New Integrative Approaches to Mental Illness and Substance Abuse
Depression, anxiety, and other behavioral health conditions are not only increasing in incidence, but have traditionally been treated almost exclusively with medications. Additionally, substance abuse and addiction are often intertwined with behavioral
An Integrative Approach to Managing Mental Illness
Health psychologist Lisa Sussman, Psy.D., a member of the Integrative Health & Medicine program at Hackensack Meridian Health, is part of a team utilizing a unique care model based on Five Pillars of Health and Well-being to help manage mental illness, stress, and overall mind-body health with complementary techniques. Studies show that mindfulness, meditation and targeted nutrition, for example, offer improved
results for managing mental health.
The Five Pillars include Nutrition, Sleep, Activity, Resilience, and Purpose. Dr. Sussman adds, “We believe that these pillars are fundamental to the health and well-being of every human being.”
“Integrative health and medicine techniques provide nonpharmaceutical methods to manage pain or the symptoms of mental illness,” says Dr. Sussman. “Some of these methods include cognitive-behavioral therapy, mindfulness, positive psychology, Emotional Freedom Technique (EFT), and other energy based interventions.”
“There are many health interventions available to guide people in learning skills which not only help them adjust to their medical status, improve quality of life and change their mindset, but also to shift into and maintain a resilient lifestyle which promotes positive mind-body change, healing, and wellness,” concludes Dr. Sussman.
Building Resilience for Behavioral Health Clients
Kathleen Welshman, RN, a Certified Integrative Nurse Health Coach with Hackensack Meridian Integrative Health & Medicine, partners with clients to help create transformation and sustainable lifestyle change.
Welshman recently launched a Personal Resilience Empowerment Program (PREP) for home-based behavioral health clients to encourage sustainable healthy lifestyles. The program supports clients with a persistent mental illness as well as the comorbidity of a chronic health condition such as hypertension, diabetes or substance abuse.
Based on the Five Pillars of Health and Well-Being, PREP helps clients attain a goal each week. At the end of the eight-week program, clients will have developed an individualized self-care plan. Welshman believes that identifying one’s true purpose and values in life are a motivating factor to create desired change.
Medication-Assisted Treatment for Opioid Addiction
Historically, the majority of drug treatment centers in the U.S. have subscribed almost exclusively to an abstinence-only model to treat opioid addiction, based on an interpretation of the 12 steps of the Alcoholics Anonymous and Narcotics Anonymous programs.
“With tens of thousands of people dying each year from drug addiction, healthcare leaders are revisiting their response to treatment,” says Mary Pat Angelini, CEO of Preferred Behavioral Health Group, which last year provided community behavioral health prevention, intervention and treatment services to 27,000 individuals in New Jersey.
Angelini adds, “Studies show that Medication-Assisted Treatment (MAT) can cut mortality rates among clients with substance use disorder substantially. MAT is creating longer periods of sobriety which provide the person who is addicted with time to get the supportive counseling they need to embark on lifetime of recovery.”
Humanizing Behavioral Healthcare Design
With a growing number of individuals in the U.S. being diagnosed with mental health conditions, organizations are designing specialized facilities where patients can be treated with dignity.
At its Lakewood facility, which provides outpatient mental health and substance use disorder treatment and counseling, Preferred Behavioral Health Group is incorporating design elements to create a light and airy space with a comfortable, home-like feel, de-stigmatizing both the facility and the clients it supports.
“This paradigm shift in architecture parallels new ways in which mental illness and addiction is viewed by society,” says Angelini, “Patients are being treated with the expectation of holistic wellness that will aid in their long-term recovery.”
Preferred Behavioral Health group
Hackensack Meridian Health Integrative Medicine
Returning Patients to Active Living
Inpatient rehabilitation facilities restore function and strength so that patients can return to their highest level of independence. You probably already know that inpatient rehabilitation is a must to achieve the best possible recovery following hospitalization for surgery, injury or a serious illness.
But knowing how to make the best choice for inpatient care following a hospital discharge can be confusing. Often both patients and families think they need to stay within the hospital system where treatment took place.
Explore Your Rehabilitation Options
“Many people are unaware that they are free to choose where their post-acute or long-term rehabilitation takes place,” says Terri Rufo, Administrator at CareOne Holmdel. “Families can make their own choice depending on considerations such as location, the patient’s needs, and their impression after touring a facility and meeting the staff who will care for their parent or another family member.”
“Ideally, both the patient-to-be and family members should explore their options before hospitalization occurs,” says Terri. “If an elective procedure is planned, such as joint replacement surgery, take the time to consider finding a rehabilitation facility that’s close to home for the primary caregivers. If your grandmother lives in Staten Island, but the family who will be visiting her in rehab after her hip replacement lives in Monmouth County, then it makes sense to find a top-rated facility closer to the caregivers’ Monmouth County home.”
Terri encourages caregivers to explore their options. “Ask friends for recommendations, learn about specialized programs, tour several facilities and then make a choice based on your needs. The benefits of in-patient rehabilitation include providing a safe environment where patients receive help with their daily needs, such as bathing, dressing, and dining. In addition, post-acute care patients should receive physical, speech and occupation therapies, as needed, seven days a week, overseen by a rehabilitation medicine physician, registered nurses, dieticians, pharmacists, therapeutic recreation staff and other team members.”
Rehabilitation should continue following discharge, says Terri. “Patients are prepared for discharge with a home preparation program so that they and their families are well-equipped to handle the patient’s care and ongoing recovery.”
Specialized Rehabilitation for Brain Injury
Sometimes a highly-specialized inpatient rehabilitation program is required. Dr. Anatoly M. Rozman, MD, a physical medicine and rehabilitation specialist notes that as powerful as the brain is when in good health, its resilience in revitalizing after injury is also remarkable.
“With time and an aggressive rehabilitation program, brain function can rebound,” says Dr. Rozman. “Although full recovery may not always be possible, early rehabilitation therapy is critical for repair and the full potential for recovery.”
“Most brain injuries are the result of motor vehicle accidents, falls, a battlefield injury, violence, and sports injuries where severe or ongoing concussion occurs, such as in boxing or football,” says Dr. Rozman. “Non-traumatic brain injuries may result from aneurysm, stroke, lack of oxygen (hypoxia), tumors, illnesses such as cancer, and brain infections or acute inflammation caused by conditions such as influenza (the common flu) and encephalitis, such as with West Nile disease.”
“Brain injury affects the entire body,” says Dr. Rozman, “and so a comprehensive rehabilitation program is required. Medical care is the first step in treatment to stabilize and promote the brain’s healing. For long-term treatment planning, rehabilitation plays an important role,” says Dr. Rozman.
“A specially-trained, multi-disciplinary team focuses on each patient to restore the best possible level of physical, cognitive and behavioral function,” says Dr. Rozman. “The focus is on improving the patient’s condition to enable a return to home, school or work, training and adaptation for long-term limitations, and home-based services as needed.”
“The goal is always to promote healing and maximize function and independence,” concludes Dr. Rozman.
Urgent Care Centers – Saving You A Trip to the ER “Urgent care centers offer an emergency room alternative to patients with medical needs that are not life-threatening,” says Dr. Cal Garcia, DO, FACOEP, Chief Medical Officer for Immediate Care, which has nine locations in Mercer, Middlesex, Monmouth and Ocean counties.
“Urgent care centers fill an important gap,” says Dr. Garcia. “Patients require immediate care on their own time, including nights, weekends and holidays, which often conflicts with the availability of the primary care physician. A trip to the ER is costly, time consuming, and commonly unnecessary.”
“An urgent care facility is also a convenient walk-in destination for vaccines and immunizations as well as school and sports physicals,” says Dr. Garcia. “Pre-employment physicals, DOT exams, and treatment for work-related injuries and illness are also available.”
“Urgent care centers are staffed with physicians trained in emergency medicine, and nurse practitioners and ancillary healthcare professionals skilled at handling all levels of non-life-threatening conditions on a walk-in basis,” says Urgent care centers, Cal Garcia, Immediate Care, Urgent Care Now, urgent care, walk in clinics, John Kulin, primary care physician, HumanizeMD, DO, FACEP, FCUCM, Founder and CEO of Urgent Care Now, with four locations in Southern Ocean County.
“Patients at an urgent care center benefit from diagnostic technologies commonly found in emergency departments at local hospitals, including radiology and laboratory services,” adds Dr. Kulin. “We also perform suturing, casting, IV therapy, and blood and urine analysis.”
“I ran an ER for 10 years before going into urgent care,” says Dr. Kulin, “and I always loved the variety of cases that came into the ER. The urgent care setting enables us to also treat patients with a wide spectrum of non-life-threatening conditions equally well, but in a timely, patient friendly, cost-effective fashion.”
Common Conditions Treated at an Urgent Care Center
• Animal and Insect Bites
• Back Pain
• Bladder Infections
• Minor Burns
• Cuts and Lacerations
• Minor Dislocations
• Minor Rashes & Skin Infection
• Respiratory Illness
• Sports Injuries
• Stomach Flu
• Wound Care
Walk-in clinic. Immediate care center. Retail clinic. Convenient care clinic. Urgent care center. Emergency room.
You’ve probably heard of most of these terms and even used them interchangeably, but do they mean the same thing? As it turns out, these terms are not equivalent. Most experts agree on the following:
“Walk-in clinic” is the most general term and this refers to – you guessed it – places where you can walk in without an appointment. The other terms represent types of walk-in clinics, with urgent care centers just one step below an emergency room, although more convenient and less costly.
Retail clinics, also known as convenient care clinics or immediate care centers, are walk-in clinics located in a retail environment, such as a pharmacy. Retail clinic services may include the treatment of minor injuries and illnesses such cold and flu symptoms, strep throat, and skin rashes. Many retail clinics also offer vaccinations, especially flu shots.
Urgent care centers, the most well-recognized term for the non-ER setting, provide far more comprehensive care for the conditions handled at retail clinics as well as for more severe,
non-life-threatening health issues, and they staff and equip accordingly. Urgent care is highly recommended to supplement times when your primary care physician is unavailable, particularly given urgent care centers’ extended office hours and seven-day operations.
Emergency rooms, typically located in a hospital, are the most expensive and least convenient walk-in option. ERs are essentially equipped to handle anything that walks through their doors. They also are required by law to accept all patients, regardless of their ability to pay. This fact, among others, often causes ER wait times to be several hours and the average cost is many times more than an urgent care facility.
A recent study found that nearly 50 percent of the diagnoses at emergency rooms could be treated by urgent care centers at a fraction of the cost and wait time. And with more than
9,000 urgent care centers in the US vs. 4,500 emergency rooms, urgent care centers are closer, more convenient options. Next time, consider an urgent care center when a nonlife-threatening emergency strikes.
With today’s evolving aesthetic technologies, women and more men are turning increasingly to advanced, non-surgical procedures to achieve a younger-looking face and body.
“Everyone wants to restore their youthful look,” says Kelly Weber, RN,BSN, the aesthetic nurse injector at Fostermd, the Facial Plastic Surgery practice of Wayne Foster, MD, FACS. “Twenty years ago, surgery was the only way to lift the face and reliably tighten the neck,” says Weber. “Today, we’re fortunate to have numerous nonsurgical options to rejuvenate the face and neck, including the nonsurgical facelift.”
The facial plastic surgeon can now restore facial volume and youthful contours, thanks to expertly placed injectables such as Juvéderm®, Restylane®, VollureTM XC, and Voluma® XC, with very little downtime or discomfort. “Imagine achieving a total facial transformation right in the office without surgery” says Weber. “Results are natural looking and can last for years, and for the most part can be achieved in a single visit.”
Having a Facelift Without Surgery
Weber suggests that, when considering a facelift of any kind, the key is to pay attention to what has changed about your face over the years.
• Have you developed jowls?
• Are your cheeks falling and creating lines around your mouth?
• Is your skin blotchy and pigmented with age spots?
• Do you have deep frown lines or hollows under your eyes?
• Do you have deep grooves creating a frown around your mouth?
“Each of these changes can be treated with non-surgical techniques in the office, or surgical procedures in the operating room,” adds Dr. Foster. “Once you have determined your goals, have a discussion with a board-certified facial plastic surgeon to determine what works best for you.”
CoolSculpting® Your Way to A Smoother, Tighter Body
“Your fat cells hate the cold,” says board-certified plastic and reconstructive surgeon, Asaad H. Samra, MD, FACS. CoolSculpting® is the only FDA-cleared procedure to use controlled cooling to safely target and eliminate diet-and-exercise- resistant fat.
“CoolSculpting® uses a patented technology to freeze and eliminate unwanted fat cells, without surgery or downtime, providing up to a 25 percent permanent reduction in fat in the focused area of treatment,” says Dr. Samra.
“Sometimes, no matter how intense your workout or strict your diet, you can’t ditch stubborn fat, especially along the torso and sides of the body. CoolSculpting can be used on areas of the body from the chin to the ankles, the thighs and arms,” says Dr. Samra, “and provides excellent results, helping patients feel and look their best.”
CoolSculpting® technology uses a powered applicator to safely deliver precisely-controlled cooling to gently and effectively target the fat cells underneath the skin during a 45-minute cycle. The treated fat cells crystallize and the body naturally processes the fat and eliminates these dead cells, leaving a more sculpted you.
After just one session, the treated area will gradually appear smoother and more toned. Results improve in 4 to 6 weeks. Most patients plan for three months to see optimal improvement.
“CoolSculpting® is safe on your body,” says Dr. Samra, “but tough on fat.”
How Can PRP Help Your Orthopedic Recovery?
Platelet-rich plasma, commonly referred to as PRP, is a nonoperative solution for injuries and chronic musculoskeletal conditions.
Although blood is mainly a liquid called plasma, it also contains small solid components such as red cells, white cells, and platelets. Platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are of prime importance in the healing of injuries.
“PRP therapy is a concentration of your body’s own blood platelets, spun in a centrifuge that separates blood by weight,” says sports and regenerative medicine specialist Daniel Savarino, DO, RMSK.
“The platelets are injected into damaged areas of the body to promote tissue repair and accelerate healing,” continues Dr. Savarino. “Platelets are rich in growth and healing factors which means, on average, an injured individual can get back to a pain-free life in six to eight weeks. Some patients require two or three injections, based on the severity of the injury, but many respond to a single treatment.”
Awareness of PRP has risen as it has been utilized successfully by professional athletes, including Tiger Woods, who received four treatments following knee surgery, tennis star Rafael Nadal, Hines Ward and Troy Polamalu of the Pittsburgh Steelers, and Takashi Saito and Bartolo Colon, both Major League baseball players.
“PRP can be a great treatment for people who have tried conventional treatments with no success,” concludes Dr. Savarino.
A Long-Lasting, Permanent Solution
Board-certified orthopedic surgeon Marshall Allegra, MD says, “Injuries treated with PRP therapy include rotator cuff, quadriceps, hamstring, Achilles tendon injuries, tennis elbow, as well as conditions such as osteoarthritis.”
“PRP therapy can also be an alternative to surgery as well as part of an enhanced healing program following surgery,” continues Dr. Allegra. “PRP presents patients with a long lasting, permanent solution that will not wear off over time as with a traditional pain injections such as cortisone. For this reason, the use of PRP could help a patient avoid joint replacement surgery, and potentially back surgery. With any treatment option, the effectiveness of the treatment depends upon the severity of the injury.”
The risks associated with PRP are minimal. It uses the body’s own blood and there may be increased pain at the injection site, but the incidence of other problems, such as infection, tissue damage and nerve injuries, appears to be no different from that associated with cortisone injections.
Physical Therapy Enhances PRP Treatment
Following regenerative procedures such as PRP, physical therapy is introduced to help restore function and improve strength and mobility of the joint or muscle,” says physical therapist David Bertone, PT, DPT, OCS.
“Treatment utilizing the AlterG® Anti-Gravity treadmill is the perfect complement to PRP therapy,” says Dr. Bertone.
“By reducing up to 80 percent of body weight, the AlterG treadmill continues each patient’s enhanced treatment plan by reducing stress and strain on the lower body from impact walking or running, while maximizing healing and conditioning.”
“Additional physical therapy modalities can be used to increase circulation and healing in the injured area,” continues Dr. Bertone. “These may include electrical stimulation, Laser class IV treatment, heat and cold therapy and ultrasound, as well as manual therapy such as massage and joint mobilization.”
Revolutionary treatments like PRP therapy, supported by the latest treatment technologies in physical therapy, are helping patients experience less pain, accelerate healing, and get back in the game of life more quickly.
Healthcare systems have increasingly begun to develop creative ways to improve performance and satisfaction for both patients and employees. As innovation becomes a mainstay in the healthcare industry, more organizations like Saint Peter’s Healthcare System and Hackensack Meridian Health are carving out leadership positions devoted exclusively to innovative processes and projects.
Engaging Patients and Staff for Better Outcomes
“I was initially hired as Director of Service Excellence at Saint Peter’s Healthcare System in 2001,” says Lisa Drumbore, “and I never looked back.” When Drumbore first started at St. Peter’s, customer satisfaction, or service excellence roles, were just beginning to emerge in healthcare. Drumbore wore many hats, with responsibilities from pastoral care to employee engagement.
In 2016, Drumbore was appointed as Vice President, Chief Experience Officer for St. Peters. “It made sense for a hospital so mission-focused to be ahead of the curve when it came to engaging patients and employees from a business perspective,” says Drumbore. “From a values perspective, we knew it was also the right thing to do.”
To improve performance, leadership must be willing to address fundamental issues within its culture and structure to transform the organization. Drumbore continues to be inspired by transformational principles from one of her favorite books, Ken Blanchard’s 2016 best-seller Lead Like Jesus, which illustrates the philosophy of servant leadership, a set of practices that enriches the lives of individuals, builds better organizations and ultimately creates a more just and caring world.
Traditional leadership generally involves the exercise of power by one at the “top of the pyramid.” By comparison, the servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.
“Success is the result of focusing on culture, communications and fostering lasting, trusted relationships,” concludes Drumbore. “The initiatives that have moved the scores are the ones that have focused first and foremost on culture and leadership.”
Helping Caregivers Do What They Love Most
Increasingly, hospitals are launching innovation centers of their own to work with researchers and design thinkers to tackle the biggest challenges in clinical quality, patient safety, health information technology, healthcare costs, billing and payment, and access to care.
“Innovation can sometimes throw people off,” says Elizabeth Paskas, MSN, RN, NE-BC and Vice President, Experience Innovation & Consumer Services at Hackensack Meridian Health. “But sometimes innovation can be simply a new way of doing things that gets us where we want to be.”
Paskas spent 16 years in Hackensack UMC and for the last ten years worked as a nurse leader on units with opportunities for improvement. Her frontline experience has prepared her with fundamental insights to help caregivers find better ways to do what they already love – taking care of patients and getting the outcomes that they need.
“Change is not always easy,” says Paskas, “but one of the main ways we get buy-in is through a program called the Experience Innovation Café. This is a place where Hackensack Meridian Health team members can come together and share their input and propose options on the strategies, tools, techniques and technologies we want to put into place. We’ve found that this co-design process creates a lot of buy-in on decision making and usually improves the process because we have feedback from so many perspectives, including patients.”
Creativity and imagination are crucial to treating patients and engaging staff, from surgeons to housekeepers. At Hackensack Meridian Health and Saint Peter’s Healthcare, the results of these innovative ideas are making a positive difference in healthcare for New Jerseyans every single day.
Hackensack Meridian Health
Saint Peter’s Healthcare System