Amanda Wilde (Host): Welcome to Recovery Unscripted, the Haymarket Center podcast, where we have meaningful conversations focused on the integration of substance use disorder, mental health, and primary care treatment. I'm Amanda Wilde with Dr. Dan Lustig, President and CEO of Haymarket Center. And today, we are joined by Haymarket Center Medical Director, Dr. Michael Baldinger, and Chief Clinical Officer, Kenyatta Cathey. Welcome to you all. Thank you for being here.

Dan Lustig: Thank you, Amanda.

Michael Baldinger, MD: Good morning.

Kenyatta Cathey, LCPC, CADC: Thank you.

Host: It's great to have you and to have this conversation. Well, Dr. Lustig, with Haymarket Center known for comprehensive substance use disorder and behavioral health treatment, what led Haymarket Center to this ambitious step to open a full medical clinic on site?

Dan Lustig: So Amanda, thank you for bringing that question up because it's one of the most significant issues of our field, is how we address care for individuals who are homeless or low-income individuals. And so for decades, Haymarket Center always provided medical care to individuals, except that we began to notice over 20 years ago that a majority of our clients really began getting their care out of the emergency departments at area hospitals. And it really wasn't a comprehensive approach at all. It actually offered more truncated care.

So, we would see patients come to Haymarket Center really not stabilized medically. And, you know, as Haymarket Center began to evolve our comprehensive approach to care, we really needed to address medical issues as it related to client well-being, as well as addressing the social determinants of health. So, this was something really powerful for us, the missing piece in good quality patient care for the organization.

Host: And Dr. Baldinger, you oversee and coordinate medical care at Haymarket Center. In what ways is medical care different for individuals with substance use disorders?

Michael Baldinger, MD: They have a set of their own particular medical complications as a result of drug and alcohol use. And in that sense, they're different. But in other sense, they're just like any other population in terms of they have their acute and chronic medical conditions. There might be a little bit higher incidence of hypertension and heart disease as a secondary impact of their primary substance use. But the problem with this population is before we developed the medical model, we were part of an episodic care intervention with these patients. And I've been here for a long time. I've been here since 1987. And we would send people out, and they would either disappear after they were in the emergency room, or they would go through treatment, and then they would continue to struggle to gain access.

There are a lot of barriers to care for everybody now, but particularly people who are a substance abusing population, who are low income, in particular the housing-unstable population. So early on, Haymarket decided to align itself with some health organizations that were community-based health organizations to kind of bridge the gap to lower that barrier to healthcare. And over the years, under leadership here, particularly Dr. Lustig, we've been able to develop this federally qualified program, which really makes it possible both structurally and fiscally to help this population.

Host: What health trends are you seeing today, Dr. Baldinger, and how is Haymarket adapting to changing needs of your particular patients?

Michael Baldinger, MD: As a result of our federally qualified program, we've been able to offer a broader range of medical services and we can also become a primary healthcare hub for these people as they go out into the world and work on other recovery issues. And I can't emphasize enough how lowering that barrier of care makes it possible to not only take care of the patient's primary substance abuse problems but become the primary healthcare giver and coordinate with our community partners in addressing some of the more severe and complicated problems.

A person who's homeless who has got significant orthopedic issues, for instance, doesn't really have much of a chance of gaining access to the care that they need to solve their problem which results in chronic disability, chronic pain. It feeds into this recurring loop of substance use. And I'm here working clinically more than I was in the past, I can see the positive benefit of this, is that we have people who have been homeless for years, not only recovering from their addiction, but getting stable housing and entering the job market. And the reciprocal effect of that in terms of helping people in recovery is hard to overstate. Because if people just stop using drugs and they don't have other lifestyle improvements, it's easy to slip back into the substance use. But when they have their chronic medical conditions met and then they're assisted with housing and employment, it really solidifies their recovery process.

Host: So, we begin to see how Haymarket coordinates care across all of the medical substance use treatment and behavioral health fields. Kenyatta, I want to bring you in at this time. From a clinical operations standpoint, what makes Haymarket's integrated model of care truly unique compared with more traditional treatment programs?

Kenyatta Cathey, LCPC, CADC: Thank you. I would like to say what makes us most unique is our ability to integrate substance use and primary healthcare. Every patient that comes into our facility will engage and initiate in medical care within 24 hours of them initiating care. Many of our patients, as Dr. Lustig has said, have fallen out of care. They receive most of their primary care in the emergency room. So to connect them to primary care and give them a medical home is key.

What we have to do—our goal is to change the patient's misperception around medical care and recovery. Many clients have had negative experiences with medical care in the past. Haymarket prides itself on providing culturally responsive and linguistically appropriate treatment medical care to our patients. We have some specialty services that, as Dr. Baldinger mentioned, would not otherwise be offered to our patients, but we're offering it to them at a low-barrier approach. They will receive culturally appropriate and responsive reproductive health care for women, where we have peer doulas that will support the woman throughout her laboring process. And our peer doulas are full-spectrum doulas and lactation specialists. We have infectious disease management for individuals with HIV, hepatitis A, B, and C. And we take patients with hepatitis A, B, and C from diagnosis to cure. For those individuals who want to remain HIV negative, we have PrEP navigation, where we can offer medications to help this person remain HIV negative. We have medication-assisted therapy, where we have a low-barrier approach to initiation for medication-assisted therapy that will start at our front door and continue once the patient moves into the community.

And we also are able to provide psychiatry for our patients, which is huge, where a person can receive psychiatry and therapy services within twenty-four hours of engagement into care. It is our belief that no one should wait for care, and that is what makes our comprehensive services unique and different from others.

Host: Very ambitious, as I said in the beginning, and very successful. Can you walk us through an example, a real-world example of successful care coordination, how medical, clinical, and recovery support staff all work together around one patient?

Kenyatta Cathey, LCPC, CADC: Yes. We do full integration. So, a patient can come in initially seeking service for substance use or behavioral health care. They then will receive an appointment for medical services the following day where they'll receive a complete comprehensive physical that will look at asthma treatment, cholesterol treatment, treatment for heart disease and stroke, blood pressure management, diabetes, reproductive health care, nutrition. While in a visit with a primary care physician, if the person endorses feeling anxious or depressed, that person will receive a warm handoff to a therapist where a behavioral health therapist will start that person on talk therapy while they're still in their appointment with their primary healthcare provider.

At that time, if they are disconnected from psychiatry or medications that will help manage their behavioral health conditions, they will receive an appointment to see a psychiatrist within that same week. So, the full integration will happen for that person within 24 hours or 48 hours of them engaging in services at Haymarket Center.

Host: A truly outstanding program. How do you build trust with patients who may have had difficult or traumatic experiences with healthcare systems in the past, as Dr. Lustig mentioned earlier?

Kenyatta Cathey, LCPC, CADC: What we do is, again, provide culturally responsive care. The patients have had been stigmatized throughout their history with medical providers outside of Haymarket Center. A person with a substance use disorder may be reluctant to tell their full truth, because of how it will be perceived during a medical visit. You don't have to worry about that here.

Our providers are fully aware that this person has a history with substance use disorders. They're fully aware of their behavioral health conditions because of the integrated model that we have here, and they can feel comfortable in telling their complete truth. The providers that they see will look like them in many instances and will also speak a language that is their primary language. Our population's language of choice is English, Polish, and Spanish, and we have providers in our clinic that speak those languages so they can speak in the language that they understand.

Host: Dr. Lustig, what do you see in terms of success and real-world effects on your clients?

Dan Lustig: Well, first and foremost, you know, the fact that we treat the three conditions simultaneously. So, we treat the substance use disorder, the mental health disorder, and any primary care issues that a patient presents with is truly an integrated approach and should help with the outcomes that we're seeing.

One of the other added benefits of a Haymarket Center patient or what patients experience as being part of our model is our on-site pharmacy. So, patients get immediate access to a pharmacist who can go over the medications that they're being prescribed, can make them understand the importance of taking medications. But what's more important and what is successful is the fact that when a patient leaves the Haymarket Center system to go home, we can mail them the medications. So, there's not a breakage of even the pharmaceutical aspect of our approach to care. So, I see success in the fact of how we approach each and every patient. Haymarket Center really truly addresses those social determinants of health that impact the population we serve. So, it's not just our medical services that provide success, but also job training on site also contributes to that. The fact that we also help people with getting education. All of those things help us address the social determinants of health as well as the overall impact to who we serve.

Kenyatta Cathey, LCPC, CADC: Amanda, may I add that our medical team consists of an internal medicine doctor, Dr. Baldinger, who is an addictionologist. We have a psychiatrist on staff. We have an OB-GYN on staff. We have nurse practitioners. We have physician assistants. We have a clinic pharmacist. We have pharmacy techs. We have RNs, LPNs, EMTs. We have medical assistants. We have substance use counselors, behavioral health therapists. We have recovery coaches, and that whole system of care is managed by our health navigators that will help to provide services to the person once they leave our facility so that the patients can continue to engage in our care even post-treatment here at Haymarket.

Michael Baldinger, MD: Amanda, can I just give you an example of the fact that we've lowered barriers to treatment allows us to continue treatment after people have gone through their primary exposure? I can't emphasize how important that is. I've worked in the private sector and I've worked in the public sector, and I've worked in various agencies over the years. Haymarket has consistently lowered barriers across the biopsychosocial spectrum of problems that people with substance abuse disorders have. Even if you have private insurance, it's hard to see a therapist. It's hard to see a psychiatrist. So, people come in here having been treated as both Dr. Lustig and Kenyatta have said in the ERs. Every time they go to an ER, they're given sometimes different approaches to their psychological symptoms. Nobody does a comprehensive assessment of what is needed and what the best medication is. When they come here, that happens after they've been through treatment, as Kenyatta has pointed out, as well as Dr. Lustig, they can get their medications.

I can't tell you how many patients, whether they be private or public, have access issues at each of these contact points with the healthcare system. They come in here, we understand what their problems are. Besides the ethnic, cultural, gender-specific issues, substance abuse is the type of problem that many people in the healthcare system are uncomfortable with. They don't have a mental roadmap of how to approach these patients. And so, the patients have these experiences of shame and the inability really to get a longitudinal care. We have solved that problem for the people who come in here. And that allows the time course to be stretched out over which they are given support.

That's absolutely crucial to long-term recovery. And Haymarket over the years has really developed these systems, not only in terms of the breadth of the systems, but the depth of the systems that is a differentiator from any other treatment program similar to us. I think that we are unique in how we approach this.

Kenyatta Cathey, LCPC, CADC: You can get all of these services regardless of your ability to pay. Everything that we named is regardless of your ability to pay.

Host: So, the care at Haymarket truly is comprehensive, integrative, and responsive, and honoring the needs and care of each individual, clearly making a huge impact in the community. Dr. Lustig, what excites you most about the future of the medical clinic, and how can the community support Haymarket Center's work?

Dan Lustig: I think the exciting aspect of the future is giving patients the ability to really thrive in their lives. The fact that we're able to provide these services in such a comprehensive way is truly, truly exciting. The future holds our abilities to expand our services. We're going to be looking at dental coming into September and October to add that service to our medical clinic so that patients who get really poor treatment in the community for any type of dental issues will be able to have a comprehensive approach done here.

One of our exciting new models that we're working on for the future is mobile health. So we will be showing up in area homes and villages offering our comprehensive approach in a year from now. That is our goal. So, we really want to bring health services, whether it's medical, psychological, or behavioral health services directly to the people or to areas that are hardest hit by the opioid epidemic or hardest hit by real poor social determinants of health. When you take a look at what's happening in the west side of Chicago relative to lack of OB-GYN services or population health issues with children, this is an area that needs attention that tends to get it sporadically. Just two miles away, there is a twenty to forty-year age difference of death for individuals that get poor care from the people that live just in the Loop. So, you don't really see those type of statistics unless it's a third-world country. But just a simple train ride away, you really can see that, you know, life expectancy is quite different. And Haymarket Center stands at the ready to truly address those areas for people that really need it the most and have often lost their voice or have been ignored by other systems of care.

Host: So, we see the result is improved health, long-term recovery, and you are a leader in how to do this. Kenyatta, Dr. Baldinger, Dr. Lustig, thank you so much for providing thoughtful, comprehensive, high-quality care, addressing substance use disorder and mental health needs. And thank you for sharing how this care continues to evolve and the future of Haymarket Center's Medical Clinic Services

Dan Lustig: Thank you, Amanda

Michael Baldinger, MD: Thank you.

Kenyatta Cathey, LCPC, CADC: Thank you.

Host: That was Haymarket Center President and CEO, Dr. Dan Lustig, Medical Director Dr. Michael Baldinger, and Chief Clinical Officer Kenyatta Cathey. For more information on Haymarket Center's Medical Clinic, visit hcenter.org. Make sure to subscribe to our podcast, share and connect with us on social media at hcenter.org/recoveryunscripted. Thanks for listening to Recovery Unscripted with Haymarket Center.