New Staff Feature: Jessica Pikowski Joins the Foundation as Communications Coordinator
In February, Jessica Pikowski joined the Foundation as the new Communications Coordinator. In her role, she brings expertise in strategic communication that she will utilize to assist the Communications Team in setting and implementing strategies that help build the Foundation’s brand and visibility. We asked Jessica a few questions to get to know her better.
Q. Where are you from and how did you end up in North Carolina? I grew up in Connecticut, but ended up in North Carolina when I decided to attend High Point University for my undergraduate degree. I fell in love with the state (and the weather) and ended up staying around to attend UNC Chapel Hill for graduate school. I think it’s safe to say I won’t be leaving North Carolina any time soon.
Q. What drew you to the Foundation? I studied strategic communication as an undergraduate, but I’ve always had an interest in working for health-related nonprofits, which is why I am now pursuing a master’s degree in Health Communication. I’ve found that I enjoy doing work for organizations that make a difference (especially in health), whether it’s at the community level or nation-wide, which is one of the main reasons I was initially drawn to the Foundation.
Q. What type of organizations have you worked for in the past? I went right from undergraduate to graduate school, so I don’t have a ton of experience in the work-field, but many of my undergraduate and graduate courses have involved working with clients in the surrounding community, so I’ve done work for a variety of clients like: the High Point Community Foundation, Kozzy’s Grille, Solar Head of State, and the UNC Volunteer Doula Program. I also worked for a small public relations agency called Creative Services, where I worked with mostly university clients, including High Point University and Davidson County Community College.
Q. What are you excited for in this position? The Foundation’s message is an important one, and one that doesn’t always get the attention it deserves, so I’m looking forward to helping with the communication of these messages and being able to help get the word out to others about the great work they do.
Q. What do you like to do for fun? I love to run, go hiking, biking, basically anything that gets me outdoors. I also love to read. With all the academic reading I have to do for school, sometimes it’s hard to find time lately to read for pleasure, but I’m trying to fit in at least 2-3 books a semester.
The Center of Excellence for Integrated Care (COE) is a program of the Foundation that works with health providers across the state to integrate primary care and behavioral health services. COE’s model of integrated care is well-suited for substance abuse issues, which can harm both the mental and physical well-being of a patient. COE Director Cathy Hudgins says that “integrated care provides those struggling with addiction an opportunity to be treated as a whole person.”
The COE helps organizations develop their ability to provide integrated health care. One of their longstanding partners is Family Service of the Piedmont (FSP) in Guilford County.
The primary care provider for FSP is Anthony Steele. Steele is a nurse practitioner with a certificate in family medicine and psychiatry. He has spent 16 years serving individuals with addiction. He says he’s a “one-stop-shop” for patients because he has the training to address their physical and mental health in one setting. In the time that the COE has been working with FSP, Steele has assisted in building exemplary integrated care services.
We asked Steele a few questions to understand how he uses the integrated care model to help patients suffering from addiction.
When did you realize that you wanted to work with addiction? I was done with inpatient healthcare. I needed to do something different. When I came in 16 years ago I knew nothing about addiction. But guess who were the best educators? My patients. They were the ones who taught me about the disease. They even taught me how to change my language when speaking to clients. I had to really adjust. Because when you’re looking at a patient and you’re calling him or her an addict, it’s one of those things that just makes them cringe. ‘No, I’m not just an addict. My name is John,’ or, ‘my name is Suzie.’
I also had to work on my perception and how I addressed individuals. I had to look at them as a patient and as a client. This is someone’s son. This is someone’s daughter. This is someone’s brother. In treatment we always want to keep people alive. Every day you see someone alive is a success. Then you work on developing tools to help them stay alive. You work on helping them build resources and you meet them where they are. Within the first month of working with addiction I became engrossed with learning about the disease process and I thought if not me, then who?
What’s encouraging about your work? When I have a patient come in who’s been using 10 bags of heroin a day and then within a week of treatment, they are looking at me in the eye, they are taking a bath, and they are beginning to see changes in their life. When you see a pregnant mother who’s been using every drug under the sun get stabilized and she’s now able to have a normal labor and delivery. When I see those patients, I know this is where I need to be.
How does integrated care help you serve individuals with addiction? We look at the whole picture. We do a comprehensive assessment when people come in. We have screening tools that look at depression, anxiety, trauma, addiction history, and physical health issues. When a patient comes in, they have bared their souls to us, and it’s a judgment-free zone. It just makes sense for us to treat the mind, the body, and the soul. If a patient is struggling with opioid addiction, but also high blood pressure and diabetes, I’m not going to ignore those physical issues. I’m not going to send them to another primary care doctor that doesn’t know them or who may prescribe other medications that could get the patient into trouble. It’s important to be mindful of not causing a relapse.
If we don’t begin to address the fragmentation of care, then our opioid addicted individuals will continue to be stigmatized. We need providers that know a patient’s history, won’t judge them, and will meet me where they are. Some of these patients don’t have their basic needs being met. When you add addiction on top of that, their addiction takes precedence over food and shelter. That’s why we help clients get their cravings under control, and then we work on the other aspects of life. Let’s get you gainfully employed. Now let’s work on relationships with your family so you can be supported on that road to recovery. Instead of disconnecting the head from the body, my goal is to connect it all together.
[box type=”bio”] “If we don’t begin to address the framentation of care, then our opioid addicted individuals will continue to be stigmatized.”[/box]
How does addiction tie in with other health issues? People who have addictions have the same chronic medical issues that anyone else has, but they might be highly elevated because they aren’t typically treated. If you look at most statistics, more than one in five adults have a co-occurring mental health and substance abuse issue. And so it just makes sense to figure out how to treat them in a collaborative perspective.
One thing I’ve noticed is that dental care is much needed and sought after. A patient who’s addicted to opioids, one of their side effects is dry mouth. If you have dry mouth you aren’t producing enough saliva, and then bacteria grows and your teeth decay. But if you’re in active addiction, you’re not going to be worrying about brushing your teeth. It’s a perfect storm for dental problems. If I have dental issues, they effect my self-esteem, and now I have self-doubt, now I’m depressed, now I’m isolated. And it continues that cycle of relapse and recovery, relapse and recovery. Oftentimes our patients are also IV drug users which opens up the risk for Hepatitis C transmission with potentially shared needles. They may not know or have any symptoms, so they keep sharing needles, snorting drugs with dollar bills and having unsafe sex.
Why do you think that integrated care for opioid addiction isn’t more widely used? Sometimes I think it’s a comfort level. Most medical programs don’t give you a lot of training in substance abuse and mental health. In primary care you maybe get one to two week’s rotation in substance abuse, and that’s it. You’re taking on the responsibility of something you really don’t know much about. And sometimes in primary care, if you don’t ask about addiction, you don’t have to deal with it. Some primary care providers do want to deal with it, but guess what? They are limited in terms of where they can refer patients. The amount of money that’s available for substance abuse treatment compared to all the other diseases is a drop in the bucket. If I’m a primary care provider and I screen for addiction, where can I get this patient into treatment? The hospital is limited and here in Guilford County we only have one in-patient detox facility, which is also limited. I think there might be 15 beds.
In your opinion how do we better address this epidemic? We’ve got to do a better job with screening and treatment. You really need to meet the patient where they are. But once we screen for it, we also need funding to cover the cost of these patients who need this service. We have to stop ignoring the issue. Because it’s here, and it’s prevalent. Until we take a very hard look at this disease, we are going to continue these vicious cycles of chronic relapse and people dying on the streets. Most people look at it as a character flaw. We in the addiction world know that it’s not. This is a disease of the brain that needs to be dealt with like any other disease. You don’t tell your diabetic, ‘you’re obese so we aren’t going to treat you.’ No. You work with that patient where they are. Oftentimes with our addicted individuals, we just don’t have that same tolerance.
Tim Smith, a past Bernstein Fellow (2012-2014) and full-time Research Associate for Carolina HealthNet (CHN), will be joining the Foundation part-time to assist them with data collection and evaluation. CHN aims to connect uninsured patients to high-quality, low-cost healthcare while educating them on the merits of a patient centered medical home. The Foundation looks forward to having Tim and his expertise on the team. We asked Tim a few questions to get to know him better.
Q: Where are you from and how did you end up in North Carolina?
A: I was born and raised in Chapel Hill, so I didn’t have much choice about coming to NC. But I have chosen not to leave! My wife, Kelly, was also born and raised in Chapel Hill and we still make our home there with our daughter, Lauren.
Q: What drew you to the Foundation?
A: When I learned about the Bernstein Fellowship and the work the Foundation does, I decided to apply for the fellowship. I was fortunate enough to be one of 4 chosen that year (2012-2014) and that is where my relationship with the Foundation began. A commitment to rural health and health equity for all are passions I definitely share with FHLI.
Q: What type of organizations have you worked for in the past?
A: I have worked for several types of organizations ranging from political campaigns, higher education and several different non-profits working with rural areas to improve economic development and health outcomes.
Q: What are you excited for in this position?
A: To be part of an organization that works every day to bring our communities closer to a place where all North Carolinians (and beyond) have access to high quality, affordable healthcare. Working across the different programs will allow me to learn about the different initiatives occurring to help us get there.
Q: What do you like to do for fun?
A: My wife, Kelly, and I enjoy playing with our 19-month old daughter, Lauren, and taking family walks with our dog, Basil. I like attending UNC Tar Heel sporting events, playing golf, running and other exercise. Relaxing with family and friends is important, too.
Rural areas are hard pressed to attract and place skilled clinicians, and loan repayment for health care education plays an important role in attracting clinicians to rural or underserved areas. When you recruit a clinician to a small rural or underserved area, and provide no community support, there is a possibility that this individual may not be happy, and ultimately will not stay once their service obligation has been met.
There has to be a partnership. There has to be support. And there has to be buy-in from the entire community so that the clinician feels welcomed as a part of that community from his or her first day on the job.
This is where the Practice Sights Retention Management System comes in. Currently being utilized by an 11-state collaborative, each of which operates the program independently, data provides states and staff of incentive programs with information to make clinicians’ service experiences as positive and productive as possible.
Practice Sights collects data in the form of questionnaires sent to clinicians and practice administrators via email. The Cecil G. Sheps Center for Health Services Research (Sheps Center) provides expertise on data collection, analysis and dissemination. The questionnaire clinicians receive three months after the start of their service obligation asks about their background, their reasons for applying to the program (needing financial assistance and/or wanting to provide care to an underserved population or area) and their needs, values and expectations of their current position and community. Annual and end-of-contract questionnaires will ask about their current work, whether the role is meeting their professional goals, etc. The questionnaires will also ask them to rate their satisfaction with various aspects of their community and practices. Alumni questionnaires are sent periodically and ask clinicians if they are at the same site and, if not, to provide information about their current work.
The rich data collected by Practice Sights allows state program administrators to identify problem areas so that they can work with site administrators to improve overall clinician retention in rural areas. The challenge, notes Jackie Fannell, Program Manager for Practice Sights, comes in getting clinicians to respond to the questionnaires, — particularly program alumni, who are no longer obligated under their contract. Most states are now seeing over 50% response rates across the board. While this leaves room to grow, it still provides a rich set of data to help improve clinician retention.
Practice Sights plans to bring more states into the collaborative and continue to grow the program. There is no other system that collects data on clinician retention in this manner and it will become more valuable and have even greater impact moving forward and the aggregated data shows trends and reveals what is working and what is not.
Community factors have been shown to greatly impact physician retention. The findings of a 2012 report prepared for the Multi-State/NHSC Retention Collaborative by the Sheps Center calls for programs to help communities learn the important role they play in clinician retention and the things they can do to promote retention, engage community leaders and intervene early — before small problems escalate — when clinicians encounter difficulties with their communities. Efforts to build Accountable Care Communities in North Carolina and other states could be an important step in bringing communities into the health-care conversation. Including community input and participation in health care from the start could help ensure acceptance and support for new providers, rather than waiting until issues arise or only including community voices as an afterthought.
Accountable Care Communities are an important part of clinician recruitment and retention in rural areas. With Accountable Care Communities, the community is involved with all aspects of the health-care environment, and is more vested in supporting and including clinicians and their families in the community. Practice Sights, in turn, plays an important role in helping create Accountable Care Communities, with its data driving the awareness of where community and other support is lacking, as well as allowing communities to become better-equipped to receive and support new clinicians from day one.