Selected Podcast
ASHRM Behavioral Health WhitePaper Series
Behavioral Health focus is paramount in today’s ever-changing environment to ensure safe and trusted health care. Kristen and Doris developed a 3-part whitepaper for ASHRM looking at providing treatment for patients with behavioral health issues who are treated across the spectrum of care including: inpatient, outpatient, and in emergency/ambulatory care. Go to ASHRM’s website and download all 3 whitepapers for FREE!
Featuring:
Doris has more than 30 years’ experience in healthcare. As a dually board certified psychiatric and family nurse practitioner, Doris has practiced in both the in and outpatient settings including: critical care, psychiatry, private practice, ambulatory and long- term care. Transitioning to risk management 15 years ago, she was the director of risk management at a large academic system. She holds a Doctorate in Nursing Practice, Systems Leadership from Rush University in Chicago. Prior to joining WTW, Doris provided organizationally specific consultation services and education as a content expert and resource on matters of clinical enterprise risk management, risk assessment, selection, and mitigation for internal and external clients at a global insurance company. Doris has published on various risk management topics and speaks with audiences nationally on matters of clinical and enterprise risk management. Doris is a certified professional in healthcare risk management (CPHRM).
Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM | Doris Fischer-Sanchez, DNP, APN-BC, CPHRM
Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM is the System Vice President Risk Management & System Privacy Officer for Covenant Health where she leads a team providing risk management, compliance, privacy, and provides legal consultation to acute care hospitals, post acute care facilities, assisted living facilities, and physician practices in the northeast. Kristen has worked for a global insurer and a brokerage company where she specialized in providing services nationally for behavioral health providers, psychiatrists, and allied health professionals. She has experience as a defense attorney at a Boston law firm where she represented hospitals, nursing homes, medical providers, and allied health professionals involved in litigation, board matters, guardianship matters, and other general health law issues. In addition, Kristen began her career as a clinical social worker in a variety of inpatient and outpatient settings. Kristen obtained her Juris Doctorate from the Massachusetts School of Law, Masters of Social Work from Springfield College, and Bachelors of Arts from the University of Massachusetts. She is a member of the bars of Massachusetts and Connecticut and the District Court of Massachusetts, a Clinical Social Worker in Massachusetts, and a Fellow of the American Society of Healthcare Risk Management. She has published extensively including as an author contributor of the book, Integrated Care Working at the Interface of Primary Care and Behavioral Health. She routinely presents nationally and regionally on legal and risk management topics impacting providers.Doris has more than 30 years’ experience in healthcare. As a dually board certified psychiatric and family nurse practitioner, Doris has practiced in both the in and outpatient settings including: critical care, psychiatry, private practice, ambulatory and long- term care. Transitioning to risk management 15 years ago, she was the director of risk management at a large academic system. She holds a Doctorate in Nursing Practice, Systems Leadership from Rush University in Chicago. Prior to joining WTW, Doris provided organizationally specific consultation services and education as a content expert and resource on matters of clinical enterprise risk management, risk assessment, selection, and mitigation for internal and external clients at a global insurance company. Doris has published on various risk management topics and speaks with audiences nationally on matters of clinical and enterprise risk management. Doris is a certified professional in healthcare risk management (CPHRM).
Transcription:
Michael Carrese: Welcome to the ASHRM Podcast made possible by the American Society for Health Care Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ASHRM.org/membership to learn more and become a national member.
I'm Michael Carrese. And because of ever changing realities and limited resources and evolution is underway in how our healthcare system manages patients with behavioral health disorders and, of course, as most of the folks listening to this know very well, those patients receive treatment in every segment of healthcare, not just the inpatient settings.
Today, we're going to introduce you to a three-part white paper series developed by ASHRM and the American Hospital Association, which offers valuable guidelines and resources for managing these patients. We're fortunate to have the authors of the series as our guides today. So I want to welcome Doris Fischer-Sanchez, a Senior Clinical and Enterprise Risk Management Consultant at Willis Towers Watson, and Kristen Lambert, System Vice President for Risk Management and System Privacy Officer at Covenant Health. Thank you very much for joining us.
Doris Fischer-Lambert: Thank you, Michael.
Kristen Lambert: Thank you.
Michael Carrese: So I'd like to start with both of you sharing some background on your credentials and careers so we can understand what you're bringing to the table today. And Doris, perhaps you can start.
Doris Fischer-Lambert: Sure. Happy to, Michael. Again, Doris Fischer-Sanchez. My background is that I'm a psychiatric and family nurse practitioner by training and clinical experience. And I have my doctorate in systems leadership from Rush University Medical Center here in Chicago, Illinois. I spent a lot of time practicing clinically and then shifted over to risk management. So I feel that the blend of clinical and risk management is kind of a natural fit and where it relates to the psychiatric world, that kind of fleshed out in this series.
Michael Carrese: Absolutely. Kristen, what about you?
Kristen Lambert: Thank you. Thanks, Michael and to ASHRM, for asking us to do this, podcast today. I have a background-- I started off as a clinical social worker, and then I went into law and did medical malpractice defense in a Boston law firm. And then, worked in insurance and brokerage and provided some direct consultation to the American Psychological Association, Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.
So now, I'm working in a hospital system and Doris and I worked quite a bit on this project together and given our backgrounds in behavioral health, it's definitely something that's near and dear to our heart for sure.
Michael Carrese: Yeah, that's quite a rich mix of perspectives and experience to bring to all of this. And I'm wondering why ASHRM and the AHA decided to do this series. What's happening with behavioral health that requires special attention by risk management professionals right now? Doris, what do you think?
Doris Fischer-Lambert: I think as a foundation, Michael, one of the things that we note is that the resources are exceptionally limited across healthcare, but even more so in the psychiatric world. There's been closure after closure of public access to mental health care in the communities, state mental hospitals, et cetera. And that has really fallen onto the backs of community and academic medical centers.
Michael Carrese: And that limited resources story, Kristen, how would you pick up on that?
Kristen Lambert: Yeah, certainly. I think even with the pandemic, particularly, there have been such limited resources or folks have had the barriers to obtaining resources as well. So certainly, this is an issue that we're seeing not only regionally, but all across the country, where there are just not enough providers and limited services available and folks need the care. So, certainly, it's an issue that we're seeing.
Michael Carrese: And I can tell you being in a rural state of Vermont, the access question, the availability really of practitioners is a very real, very big problem. So, the first part of the series focuses on outpatient settings. Kristen, what are some of the emerging models there for integrating behavioral health in those settings?
Kristen Lambert: Sure. So, I first became involved in sort of the integrated care, collaborative care model back in 2013, through some projects with the APA and, since that time, and it was sort of a newer emerging model where behavioral health providers were working in collaboration and with PCP offices or outpatient providers.
But now we're seeing this has become much more commonplace where behavioral health providers are working in consultation and in collaboration with PCP offices to provide the care to patients who really need it the most. There are a lot of different models of this type of care out there. They might have a behavioral health provider on staff or there might be cross-state consultation, or there could be telehealth consultation with a provider and that the behavioral health provider may not actually see the patient. So it really depends on the model, but the goal is to provide care to the underserved population, dealing with behavioral health issues.
And again, as I mentioned with a pandemic we're seeing an increase of suicidal ideation in the healthcare and hospital settings really across the spectrum. So having this type of model, which provides that overlap of care or wraparound care to patients in the outpatient setting is very important and it's needed.
Michael Carrese: Absolutely. The second white paper deals with behavioral health and EDs and emergency rooms. And they've of course seen an increase in patients with psychiatric and behavioral health needs. So Doris, what are some of the key challenges and considerations for handling this population of patients in that setting?
Doris Fischer-Lambert: So the emergency room by default has become somewhat of an ambulatory care setting over the years. And I think with that comes not just medical conditions, obviously, but behavioral issues as well. And we all need to understand that folks that have behavioral health problems or issues also have medical concerns as well. And so part of the problem for the EDs is that they're hit with anything that walks through the door, you know? And so I think from a risk management perspective, we have to be up to the challenge and the assistance to the providers to help them understand when we begin to understand that a behavioral health issue is really emerging as one of the more prevalent issues in that particular episode, how to make sure that we're.
Coordinating and providing, care that's, both physically and mentally appropriate. Potentially as well, referrals. And then on top of that, again, specifically risk related, do we understand the legalities and the federal confidentialities and those higher level things that are associated with mental health care and behavior.
And I think as risk managers, we need to be that resource and referral for our providers so they can accept the considerable challenges that are associated with caring for these folks.
Michael Carrese: that white paper also talks about discharge planning from the ed and the use of community resources. What are some of the key points there?
Doris Fischer-Lambert: Well, because of the limited amount of resources that are available within communities. I think it's important to understand that as ed providers, risk managers, who do we reach out to within our own community, meaning with inside of the organization that we're working with an externally. See if there aren't available extension of services beyond the emergency room, or even more imperatively if there's the need for an inpatient admission by default, because there is nowhere else to help these folks, get care.
And so I think part of the takeaways from our series at any rate is. The appendices that we have within each series within each section to provide some resources and referrals for folks, in the event of, the need for some other options for care.
Michael Carrese: right. And I should have mentioned at the beginning that this series of white papers is available to download from the Ashrm site and we encourage all you folks to go in and do that. So, Kristen, back to you, we're, we're all aware of course, that the use of telehealth technology has skyrocketed during COVID-19.
How has that impacted delivery of behavioral health services?
Kristen Lambert: It certainly has impacted it tremendously. over the years we've seen tele-health used in behavioral health and substance use services, but with the pandemic, patients couldn't get treatment, through providers because either offices were closed or the real limited offices that were open, there might be, Fear from patients who, may not want to go into an office setting.
So there was a need, an emergent need to implement technology and many offices set up. Technology, to provide care that they hadn't had before. So, some providers may not have, provided the tele-health service before it might've been only in-person services.
And so there was that urgency to get that implemented. But what we've seen is that, there was a. Tremendous increase in the news of, the technology across the spectrum, after the pandemic. And I think that we're going to see that change continue on once the pandemic has subsided, I think we're going to continue to see that and areas that might have been, Not as progressive as, behavioral health in the area of substance use.
We've seen an increase in, providing services and care in that spectrum as well, or that, area of, treatment as well. So, I just think that it's going to increase as time goes along and, people become more comfortable and want to use it, that type of service as well.
Michael Carrese: So for risk managers, what do they need to be paying attention to here? Is it a cross state licensing or what are some of the other things attached to tele-health?
Kristen Lambert: So that's a great question. there are, cross state licensure issues that, providers in particular need to be aware of. with, the pandemic. There have been some federal and state. regularly since that has been relaxed or, altered temporarily to allow for, different types of, treatment across state lines, or some sort of relaxed standard.
and I would encourage risk management professionals to be aware of what the federal rules are as well as state rules as There are variations across, States, but, yes, providers need to be aware of what the rules are in their particular state, as well as, federally to make sure that they don't face a licensure issue if they are practicing in a state that they're not licensed to practice in, so yes, that's for sure.
Michael Carrese: Awful lot to keep track of. so the third white paper in the series, doors addresses behavioral health and substance use issues presented in inpatient settings. What should be top of mind for risk managers in that category?
Doris Fischer-Lambert: The things that, Kristen and I tried to do with the series is to help risk managers and all healthcare professionals understand that this is a continuum, right? it's, a circle and, it's a chronic issue. And there are very few things that cause just one episode. And so we like to make sure that risk managers are top of mind again with regs.
state and federal. As it relates to the pandemic. And Kristen alluded to the 1135 waivers, which of course are temporary, during the period of COVID, but to be aware and pay attention to those and to understand that, we will see these folks again, whether it's in a behavioral setting or whether it's in a medical setting, but that, patients have rights.
in certain States, making sure that even that they're aware of them and that they've been informed that family members to the degree that they're able to participate in care. There are more federal confidentiality laws that are associated with mental health and there are with other medical issues.
And I think just utilizing the series as a primmer, to understand that, there's a lot to this and it's very manageable and very workable, right. But it does have a subspecialty component of its own and that, we need to be that resource and referral for our colleagues so they can continue to do that clinical work.
Michael Carrese: Throughout the three, papers, you point out special considerations for particular populations at risk. And Kristen, I wanted you to have you touch on the domestic violence patient population. What would you like to highlight about that?
Kristen Lambert: Yes. so this is a really important area and I think. it's something that, well, I was a social worker. it's something that I have, been very involved in over the course of my career. and so if you think about it, folks who experienced domestic violence within the home or with their partner, especially right now where people may not be able to leave their home, they may be confined with her abuser.
They may not have the resources out there because the resources aren't closed or limited. or People who are working in those types of settings may be remote. So there's nowhere for, people to go. They might be afraid to go to a shelter because of fear of exposure or fear in general.
So I just want to highlight that. People who experienced domestic violence. they can also experience depression and anxiety. It's very common to have behavioral health issues go along with that, domestic violence within their relationship, whether it's their parents, whether it's their spouse or a loved one.
Anyone that they're involved in closely. So, certainly an issue that we're seeing. And right now with a pandemic, with folks who are, who may be out of work or have, additional financial stressors, the domestic violence, aspect, may be increasing and that is certainly a concern on behavioral health, with respect to behavioral health as well.
Michael Carrese: Right. Unfortunately, something else to keep an eye on throughout this whole situation. So as we wrap up here, I wondered if I could get final thoughts from each of you on this series, in which you're hoping to accomplish Doris, why don't you start.
Doris Fischer-Lambert: I think given this was the first cooperative between the aha and Astrum and we did undergo a rigorous review process, from both the AIJ and ashram, I think, Kristen and I have found out that, looking at behavioral health from these particular. sections within healthcare are similar yet very different, and we need to help each other, understand that, working together this, again, a lack of resources, a pandemic included, and being, kind of a difficult area to begin with just from all the laws and regs and such you can't learn it overnight, but, certainly something of this nature, is hopefully that helpful, go-to document that at least gives you a bit of a roadmap.
Michael Carrese: Kristen, what would you add to that?
Kristen Lambert: Sure. So I think, Doris really said it very nicely and it was truly a cooperative project. Between Doris and I, and also Ash from ad the aha. And I think our goal really was to put together a very comprehensive. Series that covered the entire healthcare spectrum. So that risk managers could just pull up one of the documents and be able to go to the resource links and find the resources and information that they needed to, really, No, how to deal with, patients who they may experience in the hospital setting and the outpatient setting in the inpatient setting.
So it was our goal to just provide resources and information, and we're very fortunate and happy to have done that and hope that it was helpful to, folks would access the resources, going forward.
Michael Carrese: And very easy to find it's on the homepage of the Ashrm website. You just go over to the resources tab. There's a dropdown menu and you'll see white papers and you can get to it that way. I'm afraid we're going to have to leave it there, but I want to thank you both very much for being with us today and sharing all of that.
Great guidance. You've been listening to Doris Fisher Sanchez, a senior clinical and enterprise risk management consultant at Willis towers, Watson and Kristin Lambert system, vice president risk management and system privacy officer for covenant health. Thank you both very much.
Kristen Lambert: Thank you, Michael.
Michael Carrese: This podcast is made possible by the American society for healthcare risk management to support efforts, to advance safe and trusted healthcare through enterprise risk management, you can visit ashrm.org/ membership to learn more and become a national member. Thanks for listening
Michael Carrese: Welcome to the ASHRM Podcast made possible by the American Society for Health Care Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ASHRM.org/membership to learn more and become a national member.
I'm Michael Carrese. And because of ever changing realities and limited resources and evolution is underway in how our healthcare system manages patients with behavioral health disorders and, of course, as most of the folks listening to this know very well, those patients receive treatment in every segment of healthcare, not just the inpatient settings.
Today, we're going to introduce you to a three-part white paper series developed by ASHRM and the American Hospital Association, which offers valuable guidelines and resources for managing these patients. We're fortunate to have the authors of the series as our guides today. So I want to welcome Doris Fischer-Sanchez, a Senior Clinical and Enterprise Risk Management Consultant at Willis Towers Watson, and Kristen Lambert, System Vice President for Risk Management and System Privacy Officer at Covenant Health. Thank you very much for joining us.
Doris Fischer-Lambert: Thank you, Michael.
Kristen Lambert: Thank you.
Michael Carrese: So I'd like to start with both of you sharing some background on your credentials and careers so we can understand what you're bringing to the table today. And Doris, perhaps you can start.
Doris Fischer-Lambert: Sure. Happy to, Michael. Again, Doris Fischer-Sanchez. My background is that I'm a psychiatric and family nurse practitioner by training and clinical experience. And I have my doctorate in systems leadership from Rush University Medical Center here in Chicago, Illinois. I spent a lot of time practicing clinically and then shifted over to risk management. So I feel that the blend of clinical and risk management is kind of a natural fit and where it relates to the psychiatric world, that kind of fleshed out in this series.
Michael Carrese: Absolutely. Kristen, what about you?
Kristen Lambert: Thank you. Thanks, Michael and to ASHRM, for asking us to do this, podcast today. I have a background-- I started off as a clinical social worker, and then I went into law and did medical malpractice defense in a Boston law firm. And then, worked in insurance and brokerage and provided some direct consultation to the American Psychological Association, Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.
So now, I'm working in a hospital system and Doris and I worked quite a bit on this project together and given our backgrounds in behavioral health, it's definitely something that's near and dear to our heart for sure.
Michael Carrese: Yeah, that's quite a rich mix of perspectives and experience to bring to all of this. And I'm wondering why ASHRM and the AHA decided to do this series. What's happening with behavioral health that requires special attention by risk management professionals right now? Doris, what do you think?
Doris Fischer-Lambert: I think as a foundation, Michael, one of the things that we note is that the resources are exceptionally limited across healthcare, but even more so in the psychiatric world. There's been closure after closure of public access to mental health care in the communities, state mental hospitals, et cetera. And that has really fallen onto the backs of community and academic medical centers.
Michael Carrese: And that limited resources story, Kristen, how would you pick up on that?
Kristen Lambert: Yeah, certainly. I think even with the pandemic, particularly, there have been such limited resources or folks have had the barriers to obtaining resources as well. So certainly, this is an issue that we're seeing not only regionally, but all across the country, where there are just not enough providers and limited services available and folks need the care. So, certainly, it's an issue that we're seeing.
Michael Carrese: And I can tell you being in a rural state of Vermont, the access question, the availability really of practitioners is a very real, very big problem. So, the first part of the series focuses on outpatient settings. Kristen, what are some of the emerging models there for integrating behavioral health in those settings?
Kristen Lambert: Sure. So, I first became involved in sort of the integrated care, collaborative care model back in 2013, through some projects with the APA and, since that time, and it was sort of a newer emerging model where behavioral health providers were working in collaboration and with PCP offices or outpatient providers.
But now we're seeing this has become much more commonplace where behavioral health providers are working in consultation and in collaboration with PCP offices to provide the care to patients who really need it the most. There are a lot of different models of this type of care out there. They might have a behavioral health provider on staff or there might be cross-state consultation, or there could be telehealth consultation with a provider and that the behavioral health provider may not actually see the patient. So it really depends on the model, but the goal is to provide care to the underserved population, dealing with behavioral health issues.
And again, as I mentioned with a pandemic we're seeing an increase of suicidal ideation in the healthcare and hospital settings really across the spectrum. So having this type of model, which provides that overlap of care or wraparound care to patients in the outpatient setting is very important and it's needed.
Michael Carrese: Absolutely. The second white paper deals with behavioral health and EDs and emergency rooms. And they've of course seen an increase in patients with psychiatric and behavioral health needs. So Doris, what are some of the key challenges and considerations for handling this population of patients in that setting?
Doris Fischer-Lambert: So the emergency room by default has become somewhat of an ambulatory care setting over the years. And I think with that comes not just medical conditions, obviously, but behavioral issues as well. And we all need to understand that folks that have behavioral health problems or issues also have medical concerns as well. And so part of the problem for the EDs is that they're hit with anything that walks through the door, you know? And so I think from a risk management perspective, we have to be up to the challenge and the assistance to the providers to help them understand when we begin to understand that a behavioral health issue is really emerging as one of the more prevalent issues in that particular episode, how to make sure that we're.
Coordinating and providing, care that's, both physically and mentally appropriate. Potentially as well, referrals. And then on top of that, again, specifically risk related, do we understand the legalities and the federal confidentialities and those higher level things that are associated with mental health care and behavior.
And I think as risk managers, we need to be that resource and referral for our providers so they can accept the considerable challenges that are associated with caring for these folks.
Michael Carrese: that white paper also talks about discharge planning from the ed and the use of community resources. What are some of the key points there?
Doris Fischer-Lambert: Well, because of the limited amount of resources that are available within communities. I think it's important to understand that as ed providers, risk managers, who do we reach out to within our own community, meaning with inside of the organization that we're working with an externally. See if there aren't available extension of services beyond the emergency room, or even more imperatively if there's the need for an inpatient admission by default, because there is nowhere else to help these folks, get care.
And so I think part of the takeaways from our series at any rate is. The appendices that we have within each series within each section to provide some resources and referrals for folks, in the event of, the need for some other options for care.
Michael Carrese: right. And I should have mentioned at the beginning that this series of white papers is available to download from the Ashrm site and we encourage all you folks to go in and do that. So, Kristen, back to you, we're, we're all aware of course, that the use of telehealth technology has skyrocketed during COVID-19.
How has that impacted delivery of behavioral health services?
Kristen Lambert: It certainly has impacted it tremendously. over the years we've seen tele-health used in behavioral health and substance use services, but with the pandemic, patients couldn't get treatment, through providers because either offices were closed or the real limited offices that were open, there might be, Fear from patients who, may not want to go into an office setting.
So there was a need, an emergent need to implement technology and many offices set up. Technology, to provide care that they hadn't had before. So, some providers may not have, provided the tele-health service before it might've been only in-person services.
And so there was that urgency to get that implemented. But what we've seen is that, there was a. Tremendous increase in the news of, the technology across the spectrum, after the pandemic. And I think that we're going to see that change continue on once the pandemic has subsided, I think we're going to continue to see that and areas that might have been, Not as progressive as, behavioral health in the area of substance use.
We've seen an increase in, providing services and care in that spectrum as well, or that, area of, treatment as well. So, I just think that it's going to increase as time goes along and, people become more comfortable and want to use it, that type of service as well.
Michael Carrese: So for risk managers, what do they need to be paying attention to here? Is it a cross state licensing or what are some of the other things attached to tele-health?
Kristen Lambert: So that's a great question. there are, cross state licensure issues that, providers in particular need to be aware of. with, the pandemic. There have been some federal and state. regularly since that has been relaxed or, altered temporarily to allow for, different types of, treatment across state lines, or some sort of relaxed standard.
and I would encourage risk management professionals to be aware of what the federal rules are as well as state rules as There are variations across, States, but, yes, providers need to be aware of what the rules are in their particular state, as well as, federally to make sure that they don't face a licensure issue if they are practicing in a state that they're not licensed to practice in, so yes, that's for sure.
Michael Carrese: Awful lot to keep track of. so the third white paper in the series, doors addresses behavioral health and substance use issues presented in inpatient settings. What should be top of mind for risk managers in that category?
Doris Fischer-Lambert: The things that, Kristen and I tried to do with the series is to help risk managers and all healthcare professionals understand that this is a continuum, right? it's, a circle and, it's a chronic issue. And there are very few things that cause just one episode. And so we like to make sure that risk managers are top of mind again with regs.
state and federal. As it relates to the pandemic. And Kristen alluded to the 1135 waivers, which of course are temporary, during the period of COVID, but to be aware and pay attention to those and to understand that, we will see these folks again, whether it's in a behavioral setting or whether it's in a medical setting, but that, patients have rights.
in certain States, making sure that even that they're aware of them and that they've been informed that family members to the degree that they're able to participate in care. There are more federal confidentiality laws that are associated with mental health and there are with other medical issues.
And I think just utilizing the series as a primmer, to understand that, there's a lot to this and it's very manageable and very workable, right. But it does have a subspecialty component of its own and that, we need to be that resource and referral for our colleagues so they can continue to do that clinical work.
Michael Carrese: Throughout the three, papers, you point out special considerations for particular populations at risk. And Kristen, I wanted you to have you touch on the domestic violence patient population. What would you like to highlight about that?
Kristen Lambert: Yes. so this is a really important area and I think. it's something that, well, I was a social worker. it's something that I have, been very involved in over the course of my career. and so if you think about it, folks who experienced domestic violence within the home or with their partner, especially right now where people may not be able to leave their home, they may be confined with her abuser.
They may not have the resources out there because the resources aren't closed or limited. or People who are working in those types of settings may be remote. So there's nowhere for, people to go. They might be afraid to go to a shelter because of fear of exposure or fear in general.
So I just want to highlight that. People who experienced domestic violence. they can also experience depression and anxiety. It's very common to have behavioral health issues go along with that, domestic violence within their relationship, whether it's their parents, whether it's their spouse or a loved one.
Anyone that they're involved in closely. So, certainly an issue that we're seeing. And right now with a pandemic, with folks who are, who may be out of work or have, additional financial stressors, the domestic violence, aspect, may be increasing and that is certainly a concern on behavioral health, with respect to behavioral health as well.
Michael Carrese: Right. Unfortunately, something else to keep an eye on throughout this whole situation. So as we wrap up here, I wondered if I could get final thoughts from each of you on this series, in which you're hoping to accomplish Doris, why don't you start.
Doris Fischer-Lambert: I think given this was the first cooperative between the aha and Astrum and we did undergo a rigorous review process, from both the AIJ and ashram, I think, Kristen and I have found out that, looking at behavioral health from these particular. sections within healthcare are similar yet very different, and we need to help each other, understand that, working together this, again, a lack of resources, a pandemic included, and being, kind of a difficult area to begin with just from all the laws and regs and such you can't learn it overnight, but, certainly something of this nature, is hopefully that helpful, go-to document that at least gives you a bit of a roadmap.
Michael Carrese: Kristen, what would you add to that?
Kristen Lambert: Sure. So I think, Doris really said it very nicely and it was truly a cooperative project. Between Doris and I, and also Ash from ad the aha. And I think our goal really was to put together a very comprehensive. Series that covered the entire healthcare spectrum. So that risk managers could just pull up one of the documents and be able to go to the resource links and find the resources and information that they needed to, really, No, how to deal with, patients who they may experience in the hospital setting and the outpatient setting in the inpatient setting.
So it was our goal to just provide resources and information, and we're very fortunate and happy to have done that and hope that it was helpful to, folks would access the resources, going forward.
Michael Carrese: And very easy to find it's on the homepage of the Ashrm website. You just go over to the resources tab. There's a dropdown menu and you'll see white papers and you can get to it that way. I'm afraid we're going to have to leave it there, but I want to thank you both very much for being with us today and sharing all of that.
Great guidance. You've been listening to Doris Fisher Sanchez, a senior clinical and enterprise risk management consultant at Willis towers, Watson and Kristin Lambert system, vice president risk management and system privacy officer for covenant health. Thank you both very much.
Kristen Lambert: Thank you, Michael.
Michael Carrese: This podcast is made possible by the American society for healthcare risk management to support efforts, to advance safe and trusted healthcare through enterprise risk management, you can visit ashrm.org/ membership to learn more and become a national member. Thanks for listening