Compassionate Home, Action Together (CHATogether) Family Intervention was recently named among the 2022 hospital innovation track recipients of the Yale New Haven Health (YNHHS) Innovation Awards. Hospital innovation track submissions were selected for their potential to immediately offer positive impact to health system workflows and were reviewed by system experts across clinical, IT and finance domains.
The YNHHS Center for Health Care Innovation (CHI), established in 2019, champions innovation and leads the implementation of novel solutions to improve healthcare delivery. The YNHHS Innovation Awards seek to provide resources to YNHHS employees and Yale University faculty working on promising ideas with potential for impact.
In the award announcement, YNHHS said the CHATogether platform will “help alleviate the constraints related to the threefold volume increase in children and adolescents visiting YNHH for behavioral health services, while improving care outcomes for patients and families.”
Eunice Yuen, MD, PhD, assistant professor of psychiatry and in the Child Study Center, founded CHATogether three years ago as a community-based mental health initiative initially targeting the Asian American and Pacific Islander (AAPI) population. When Yuen began working with the Adolescent Intensive Outpatient Program (IOP) earlier this year, she started a collaboration with Ruby Lekwauwa, MD, assistant professor of clinical psychiatry and others prior to receiving a grant from the American Academy of Child and Adolescent Psychiatry (AACAP) to launch the pilot run of the program.
Now, CHATogether is led by Yuen; Lekwauwa; Carol Cestaro, assistant director of Ambulatory Clinical Affairs, Psychiatry & Behavioral Health; Sarah Barnes, PhD, assistant professor of psychiatry; Katie Klingensmith, MD, assistant professor of psychiatry; Naomi Kunstler; Tammy Smith, recreation therapist at Yale New Haven Psychiatric Hospital; and Stephanie Leblanc.
Smith and Kunstler both had voice, acting, and film production experiences prior to their mental health career.
“The cool thing is the serendipitous way we formed together,” Yuen said. “I had an idea, but everyone else was so excited about it and wanted to chip in and contribute to a bigger goal and ambition.”
There are three main components to the CHATogether structure, Yuen explained: a teens group where patients watch video skits illustrating “problematic scenarios,” and talk about their experiences of communication with their parents, changes and challenges; a family session where individual families meet together to watch video skits and share how much they can relate to characters in the video, how relatable the scene is to their own experience, and how much they want to change; and a parenting group, where parents watch and discuss the video together. Yuen said CHATogether’s theater-based model breaks down the barriers many parents and patients have so they feel safe enough to talk about the issue.
This intervention tries to help parents hold their child in mind and think about, how does my child’s mind work, what’s their perspective, what’s my perspective, and how can we work together. It invites people to do that in a way that gets past their defenses and allows them to connect. We’re not saying to either parent or child, ‘hey, you’re doing it wrong’ – instead, we’re going to talk about something else that’s not your relationship.
Ruby Lekwauwa, MD, assistant professor of clinical psychiatry
Lekwauwa agreed, saying: “This intervention tries to help parents hold their child in mind and think about, how does my child’s mind work, what’s their perspective, what’s my perspective, and how can we work together. It invites people to do that in a way that gets past their defenses and allows them to connect. We’re not saying to either parent or child, ‘hey, you’re doing it wrong’ – instead, we’re going to talk about something else that’s not your relationship.”
CHATogether’s skits cover a broad range of topics, from cyberbullying to LGBTQ+ coming out experiences, to substance use and risky behavior, as well as culturally diverse topics, such as cyberbullying in the Asian American and Pacific Islander (AAPI) community, the Black Lives Matter movement, and more. To create a skit, improvisational actors act out a story based on real-life experiences and the dialogue is transcribed into a script for another actor to act out.
Yuen and Lekwauwa said they have received positive feedback from teens and parents alike about their experiences. Yuen said many who participate in the program feel relieved at the opportunity to sit together and have conversations that often aren’t able to happen at home. As a result, the teens have felt more comfortable reaching out to their parents when they previously felt invalidated. Likewise, parents have been able to gain unique insight into their child’s experience and tools to support them.
While they are in the process of creating a standardized manual and infrastructure by which to expand the program, Yuen and Lekwauwa said ideally, CHATogether will be extended beyond the IOP to create a virtual platform to showcase CHATogether’s skits and related topics that would be available to other clinicians who want to use the CHATogether model in their work, or to other people working with adolescents and families in the community. The program is scalable both nationally and internationally, Yuen said, able to be adapted to multidiverse cultures and translations.
“You don’t need to be a mental health provider to get what the program is about,” Lekwauwa said. “There’s something very human about isolation and disconnection. We all have had that experience of not feeling understood or not understanding someone else we want to desperately be connected to. “
To learn more about CHATogether, search for “Compassionate Home Action, Together” on YouTube or email Yuen at eunice.yuen@yale.edu.