Bringing Mental Health Services Home – Podcast

David Hancox, Podcast Host and Accra Chief Administrative Officer: Well welcome listeners to another episode of Champions of Homecare Podcast. After a brief hiatus, we're excited to be back. Right, Jason?

Jason Dorow, Podcast Co-Host and Producer: I’m pumped that we're back in this room together, David. We have an awesome conversation on tap today. Our last couple episodes were great. We were able to focus on community resources, including resources for the autism community, and accessibility at the State Fair back in August and September. Today, we're going to get back to Accra service programs, and deep dive on mental health services.

David Hancox: Great. And to help us learn a little bit more about this program. Our guest today is Sarah Boyd, one of Accra’s mental health professionals. So let's welcome Sarah to the show. Hi, Sarah, how are you this morning?

Sarah Boyd, Mental Health Professional: Good. How are you?

David Hancox: Fantastic. It's a beautiful, beautiful, sunny morning, fall morning out there, a little crisp, but it feels really good. So we're glad to have you here with us this morning. So let's just get started right away. Because you know, mental health services is one of the newer programs at Accra, we've been doing this now for a little over a year, but it is still one of the newer programs. So spend just a couple of minutes to tell us exactly what these mental health services at Accra look like. And how what is your role as a mental health professional at Accra?

Sarah Boyd: Yeah, like you said, you know, mental health services is pretty new for Accra, in the scope of programming and development. Accra, as everybody knows, has historically been in the home and community-based services and home health care. So when we decided to add mental health services, it was pretty exciting, because there's quite a bit of overlap, which I think we'll talk about later. But really, what we offer right now is individual therapy and ARMHS services. And then we have a few other types of services in our menu of options right now that are currently being developed.

Individual Therapy

David Hancox: With those different types of services that you've just mentioned. Could we focus initially just on what exactly is the individual therapy?

Sarah Boyd: Yep. So and I think you asked me about being a mental health professional. And it's funny, I think we're talking offline that not a lot of people know what that term means. It's sort of a, it's our language that we use, you know, everybody, every service has their own language. So really, what a mental health professional is, is an individual therapist. And so for that role at Accra, one of the things that I do is I assess, and I can diagnose and treat mental health disorders. And then treatment involves things like talk-based therapies or utilizing evidence-based practice interventions. Some people may have heard the term, you know, cognitive behavioral therapy, we pull a lot from that, as well as a number of other modalities. And then we can do some skills-based stuff to polling family members here and there if we need to, depending upon, you know, what's going on. But, um, I think for a lot of individuals, when you hear the term therapists that is sort of like the term that that people are more familiar with.

David Hancox: Can the individual therapy be done through like a telemedicine like over the phone? Does it require in person? Is it either?

Sarah Boyd: Yeah. So we offer individual therapy in person at our Minneapolis location, our Duluth, Hibbing and Virginia locations. And then we offer telehealth services really, throughout, you know, the state of Minnesota. So we have a lot of options to meet client's needs.

Person-Centered Services

David Hancox: Well, that's really helpful to know, because that makes the service that much more accessible. And is there a particular philosophy? I don't know how else to ask this, a particular philosophy that Accra uses to approach their delivery of mental health services?

Sarah Boyd: Yeah. So um, you know, one of the things is, you know, everybody's different, you know, so you can have two people each with depression, you know, for example, and it's going to present differently. Their depression stems from different things in their lives, or the different things that they have learned about themselves, or different ways they view the world. And so really, truly, what we will be called that as, you know, we provide services in a really person-centered manner. Each person, you know, while we know clinically, you know, what symptoms and treatment interventions and whatever works with different disorders. We still look at the whole person where they came from, their family history, their social history, all these different pieces of them because we're whole people. And we then we cater those interventions, based on who that individual is.

David Hancox: So like other services at Accra, our approach to providing mental health services is very individualized. It's not what some people might say, a cookie cutter approach. It's very individualized. It's very client centric, it's very person centered. So I think that would be, you know, quite a relief to a lot of people to know that if they do reach out for these types of services, that the services they receive are going to be really tailor made to their specific issue or need that they may be experiencing in their life.

Sarah Boyd: Yes, exactly. You know, one of the things I've said before, David, when I start with a diagnostic assessment, that's where we go through a whole kind of interview. And it's pretty in depth, there's some screening tools and stuff that I use when I do that. But ultimately, we end up with providing somebody a diagnosis for what's going on. And that diagnosis, for those of you listening, and I think people get a little bit skittish around the idea of a diagnosis because it feels like a label. But really, what that's meant to do is to inform treatment, we need to understand what that diagnosis is, and how somebody got to where they are with that diagnosis, in order to cater treatment to your needs. But while that all is true, we are not in the business of checking boxes, and that is something when you're looking for providers, whether it's Accra or elsewhere, looking for providers who don't do that, because it is really easy to send, go, oh, this person has XYZ, you know, whatever, check the boxes, and okay, well, that's your disorder. And that isn't always the case, it's that I'm getting in the weeds a little bit, but I think it's an important thing to note, we're talking about person-centeredness. I'm gonna give you an analogy. If you have a cough, and a stuffy nose, and you go to the doctor, they're going to look at a cold, they're going to look at a sinus infection, they're going to look at COVID, now. They're going to look at the flu, I think I might have said that already. But either way, you get my point. So they're gonna look at all these different things, these symptoms overlap, and you go through a screening process and an assessment process to determine what in fact, you actually have. If you have the flu, then you get you know, maybe you get prescribed a special type of medication to help you that maybe they just send you home with cough syrup. I don't know now I'm making stuff up. But you understand what I'm saying? It's really not all that different. So if I'm assessing somebody, and I could very easily say like, “Oh, you have this, this and this, you know, you got a low mood and low interest, and you must have depression.” But then, if I'm not really doing a full assessment, maybe come to find out they've had some really significant trauma in their life and not as a contributing factor to their low mood or whatever. I'm oversimplifying a bit. But the analogy with like the cough and cold, mental health isn't that different when you're being assessed, we have to look at the symptomology and conceptualize that in the case of that person, because things are going to present differently.

De-stigmatizing Mental Health

David Hancox: And, you know, Sarah, you touched on something that I think is really, really important. And it's a message that throughout my career that I've tried to give to families, to parents, to individuals with disabilities, as well, is, you know, as they're developing some of their self-advocacy skills, and that is that you made a comment, that the diagnosis doesn't define the person. It creates opportunity for treatment, it helps open certain doors, but it doesn't define the person as a whole, who they are holistically. And I think that's an important message that Accra delivers not only in its mental health services, but all the other services that we provide as well that even though you may have a diagnosis of a disability, that is just a medical term. It can be used in certain circumstances to create opportunities to open doors. But it doesn't define the person that doesn't make a mono dimensional view of that individual. And I think it's really important to stress. So thank you for bringing that up. Hopefully, people understand that we don't approach it that way, that they’ll be more likely to seek that support and that assistance, as well. Because we know that we're not going to use that term to wholly identify or define who they are as a person. So I think that's really important to stress.

Sarah Boyd: Yeah. Well, and when we talk more globally outside of Accra, and like, sort of the things that we see in the media or socially or whatever, and the idea of like, de-stigmatization of mental health, that's kind of where it starts, I think. This diagnosis doesn't mean that that's who you are, you know, and that is especially true with a lot of clients that we have work through that actually pretty consistently. That's kind of reframing that thought process, sort of like we would call like maybe more heavy hitting diagnoses, more severe diagnoses, if you will, that really have a large stigma attached to them. There's a lot of guilt and shame that comes with that. So there's these other layers of things you're working through when, when it becomes a label.

David Hancox: I’m sorry, I don’t mean to interject. You're saying such wonderfully interesting things that are creating these questions. And one of the things that you just said also is that stigma that it creates, and it's kind of interesting, because when we look at individuals with a mental health diagnosis, you know, again, that we've already agreed that doesn't define the entirety of the person, you know, they're still a multi dimensional individual. But when they have that mental health diagnosis, suddenly, the larger public seems to assign a personal responsibility to that, that they don't assign to other types of disabilities. If somebody has a physical disability, or an intellectual disability, we don't assign personal responsibility for that. But when somebody is diagnosed with a mental health disorder, or condition, temporary or pervasive, we somehow assigned to them some kind of personal responsibility. And I just find that to be kind of a unique circumstance that is hard to, to explain, and just wondering if you might address that just real briefly.

Sarah Boyd: Yeah. So I think it's a complicated thing. I actually really love that you asked this question, because in some shape, fashion, or form this does come up, both in individual therapy and with our ARMHS clients. So people arrive at, of course, there's environmental factors, right, and genetics and stuff that play in to different disorders. That is true. There's also, you can be genetically or environmentally whatever predisposed to certain disorders, and then they never develop, because, you know, you have what we would call like protective factors in your life. Again, I'm getting in the weeds a little bit, but I promise I'll answer your question.

David Hancox: I lead you there, it’s okay.

Sarah Boyd: That's where I end sometimes, but I come around. I promise. So if somebody has protective factors, like say, a supportive family, means and resources, you know, education, those sorts of things, they're less likely to develop certain types of disorders, because their environment has sort of supported them. And I may, I'm kind of oversimplifying this, but for other people, if you're sort of like predisposed to certain disorders, and then you have an unstable living environment, maybe then you experienced abuse, or you start using substances or something like that, because you're coping, whatever. So we have things that happen in our life, social things, environmental things that teach us things about the world. They teach us things about people, they teach us that and they turn into beliefs about ourselves. And then disorders form, you know, and again, I'm oversimplifying a little bit, there's certainly other types of disorders, that maybe isn't going to happen quite that way. But the point is that idea of assigning responsibility for people who had some of these diagnoseable things, assigning them responsibility, I don't think is a fair thing, right? However, this is where it gets complicated, we do have a responsibility to get better. So the same way that like, if I get diagnosed with diabetes, again, I'm using these things that I'm going to come back to why I'm using these analogies, because it'll make sense in a second. If I get diagnosed with diabetes, and I want it to be well managed, and I want a good quality of life, it's my responsibility to make sure that I'm engaging and being compliant with my treatment, otherwise, I'm gonna get sick. And I guess that's my choice to right, but I'm going to, I need you to take insulin, I need to manage my diet or whatever. So when I'm working with people, we actually have those types of conversations a lot. I don't necessarily say this is your responsibility, if that's not maybe the best way to characterize it. What it is more is empowering them to feel like they have control to get better. So that is like sort of the different way of looking at it as like, I'm not saying you're responsible for this, but now I want to empower you to take control of your life.

David Hancox: And in your explanation, the real fundamental takeaway there is that if that predisposition exists to a mental health episode or experience or diagnosis, the individual who’s experiencing that has no control over that predisposition. It is part of who they are. So you can't assign that personal responsibility to them because they have no control over that predisposition, you know, any more than another person. I have a niece who was born and ultimately diagnosed with Down syndrome, she has no control over that. She can't change that. She will always be a person diagnosed with Down syndrome. But that medical diagnosis doesn't define the whole person. She's a multi-dimensional individual with a lot of likes, dislikes, wants, needs, pleasures, frustrations, you know, all kinds of stuff. And a person with a mental health diagnosis has no control over that as well. And yet, as a society, we tend to hold people personally responsible, and I love the way you describe that, that we do have a responsibility to get well. But the fact that we may have that predisposition that may evolve into a mental health diagnosis, we have no control over that. So to assign a personal responsibility is really unfair. Jason, I'm not letting you get a word in edgewise. Say something, say something, save us, Jason.

Accessing Mental Health Services

Jason Dorow: You know, I'm the happiest fly on the wall right now because this conversation has been incredible. But I'm thinking back to Sarah, when you started talking about the diagnostic assessment and that process. And perhaps you could explain to us who is eligible for therapy? And how do they start the process of accessing mental health services? Do they make a call, or are they're going to be stuck on a waitlist? Can you take us through that process?

Sarah Boyd: Sure. So the short answer is just about anybody can access individual therapy. We serve adults, children and adolescents in our various offices, or telehealth. And then there's a couple of different ways that somebody could ask, oh, let me actually back up for a second. We take most of the major insurance providers, and then MA. So when you make a referral, we run insurance to make sure that everything's you know, good. But really, truly, aside from any insurance barriers, we can serve just about anybody for individual therapy. To make a referral, you can either call our number, which is 952-935-3515. When you call the number, you can ask for the mental health department. You can also email us at ARMHS@accracare.org. Or you can go to our website at accrahomecare.org. You'll click on Services. And then there's a drop down to click on mental health services. And then if you scroll all the way down the screen, there's a link to submit a referral online. We've actually gotten a lot of referrals that way.

David Hancox: Great. And one of the other programs that you mentioned earlier also was ARMHS, could you talk a little bit about ARMHS and how it differentiates perhaps from other mental health type services that we provide?

Adult Rehabilitative Mental Health Services (ARMHS)

Sarah Boyd: Sure. So ARMHS stands for adult rehabilitation mental health services. And really what that is, is a skills-based service. To qualify for ARMHS, if i may go there first and then I can unwrap it a little bit, you have to be on MA and you have to be over 18. And you have to be diagnosed with a mental health disorder. And so what ARMHS does, and this will be helpful in differentiating also between others types of services that Accra offers. What ARMHS does is it really is truly a mental health service. And it targets areas of somebody's life that have been impaired because of their mental health symptomology. So they have skills-based interventions to restore those areas. So for example, because that's super wordy. If I am somebody who, let me think of something here, I'm somebody who has really bad anxiety. And it's so bad that like, if I go into the community, I really struggle to be around other people, I hyperventilate, maybe I start to feel like I might have a panic attack. That symptomology because of the anxiety is preventing me then from like doing my day to day things, like go to the grocery store, buy groceries, engage in my community at all things that you and I probably do every single day. So what ARMHS is going to do is they're going to work with that individual and come up with a treatment plan with goals and interventions to help them be able to restore that type of functioning. So they're going to try to target the things like hey, you need to go to the grocery store and you need to engage in these activities. How do we help reduce your anxiety in the moment when we're out in these environments? And so it really is specific to big barriers that mental health symptomology create. Now we have another service that sounds super similar to. That is 245D individualized home supports with training, which is also a skills-based service. I promise I'll stay in my swim lane. But I just want to make the note that for people who are aware that used to be ILS services, and it's all about independent living skills. So when I'm talking about ARMHS and going to the store and engaging in the community, yes, we're doing a lot of independent living skills. But there's things that the impairments in doing those skills or completing those daily tasks are because of your mental health, not because of maybe physical limitations or developmental types of things. So that's the big difference. And we do have to spend some time and this is again, getting in the weeds a little bit. But on our end of things, we do sometimes have to kind of differentiate and figure out where the best service is to help that individual.

David Hancox: I'm glad you mentioned 245D. We had Tyler [Langenfeld] on several episodes ago, and he talked about that as well. So thank you for making that link. And that's really great. But it sounds like with ARMHS services, there is a strong involvement or use of therapeutic approach as well. Just as it would be an individual therapy service, isn't that so there is again, there are those links as well, to those services. I think that's a great distinction. And I know that ARMHS is not a service that is quite as well-known across the service community. So it's really good to point that out and share that, and we really appreciate that very much. You know, when I think about everything that's happening right now at the state legislature, you know, nationally in terms of service trends, the way we're designing and providing services to people with all different types of disabilities, the challenges that we have for having those services funded, whether they be in developmental intellectual disabilities, mental health services, etc. It really kind of paints a particular picture of the future of services, especially mental health services. And one of the things that we also, just as a little caveat, one of the things that we also learned was coming out of COVID the tremendous impact that our collective experience with it has had on mental health, as well across the country. So any prognostications or thoughts about where we're headed, in terms of mental health services in the state of Minnesota or nationally? Big question, I know. Sorry!

Integration of Home Care and Mental Health Services

Sarah Boyd: That's okay. To be honest with you, David, I think one of the things that excites me kind of answering this in a roundabout way is like, what Accra is doing right now, in terms of adding mental health services, as one of its menu options, is, when I look at where we could go like that, that makes me excited. And let me explain this, when I, when I got done with with my schoolwork, I decided to stay at Accra, because they knew we were going to be developing this program. And I was really excited to be a part of something and grow something and kind of mold it a little bit. Because as far as I'm aware, and somebody might fact check me and that's, that's fine. But I don't know that there's another provider out there who's married home and community-based services and mental health services. And, for me, you know, I've worked in a lot of different areas of the system, including the court system, and watching sort of, like the trajectory of how people might arrive at where they are in life. And we tend to stay kind of like in our swim lanes as providers. We specialize, you know, our DD case managers specialize in DD or CADI case managers specialize in CADI, mental health professionals stay in their mental health swim lane. So like, that's not a bad thing. But what ends up happening as we grow and get bigger and we see this need for services in our community, is that we end up kind of compartmentalized, and we don't do a great job of talking, understanding the co-occurrence of things. And what I love about what Accra is doing is that by adding in mental health, we sort of whether we realize we did it or not, I have no idea. But we've acknowledged the fact that things overlap, like we're complex human beings, like we're not just somebody - this is sort of circling back to what we talked about before - we're not just somebody with autism who needs you know, DD services, you know, to fortify these services or PCA services. We might be somebody who has autism who needs that and also has really bad anxiety and needs support from a mental health professional or ARMHS. So when you ask me kind of like where I think things may be going, maybe I'm answering in a way like this is where I hope things are going is that I want our services and our systems to recognize that we have to do a better job of talking to one another. And I'm not asking somebody else to be an expert in my field, nor do I want to be an expert in somebody else's field, that would be a disservice as well. But we do I think have to broaden our understanding a little bit of how these services work together, and how they can be beneficial, and like wraparound services, you know. The individuals that I'm working with, asking them like oh you got a CADI waiver, let's talk to your case manager. This is like something that would be super helpful for you, or work, we talk a lot more now about 245D and PCA services, which is phenomenal, because they're going, “Oh, I got this client we are doing all this skill stuff. But man, their anxiety is so high, or man, their depression is just so bad that they can't put one foot in front of the other guys. And that, to me is really exciting.

David Hancox: My takeaway from your comment is that it really does require kind of a holistic approach. Yes, I used to work in the independent living field. And we did a lot of collaboration with vocational rehabilitation. And one of the things that we always said was, you know, a part of developing an experienced, successful independent living, includes employment, which includes vocational rehab. So if you're going to be successful with independent living, you've got to have that, that employment or that job, but if you're going to be successful in your employment pursuits, you have to have good independent living skills, right? They overlap, and it's exactly what you were just saying, is the importance of treating that holistic person, right? You can't, and what we're seeing, and I think what Accra’s addition of mental health services, it helps break down some of those silos. So that we are seeing the person more holistically and saying, well, they may have a physical disability, but they're also experiencing a mental health crisis. Yeah, mental health episode, and we have to treat both because they're not separate entities. They are, you know, embodied in that same individual. So they have to be treated that way. So I appreciate you’re saying it the way you did, because it makes such perfect sense. And I think it encourages people to recognize that they can coexist in the same person. And both be treatable. And you know, so I appreciate you’re saying it that way. Thank you very much.

Sarah Boyd: Well, it's interesting, you know, on the side of things, too, if I'm working with somebody who is struggling with, we'll just use depression and anxiety, because that's an easy example. But um, you know, they're having trouble putting food on the table, or paying their bills or keeping a home over their head. I mean, there's only so much you can do if you're not also addressing those like physical health and safety needs. And then that's where we wraparound services again. But if I don't know that those other services exist, then how am I really, truly going to help and provide services in a holistic way? Yes, I can use skills and stuff to help them manage their depression and anxiety. But we also have to meet those physical needs. So I love the way you said it to, you know, because it's a holistic approach. I think we have to start looking at things like that more, and then systemically to looking at all of those things. And I think some of that requires us to provide education and training to other providers that we work with also receiving feedback from them when they provide something. I mean, it really is sort of that globally, like team and communication approach.

David Hancox: I think the mental health services that we offer here at Accra, it’s one area that from the administrative perspective that we hope will expand and grow and flourish, and that people will see the value of and utilize that service as well. So, Sarah, thank you. We've taken up a good bit of your time this morning. And I know it's a busy Monday morning. Thank you, thank you for taking your time to be here with us and with Jason and I, and providing some really valuable information about the individual therapy, the ARMHS services and your approach to providing those services to clients of Accra, and how to access them, you gave us a lot of good information about just how to access and get started with those services, which is often the most difficult step for most people is just how do I take that first step. So thank you very, very much. And I again, I really appreciate the holistic approach, which you are pursuing the delivery of these services, you and the rest of the mental health team here at Accra. So again, thank you for your service. Thank you for your commitment to Accra clients and thank you so very much for being here with us this morning. Jason any final words from you?

Jason Dorow: That was so beautifully and eloquently put.

David Hancox: Well, I will tell you flattery will get you everywhere.

Sarah Boyd: Well, thank you for having me. It was a pleasure, guys. Thank you.

Parent-Spouse PCA Extension Ending

David Hancox: Thanks. Have a great day. Well, that was fantastic. That was just really, really incredible. I can't express enough how much I appreciate Sarah's information that she provided and shared and how valuable it was. And I hope that listeners, I hope that you will take note of it. And if you have a need, or you know, somebody that has a need, that's part of the Accra family, please reach out to Sarah and her team and, and see if their services would be available and appropriate for you. So please take advantage of that resource. A couple of notes that we have here, Jason, for the news and views. Just want to remind folks that the COVID-19 era rule that temporarily allowed parents and step parents and legal guardians of children under 18, as well as spouses to be paid as PCAs for their family members will expire on November 11. And, Jason, you weren't aware of this, because I didn't share with you and I should have, I just talked with some folks at DHS, the department of human services, folks here late last week. And they indicated that they did in fact, reach out to CMS, the Centers for Medicaid and Medicare Services for a possible extension of that but were denied. So there will not be an extension beyond November 11. There will be a gap beginning on November 12. And whenever CFSS implements. So people do have the option of enrolling in alternative programs like the community support grant or CSG, or the Consumer Directed Community Supports Program (CDCS), both of which allow parents and spouses to provide care. But they should do so and begin to make that transition as soon as possible. Because it's not just a simple flip of a switch, it takes a little time to process that. So reach out to your service coordinator or your qualified professional, your QP, if you have questions about how to do that, call our navigation team here at Accra through our home number 952-935-3515. And get that conversation started if you're interested in making that transition. I know DHS is disappointed by that decision by CMS as we are, but they at least made the effort. So we really appreciate that. So, Jason.

Jason Dorow: Well, thanks for that update. David, you always have the latest breaking news when it comes to legislative action. So it's imperative that we have you on each podcast.

David Hancox: Call me Mrs. Kravitz, yes.

Updated COVID-19 Vaccine and Free Test Kits

Jason Dorow: There's also some updates just from the COVID-19 sphere, mostly that an updated COVID-19 vaccine targeting currently circulating variants is now available at primary health clinics and participating pharmacies. The CDC is recommending that vaccine for everyone six months and older. Additionally, all households can now order up to four at home COVID-19 test kits free of charge. Oh, great. So if you go to Accrahomecare.org and click on the banner at the top of the screen, you can learn more about the updated vaccine, that'll direct you to the CDC website where you'll get all the information they have about recommendations, who they recommend should get it. And then there's also a link to another website where you can order your four free test kits. So first, go to Accra homecare.org, click that banner, and then you'll have links to all the latest regarding vaccines and test kits.

David Hancox: Great. I need to schedule my newest vaccine, but I did get the additional test kits. I've already done that. So thanks for that reminder, Jason. That's really valuable. Listeners, we want to thank you again for tuning in to another episode of the Champions of Homecare Podcast. And we hope you have a great day. Jason, any final words? Any final thoughts? Any words of wisdom for us?

Jason Dorow: No, I'm just glad this train is rolling again. We should have more podcasts coming in the weeks ahead. Make sure to follow us on Spotify. You can catch us on YouTube. Of course, if you're watching this, you already know that. But we'll keep the podcast posting on Spotify and Apple podcasts.

David Hancox: Fantastic. Thanks, Jason. Thank you, David.