Joey Wahler (Host): It can be life-changing, even life-saving, so we're discussing addiction treatment. Our guest, Cathryn Nolan, a medical social worker and Assistant Vice President of Managed Care and Clinical Services for St. John's Riverside Hospital.

This is the Riverside Radio HealthCast from St. John's Riverside Hospital. Thanks for joining us. I'm Joey Wahler. Hi there, Cathryn. Thanks for being with us.

Cathryn Nolan: Pleasure to be here.

Host: Pleasure to have you. So first, we'll get into some details in a moment, but what addictions do your outpatient clinics address and what services do you provide?

Cathryn Nolan: At this point, with everything that's going on in the world, there's very few services that we don't address. We are working to have a truly robust programming, to make sure we're meeting the needs of our local community, because we're not always doing a fabulous job in our communities to make sure that services are robust in our areas. So, what we're trying to do is meet all of the needs that are coming up. So, we are meeting the needs for all substance abuse issues. And with that being said, we also address the co-occurring mental health issues.

Host: And of course, mental health has gotten much more attention in recent years, so that's an area all unto itself, right?

Cathryn Nolan: Right. And you'll find that the services are very hard to get. You find specific mental health services. There's scheduling issues, insurance issues. So, what we try to do is become a one-stop shop for our patients and make sure that once our doors are open, we can service everybody who comes through them.

Host: Gotcha. And we will again talk about some of those offerings in just a moment. But first, are we talking here about individual or group therapy or maybe both?

Cathryn Nolan: So, we do both. We also bring in the family dynamic. One of the big pieces of addiction is, you know, it affects your whole family. So, we try to meet the three needs within our clinical environment. So, we have individual therapeutic involvement. We have a pretty robust group scheduling and we offer any kind of family services as well.

Host: Gotcha. So, many of your referrals come from the emergency department. Why is that so important? Because they're seeing, obviously, what's happening with a person first.

Cathryn Nolan: I think what you'll find is hospitals become beacons for people in need. An emergency room is a place where people can go for safety. If that's law enforcement, if that's patient, family, people just on the street, I think what we'll find is a good beacon of hope is an ER for keeping patients safe. So, what we'll find is a lot of people, good samaritans on the street, they dial 911, patients are brought to ERs. So, your ER is a safe place, and what happens after you leave those doors? So, we do have a very tight connection to the ER and the beautiful thing about our system is we have one within our system. But that ER is a place, as soon as you leave, you don't have to start looking for services. We are connected right as you leave that door.

Host: Right. And we're going to talk about that for sure. So, speaking of which, you offer what's known as one system of care. You mentioned you have an ER as part of that. So, what does that mean and what's the benefit of it?

Cathryn Nolan: We have lots of services. None of them wrap around. You could be in a program in Westchester that never speaks to the other program in Westchester. We all have different needs, and the programs that help us fill those needs don't speak. There's no communication. There's not necessarily a requirement to speak to each other.

With St. John's, we have brought all of our services together so that if a patient walks into our emergency room, we can connect them to our inpatient, our outpatient, wherever you come in for our point of entry. We make sure that we know how to connect you and keep you safe without having to leave, right? I think that's the biggest thing. We had help when you leave the door, the unknown, the uncertainty, even sometimes the anxiety about making that phone call. If nobody answers, what does that mean? if there's a long wait time, what does that mean? From our ER, we can connect directly to any of the program directors through our behavioral health services and make sure that those important appointments get made and they're prioritized.

So, what it means in essence is wherever you come for help at St. John's, we can connect you to the person who then can follow up the care. If you come in through our ER, we'll make sure we connect to the program director that can help you with an appointment next day, or telehealth. Whatever it is to meet your needs, we'll make sure that whoever you come in contact with gets to the next person to keep your care moving along,

Host: So, you're talking there obviously about connection of care. Sounds simple on the one hand, but on the other, as you point out, not every place offers it.

Cathryn Nolan: Right. One of the big things that we found too is even in our building, how we have a financial aid department that can help you should you have insurance issues. Should your insurance not really provide the services you need, we have a department that can help you. Most programs, they'll send you over to an office or a phone number and say, "Figure out your insurance. And when that's figured out, you can come back to us." But we don't have to have that disruption in care. We know that there's an issue with insurance. We're going to connect you to this person who can help you with your insurance so that we can schedule your appointment.

Host: And I presume that often times the people that you're treating with addiction issues and often of course issues associated along with that, the slightest interruption in treatment could knock them off the track, right? So, you want to make things like red tape, financial aid, insurance, et cetera, as easy as possible, no?

Cathryn Nolan: Correct. I even think for an everyday working person, how hard it could be, you have a small minute of time, you pick up the phone, you make a phone call and no one answers. And then, it could be a week before you remember to do it again. So, I just think, in general, having that connection is good for everybody. We want to make sure that if you pick up the phone, there's somebody on the other end. If there's any issues that you come across, that there's someone to escalate to and make sure that connection keeps going.

But you're right, the smallest thing can just derail anybody. And I think, in this profession, we have to be visible. We have to be able to be there to help you, no matter what your need. If it's a busy schedule, if it's that uncertainty or that connection, we'll be there when you pick up that phone and you decide to make that decision.

Host: Now, you also offer something called the Low Threshold Program. So, how does that help with this connection of care?

Cathryn Nolan: So, this is a pretty large revolution in the journey. We have all of these regulations regarding getting access to medications that are life-saving. Historically, most people know methadone, but there are a number of new medications that can keep people safe and keep them on their journey to recovery. So, we partnered with Westchester County, and we were able to create a program through our emergency room so that once a patient comes into us in distress, in acute need, we could get them connected to a medication right away.

One of the biggest gaps that we continually find in behavioral health is the ability of a quick turnaround for follow up. We can refer you to a program and it could be two weeks until you can see a doctor. What we've done is we've taken away that gap, and we've decided we're going to start treatment right now and then we're going to connect you. So if a patient comes into our ER, it's a Friday, no programs are available, nothing is open, no one's doing intakes, you can come into our ER, the doctor will assess you, the doctor will be able to provide you with a seven-day script And then, our pharmacy on site will be able to provide the medication. We have counselors in our ERs that will meet with you, schedule appointments, start our assessment right then and there, and make sure there is no gap in starting you in the services that you're entitled to and life-saving medication to help you stay on your recovery journey.

Host: Awesome. So, your treatment also includes a primary care connection. I guess it goes without saying that people with addiction issues often have gone a while between trips to a primary care doctor. So, why is that so important?

Cathryn Nolan: I think there's a lot of shame. I think going to a yearly physical can bring a lot of anxiety for a lot of people. It could be you're concerned about a weight gain or weight loss or just substance abuse, use, and misuse and those questions that they ask. Sometimes it's even the mental health questions that can cause anxiety and you could stop you from going.

So, we have practitioners in our outpatient sites as well as our inpatient site that will address your immediate needs and connect you along the continuum if they escalate. So, we are making sure that when you come in, if you have some kind of issue with your legs, we can address it. If we can't fix it, we can refer you then through our robust system to someone who can.

Host: How about medication-assisted treatment? You offer that as well. How does your system improve access to that?

Cathryn Nolan: So, as I brought up before, we have a wealth of knowledge on how to keep people safe. We have things like methadone. We have other resources, other medications that can keep people while they're becoming engaged in treatment and on their recovery journey, we can get them medications that could keep them safe.

So, MAT is what we call medication-assisted treatment. There are a lot of options available. And we want to make sure that we help people if they're interested. All of our outpatient sites, including our inpatient site, will start, and as we discussed, our ER will start you on a medication that is life-saving while you're on this journey of recovery. So, from our opioid treatment program to our outpatient sites, we will do the medication management while you are on your journey. We have providers, we have nurses, and we also have the pharmacies that are located in our buildings where you can fill the scripts. So, it's pretty much all managed within the system.

Host: Couple of other things. One being, you alluded to this earlier, I wanted to come back to it for a little more detail, how important is incorporating a patient's loved ones in treatment so they can provide the support these people needs?

Cathryn Nolan: It's vital. I think from a treatment perspective, it's important. Addiction is a family disease. We want to make sure we also support our patients as they're going through the change. A lot of things come up and we want to be able to help them and assist them while they deal with those issues head on. I want to really just be able to support anyone who comes in our door, and that includes the families that are supporting them getting through that door, right? Going over that threshold is a big achievement. And we want to make sure that the families that are there supporting and helping that journey also get support while they do that.

I think with this disease, there are very few people whose lives are not touched. And we want to be able to give those services or help them to connect them to services that can meet their needs, right? So if we can't do it, we know someone who can.

Host: Absolutely. And so in summary here, Cathryn, what would you say you're most proud of about this great work that you and yours do at St. John's Riverside Hospital concerning addiction?

Cathryn Nolan: This might sound a little funny, but it's the fire. You see the fire in all of the employees every day. They want to do better. They want to reach as many people. When you do the work that they are doing, it touches all parts of their being, their every day, their why's, their justification for doing more and more every day.

So, I think what is so vital and pure about the work that we're doing is the meaning behind it and how much our staff here want to see our patients succeed. They become meaningful to them. It's not just a task. It's not just an appointment. It's not just another thing they have to do. And I think that when you look at it, what's the difference? What's the true beauty of the program? And our employees and their desire to want to make change for the people experiencing the issues that bring them to our behavioral health system.

Host: Yeah, I can certainly hear the passion coming through in your voice. It's really a line of work where you have to have a passion for it, right? There's no faking this.

Cathryn Nolan: And it doesn't. You know, there's a lot of burnout in the profession, but the onus falls then on the organization to make sure that we're providing the resources employees need to stay in the work and keep them educated through professional CEUs, things like that, so that they want to keep coming back, even though it's hard. And I think that that's it. What do we want to do? And we want to keep doing this and we want to do it well. So, I think from the day to day interactions from what happens in boardrooms and meetings, everybody is dedicated to changing that number of deaths every year due to substance use disorder.

Host: Very well said indeed. Well, folks, we trust you're now more familiar with the wonderful, passionate work being done for addiction treatment at St. John's Riverside Hospital. Cathryn Nolan, a pleasure. Keep up the great work, and thanks so much again.

Cathryn Nolan: Thank you.

Host: And for more information about Behavioral Health Services, please call 914-964-7537, or you can email at info@riversidehealth.org. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. Thanks again for listening to the Riverside Radio HealthCast from St. John's Riverside Hospital.