that it's
02:48both simple and part,
02:50but it is simultaneously simple and part.
02:53And it really are to
02:55practice gratitude and grace,
02:58to remember, to thank people,
03:00to remember gracefully,
03:02to be forgiven and be open,
03:05to connect, connect, connect.
03:06And I'm going to come back to that at
03:09the end to show respect and compassion.
03:11We've just had two remarkable sessions
03:14with a colleague of ours remain
03:16compass about respect to listen
03:18actively to our colleagues as well
03:21as our patients and to take breaks,
03:23which I hope is all done actually
03:25over the last few weeks.
03:29So keep that in mind because what
03:32we're going to do now is looking at
03:35going to do a little bit of welcoming,
03:36perhaps a lot of welcoming.
03:39We've grown so much that I can no longer
03:41ask all of you to for you to stand up
03:43and you do that and for just two days.
03:45So we'll do that with 50.
03:48We'll talk about those and challenges for
03:51this next year in these areas and spend
03:54a lot of time on 1st 3 and we'll come
03:57back in the very end to being grounded.
03:59And I hope given our technical
04:01issues in the beginning that we'll
04:03be patient and get a little time
04:06past two if you did not so OK if you
04:09did I just want to know what the
04:11standing about but we're just telling
04:13you that their seats their seats.
04:15So First off to come to welcome it is
04:19September but I'm really really glad
04:21to welcome our new follow welcome
04:23to those of you in the audience.
04:24I'm so glad you're here.
04:26We have a deep responsibility to all
04:28of you that we take very seriously
04:31to be sure that your training
04:33and why you have come to us,
04:34that we fulfill what you expected.
04:36You need to punch to us that we
04:39create a climate and a culture of
04:42education and learning that is most
04:44beneficial for you and how to launch.
04:46You can see all of you can see the pictures
04:49of our new fellows we're really glad to hear.
04:53But we have more than just our psychology
04:56classified through social work fellows.
04:59We also have our interns and
05:01practical students and very,
05:03very grand here.
05:04Here we have the same responsibility to you
05:07through a different stage in your training,
05:09but to help you launch group reviews.
05:13And then we have our
05:14research training program,
05:15our T32 directed by Michael
05:18Crowley and Michael Walk.
05:21And you can see their mentors,
05:22Very grateful to the mentors
05:24for the work that you do.
05:25The mentorship is going to
05:27be our team as I thought.
05:29So here are our trainings for 2023
05:33and then we have our Master's program
05:35from University College London.
05:36We're welcoming 12 individuals from all
05:39over the world coming for this one year
05:42Master's program led by Doctor Rogers Group.
05:45So very,
05:46very glad that you're here as well.
05:48And then believe it or not,
05:50we have so many posts for any of our
05:53fellows and hosts and host docs that
05:55next year will go over onto 2 spots.
05:58But really glad that he was
06:00going with and maybe fulfill our
06:03responsibility to you and let us
06:05know all the way which we are.
06:08And then we have some new kind of research
06:11faculty to welcome from social work,
06:13nursing,
06:13marriage and family therapy and
06:16three colleagues who have joined
06:18the associate research finances.
06:20It's a remarkable route.
06:23And then and then a number
06:25of you may or may not know.
06:27I hope you do know because this
06:29happened in March of 2022.
06:30But our colleagues from the Haskins
06:33Laboratory join us and Haskins to
06:36say Ross is are really creative
06:39research groups working on language,
06:41the science of language,
06:43the science of the acquisition of
06:45production of language and have joined
06:47us now at the hospitals and joining
06:50Yale and School of Medicine for a
06:52program in development where we visited.
06:55So I hope you will get to know Doctor Taslin,
06:58Bachlitz, Whalen,
06:59Austrian landing near Greco and Peers.
07:04They work on language from
07:07multiple perspectives.
07:07They already have collaborations with a
07:09number of folks here in the department.
07:11Sam, for example,
07:13does a lot of work on music
07:15as another valid language.
07:18Sam is in New Zealand,
07:19but we've learned over the
07:21pandemic that once a world away
07:23we have virtual connectivity.
07:25So please get to know them and you'll hear
07:28more about their work for the community.
07:30We also have new staff that have
07:33joined the center wanting to
07:35acknowledge how essential they
07:37are to having really the work that
07:40drives us all and then also to
07:42note a few faculty transitions.
07:44I'm very glad that Marine and
07:46Darren have become moves from ARS.
07:48We have soon been put back to.
07:50This is great congratulations to Carla
07:52and to Dennis for becoming professors
07:56in this developmental trajectory.
07:58After all,
07:59we are all about development and
08:01following on to the associate catastrophe
08:12and then some other new roles.
08:16Jose, so new Associate Training
08:17Director for our child and
08:19adolescence partner, Cecilia,
08:20her family based recovery coordinator
08:23of that program and Lori and Maggie,
08:26the inaugural directorial team
08:29for pediatric psychology.
08:31So very glad you've taken on those rounds.
08:34And then at the other side of
08:37the developmental spectrum,
08:38we've had some retirements.
08:40We have Fred retired officially in July.
08:43We will celebrate that.
08:45We'll celebrate some funny word
08:47about retirements.
08:48We will mark that in the fall as
08:50well as the David Reese very grateful
08:53for Judy Eisenberg for all of the
08:55work that she did with so many
08:57families in United Home Programs and
08:59Rosemary and Sarah who worked in the
09:02Chair's office for so many years.
09:04These are the kinds of developmental and
09:07transitions that we need to regularly
09:10know and to regularly be aware of.
09:12This is a part of being grounded
09:15and being in the department.
09:18So whatever our goals and challenges for
09:212023 and 2024 in these particular areas,
09:25as I said,
09:26I'm going to focus a lot on the first three,
09:29but we'll touch your time
09:31permits on the other group.
09:33And before I do that,
09:34before I really brought in,
09:36I want to actually say that there are some
09:38challenging areas for our department.
09:39They're going to cut across all of the
09:42goals that I'm going to talk about,
09:44and we'll come back to these
09:47challenging areas regularly,
09:48but we'll come back to them
09:50in January as well.
09:51Up on the list is to build an inclusive,
09:56respectable culture and to hold
09:59us together as an increasingly
10:01diverse community.
10:03Those are absolute
10:05priorities and commitments.
10:07Similarly as the interface of our
10:09research and clinical missions,
10:10I'm going to talk about how we
10:11need to hold our missions together,
10:13but we need especially to be
10:15attending to how our research,
10:17clinical and our education really
10:20work Better Together.
10:22I've already hinted that we need to
10:24adapt to the changes in academic and
10:27we need to strengthen our education
10:29efforts and address the changing needs.
10:31For those of you that I have just
10:33showed your pictures on those
10:34of you who have joined us,
10:36you have changing education needs
10:38in this changing world and we
10:41need to be flexible to that.
10:44And I want to be really clear when I
10:46say we have a responsibility to you.
10:48That's not just words.
10:50We have a responsibility to be sure
10:52the education we are providing you
10:55meets your needs in 2023 and then
10:58finally just communicates regularly,
11:01But how do we do it more broadly
11:03and more thoroughly and you can
11:04never communicate them out.
11:06I learned that actually in my
11:08first year in this job.
11:09I thought, you know,
11:10he said it once and he said it,
11:12but no,
11:12you can never actually communicate
11:15enough and they really need to
11:17keep working on you.
11:19So the other thing to remind you
11:22that I have said back actually
11:24in January is to hold us all
11:27comfortable when I talk about
11:29goals is that we're trying to be
11:31very intentional about smart goals,
11:33goals that are specific that we can attain,
11:38that we can measure,
11:40that are actually relevant to the
11:42department we want to have and our
11:44time bound not better in this.
11:47So all those accountable I'm going
11:48to show you those that we anticipate,
11:51those that we met but but we never
11:54keep thinking in that climate.
11:57So climate and culture,
12:00I showed you this picture before and
12:03I'll continue to show you this picture,
12:05remind you that climate is what we perceive.
12:09Climate is what we experience on
12:12the day that it's what we perceive.
12:14It's we perceive it in the language
12:17and the actions and the programs.
12:20Culture is what we believe.
12:23It's what under the surface.
12:25So we believe that we want to have
12:28an equitable improvement culture
12:30where everyone feels they have a
12:32place and they have their voice.
12:35Do you perceive that?
12:37You perceive that in the actions
12:38and the things that we're doing keep
12:41thinking about that and keep thinking
12:44about that meaning and those through
12:46our actions reflect the culture that
12:49we want and the values that we have.
12:52That is not a question that I want us to
12:55ask from a quarterly or an annual race.
12:58I want us to be asking that
13:00question every day.
13:01Basically every hour is what we're doing,
13:04reflecting what we believe and what we want.
13:08So I'm actually really grateful Tara and
13:11her role as vice chair of DEI or DEI doing,
13:15and here's a number of the things and the
13:18goals that we met chair on that in 2022-2023.
13:22We have a mentoring program in
13:25coordination with our reserve
13:27efforts in the department and you'll
13:30hear more as I go through.
13:32We have onboarding now for every new
13:34person in the child Study Center and
13:35that may not sound safe with now,
13:37but actually it's deeply without
13:40that Every person that comes to the
13:42center to work here at the center
13:44now has a similar result,
13:45similar onboarding across
13:47whatever mission we're doing.
13:49It's a work in progress,
13:51give us feedback to want to be
13:53sure that we're doing that.
13:54But at least that's that's the
13:56goal that we're trying to meet.
13:58We've clarified our search and par
14:00and host and standards so that we're
14:02trying to do that on a transparent
14:05basis across every kind of certain
14:08position and then includes bias stream
14:11and will soon have the guidelines
14:13online so that you can go look at.
14:16There's a number of ongoing workshops
14:19around anti racism around respectful
14:22culture that will continually
14:25clarify the process for consultation
14:27and addressing concerns through.
14:30And the last one may not sound actually
14:32but this took a lot of work to get
14:34CEU's for our master's level clinicians.
14:36So when you come to grand rounds,
14:38everyone can get credit for coming
14:40to grand rounds.
14:41And actually it's a great deal.
14:45And we have the Action Group,
14:47the names of the Action Group that
14:48were very closely with Tara that
14:50I just want to know and thanks to
14:52Amy and to see for their service on
14:54the committee they're rotating off,
14:55but others are joining,
14:57but very much thanks to him.
15:00But there's some other highlights from
15:0420/22/2022. We've been working very
15:06closely with Angry Kennedy at CERT
15:08around those goals on that bias,
15:11understand deeply power and privilege and
15:15we really have difficult conversations.
15:18The other point to say about Ingrid is that
15:21Ingrid is in her own learning process.
15:23She's going after an additional degree
15:25herself and we the child studies
15:27Center are now her capstone project.
15:29I think that's pretty cool to
15:32be her capstone project.
15:33And so we will continue to learn from her
15:36as well as we called her it's very mutual.
15:39We have the racial inform clinical
15:43formulation workshop Rice started
15:45by Cecilia Fermeto and wonderful
15:48that Cecilia started with now has
15:51an advisory committee working with
15:53Tara and this is making great profit.
15:56We've had a number of opportunities
15:58over the last months to celebrate
16:01for example that History Month and
16:03also to celebrate women in medicine
16:05and women in academia,
16:07how we think about those kinds of roles.
16:10And then we've had a lovely beautiful
16:13celebration in the courtyard Between
16:17was brought together by Damien and
16:20Belinda and and Camille and Christian,
16:23also the collaboration with the Black
16:27African American Infinity group.
16:28And we had a black business come and
16:31provide us really wonderful treats.
16:33But that was a great celebration for
16:35Juneteenth and another mark of our
16:37community come and get better social
16:39work that Carolina brought together
16:41with all of our social work faculty.
16:44Another example of pulling our
16:47community together.
16:48Carolina also working with
16:50Claire and Claire's Pornophobia.
16:52This is not an advertisement for Claire,
16:54but if you want to go to Claire,
16:56the carrot takes absolutely out there.
17:00The players in collaboration with
17:02us has created a closet where you
17:05can donate materials for family.
17:07And then just in the last few
17:09weeks as I mentioned,
17:10we've had to understand in the college
17:12from Central Campus fund and talk to us
17:16about building under spectacle places
17:18and ever will continue to work with us.
17:21This is a remarkable amount of activity,
17:24but it's all in the service of building
17:27and strengthening our culture and economy.
17:30And then just to tell you,
17:31we have the Viola Renard fund which
17:33we've had for a number of years but but
17:35it's taken some work to get it going.
17:37And we now have violent in our social
17:40justice and top equity fellows,
17:42an inaugural year for these fellows
17:44who will work closely with tariff
17:47around again addressing public
17:49climate you know lecture series,
17:51these two lectures.
17:53I hope that if you haven't heard them,
17:54go online and listen to the recordings
17:58and then the violent in our award
18:00for any Q Senate is received as a
18:03very encouraging proposals focusing
18:04on HealthEquity,
18:06social justice and engagement
18:08in the community.
18:09Our two inaugural fellows
18:11Parliamentarian and Dakota Becker.
18:13And then just shortly in a few days
18:16we'll announce this year's by Albany.
18:19A lot going,
18:21a lot has been achieved in this past year.
18:25But I want to remind you on a few things
18:27that Tara regularly reminds us all and
18:29it's just we need to be very, very clear.
18:33We're creating a learning community.
18:35This is not a one time com.
18:37You come to a workshop where
18:39you've got this is not really
18:42learning how to use this BSS.
18:44This is really we're creating the
18:47professional learning community
18:49where we learn from each other,
18:51we hold each other accountable and
18:53positive learning and that we center.
18:56We center these ways of thinking of all
18:58that we do that we're always asking.
19:01These questions were actually really
19:04helping each other learn and grow.
19:08And it is the department's
19:11commitment over the long time.
19:15When I was in college,
19:16my religion professor,
19:18whom I reconnected with in the last
19:21few weeks for a whole host of reasons,
19:23introduced us to a book called The
19:26Loneliness at a Long Distance Running.
19:29But the whole metaphor was
19:30about going the distance,
19:32going the distance of a long distance.
19:35And that's what this work is.
19:37It is a long run.
19:39It is not the spring.
19:40And we are highly committed to it.
19:44And here are some of the goals.
19:46Culture, Climate for 2023.
19:47And I just mentioned we'll have
19:49the next round of the awards.
19:51We're considering having a
19:52symposium for the Viola Bernard,
19:54not just one single lectures.
19:57Tara has resumed Friday. Focus.
19:59Come, enjoy them, learn from them.
20:02We will be putting into place more
20:05about accountability for leadership
20:07as well as some exit interview
20:10approaches where ongoing training
20:13and best practices for searches
20:15working on our community engagement.
20:17Not just this community,
20:18but patients and people that are in our
20:21broader new neighborhood community.
20:23We're partnering now with our research
20:25labs around to have a better recruit,
20:27more diverse individuals into research
20:31and advocating for our post grads.
20:33You come to us as post grads
20:35right out of college.
20:37You come to us again.
20:38We're responsible for education,
20:40but you often make sacrifices that
20:42make it hard for you to come.
20:44And so we really want to address to
20:47that and advocate for your having
20:49a less stressful time if you will,
20:51the mentoring program and partnership
20:53with our research and we'll
20:55continue our restorative practices.
20:57Let
20:59me turn to research
21:02and 1st off, my thanks to Tom and serving
21:05in his role as Vice Chair of Research.
21:08And also I put the graphic up at the very
21:11top just to remind us that as much as
21:13our culture climate is our commitment.
21:16We do center developmental research
21:19and learning and continually
21:21research learning environment.
21:22That is the score of our clinical work,
21:25our education.
21:27There's a number of things that have
21:30happened today that Tom has has really
21:32brought us together for We've had he
21:34convenes our researchers for sharing goals.
21:37I'm going to show you a specific
21:39one shortly regular now research
21:41communications research and Congress.
21:43I hope you've noticed the cross
21:45talk sessions and faculty meetings.
21:48We've clarified guidelines
21:49for space allocation.
21:50Nothing gets researchers more
21:53alert than the word space.
21:57And so we've clarified those guidelines,
21:58hoping to be more transparent about it.
22:01And then mentorship committee and Tom
22:03has surveyed the needs of the faculty.
22:08You may have seen this in January.
22:09I want to circulate it again that
22:11how do we talk about our research
22:14rather than list all the number of
22:17programs and grants and studies,
22:18how do we talk about them in a way that
22:21is coherent and actually allows people
22:23outside our department to understand.
22:26We really have research in these
22:27broad areas and neuro developmental
22:29disorders and movement disorders,
22:31mood, emotion regulation,
22:33stress, trauma and HealthEquity
22:35and delivery of services.
22:38Like every other service
22:39department in the medical school,
22:41we have these missions,
22:43we include policy.
22:44But in every one of these areas we have
22:47an educational and clinical or component
22:50and I hope eventually policy component.
22:53And what makes the Child Study
22:55Center especially unique is
22:57that across all of these,
22:58we also have a focus on
23:00normative development,
23:01implementing things in the communities,
23:03multidisciplinary and even
23:06thinking across generations.
23:08So this I think is A-frame for our
23:10research efforts that I hope you'll,
23:12you'll play with.
23:13You'll continue to use your test,
23:15you'll use it as a framing for our research.
23:20There's other things that are
23:22happening that are really important.
23:23Our clinical and research faculty
23:26Development Fund is we award three times
23:29a year and October 15th is the deadline.
23:32And we've had some really successful
23:34ways of actually using those funds
23:37for people to leverage other grants.
23:40We have pilot research awards
23:42for trainees and fellows.
23:44We've awarded seven of those in the
23:46last two years and again have been
23:48leveraging for other grants and we have
23:51travel awards for postgraduate fellows.
23:54I especially want to call out just
23:56a recent award to the Tara Thompson
23:58Felix who got a postdoctoral award
24:00from the Hartwell Foundation.
24:02It's really wonderful for Tara
24:04and it's again,
24:05it's just the way of trying to leverage
24:08on getting these early awards.
24:10There's things happening on campus in
24:12this last year that are significant
24:14for us as well.
24:16The Lusai Institute is an institute
24:21created by a very generous donor,
24:23Lusai, around the normative develop,
24:26cognitive brain develop.
24:27It's really we talk about psychopathology
24:31and when development goes off track,
24:33Lusai talks about normative development.
24:36So it's a natural synergy.
24:38A number of our faculty or now faculty
24:41in Lusai and actually really cool is
24:45that Lusai as well as collaborators
24:47in the Department of Psychology
24:49have just moved across the street.
24:51They are literally now in 100 College.
24:53They are literally across the street.
24:55So you can do more collaborations.
24:57You can walk across the street and see
25:00them in their new natural habitat.
25:03We also have a new Center for Mind and
25:06Brain Health or Brain and Mind Health
25:08that Jamie Mcpartland asked Jamie about.
25:10New faculty lines,
25:12new collaborations across
25:14develop across departments,
25:16it's really great.
25:17It's uniting departments that are
25:19focused on brain and mind health
25:22where LUCI is normative as you can
25:25gather from this one Center for
25:26brain and mind health really looking
25:28at those kinds of developmental
25:31off track kinds of questions.
25:33Haskins Laboratories I've
25:35mentioned have joined us now.
25:37The Yale Center for Clinical Investigation
25:40has new leadership and is really interested
25:43in pediatric trials and recruitment.
25:45And then the Janeway Society is organized
25:48centrally through the Dean's office.
25:50But it's a way to foster development
25:53and mentorship for younger faculty.
25:55And a number of our faculty
25:57are now members of IT.
25:59They are always looking for people to speak.
26:01They're always looking for
26:02ways to build links across.
26:07So what are our research goals for 2023-2024?
26:11We have with Tom and Young Sons
26:14leadership one of the most important
26:17shared resources across our research
26:19labs is a shared subject recruitment.
26:22And so they are putting together a way
26:24now that it's not individual labs trying
26:27to recruit often the very same family,
26:29but actually shared recruitment
26:31across and that's really a good,
26:34a good and most needed resource.
26:37Similarly, we're working collaboratively
26:39with YCCI to increase the their sensitivity
26:43to pediatric behavioral health enrollment.
26:46They're looking to tell us now for
26:48our expertise the mentoring program
26:51I've mentioned clarifying guidelines
26:53for how to apply for K awards and
26:55how those fit in the department
26:57center additional training grants.
27:00And then the last two you should actually
27:03call me on because the last two are
27:06not exactly framed as smart goals.
27:08We do need to rethink our strategic goals
27:11and where our gaps are for our research.
27:14We do need to rethink that and what
27:17are our opportunities and Tom will
27:19bring it together a committee and
27:21hopefully we'll get to a SMART goal
27:23and then the continuing strengthening
27:25the research clinical interface.
27:33So I'm going to make a point.
27:35I think probably in the last three years,
27:38maybe last two, COVID time tends to blur.
27:42I've always begun with our clinical mission,
27:45always have talked a lot about that,
27:49then gone to research,
27:50then gone to education.
27:51I very intentionally flipped it because
27:54one of the things that I'm quite worried
27:57about is that it can be all consuming.
28:01We talk an enormous amount
28:03about our clinical mission.
28:04It is all consuming.
28:05There's a lot on our minds,
28:08and there are a number of synonyms for that.
28:11Fervent compassion, intense,
28:14frantic, even.
28:16But I wanted to reverse the order.
28:19Now, it doesn't mean I'm not
28:21going to talk about our,
28:22but it's really important that we
28:24maintain the balance and integration
28:26across all of our missions.
28:28I worry a lot that by being so all
28:31consumed about all of the changes
28:34happening in academic medicine,
28:36that oftentimes it feels as if we are
28:39not talking as much about our research,
28:41we're talking as much about
28:43our education of anyone.
28:44So I don't mean to be flippant to you,
28:47but it is really important
28:50to integrate prompts.
28:51That having been said,
28:54there is a tremendous plentiful need.
28:57The plentiful need is still great.
29:00I look to Michelle,
29:02I look to Aaron,
29:03I look to Young as our clinical team,
29:06clinical leadership team as you can read.
29:09And there's still a dramatic increase
29:11in emergency department visits,
29:13behavioral health and primary care
29:16dramatically increased and up in
29:18eating disorder, suicidality,
29:19all of you immersed clinically.
29:21I do not need to go into the
29:25specific details and then we
29:26have the wait list reality.
29:28We cannot serve everyone
29:30coming to us in a timely life.
29:33We do have a clinical enormous
29:36need that we are struggling to
29:39meet and we've asked this question
29:41now in the last few months.
29:43I think we should just agree
29:44that it's no longer a surge,
29:46that it is the new normal,
29:48that there are actually many,
29:50many more children and adolescents
29:52with mental health needs that have
29:55been so in the last over the last year.
29:59It is the new normal.
30:02At the same time, I think we've actually
30:05done a pretty good job of really defining
30:07what is our continuum of clinical care
30:09and we actually have a continuum.
30:11So we have inpatient psychiatry.
30:13We had our Winchester one unit,
30:15we have CL and Pediatrics.
30:17We are now embedding Pediatrics
30:19psychology and Pediatrics of specialty.
30:22We also embedded in primary
30:24care when Dorothy's leadership,
30:26we have access mental health
30:28linking to pediatricians.
30:30We have our outpatient behavioral health
30:32services, treatment and assessment.
30:34We have our income services,
30:36our Children's Day hospital,
30:37our emergency room and there is
30:40a flow across these services.
30:42Could we strengthen that continuum?
30:43Yes, we can.
30:44Can we make it a more seamless flow?
30:47We can, but we do actually have a continuum.
30:52These are some of the clinical highlights of
30:562022-2023. So we have increasing
30:58our collaborations with Pediatrics
31:00for access mental health.
31:02You can see over about 11,000 consultations
31:05in 2022 roughly a little over 2000.
31:10You need you.
31:12We're doing a training for pediatricians
31:14with our colleagues in Pediatrics
31:16to improve their behavioral health
31:18knowledge and impact the end the
31:21the entry into that continuum care.
31:25We've had some grant awards around
31:27behavioral health urgent care.
31:29DCF gave us a grant to build an
31:31urgent care center that will
31:33come online around late 2024,
31:35early 2025,
31:36a zero suicide grant so that we can
31:40actually really think I'm more carefully
31:42about how to intervene and address
31:46the increase in suicidality program growth.
31:49The day hospital,
31:51we have a children's day hospital
31:52now on the first floor of 350.
31:54George,
31:54I'll show his pictures.
31:56We're getting again as I've said,
31:58pediatric psychologist using
32:00telehealth to reach families and then
32:03going back to climate and culture.
32:05We've addressed salary equity.
32:06There's more to be done but
32:08address salary equity with our
32:10Master's level clinicians and had a
32:13inaugural Clinical Excellence award.
32:15So even in the midst of all
32:18that clinical need,
32:19there's a lot that's happened that's good.
32:22And here's just some pictures
32:24from the Children's Day hospital
32:26and to make the point that we
32:28are supporting the continuum
32:30care through physical colocation.
32:32Being together in one space really does
32:35impact how you think about clinical
32:38care and very grateful to yarn for
32:41his efforts in making this happen.
32:46At the same time,
32:48we do have a clinical financial,
32:50yeah, behavioral health does not pay.
32:54So in fiscal year 22,
32:55we had a $6 million deficit that
32:57was covered by ill medicine for
32:59the reasons that many of you have
33:01heard me talk about too much,
33:0591 percent or overnight hopes
33:07are over 90% of our clinical
33:09expenses are salaries and benefits
33:12and also our space cost.
33:15The reality that we've talked about a lot,
33:17the commercial payers don't cover the cost.
33:20And then our patient population,
33:21while it is going down as
33:23my colleagues and your,
33:24our colleagues and your medicine to say,
33:27don't necessarily have an optimal payer mix,
33:30we still serve more vulnerable families.
33:34So in January,
33:36I asked us to think about these
33:39questions and these are still questions.
33:42What kind of practice do we want to have?
33:45Where are, What is our expertise?
33:48What's our unique niche as
33:50a clinical service?
33:51What are our metrics of excellence?
33:53These are the questions I
33:55asked us to think about then.
33:58And in March this year, well,
34:01we began in December of 2022,
34:04we actually had a series of work
34:06groups and consultations with Doctor
34:08Ken Craft about our practice,
34:11came up with a final report in March 23,
34:15started implementing April,
34:17spring into the summer.
34:19And then something happened
34:23and that's called the new funds
34:25flow model with a health system.
34:27I am not going to go deeply into that,
34:29but I'm going to introduce you to it because
34:32it has tremendous implications for us.
34:34We're still implementing.
34:36But let me tell you what the funds flow is.
34:40What in the world is funds flow and doing?
34:44How many of you manage
34:47your personal accounts?
34:48You have money coming in.
34:49You have money going up, basically.
34:51That's fun, Slow.
34:53It's slightly more complicated
34:55though with our health system and I
34:58showed you this diagram many times.
35:01We are a part of the School of Medicine.
35:04The School of Medicine is
35:05a part of your university.
35:07Separate entity is Yale New
35:09Haven Health or Yale New Haven
35:12Hospital right across the street.
35:14This arrow is the relationship between
35:18these two systems and that's funds flow.
35:22The health system purchases
35:24services if you will,
35:26from the medical school
35:28and that's how funds flow.
35:31But historically,
35:33historically that was done
35:35in the following way.
35:38Don't try to read all the details on this,
35:40just take, just take the visual image.
35:45It was actually done by individually
35:48negotiated agreements between
35:50departments and subsections.
35:51There are over 200 of those individually
35:56negotiated agreements was not based
35:59on clinical need necessarily and
36:01those agreements stayed in place.
36:03It's an incredibly inefficient system.
36:07So where we are right now in
36:09a new infra model is this.
36:12And by the way behavioral health was
36:16historically underfunded and disagreements.
36:19So here are the key points about
36:21funds flow to know right now and
36:24that is first that funds now don't
36:27flow by individual agreements,
36:29but they come from the hospital
36:31to the medical school based on
36:34the number of patients,
36:36based on the clinical need, pretty logical.
36:41The more patients,
36:42the more you need to see those patients,
36:45very logical.
36:48Their fixed costs like the
36:49space costs that I mentioned are
36:51transferred and paid centrally.
36:53So that comes off of our goals.
36:56Our clinical revenue here to
36:59heretofore was actually taxed,
37:00no longer taxed.
37:02We are paid for the patients we
37:05see and so far it's September,
37:08funds flow started in July.
37:09So far it looks positive for us.
37:13That really actually looks positive.
37:15Now I am more than 30,000 feet.
37:19And in September, October,
37:20I'm going to offer,
37:22we are going to offer a number of
37:24really detailed workshops on the funds flow,
37:27showing you is the ACT,
37:28the numbers showing you what we
37:30are seeing in the first quarter
37:32and the early second quarter,
37:33showing you how it is impacting
37:36us and the implications for us.
37:38But that has actually changed how we
37:42think about our clinical practice.
37:44That doesn't mean even though
37:46I put 4 red asterisks there,
37:49it doesn't actually mean that we
37:51shouldn't be thinking about how we
37:53think about our clinical practice
37:55and what are the additional
37:56things that we can do to have the
37:59practice that we want to have.
38:01And so here are some of
38:03the clinical goals for
38:052023-2024. Besides really
38:07understanding Punsville,
38:08the 1st is focusing more
38:10on what we do really well,
38:12comprehensive assessments.
38:13We are known across the world and
38:16the country For the comprehensive
38:18assessments that we provide.
38:20We already do short term
38:21evidence based treatments,
38:22but making it very clear that this
38:24is what we do and then creating
38:27referral networks and partnerships
38:29if families might need longer.
38:31Creating a self paid practice for
38:33those things that we cannot build
38:35for where there's not building
38:37codes for such as executive
38:39coaching or such as some aspects
38:41of speech and language or any
38:43number of those kinds of things
38:45that we we know families need but
38:47we can't build For continuing to
38:50embed psychology and Pediatrics.
38:52We have a developmental behavioral
38:54pediatrician joining us in November
38:56and continuing to grow that,
38:59enhancing our telehealth
39:01digital interventions and also
39:03thinking deeply critically about
39:06our measurement based here.
39:08We say that we do excellent care,
39:10but what are our metrics to that?
39:13Remember the theme of accountability.
39:18So let me just also pause here.
39:21I never want to actually miss.
39:23I never want.
39:24I've said that gratitude is
39:26the way of being grounded.
39:28All of you who are seeing
39:30patients and seeing them,
39:31you are so you see so many people and you
39:35carry the burdens of their lives with you.
39:39So I want very much to always express
39:41my gratitude for the work that you do
39:43and to continue to try to do that.
39:45We can never thank you enough for doing that.
39:48Well, thank you.
39:51So just in the last few minutes,
39:54I just want to know about education
39:57and professional development and
39:58IT and that that I will spend less
40:00time does not mean that it's less
40:02important that an hour is an hour.
40:05So here are some of the things that
40:08I think that we have done and notice
40:10I want to just call out that it's
40:12not just education of our fellows,
40:14of all of you that we have welcomed,
40:16but also the idea of
40:18professional development.
40:19We do more than run training programs.
40:21We actually train people in
40:24communities and so we're recruiting.
40:25We've had a diverse group of fellows,
40:27but as I mentioned earlier,
40:29want to work to improve the climate
40:31and culture of our training programs.
40:34We have well subscribed
40:36professional development efforts,
40:37but can we do more?
40:39I mentioned the behavioral health
40:41training for pediatricians and
40:42we have we do reach many schools,
40:44but what else can we do?
40:47So here are some of the things
40:49that goals that I would like
40:51us to set educationally again,
40:52we need to really attend to our
40:56climate of our training programs
40:59and attend to the heavy clinical
41:01demands and always be sure that in
41:03the midst of those clinical demands,
41:05there's education happening,
41:08rebuild a learning community.
41:09We've been distanced for a while,
41:11how do we rebuild that?
41:14I've spoken about this thing and then
41:17in January I said that we needed to
41:18develop a unifying professional brand.
41:20We have not quite gotten there yet,
41:22but I want to be sure that every training
41:24program we do for people in the community,
41:26it's just it's not the same content.
41:29But you know when you come here,
41:30this is what you get.
41:32You can expect it across all
41:35of our professional zone okay.
41:37I'm not going to spend a lot of time on
41:39operation management because you know,
41:40sometimes that can be a kind of home go down.
41:46But what I really do want to
41:48emphasize is this.
41:49We're still adjusting to a hybrid world
41:51by virtue of the fact that we had a,
41:53we were really trying to figure
41:55out how to get hybrid on earlier.
41:56We're still adjusting to a hybrid world.
41:59Interestingly though,
42:00there actually have been some surveys
42:02just recently that the shift is
42:05happening to a preference or in person now.
42:08It's not overwhelming.
42:09I mean, it's kind of a lie,
42:12but actually the really interesting and
42:14one survey was this generational difference.
42:16It's very interesting that Baby Boomers
42:19team still seem to prefer hybrid,
42:22whereas younger tend to prefer,
42:25at least in this survey,
42:26in person.
42:27All this is to say is that it's
42:30shifting and I think rather than
42:33being dichotomous in person or not,
42:36virtual or not,
42:38we actually need to start
42:40thinking about this, adapting,
42:41adapting our ways of
42:44working together to purpose.
42:46When is hybrid better,
42:48when is in person better,
42:50when is virtual better and
42:51what purpose do we have
42:53for the meetings.
42:56I am going to this this simply to say
43:00that there's a lot of organizational
43:02work going on and I'll be glad
43:04to talk about that maybe in the
43:06workshops in September, October,
43:09because I really want to get you to this.
43:12There's some new offerings in 2023 and
43:15Darren David has started a leadership blog.
43:18One of the concepts we introduced last year,
43:212022 was the idea of service leadership,
43:25service leadership being that my role,
43:28anybody in a leadership role,
43:30is not to be up here.
43:32My role is to serve you.
43:35My role is to be sure that you can achieve
43:38the goals that you have as a faculty member,
43:41as a trainee, as a staff member,
43:44that service leadership.
43:46Darren has started a leadership block
43:48where we start to build out this idea
43:51and then we're actually having a
43:53lecture series on service leadership.
43:55And our inaugural lecturer will
43:57be Pam Sutton Wallace,
43:59who is the Chief Operating
44:00Officer of the health system.
44:02It's just so great to have someone
44:04from the health system coming.
44:05So really do try to come
44:08we'll it will be virtual,
44:10so easy to sit at your desk and then
44:13in the fall going to offer some
44:15several workshops on how you think
44:18about as we try to be more transparent
44:20about roles and responsibilities,
44:22workshops on the tool for how you think
44:25about roles and responsibilities.
44:27And we'll,
44:27I'll do my best to make it
44:30exciting and engaging.
44:31But it's an operational need that we really,
44:34as we grow,
44:35we need to be clearer about
44:38who's responsible for what.
44:41And then my thanks to Kristen,
44:44Krista is our essential blue.
44:45I might need to think of a better metaphor,
44:48but Krista,
44:49thank you so much for all the work you do.
44:51And as I've said,
44:52you cannot communicate enough,
44:54really can't communicate enough.
44:55And thank you for thinking
44:57about how we do it more broadly,
44:59how we do it more thoroughly and the
45:01innovation that you bring to that.
45:04So in the last minute,
45:06I want to go back to this.
45:09So I know a lot is happening and a lot
45:12is changing and I wouldn't be surprised,
45:16I would not even be insulted if you
45:19just sort of way too much probably is.
45:24There is a lot happening and
45:26there's a lot good happening
45:27and there's a lot of challenges.
45:29But I want you to remember this message
45:32they grounded, expressed gratitude.
45:35Come together as much as you
45:38can or feel comfortable with.
45:40Come together, Connect.
45:43Be compassionate for all of us together.
45:46Be respectful and we will struggle with
45:49defining what this respect actually means.
45:51And then listen to one another.
45:54On that note, I'm very open for questions,
45:58discussion.
45:59I know we're right at the hour,
46:01but we didn't have the technical
46:02flurry in the beginning.
46:03So if you actually have time,
46:05please any questions, discussions,
46:06I'm just really grateful to have you all
46:09here and grateful for everything you do.
46:11And we'll have a great activity
46:13here ahead of us.
46:14Thank you.