Transcript – Episode 110

Narrator:  This podcast is a project of the Mass Cultural Council. We believe in the power of culture – the arts, humanities, and sciences – to enrich communities, advance equity and foster creativity.

Adrien Conklin:  This is an opportunity for the family to have something fun, and that’s how I really talk about it with the family is like, “We can give prescriptions for medicine, we can give prescriptions for you to see a neurologist, but we can also give you a prescription for something fun to do with your family.”

Anita Walker:  Hi, I’m Anita Walker at the Mass Cultural Council, and welcome to Creative Minds Out-Loud. Our guests today are Dr. Deborah Buccino. She is a Pediatrician at the MACONY Pediatrics Clinic in the Berkshires. And also with us is Adrien Conklin, she is an RN Practice Manager also at MACONY Pediatrics. And welcome to our program today. We invited you to join us because we are so excited about this practice called Social Prescribing. The idea being that not every single illness or pain is solved necessarily by a pill or a crisis intervention at a hospital. That a lot of these things can be addressed with, believe or not, here at the Mass Cultural Council, we think, arts and culture. Arts and culture being a protective factor to improve the health and well-being of people. You have been working together as part of a collaboration to think about ways to address problems that walk in your door at the Pediatric Clinic, have more of a creative solution. So first of all, tell me about your collaboration, and how you came together.

Dr. Deborah Buccino:  Okay, I’ll start with that. First of all, thanks for having us, and being interested in our program, and we’re excited about CultureRx, it’s added a lot of excitement and fun to our practice. But our collaboration actually started about five years ago. We call it the Southern Berkshire Collaborative Care Team. Basically, pediatricians, and in talking with Mary Berle, who was then a local elementary school principal, we both realized that we were seeing increasing numbers of children with mental health needs, and dysregulated behaviors, and we were both — both from the pediatrician’s office and from the school — making referrals that were basically ineffective. I mean, we would give the family three names, or a few names of mental health therapists, and a few months later, they’d be back in our doors in the same position with no services in place. And that’s very draining to kind of see these families struggling with these things, and the kids struggling with these things. So we created the Southern Berkshire Collaborative Care team that really brought together families, schools, pediatric healthcare providers, and community resources into a network that really is based primarily around our Care Coordinator, Adrien. And she has — one thing that she utilizes is a database that Adrien collected all the resources in the community that can be helpful to families in these ways, and as she was doing that, she builds relationships. So I think a lot of our collaborative care work is relationship building. It also breaks down silos. I think we’re all finding in our lives that the pediatric office is one silo, the school’s another silo. And so through this system, we created more effective referrals, and more accountability, often utilizing resources that already existed in the community.

Anita Walker:  We introduced the idea of arts and culture being one of the resources, and obviously rich in arts and culture out in the Berkshires. But before that came to the door, what types of resources were you connecting people with?

Adrien Conklin:  Connecting with intensive care coordination services through the Child Behavioral Health Initiative, local mental health counselors, food pantries, transportation. Any type of kind of resource that might address the social determinants of health.

Anita Walker:  So when you say social determinants of health, what does that mean?

Adrien Conklin:  What does that mean? So–          

Dr. Deborah Buccino:  Well, for me, one thing that I was seeing was that families were struggling with increasing poverty, they’re struggling with substance abuse in the family, and domestic violence, and that’s affecting the family structure and the children. I think that’s what I think of in part as social determinants of health. There’s a concept called Adverse Childhood Events, or ACEs, which really tries to document that, and that has been shown when the kids have more of these ACEs, it’s directly related to adverse health outcomes throughout their life.

Anita Walker:  So it’s sort of the idea that whether or not you have a roof over your head, whether or not you have a healthy diet, whether or not you get exercise, whether or not you– all the things that surround you really are contributors to whether or not you have a healthy lifestyle or a healthy life.

Adrien Conklin:  And how can you talk about a healthy diet, if you don’t have food? So it’s the very basics. How can we talk about getting you to medical appointments if you don’t have transportation to get there? So we have to address those to be able to address the bigger parts of their health as well.

Anita Walker:  So what we’ve been looking at at the Mass Cultural Council are these social determinants of health, sort of basic essential things that people need before they can do anything else. And also looking at what are considered protective factors to prevent unfortunate health consequences. And we have been looking at a lot of research that suggests that the arts and culture — arts and cultural participation — is a protective factor, and that people who actually produce the arts and culture are healthier. They’re less lonely, they’re less isolated, which also leads to a lot of negative consequences. So naturally, we were delighted when there was an opportunity to bring in as one of your resources, the cultural assets out in the Berkshires. So now your partnership includes — talk a little bit about who’s in it with you.

Adrien Conklin:  Sure, so we have CATA, the Community Access to the Arts. We have Berkshire Theatre Group, Norman Rockwell Museum, MassMoCA and Mass Audubon as well. So a little bit of nature kind of mixed in with the other cultural organizations in a nice mix.

Anita Walker:  So Adrien, tell us a couple of the stories. What happens when you have the opportunity to refer one of your clients to a cultural organization.

Adrien Conklin:  Sure, so we have a brief huddle in the morning to figure out who might — who we can identify who might benefit most from one of these cultural prescriptions. So I talk to the pediatricians in the morning. And then so when I do enter the room to talk to them about these opportunities, it’s just — the dynamic in the exam room shifts. So instead of talking about medications, or a referral to a specialist, or something that’s, you know, maybe not negative, but kind of perceived as like “one more thing to do,” this is an opportunity for the family to have something fun, and that’s how I really talk about it with the family, is like, “You know, we can give prescriptions for medicine. We can give prescriptions for you to see a neurologist. But we can also give you a prescription for something fun to do with your family. And that’s just as important as some of those medicines or some of those things. Because that really addresses your whole family, it’s a nice day. It’s something to do that you might not get to otherwise.” And really families are so appreciative, and love the concept. And it’s been so well-received. It’s nice to see. Recently, I had this one young middle-school aged child come in, and they were specifically coming in to talk about some social challenges that he’s had recently, and he was kind of this just droopy little flower when he came in. And we were talking and he had, you know, like I had presented a program to them, and I had talked about the different organizations, and he was like, “Oh! Audubon! Like that might be a really good idea!” And you could see just the — like just the shift in his presentation just changed, because he just — he had something — he was forward-thinking. He was thinking about something that was fun to do. He wasn’t focused on what he was there for. He came in kind of sullen-looking and just sad. And as they were leaving, they had something to look forward to, and plans for the future.

Anita Walker:  It changes the whole environment at the clinic, for the doctors, too. Can you talk about that?

Dr. Deborah Buccino:  Yeah, so I mean, one thing that I find, myself, feeling at times is I’m saying– I sound like a broken record. I’m saying the same thing over and over again, “Make sure you get an hour of exercise a day. Make sure you spend time with your family,” and to have a new tool that’s a fun tool to get people to smile and have a good time has added a lot for me, and specifically it enables moving from just a recommendation into actual action. It’s a program that creates an action that is not just a prescription in words. And so I think that’s been a nice part of things. I think a couple other thoughts I’ve had about the program are that it enables us actually to listen to where families are coming from a bit more in the sense that when Adrien will sit down with a family and talk about what the different options are, she hears more about the family. Like, for instance, there’s an exhibit at the Norman Rockwell Museum right now on immigration. And so sometimes we’ll hear about family stories of immigration, and doctors don’t always have time to get into that. But I think that if families feel more heard, then I can feel them engaging in the experience at the doctor’s office, and if they’re going to engage in the experience more, it’s more likely they’re going to follow through on the things we want them to do with healthcare.

Anita Walker:  So you’re not just doing a checklist of symptoms, of clinical symptoms of a particular ailment. It’s more about the real person. One of the ripple effects of this program is that while the patient may actually be a child, the work actually is extending to the entire family.

Adrien Conklin:  Yeah, so we recently just had a wonderful opportunity for this young man that was able to bring his family to Norman Rockwell, and he just so happened actually had some of his own artwork on display there. So he was very excited to be able to bring them. But interestingly, while they were there, they saw the Immigration Exhibit from a polish immigrant, and they actually, this family had a polish heritage, and so this– four generations of this family all in the same room, actually got to have dialog around what their own personal history was.

Anita Walker:  So it seems like a pretty straightforward program. You know, you send people to cultural organizations in the community. But there’s really a lot more to it to really make it work. From the physician’s point of view, what do you need to know? What gives you confidence that this is a good idea?  

Dr. Deborah Buccino:  There’s been a lot of research, that you guys have educated us about <laughter>, on the benefits of culture and on health. I think that the other piece that’s important to me is that this program is coordinated in a way that the cultural institution is set up to receive a little information about the family that’s coming. And they are prepared so that they meet the family and make sure it’s a positive and meaningful experience. And I think that it’s important that that happens. I think without that, I mean, it’s the same thing as if you just give a piece of paper without the family feeling any sort of warm handoff, or having any sort of warm handoff, in general, referrals don’t work as well as when there’s a warm handoff.

Anita Walker:  So this is really part and parcel of this collaborative, this collective partnership that you’ve put together. What is your interaction with the cultural organizations?

Adrien Conklin:  So we have a– and also we do need to be mindful of HIPAA, so we’ve created these codewords with families. So there’s no shared protected health information or anything with the cultural organizations. But we come in the office with the patient, you know, a special codeword that they’d like to use, and it might be Superman, or their family dog’s name, or something that they would remember. So the communication with the cultural organizations, we have a shared database with those–

Anita Walker:  Codenames.

Adrien Conklin:  — codenames, and just kind of minor details of, “Needs to have wheelchair access,” or something like that, so it’s a little bit more user friendly for the patient when they arrive, and their family, and about how many to expect. So, “There’s mom, dad and three children.” And just to give them a little bit of a heads-up. And so we document in our side, and then they pick up from there.

Anita Walker:  Is there a feedback loop? Do you hear them? Do you have a conversation after the fact with the organizations, how it went?

Adrien Conklin:  Yes, so we put in — When did they use it? When did they use the tickets? How many people showed up? Did they fill out a survey at the end?

Anita Walker:  So you’ve been doing this for a bit of time. It sounds like it’s working well, I mean, from the physician’s point of view for starters.

Dr. Deborah Buccino:  I think that one thing that Collaborative Care, and again, CultureRx as a tool of Collaborative Care has made a huge difference for me is that we all know and Massachusetts Medical Society is paying a lot of attention now to physician burnout. And I think as we face challenges that families are facing, with the things we’ve talked about before, about increasing poverty, and other challenges that are challenging the family’s structure, it can be demoralizing to have — to see this all the time, and to not really feel like you have tools to deal with it. And so too, one, do it as a team, instead of feeling like you’re doing it by yourself. And two, to actually feel like you’re making some success and making successful referrals and seeing these families have positive experiences. And also, getting to know people more as people, instead of just their physical bodies is — does a lot to combat physician burnout. That’s one thing I’ve reflected on over time.

Anita Walker:  Adrien, I’d like you to tell one more story. This one you told me earlier today.

Adrien Conklin:  Yeah, yeah.

Anita Walker:  But it was about a trip to the theater.

Adrien Conklin:  Oh, sure. A young little friend of ours <laughs> went to the theater with his caregiver, and unfortunately, this child has many — a complex medical situation, and they had related that when I talked to them after their visit that, “This was 45 minutes of peace,” that they could — she could sit there and watch her grandson having a good time, enjoying himself. He’s not sitting there, you know, they’re not thinking about his diagnosis. They had time to just sit there, the two of them, as a family, and have a good time. And that’s something that they don’t get to have all the time.


Anita Walker:  Dr. Deborah Buccino, Pediatrician at MACONY Pediatrics and Adrien Conklin, RN Practice Manager at MACONY Pediatrics. Two more of our Creative Minds out loud. Thank you.

Dr. Deborah Buccino:  Thank you!

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