COVID-19 and Department of at URMC Our Journey Forward

Hochang Benjamin Lee, M.D. John Romano Professor and Chair Department of Psychiatry

1 Objectives

1. Introduce Department of Psychiatry at URMC.

2. List challenges posed by COVID-19 on delivery of psychiatric services in both inpatient and outpatient settings at URMC. • Emphasis on telepsychiatry and innovative models of care. • Recent issues related to overcrowded CPEP

3. Discuss our journey forward as psychiatry is at the forefront of socioeconomic and racial reckoning in our society.

4. Highlight the need to address the Staff and Faculty Wellness

2 Origin of Department of Psychiatry at URMC

Friendship between a and an internist began in Boston (1941). • Soma Weiss, -in Chief at Peter Bent Brigham Hospital

John Romano – an “embedded” psychiatrist in the unit.

George Engel – a “graduate assistant” in the same medicine unit.

Recruited to Rochester in 1946 from University of Cincinnati 3 : Home of Biopsychosocial Model (Engel, 1977)

“Illness experience results from complex interaction among biological, psychological, and social factors that impacts clinical care between the patient and physician.”

THE organizing principle for training of nearly all medical schools and psychiatry residencies in the United States.

4 Our Vision: “Psychiatry without Boundary”

Rochester Psychiatry with what John Romano has once called a “permeable boundary” across disciplines, roles, and departments. 1. A multi-disciplinary department that maximizes the strength of each discipline while aspiring to move the field forward together as a team. 2. A department with integrated missions—clinical care, community service, research, and education—and without the silos based on academic and clinical roles (e.g. researchers, clinicians, educators, etc.) 3. A biopsychosocial department that strives to integrate behavioral health service vertically and horizontally across the URMC and deliver a world class, compassionate care for psychiatric patients in our community and beyond.

5 URMC Psychiatry: “Department of Permeable Boundaries” Chair Ben Lee Associate Chair of Research Vice Chair of Steve Silverstein Faculty Affairs Yeates Conwell Associate Chair of Clinical Sue DiGiovanni Associate Chair of Associate Chair of Diversity and Education Inclusion Deborah King Telva Olivares

Geriatric Collaborative & Acute and Adult Community Child & Adolescent Psychiatry and Psychiatry and Consultative Psychiatry Memory Care Psychiatry Psychiatry Outreach Medicine Co-Chiefs Co-Chiefs Co-Chiefs Co-Chiefs Co-Chiefs Sue DiGiovanni EJ Santos Michael Scharf George Nasra Rob Weisman Wil Pigeon Anton Porsteinsson Peter Wyman Susan McDaniel Steve Lamberti (interim) Yeates Conwell Department of Psychiatry at URMC •Training and Education – largest pipeline of behavioral health service providers outside of NYC (135-150 trainees at any given moment) • Psychiatry Residency (adult: 8 per year; child: 4 per year) • Fellowship in Forensic, CL, Geriatric, and Child (Addiction next) • Pre- and Post-doc Psychology Fellowship (16 per year) program. • NIMH T32 post-doc fellowship in suicide prevention. • Master’s degree in Family and Marriage Counseling (n = 26), Social workers, LMHPs, CASACs, • Partner with School of Nursing: Psychiatric APNs (n = 52) 7 Psychiatric Research: $21+ mil in 2020

Center for the Study and Prevention of Suicide • The only CDC-funded suicide prevention research center in US (PI: Caine) • The only VA Center of Excellence for Suicide Prevention in US (PI: Pigeon) • Rochester Roybal Center for social Ties and Aging Research (PI: Kim Van Orden and Kathy Heffner)

One of three Regional Center of Excellence in Substance Abuse education • $9.5 million HRSA grant over next three years – Recovery Center of Excellence

Del Monte Neuroscience Institute – Psychiatry collaboration – NYFirst Grant • Schizophrenia (Vision), Alzheimer’s disease (Clinical Trials), and Chronic Pain research based on neuroimaging modalities – fMRI, DTI, EEG, PET, etc.

Developmental Psychology and Child Psychiatry • The Rochester ECHO Project (PI: O’Connor) • Sources of Strength in High School (PI: Peter Wyman) 8 Outreach/Advocacy Research in Psychiatry • Forensic ACT team (PI: Lamberti), Women's Initiative Supporting Health-Transitions Clinic (PI: Morse), Laboratory Interpersonal Violence and Victimization (PI: Cerulli) URMC Psychiatry – A Clinical Department

• 140 full and part-time faculty members (45 faculty recruits in 3 years) • About 1300+ employees in total. • 93 certified psych inpatient beds (includes 24 child and adolescent beds) • Operates a 20-bed Med-Psych Unit -to be expanded by additional 10 beds. • Partial hospital programs for child and adolescents. • 370K outpatient visits annually (largely from OMH-certified programs) • CPEP (Psychiatric Emergency Program) seeing over 10,000 visits annually • Telepsychiatry program – 60 nursing homes and 3 regional hospitals • Numerous collaborative programs in primary care and specialty care settings – inpatient and outpatient.

9 URMC Psychiatry has a broader scope than most other academic psychiatry department

Vast majority of DEMENTIA CARE in our community is under Department of Psychiatry through Memory Care Program (Director: EJ Santos, M.D.) • AD-CARE Program also resides in Department of Psychiatry (Director: Anton Porsteinsson) • Finger Lake Center of Excellence – (Director: Carol Podgorski, Ph.D.)

URMC Psychiatry is the only academic department in US that operates MEDICINE IN PSYCHIATRY (MIPS: Director: Telva Olivares) • iMIPS inpatient unit (Director: Marsha Wittink, M.D.) • MIPS Primary Clinic (Director: Kevin Brazile, D.O.)

URMC Psychiatry operates the employment-based wellness and behavioral health programs – 65K UR employees, retirees, and adults dependents. • EMPLOYEE ASSISTANCE PROGRAM • BEHAVIROAL HEALTH PARTNERS 10 URMC Department of Psychiatry Volume: 10% inpt and 40% outpt increase between 2017-2019

Fiscal Year 2015 Fiscal Year 2016 Fiscal Year 2017 Fiscal Year 2018 Fiscal Year 2019 Adult Division • Inpatient 18,490 18,912 19,089 19,241 20,046 • Outpatient 87,778 93,809 95,647 102,585 110,333

Child and Adolescent • Inpatient 7,814 6,686 7,344 7,566 8,286 • Outpatient 24,929 26,172 26,660 40,352 50,273

Medicine in Psychiatry • Inpatient 7,162 6,478 5,700 6,436 7,204 • Outpatient 5,500 6,413 7,924 8,414 8,180

Addictions Psychiatry • Chemical Dependency 13,517 16,783 21,222 20,487 18,871 • Methadone (OTP) 62,607 68,118 69,842 89,721 110,295

Total Patient Volume 33,466 32,076 32,133 33,243 35,536 • Inpatient 194,331 194,512 • Outpatient 200,073 241,072 279,081

% Change Year over Year • Inpatient (4.2%) 1.8% 3.5% 6.9% • Outpatient 0.9% 2.9% 20.5% 15.8% Then comes the Age of COVID-19

Li Wenliang,M.D. (died on 2/7/2020)

12 13 South Korea becomes one of the epicenter of COVID-19

Initial spike in COVID19 in South Korea was in a geriatric psychiatry ward

Entire 101 patients and staff were infected (except 2 people) • Whole floor with units were “cohorted” and quarantined. • 7 died of COVID-19 14 URMC Psychiatry Response to COVID-19 March 2nd – Faculty Meeting about coronavirus.

March 7th – “No More Handshakes and Hugs” Letter to Department

March 10th- Departmental COVID-19 Huddle – 12 PM (Tuesday, Friday) • Steering Group: Ben Lee, Sue DiGiovanni, Carole Farley-Toombs, Telva Olivares. • Members: Clinical Chiefs of 5 Divisions (EJ Santos, George Nasra, Rob Weisman, Michael Scharf, Sue DiGiovanni), Program/Service Directors (Marsha Wittink, Noni Niculescu, Patrick Seche), Nurse Liaison (Laura Inclema), and Social Work Liasion (Jewel Hopkins). 15 Psychiatry Department: COVID Response

Psychiatry Dept huddle – Tues/Friday Ben Lee

Ambulatory Leadership Daily Inpatient Leadership Huddle Daily Huddle Carole Farley Toombs Sue DiGiovanni

Ambulatory Nursing Daily Inpatient Nursing Daily Huddle Huddle Kerri/Laura Inclema Kerri/ Heather Jackson

16 Division-based Clinical Decision structure

Steering Committee Ben Lee , etc.

Child Geriatric Adult Collaborative Community

Michael Sharf EJ Santos Sue DiGiovanni George Nasra Rob Weisman

Strong Child Amb Partial CPEP Partial Strong BH EAP/BHP Recovery Linda AG Charlene Weeks Noni AURELIAN Heidi Hakes Kathy Castle Ann Cornell Patrick Seche

17 Dramatic rise in cases in US in March 2020

18 COVID 19 Challenges to URMC Psychiatry 1. How do we preserve our psychiatry service lines that provides mental health for our region? • URMC Psychiatry is the “last line of defense” for regional mental health.

2. How do we protect our vulnerable patients? • Our patients with SMI are physically vulnerable. • Our 93 inpatient psychiatric beds are vulnerable ----- how do we bring in medicine culture to psychiatry?

3. How do we support and protect our staff in terms of health and employment?? 19 Clinical innovations in mental health service during COVID-19

Child and Adult Partial Hospital Programs • Converting to Zoom and telephone-based contacts • Fully operating 4 hours of program all-online.

What about those who needs to be seen in-person? • Methadone maintenance therapy – curve-side • Group therapy – socially distanced, combined therapy

20 Resilience – displayed by Department of Psychiatry Strong Recovery Methadone Maintenance Team Curve-side – “Drive Through”- Methadone Dispensing Program

21 Psychiatry Call Telepsychiatry Psychiatry Billing / Center Leads Team Leads Compliance Lead

Laura Inclema Lara Press-Ellingham Julie Moeller Kristy Lamb Linda Williams Lynn Dejonge Steve Fasone Jennifer Richman Michael Hasselberg

TeleMental Health Champions

Child Psychiatry Community Collaborative Care Geriatric CPEP and Mobile Division Division Division Psychiatry Division Crisis Service Lines Service Lines Service Lines Service Lines Service Lines

In-person to Telepsychiatry Conversion 22 UR Medicine Switch from Announces TeleHOME Visit Postponement Type to new of Non-essential In- Dept. of Psych person Visits Workflow March 15 TeleMental March 25 Health Champion Farley-Toombs and TeleMental Bishop and Farley-Toombs and Meeting Hasselberg Health Hasselberg Hasselberg March 23 Ambulatory Planning Sessions Champion TeleHOME Planning Session Video Encounter March 11-12 Meeting Meeting March 17 MyChart March 16 March 25 Self Attestations Hasselberg / Kelly “Go-Live” st Submitted to 1 TeleMental Telemedicine March 30 Health TeleMental Zoom OMH and OASAS TeleMental TeleMental Champion Health Training for March 14 Health Health Meeting Champion ProvidersMarch 24 March 17 Training of Child Champion Champion Meeting Telepsychiatry Psychiatry Meeting Meeting March 18 Billing / Division on Team and Dept. March 17 March 31 Compliance of Psych Call Video TeleHOME Encounters Center March 25 Meeting TeleMental Planning Session March 24 Health March 16 Champion Ambulatory Ambulatory CPEP/Mobile Farley-Toombs and Meeting Telepsychiatry Telephone Crisis Telephone Hasselberg March 30 Meeting Encounter Encounter Planning Session March 13 “Go-Live” “Go-Live” March 26 March 17 March 23

March 2020 Telepsychiatry “Go-Live” by March 17th 80% of Ambulatory care was delivered by telepsychiatry by end of March

TeleMental Video Encounter Health Scheduling Champion Meeting Meeting April 1 April 8

Ambulatory Final Video Encounter TeleMental Email Health “Go-Live” Champion April 2 Meeting April 14 TeleMental Health Start of Psych AV Champion Zoom / Tech Daily 2pm Meeting Office Hours TeleMental April 3 April 15-present Health Champion Meeting April 2

April 2020

24 URMC-wide: 60% of usual Volume: 46% telemedicine by April

Psychiatry: 96% of usual volume: 80+% telepsychiatry by April

25 Year-Over-Year % Change in Volume by April

Psychiatry URMC – overall

26 Telepsychiatry reduces cancellation and no show rates:

No show cancellation

27 28 URMC Furlough – May 8th announcement

Total: 3474/17,885 (19.4%) • About 20% was full furlough • 80% was partial

Department of Psychiatry (<2%) • Substantially smaller portion • Primarily affected clinical admin, research and education

29 COVID-19 Challenge: Inpatient

COVID+ patients needing psychiatric inpatient admissions : • 3 COVID+ psychiatric patients in CPEP one Saturday in March. • How do we safely care for these patients while protecting the staff?

• Moved 3-9200 Geriatric Psych unit staff and patients to Rochester Psychiatric Center –unoccupied inpatient unit – and protect the geriatric psychiatry inpatients – the most vulnerable population to COVID-19 infection • Developed COVID+ psychiatric unit at 3-9200 with assistance from Med-Psych and Acute care clinicians.

• This ends up being an expansion of 12 psychiatric inpatient beds during this challenging time. 30 Inpatient planning for COVID+ Unit

1. Discussion started on 3/25/20

2. Task Force/planning started in 4/2/2020

3. DOH/OMH approval happened on 4/8/2020

4. By mid- April, we were already ready to act on the plan • 3-9200 as COVID+ unit • Moving 3-9200 to RPC

5. 2 patient threshold – COVID+ unit plan triggered – patients moved to RPC on 4/22/20

31 Creating a New COVID-19 Positive unit at URMC.

32 33 Inpatient: CoVID-19

Relatively low utilization of COVID+ Unit • Only triggered the plan twice. Highest number of COVID+ patient was 6 patients at one point.

Two COVID-19 Outbreaks in inpatient Unit last year • Had to quarantine an inpatient unit twice.

Remarkable work by the nursing but quite stressful for them. • Staff wellness and overall level of stress in the unit 34 New causes for Concern: Our CPEP

1. We have more “boarded” patients in our CPEP than ever. • We routinely have 7-15 patients being boarded in our CPEP • At one point, we had 20 patients boarded in our CPEP • We transferred several to RRH during the last few weeks.

2. Our outpatients seems to be more anxious and depressed than before – social isolation, economic downturn, and fear of COVID

• Brooks SK et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020 Feb 26. • McIntyre RS, Lee Y. Projected increases in suicide in Canada as a consequence of COVID-19. Psychiatry research. 2020 May 19:113104.

35 A Recent Survey: COVID-19 and Mental Health Czeisler MÉ. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic— United States, June 24–30, 2020. MMWR. Morbidity and Mortality Weekly Report. 2020;69. •Surveyed 5.412 above age of 18

•About 40% reported at least one adverse mental or behavioral health conditions.

•Suicidal thoughts (11%) were more common among 18-24 years old, Hispanic or black persons, “essential worker,” and “unpaid caregivers.” Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24– 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057

37 Patient volume in CPEP has fluctuated

Individuals Seen 300 273277 264 252 253247 250 245 240 250 229 234229 232 233 222 223 227226 225 220 214 219 215 219 212214209 209 211207 209 207 204 203202 199206 205 195 195 197 200 198 200 183 187 182 183178 178 177 171 170 174 163167 169 164 155 150 138140 143 128123127 129

100

50

0 12/29/2019 1/29/2020 2/29/2020 3/31/2020 4/30/2020 5/31/2020 6/30/2020 7/31/2020 38 39 Number of patients admitted to Inpatient unit has been about the same or more.

Admissions to Inpatient 50 44 45 40 34 33 34 35 32 31 30 31 29 28 28 28 28 29 30 27 27 26 26 25 24 24 23 23 23 25 22 22 22 22 22 21 18 18 20 16 38 34 34 34 15 31 30 29 31 31 29 29 27 26 27 27 27 28 26 28 26 25 23 25 25 24 25 24 24 25 10 20 17 19 5 11

0 12/29/2019 1/29/2020 2/29/2020 3/31/2020 4/30/2020 5/31/2020 6/30/2020 7/31/2020

YEAR 2020 # of Admissions 40 Why is our CPEP getting over-crowded?

30-40 patients in our CPEP with 7-15 patients boarding is our norm.

Number of patients being boarded in CPEP has gradually increased over the last year due to: • Slowed “throughput” in CPEP and Inpatient Unit – length of stay in both areas have increased • Reduced outpatient mental health resources • Forensic/legal issues related to the bail reform • Recent closures of inpatient psych units in the region. • Overall COVID-related stress taking toll on our patient.

41 42 Systemic solutions needed

Working with RRH to increase the bed capacity in the region

Working with RPC to transfer long stay patients from our unit

Develop mobile crisis teams to divert patients for ED

Increase staffing (e.g. SW) to improve the throughput issues.

Many meetings these days about the CPEP issues.

43 Racial Injustice/George Floyd Protest in Rochester – May 30th

44 “Acknowledging Pain, Anger and Fear” message from Psychiatry Office of DICE 5/26

Death of George Floyd in Minneapolis, MN (May 26)

Death of Ahmaud Arbery in Atlanta, GA (February 20 – May 7th)

AND

Amy Cooper/Christian Cooper incident in Central Park, NYC (May 25th)

AND

Death of Breonna Taylor in Louisville, KY (March 13) and others June 5th, 2020: White Coats for Black Lives demonstration on Brighton Health Campus

46 Shooting of Jacob Blake in Kenosha, WI (8/23/20)

47 Death of Daniel Prude: September 2nd, 2020

48 Death of Daniel Prude and URMC

9/2/2020 – News conference – highlighted the body camera video and autopsy report of homicide as a result of “complications of asphyxia in the setting of physical restraint.” • Daniel Prude was evaluated and discharged several hours prior to death.

9/4/2020 – URMC statement released to the press. • “Medically appropriate and Compassionate care” after an internal review”

4 external reviews – NY State OMH, DOH, Justice Center, and Joint commission- have concluded and supported the initial49 URMC statement. Department of Psychiatry Well- being Survey 2020 Results and Future Direction

IDEA CORE Members

50 Gratitude to IDEA (Implementation, Dissemination, Evaluation, and Analysis)Core members Wendy Cross, Ben Chapman, Daniel Maeng, and Patrick Walsh

51 Survey Goal: Learn about Our level of Stress and Wellness

Background, development • COVID-19 outbreak declared a pandemic by the WHO (March 11) • George Floyd murder (May 25) • Consulted with Psychiatry Office of DICE • Process required HR review

Constructs, measures A) Job satisfaction, stress, burnout - [Mini Z burnout survey] B) General wellbeing (sleep, exercise, perceived stress]) - [Perceived Stress Scale] C) Experience (impact of COVID-19 and social justice protests, work expectations, working remotely, Zoom fatigue) D) Employee feedback: Feeling valued at work, satisfaction at work [Qualitative Items] E) Work role Survey administration

Administered from 8/17 to 9/2/20 • REDCap online survey • 1227 survey invitations (psychiatry all distribution list) • 10 removed from list (email ‘failures’, no longer work in Psychiatry Department) • 13 unavailable during survey period • 1204 potential participant population Participation: 603 (50.1%) Survey participation Participant population Participation rate (%) Nonfaculty 46.8 Faculty (self report) 70.7

Faculty by division… Acute and Adult Psychiatry 83.8 Child and Adolescent Psychiatry 84.4 Collaborative Care and Wellness 64.5 Geriatric Mental Health/Memory Care 73.7 Community Psychiatry 56.5 Still looking at which division had staff participation rate Job Satisfaction: 73.5% (12% - “neutral”)

Overall, I am satisfied with my current job: (missing n = 5) Job satisfaction category Faculty Staff (strongly disagree – strongly agree, (n = 118) (n = 437) 5 pts.)

Not satisfied n (%) 24 (20.3) 123 (31.4)

Satisfied n (%) 94 (79.7) 314 (71.9)

*Satisfied = agree or strongly agree;

‘Mini Z’ Burnout: 40.9% report symptoms of burnout Using your own definition of "burnout” circle one: (1-5, from “I enjoy my work. I have no symptoms of burnout” to … I feel completely burned out. I am at the point where I may need to seek help”)

Job burnout category* Faculty Staff (n = 118) (n = 437)

Not burnout n (%) 77 (65.3) 251 (57.4)

Burnout n (%) 41 (34.7) 186 (42.6) *Burnout = score 3 – 5.

‘Mini Z’ *Linzer et al. (2016). Worklife and wellness in academic general : Results from a national survey. Journal of General Internal Medicine, 31(9), 1004–1010. https://doi.org/10.1007/s11606-016-3720-4 Sleep & Exercise

SLEEP: More or less than before COVID-19? • More (9.7%) • Unchanged (61.6%) • Less (28.6%)

EXERCISE: More or less than before COVID-19? • More (17.8%) • Unchanged (40.9%) • Less (41.3%) Perceived Stress Scale*

10 items. Scoring range: 0-40, higher > stress

Department Mean=17.2 (SD 6.7)

Faculty = 16.0 (6.3) Staff = 17.4 (6.7) Perceived Stress Scale by category Low Moderate High (0-13) (14-26) (27+) Staff 27.7% 62.9% 9.4%

Faculty 34.7% 61.9% 3.4% Total 29.2% 62.7% 8.1% *Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396 As compared to before COVID-19, work-life balance is: 48.5% - “worse”

48.5% 37.3%

14.2% IN THE PAST MONTH (August)… …how much has COVID-19 and its consequences impacted your: None A little Somewhat A lot Extremely Stress level (%) 4.0 15.9 32.2 36.3 11.6 Overall life Impact (%) 2.5 13.3 34.1 42.0 8.1

…how much have recent Black Lives Matter movement and protests against racial injustice impacted your: None A little Somewhat A lot Extremely

Stress level (%) 18.9 29.7 30.3 15.6 5.5

Overall life Impact (%) 17.2 36.0 28.4 14.4 4.0 * Pre Daniel Prude video (9/2/20) How have the expectations of your work changed since COVID-19?

Summary: 72.8% report ‘more’ expectationsFaculty vs Non-Faculty. Work expectations Faculty Staff

Work expectation (n = 118) (n = 437) More n (%) 74 (62.7%) 330 (75.5%) About the same OR less n (%) 44 (37.3%) 107 (24.5%)

More expectations: Staff > Faculty IN THE PAST MONTH, in a typical week you were working, what percentage of your work time has been spent remotely rather than onsite?

NA (2.0%) 80- 100% None

Staff: None= 44.2% Faculty: None = 13.8%

40- <80% 1<20% 20-<40% In a typical week, the number of video calls you participated/attended on work days was... Faculty: 0/day = 7.6% 3+/day = 61.0%

Staff: 0/day = 28.1% 3+/day = 31.4%

38.6% 23.8%

15.1% 15.7% 6.8% IN THE PAST MONTH, considering the nature, amount, and length of calls, as a result of video call participation… [respondents that reported 1+/day video calls]

I feel mentally exhausted …

Not at all A little bit Somewhat Quite a bit Very much

Faculty. & 18.5 20.9 22.0 30.1 8.5 Staff (%)

60+% report mental exhaustion Qualitative: Total respondents: n = 487 (to 1+ items), 80.8% Q1: Impact of COVID-19 and protests

Please use this space to comment, in any way you feel appropriate, on how your experiences have impacted your well-being IN THE PAST MONTH:

Item respondents: n = 158

Q2: Valued at work

Please take a moment to comment on feeling valued and satisfaction at work.

Please list up to 3 things that contribute to you feeling valued at work:

Item respondents: n = 455

Q3: Improve work satisfaction

Please take a moment to comment on feeling valued and satisfaction at work.

Please list 1 to 3 things that would improve work satisfaction if initiated:

Item respondents: n = 411 What have we done so far?

Faculty data presented on November 7th – Faculty meeting

Divisional data presented on November 7th – All Chief’s meeting • Divisional data distributed in early December

The short answer, qualitative data are being analyzed. • Impact of COVID 19 and Protests • What makes you feel valued at work? • Suggestions to improve are listed and acted on.

66 Announcement

• Autumn Gallego is appointed as our new “Psychiatry Wellness Officer” as of January 1st, 2021

• Will be in Office of DICE for the role and develop a bridge to EAP/BHP

• Will coordinate departmental efforts to assess and improve faculty and staff wellness

• Will coordinate with URMC Chief Wellness Officer (to be hired).

67 Example: Strong Recovery Program

“Fun” Committee – three teams, takes turn in chairing. • Develop “fun” activities. • Fun Fridays • NFL Jersey days (Go Bills!), Flannel Fridays, Jeans Day, etc. • Recognizing “most valuable colleagues” and “Cool under pressure” award.

“Well U” Champion – Itza Morales for SRP • Disseminate information from the “Well U” program • Yoga, mindfoolness, meditation, workshops, “water challenges”etc.” • “Wellness” Room – used to be a storage room

• Decorated and equipped with sound machine, candle (battery) and massage68 chair Wellness Room & SR Latinx Celebration (we had music and outdoor games) Staff Wellness during COVID-19 Work stress and anxiety about Coronavirus? Life-Work Connections Employee Assistance Program (EAP)

Created a COVID-19 hotline for UMRC

A voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals and follow-up services to employees who have personal and/or work-related problems 70 Lessons learned during the COVID-19 1. Must establish a command structure to process new information and make appropriate decision quickly. • Must delegate and empower huddles and work groups and task forces to achieve maximum efficiency and speed in decision making.

2. Telepsychiatry is here to stay. • Must incorporate technology and develop new models of delivery to meet the needs and evaluate for success and failure.

3. We are more connected to each other than ever. • All “boundaries” are permeable.

71 Conclusion

1. COVID-19 has posed tremendous challenge to delivery of mental health services. • However, by leveraging technology, innovation and teamwork, we could overcome COVID-19 imposed challenges.

2. Social isolation, economic downturn, and racial unrest have all increased mental health service needs in our region. • It has affected our healthcare workers as well

3. Every crisis is an opportunity.

• Psychiatry has much to improve for our patients and72 ourselves.