- Welcome to Mutually Inclusive.

I'm your host Kylie Ambu, and on this episode we're talking with experts in the healthcare field about ongoing pushes for health equity and access.

(upbeat music) - [Narrator] Support for Mutually Inclusive comes from the W.K Kellogg Foundation, A Partner With Communities Where Children Come First.

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(upbeat music) - We're hearing the terms health equity and access to healthcare a lot, especially in the midst of the COVID-19 pandemic when disparities across groups have been highlighted and underlined, today we're joined by a panel of those working in the healthcare field today to talk about what equity looks like, the barriers to it, as well as solutions.

To weigh in is Dr. Diana RO, a Licensed Psychologist with Pine Rest Christian Mental Health Services, Scott Opperman, a Senior Leader at Mercy Health and Margo Schlewitz, the Director of Metro Health Community Clinic.

Well, thank you all so much for being here today and dedicating your time and your expertise.

I think we've talked a lot in the media, in our conversations especially with the COVID-19 pandemic about the different barriers to health equity and I was talking with Dr. Ro prior she had mentioned there's systemic barriers and there are individual barriers.

So I think for today, let's start with the systemic and work our way down to individual.

The first is awareness of resources.

Margo, I know that you direct a community clinic, are people aware of the resources generally that are available to them in your line of work?

- Well, I think that depends.

Refugees who come through a refugee resettlement agency they do have a lot of support around accessing those resources and applications for Medicaid, et cetera.

Some of our community members who have not had to rely in the past on any kind of community benefits don't have that information and so we work with them to provide them with information and help them to navigate for example, their Medicaid application.

Our financial assistance program requires that they at least apply for Medicaid before they can be accepted into the financials.

- And I know Dr. Ro that mental health services, we have seen an incline of people who are taking advantage and using them, but that still seems to be an area where people might not be aware of the resources that are available to them.

What do you see working at Pine Rest?

- I mean, absolutely.

I think fortunately there's been such a surge and understanding that there's access to this, it's safe, it's comfortable especially during the pandemic because a lot of individuals didn't have transportation to the clinic or couldn't afford certain copays or didn't even have access to a therapist but with the pandemic lot insurance companies have opened up who you can see, where you can see them, the fact that it can be tele and really kind of decrease the barriers in terms of transportation and access that way.

Living in Traverse City, I've been able to reach the UP and a lot of the communities around the area which has been amazing because there's been no access there so that's really opened that up however, there's still issues with internet access, privacy in your home, if you wanna have a therapy appointment and there's people running around all over the room it's a little bit hard so lots of improvement and gains, but yet still a lot of work to be done to help make sure that all communities have access to mental healthcare and to healthier living.

- And we talk about certain barriers like internet access, transportation.

I know that there have been an influx and I guess, aid that's been available to people during the pandemic, I know some internet companies have been taking some money off the bill.

None of that can really help though unless people know about it.

Can you talk with me a bit about the marketing and who resources are generally marketed towards.

- Historically I think it was what we knew and now I think there has been a lot more inclusion in terms of where the marketing is going to in terms of how we're spreading the word in our advertising, how we're spreading the word in terms of our community outreach.

Before I think, to be honest it's just kind of what we knew, we kind of did the same thing over and over again but now it's being a lot more intentional and inclusive about where it's going to, I think has really shifted to make sure that people have awareness of it and even presenting it in different languages, different areas that maybe we didn't know about.

We have an EAP and a CP program where we connect with different employment offices and different churches and religious groups to make sure that they know this resource is there and I think it's been an amazing kind of push during this time.

- And I know Scott as a senior leader and really a mission leader at Mercy Health, are these conversations that have been happening in the boardrooms and what ways you trying to push forward really access to resources but also the knowledge of them.

- So, absolutely.

So St. Mary's has strong relationships with community partners and so one of the things that we're trying to do is go to those who have the most impact in the community.

So we have strong relationships with Hispanic Center, with the Grand Rapids African American Health Institute, with the West Michigan Asian American Association with the Grand Rapids LGBTQ Healthcare Consortium, with the YWCA and others and so they really help us get the word out about those resources in so much is word of mouth.

So we aren't experts in every single culture, but we try to respect the fact that not everyone is gonna receive the information in the same way and even in the same language and so that has been very helpful and through those relationships more and more we're getting into minority publications and in other avenues that we hadn't in the past.

So this is just COVID has raised an awareness of issues that have always been there but it's put a spotlight on them for us.

- Absolutely, and I know you talked about languages, language can be a huge barrier when it comes to understanding information and understanding the resources that you have available and this question can really be for anyone, but where are we at in terms of the healthcare field and in terms of having equitable care for people who might speak other languages or who might just interact differently because of their culture and really that strive to have cultural competency in the workplace?

- We have over 30 different languages that are spoken here in our clinic among our patient population and so providing written materials is a big challenge.

We do have written materials for the most commonly spoken languages, but not for everyone and so a lot of times we're just reviewing things orally.

The advent of the video remote interpreter has really made coordinating interpreter services and accessing rare languages much easier than it has been in the past.

- Wonderful.

Thank you so much.

And Scott, I think you were about to say something as well.

- Yeah, language is so important.

In the largest minority population in Grand Rapids, of course, is the Latinx population, so we have many Spanish speakers.

So we do have lots of providers, especially at Clinica Santa Maria and Sparta who speak and that helps build trust because trust is fundamental in healthcare for everything.

And also language services in the hospital, actually of our trinity health hospitals of our eight hospitals in Michigan we actually have more translators than all of our other siblings, and so that really helps, but the video translators those have made inroads because one of the things people don't always know of Grand Rapids is in the Asian American population, how many different languages are spoken and how much language is a barrier to trust and good care.

- Absolutely.

And I know that with trust there's also that dynamic of do I feel comfortable with my care provider?

That's something I'd like to get into more when we talk about individual barriers, but when it comes to just even getting in the door, we've talked about transportation, we've talked about devices and having access to telehealth care, what about insurance?

What about the access to being able to pay your copays, being able to understand your insurance policy?

- Luckily over here at Pine Rest, we actually have a patients assistance fund where we collect donations and fundraise, where we can have a sliding scale, We can provide assistance with even copays and I know lately insurance is shifting a lot to high deductibles.

That's another thing where we see it drop during the beginning of the year, that kind of resurgence later in the year.

So I think having systems like that in place to really help the systemic issue of financing your care.

And then really, I mean, hopefully, and this could be kind of another thing really lobbying in the field how important it is to have funds allocated from insurance company and it had coverage for clients to be able to access the care that they need because it does really reduce funding or reduces costs of other healthcare issues if their mental health is well as attained to, so just a lot of things like that I think would be helpful in making sure that financing is available but then again, kind of piggybacking off of what the other two have said, we can't do everything all at once and so really it's a community effort to kind of get this going.

- Absolutely.

And speaking of community effort, Margo, I wanna turn back to you and talk about just the community clinic and the issues that you might see people coming and getting to you and accessing care, because I know we've gone over quite a few barriers already, one being transportation but I wanna talk about location because if you don't have transportation, if you are not close to the nearest clinic, what can you do really to get there?

And at what point does someone say, someone with children or someone who works two jobs say I just can't get in to get myself care?

- Well, I think the job issue is really a common problem so even if somebody has insurance through their work, they can't take time off for their preventive care, so they're not gonna come unless they're sick, and so trying to encourage people to make arrangements.

So that means we have to create time outside of our normal office hours into the evenings or weekends that there's accessibility for people who are working and that is a common issue as far as transportation we're on a bus line and I think a couple of different buses come through here, one ride right to our door basically and that is helpful.

Also the Medicaid plans, all the Healthy Michigan Plans do provide transportation to doctor's appointments but you do have to schedule that in advance, so if you're having an urgent need that becomes a new problem for transportation.

- One thing that I'd love touch on is you talked about really having to work harder to get certain people from certain groups in the door if someone doesn't speak the language there has to be an interpreter, if someone can't be there because of the location or work hours that you have to work later, I guess, is our healthcare field right now prepared to make those accommodations to people?

And how has that changed over the course of the past few years?

- I think we've all changed our hours from the normal business hours to include more evening and weekend hours for all of us.

And I think telehealth, the fact that insurance is reimbursing for telehealth now has really opened up the doors for a lot of people who couldn't make it physically in for whatever reason and that includes video, virtual visits, but also telephone visits.

So even if you don't have access to a device that would allow you to have the video visit, people can call on their phone and have a phone visit.

Well, I think we are going to move in more to the individual barriers that some people might face, but before we move on I know that we've talked Dr. Ro about you had mentioned a lot of the systemic barriers, do you wanna give me an overview of just how deep some of those systemic barriers can go when it comes to the access problem that we're seeing today?

- I mean, it kind of almost bouncing off of the previous question too.

I mean, it is a group effort because if let's say us individually extend our hours then we're putting strain on just our employees, right?

If we put, it has to be a transportation city, their jobs have to be more open to allowing them to take an hour off to go to an appointment.

I mean, it's really a group effort so the system is working better but it really is broken in a lot of ways of understanding how different people access care and even the help seeking behaviors of each individual culturally in different areas and even if we think of telehealth with the aging population, oh man, a lot of my clients who are were older that only had landlines or didn't have access to certain tele devices and didn't even know how to use it, so it really runs anything so deep and so many areas that we didn't even think about when we have the privilege of not thinking about it.

I have the privilege of being so tech aware so I didn't even think about landlines.

And so really I think it goes so deep into looking at the privileges that we have and seeing how not everyone has those advantages and looking at each area and really challenging ourselves in addressing that.

- And I love your comment about privilege because something that I think is a privilege for a majority of people is representation, is potentially seeing people and being cared for by people who look like you, who understand you or culturally identify with you.

You might be able to crack jokes with your doctor, whereas some people might not feel comfortable if it's a different culture, different environment.

Scott, how big of a role do you feel like representation plays over at Mercy Health?

- I think it plays a huge role.

And that's one of the reasons why we're spending so many resources on diversity and inclusion very much in our medical practice, we are diversifying our providers because we need it in the community.

Grand Rapids is becoming more and more diverse and not everyone has the cultural competency for all of our patients, we are developing that as well, because again, trust is essential and if we don't have those cultural competencies, if people don't feel comfortable, then we're not gonna have great outcomes and the number one thing we want is equity in healthcare.

We want good outcomes for everyone and so it's a must both to diversify our provider base in this community and also cultural competencies.

You would not believe the stories for instance, we had a listening session from our LGBTQ community and some of the stories are horrible in terms of their interactions in Grand Rapids among all the health systems at some point and independence and then you think about the Latinx community we have undocumented patients and oftentimes they're fearful to get care, they're fearful to sign anything, to even register and so we have to, again be inclusive in the greatest sense and focus on equity and for healthcare in our community.

- Absolutely.

And I know Dr. Ro, you have published written works about talking about the importance of representation in the field of mental health.

How does that relate to, I guess, a communication or a relationship between a therapist and potentially the client that they're seeing in terms of understanding life events or what they might be going through?

- I mean, absolutely.

I mean, therapy is such an intimate process where you're really sharing and bearing your soul and who you are and what's going on and so the power dynamic that comes out when you're talking to a therapist and being a patient is such a huge dynamic to consider.

and so when we think about kind of piggybacking off of Scott's trust, unfortunately a lot of marginalized communities are overpathologized, overdiagnosed, they are not listened to in terms of seriousness, so on the reverse of their symptoms and what's going on, and we don't understand the context in which someone is coming from then we miss them as a whole person.

If I went into a therapy room and they did not at all talk about my racial background and how that affects how I see the world, how I see my symptoms, how I interact with people I would think they're missing a huge part of who I am and so really just that explicit awareness and conversation about how does it affect your family life, your symptoms, how you're doing, if that's not there, it ruins or can't say ruins, it really taints the interactions and the health that someone can accomplish and so definitely in that relationship it's so important to be able to help the person feel like I'm here to help you, I'm here to listen to you and I may not know everything, it's not that we have to know everything when Scott talks about cultural competency, it's not that I know everything about every culture and every language but kind of what Margo said, if there's this openness and this curiosity and this awareness and vulnerability I think even coming from the expert to learn and to work with the individual I think that's what really is important.

- And I know Margo, you have said that a big part of the community that you serve is the Latinx community, what steps have you and your employees taken over at the community clinic to best serve people who might not look like you or might not speak the same language as you?

- Well, one of the things that we do is we try to hire and recruit people who do represent these communities, so we have a number of different languages spoken among our staff.

And I can tell you that when somebody is speaking to somebody in their primary language, that the encounter is much richer than it is when we're using an interpreter.

So that's always a nice feeling to be able to hear and see those interactions but we do a cultural competency training on a regular basis.

And like I said, a large part of that is just learning to be open and curious and humble in your interactions, so that's what we're doing.

So we do have a number of Spanish speaking staff.

- That's wonderful.

And I know that in talking to all of you today, you've offered insight into barriers, but you've also offered insight into solutions, having training at work, diversifying the workforce, where are some of the key areas that you think are, I guess, in need of solutions right now that we might be on the right track to?

- I think the step of diversifying our staff and our companies and our understanding, and then really shifting the focus to inclusion 'cause it's one thing to invite people to the table but it's another thing to actually have the individuals feel welcomed and included in the process as well.

And that one's a trickier one to be honest of how to be inclusive and respectful of all different cultures, different age groups, different religious backgrounds and orientations and whatnot.

So I think that focus on how do we help individuals feel included, respected, and safe is the biggest thing and so different things that at least our company is doing is making sure there's smaller groups created that have each department come together and talk with each other about different things that can happen especially for diversifying our staff, something that I've unfortunately have experienced and I'm sure many staff has is microaggressions and actually racism discrimination from our patient population as the professional.

And so it goes back and forth and multiple different ways so really protecting our staff while including them to making sure that they feel safe and also for our patient care too for access to barriers 'cause then we can have that connection.

So I think inclusion and really focusing more solutions on inclusion.

- I know we talk about diversifying the workplace, obviously, that doesn't just mean in terms of employees of color languages.

We're also looking at gender orientation and sexual orientation, creating intersectional relationships with people.

Do you feel like it starts, I guess, culturally in the workplace for employees like Dr. Ro said to feel safe and then inviting more people to the table there to have that discussion in healthcare?

- Yeah, you have to make it a priority.

And one of the things that you have to do first is allow people to self identify and that's both for colleagues and for our patients because if we don't have a whole picture, then we can't really provide equitable healthcare because there are certain factors for some of us, depending on how we identify, and so again, building that trust is essential and that's essential in recruiting in our community so that our healthcare workers represent the communities that we're serving.

So that's a fundamental start for that.

I would also say the social influencers of health is another factor we haven't talked about but are sometimes called social determinants but oftentimes that's like 80% of a given health condition, those social influences are impacting that.

And so I think we've made strides at being more evidence-based because when someone presents in the emergency department we know what to do when someone's having a heart attack, right?

We have evidence-based interventions, but for so long there's been goodwill in terms of addressing the social influencers or social determinants of health, but it hasn't been as evidenced base and so a huge factor in our community of having equitable care is actually addressing those.

And again, I do think we're making some strides, but we have a long ways to go.

- And I know we are to a close now, but any final words from the three of you in ways that we can really push forward and just make our healthcare system somewhere where everyone feels welcome and appreciated and like they can go to for care?

- I think just continued conversations like this, where we're kind of coming together with different individuals from different areas in the field and talking about what can we do 'cause really brainstorming as a team is gonna bring about the most ideas and the most diverse ideas of inclusion and so definitely having the discussions and really being again humble and open and curious are the key words that I keep flying around in my head anytime I think of inclusion, not complete knowledge, 'cause I think we can get a little bit scared and get really defensive and nervous, like but I don't know that I'm sorry, I made a mistake, I put my foot in my mouth, that's okay, come to the conversation very open and respectful and wanting to learn and I think that will make the biggest difference in our progress moving forward.

- Perfect.

Anyone else final words?

- Yeah, I think patient engagement is very important and I think that as an industry we've really grown in the ability to engage patients and family members and caregivers as advisers in our work on a day to day basis, and so I think that's really something that is improving, continues to improve and will continue to help inform how we provide care in our community.

- Wonderful, wonderful.

And Scott?

- I think the largest factors that will help us is actually having a healthcare workforce that's representative of the community we serve and if everyone has an equal place at the table, because if our workforce is representative, then we're gonna be thinking of things and doing things we haven't done before and it's automatically going to improve the care of the community.

- Well, thank you so much for joining us with your time and your expertise.

For more information on Mutually Inclusive shows, just head to our website wgvu.org/MutuallyInclusive.

We'll see you next time.

(upbeat music) - [Narrator] Support for Mutually Inclusive comes from the W.K Kellogg Foundation, A Partner With Communities Where Children Come First.

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