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What Healthcare Gets Wrong About Trust | E105 · The Advancing Healthcare Innovation Show

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Hello and welcome back to the Advancing
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1:13
Okay. So, there is a phrase that we use
1:16
a lot in healthcare
1:18
that uh myself and our next guest
1:22
kind of have a problem with.
1:24
And that phrase is
1:26
hard to reach, as in hard to reach
1:28
patients, hard to reach communities,
1:31
hard to reach populations. And Dr.
1:35
Melissa Gutierrez
1:37
Kaplan
1:38
uh sees it a little bit differently. And
1:41
and maybe maybe they're not hard to
1:43
reach. Uh maybe maybe we're just doing
1:45
it wrong. So, Melissa is the director of
1:48
health equity research at Sinai Urban
1:52
Health Institute here in Chicago. And
1:54
she has spent a lot of her career
1:56
studying something that I think
1:57
healthcare talks about a lot, but
2:00
doesn't always necessarily kind of get
2:02
it right. So, let me just break it down
2:04
for a second. So, trust.
2:06
Not just how you build trust with
2:08
another person, but what happens when
2:11
the institution
2:13
that you represent hasn't really earned
2:15
that trust in the first place. Like to
2:18
me fundamentally that question changes
2:20
things. It changes how you think about
2:23
research,
2:24
how you bring clinical trials into
2:26
communities, how you even look at health
2:29
equity. And even how you interpret data
2:33
once you have it. So, and I think
2:36
something healthcare gets so focused on
2:38
like we need
2:40
people. We need people to understand
2:42
like sometimes we forget to ask what
2:44
they might need from us. And that's
2:47
some of the things that I want to
2:48
explore today.
2:50
Like what happens when we stop
2:52
calling people hard to reach
2:54
and start asking whether we're doing
2:56
enough to reach them.
2:58
So, that's
2:59
what I'd love to talk about. Melissa,
3:01
it's great to see you. Welcome to the
3:03
show.
3:04
>> Thank you. Thanks for having me.
3:06
>> So, I I kind of want to start there
3:08
because when we first spoke
3:10
um you said something that kind of
3:12
really stuck with me.
3:14
You said, "We're not hard to reach."
3:16
quote unquote, "You know, you're doing
3:17
it wrong." Where Where did that belief
3:20
come from?
3:22
>> Um I was at a conference and we were
3:25
talking about how to
3:27
um
3:28
get diverse populations to respond to
3:31
surveys and
3:34
the presenters kept saying, "Oh, well,
3:36
the hard-to-reach populations,
3:38
hard-to-reach populations." And someone
3:39
in the audience said,
3:41
"My communities aren't hard to reach.
3:43
We've been here the whole time. You
3:45
researchers are doing it wrong." And it
3:48
was so powerful because, you know, an
3:50
audience member saying this in front of
3:52
a bunch of researchers just really had
3:54
this profound impact on me and I you
3:58
know chatted a little bit about after
4:00
and then there you know as you said
4:02
there's this concept of trust and
4:04
trustworthiness
4:06
and it's
4:08
it's silly for us to think that people
4:10
don't want something right that there is
4:13
a community that's hard to reach because
4:14
they don't want certain health care or
4:18
want to be a part of a clinical trial
4:20
you know
4:21
those things are universal right or it
4:24
doesn't matter where you come from what
4:26
you look like if you want to participate
4:28
or not um but whether or not you have
4:30
access and trust the health care system
4:34
and governments that have typically not
4:37
been trustworthy
4:40
is the issue and um you know again I I
4:43
just thought it was so powerful this
4:45
person in an audience with a bunch of
4:47
researchers saying please stop calling
4:49
us that you are the ones doing it wrong.
4:52
>> Do you do you feel like sometimes in
4:55
health care
4:56
we you're we're using hard to reach as
4:58
like an excuse?
5:00
>> Hm interesting. Um I don't know if it's
5:03
excuse I think we
5:05
that I think sometimes we're just really
5:07
clueless that
5:09
um that we're doing it the wrong way or
5:12
that
5:13
something that works for
5:17
the the norm or the typical
5:21
it's not that it isn't working for
5:23
someone else it's that they're hard to
5:24
reach right instead of saying maybe
5:28
maybe we need to think about it a
5:29
different way and and this is sort of
5:31
like why community engaged health
5:33
research is so important.
5:35
>> Yeah.
5:35
>> Because what is working for one
5:37
community is not going to work for the
5:39
other and if you don't shift you're
5:41
going to you're going to run into you
5:44
know problems and
5:45
and
5:45
>> I think what that person was saying, and
5:47
then the problem is on you. Don't put a
5:50
pin on us for her to reach. That problem
5:52
is your problem that you need to own and
5:54
adjust for.
5:55
So.
5:57
>> You know,
5:58
you know, you're an as an
5:58
epidemiologist, right?
6:01
You've mentioned this earlier about
6:02
trust and trustworthiness.
6:04
And they They do They sound similar, but
6:07
I know they're very different. Would you
6:08
mind maybe just sort of sharing the
6:10
distinction between both of those?
6:12
And why people maybe sometimes mix them
6:14
up?
6:15
>> Yeah. So, I think trust, you know, and
6:18
and you know, you write about how
6:20
important it is.
6:22
Um it's key to all of our relationships,
6:24
whether it is with our children,
6:27
patients, um you know, community
6:29
members. But that trust is really this
6:32
one-on-one
6:34
um belief, right? That I
6:37
through communication, through showing
6:39
up authentically,
6:41
I am building trust. And it's what we
6:43
focus a lot of our time on patient um
6:47
physician um
6:49
relationships is do if patient trust
6:52
their doctor, they are more likely to
6:55
take their medication as prescribed,
6:57
listen to them, follow directions, etc.
7:00
But the problem comes is that for many
7:03
of the communities that are
7:07
under medically underserved or have been
7:10
hardest hit by many of our health
7:11
conditions, COVID being a good example
7:14
of recent times,
7:15
the systems themselves or the
7:18
whether that reaches all the way up to
7:20
government or either some hospitals
7:23
aren't trustworthy. They have not
7:26
established their trustworthiness within
7:29
the community. So, it's sort of that
7:30
systemic aspect of trust. Like, what is
7:33
the trustworthiness
7:35
of
7:37
a health system, of you know, a
7:39
government in a community, things like
7:41
that. And if that hasn't been built up,
7:45
the trust one-on-one patient and a
7:46
doctor will fall short.
7:49
>> Mhm.
7:49
>> Yeah, so we spend a lot of time thinking
7:51
about trust with this one-on-one and if
7:54
we're not building trust up in a
7:56
collective community,
7:58
then that trust at some point will
8:01
falter.
8:03
Um
8:04
>> I'm even just thinking like can a can a
8:06
trustworthy
8:07
person
8:09
represent an institution that people
8:13
have
8:14
every reason not to trust. And like if
8:16
you get enough of the trustworthy people
8:19
in there,
8:20
I don't know if that's like a shortcut
8:22
or like a way to microwave that.
8:25
>> Well, and I don't know if there's an
8:27
exact formula, right?
8:29
>> Yeah. Yeah.
8:30
>> One of the ways we tried to measure
8:32
trustworthiness is through like income
8:35
inequality, really trying to look at
8:37
those like social aspects of
8:39
trustworthiness.
8:41
Um and those, you know,
8:44
actually played a bigger part in whether
8:47
or not people got the COVID vaccine than
8:49
trust with their doctor.
8:51
And, you know, we controlled for a lot
8:53
of other things like did you have
8:55
insurance, stuff like that. And still
8:57
this like
8:58
this inequities in income within a city
9:02
or a neighborhood is what stood out the
9:04
most. And so that is we kind of thought
9:07
about that trustworthiness of that like
9:09
a like a societal aspect, but
9:13
you know, for hospitals, I work at
9:14
Sinai, um Chicago, and you know,
9:18
people we are treating sick people. And
9:21
so there are different outcomes. The
9:23
goal always is to get someone back to
9:26
their prime quality of life so they can
9:29
go to their many, many more
9:30
Thanksgivings with their families, you
9:31
know.
9:32
>> Yeah.
9:32
>> Um but the outcomes aren't always
9:35
there, but you know, one thing about
9:38
Sinai is it has steadfast
9:41
support of the community that it's been
9:42
in for over 100 years, regardless of
9:45
what that community looks like. And so,
9:48
I would say Sinai is a trustworthy
9:51
institution in the fact that no one is
9:54
turned away. So,
9:57
I don't know
9:59
I don't think there's a balance. I think
10:01
you need both.
10:03
But the idea that everyone everything
10:05
can be solved in this one-to-one
10:06
trusting relationship, I think we're
10:07
missing the boat.
10:09
>> So, when you walk into
10:11
um a community event and you're rocking
10:14
the Sinai
10:16
badge,
10:17
is that the overall sentiment knowing
10:19
that people see Sinai as like, "Yeah,
10:21
they care for me." That What kind of
10:23
feedback do you get?
10:25
>> You know, so when I I'm going to
10:27
community meetings and I often try to
10:31
show up
10:32
as
10:34
um like there's this like no one to stop
10:37
up and no one to stop back.
10:39
And when I go to a community meeting, I
10:41
see myself as stepping back, right?
10:43
Like, I'm the one that shouldn't have
10:45
the seat at the table. And so, I don't
10:47
actually know if I wear my my Sinai
10:50
badge to stand out. It's not
10:52
>> Okay.
10:52
>> Um no, I will say I get my foot in the
10:55
door more often than not because with
10:57
community groups because I am from Sinai
11:00
and not Northwestern, right? Like, I am
11:03
like they see us as a member of the
11:05
community. Um but I'm
11:07
>> Interesting.
11:08
They don't with the others.
11:10
>> It's
11:11
very, very true. Like, it is this sort
11:14
of like, "Okay, you're one of us." Like,
11:16
"You live in this neighborhood, too."
11:17
You know, like, "I go to your clinics. I
11:20
see them."
11:21
>> Mhm.
11:22
>> And um you know, we we see this a lot in
11:24
academic community partnerships. Um
11:27
but the you know, same for me as a an
11:29
academic researcher, like,
11:31
I have to step back when I go to
11:33
community meetings and let them step up.
11:36
>> Mhm.
11:38
>> So, it's important.
11:40
>> You know, you um
11:42
you told me a story. You actually told
11:43
us the story when we were on that panel
11:45
discussion together that I still haven't
11:47
forgotten that.
11:48
Um
11:49
you were younger in your career and you
11:51
were working on this asthma program and
11:54
one of your community health workers
11:57
comes back with without the data that
11:59
you were expecting.
12:01
Can you like take me back there? Like
12:03
what what happened?
12:06
>> Um so, I think I was 26 at the time um
12:10
and it was my first job out of my
12:12
master's degree and we were um
12:14
implementing a community health worker
12:17
model asthma intervention across the
12:19
state of Illinois. So, we did a lot of
12:21
trainings on of community health workers
12:23
on asthma and then how to collect data.
12:26
Well, that was my job to train people on
12:28
how to collect data um cuz I'm an
12:30
epidemiologist, I want my good quality
12:32
data.
12:33
So, when community health workers came
12:35
back from the visit, we'd see like did
12:37
you talk about all the education stuff?
12:40
Did you collect all the data? You know,
12:42
do a a debrief. And one of the community
12:45
health workers came back and
12:48
she said, "Melissa, I didn't get your
12:51
data. But and you know, 26-year-old
12:56
me was like, you didn't get my data? I
12:57
need my data. It's very important."
13:00
And she, you know, the the greatest
13:02
thing is she said, you know, Jane was
13:05
having a really hard day. Her
13:07
her and her partner had just split. She
13:10
didn't know what she was going to do.
13:11
She was in distress.
13:14
And this community health worker, this
13:15
woman, showed up for Jane in an
13:18
authentic way
13:21
building trust
13:23
and
13:24
saying to her, this other stuff of
13:26
asthma education and data collection can
13:29
wait.
13:30
Because what's most important right now
13:32
is those things that you need and you
13:34
can't
13:35
address your child's asthma if if you
13:38
yourself can't be a a whole person.
13:42
Um
13:43
you know, and it it made me realize like
13:45
we have we have to soften on some of our
13:49
on what we think is right and wrong and
13:51
um you know, community health workers
13:53
are such
13:55
powerful
13:56
um
13:57
you know, health care workers and
13:59
advocates for their patients and
14:02
you know, they have more time than
14:03
physicians and can do things like that
14:06
um and
14:08
you know, I would say maybe another
14:10
thing that makes Sinai so trustworthy is
14:12
we have about 50 community health
14:14
workers on staff
14:16
that are treating patients in the ED and
14:18
out in the community and and we still go
14:20
to people's homes for
14:22
for asthma. Anyway, she ended up going
14:24
back getting the visit and that patient
14:26
finished the year-long intervention
14:29
and saw improved in asthma management.
14:31
So right? Like we got the goal we wanted
14:33
which is improved quality of life. So,
14:36
thanks for bringing that up. It's a it's
14:38
a near and dear story.
14:40
>> Yeah, no. I I mean, there's so many
14:43
golden nuggets in that story, right? Cuz
14:45
you're
14:46
I think the early
14:47
Melissa
14:49
obviously had was frustrated and
14:51
probably some of you was like pissed
14:52
off.
14:53
But then as you look at the bigger
14:55
picture
14:56
you're like, well, she actually the
14:57
community health worker did do the right
14:59
thing. Did the best thing in that
15:01
situation which was to
15:04
basically showcase grace and in that
15:07
moment what was needed was social
15:09
support.
15:10
>> Yeah.
15:12
>> Not another research protocol in in a
15:15
sense.
15:17
So, that
15:17
>> Yeah.
15:18
And that's sort of like when we think
15:19
about the community health worker model,
15:21
we
15:22
think about it as it
15:24
that they provide the best asthma
15:26
education that anyone can give. Maybe,
15:29
maybe not, but they provide all these
15:32
underlying things like social support
15:35
>> Yes.
15:35
>> that
15:36
that lacks in our health care system,
15:39
not because people don't care, but
15:41
because we just there's no time left in
15:44
health care, you know? I
15:45
>> Yeah.
15:46
Uh-huh.
15:47
>> 15 minutes is a luxury these days for a
15:49
visit.
15:51
>> Yeah.
15:52
She did Listen, technically, looking
15:54
back at the story, like the community
15:56
health worker, like she didn't do what
15:57
she was what I'm called supposed to do.
16:00
She did the right thing.
16:01
>> Mhm.
16:01
>> Cuz she understood something
16:04
about that woman that maybe
16:07
you in your younger years at that point
16:09
in your career didn't maybe understand.
16:11
>> No.
16:14
Not at all. Um
16:16
but those are
16:18
like amazing lessons and now
16:22
you know, I get to teach my team
16:24
those same things. Like
16:27
you know, there are
16:28
new young epidemiologists coming into
16:31
our world and we get to kind of talk to
16:33
them about
16:34
putting a face with the data and
16:37
you know, when you go to communities
16:39
representing and showing up
16:42
in in a trustworthy way.
16:45
Um and I you know, and then advocating
16:48
for policies that
16:50
make our neighborhoods
16:52
make our neighborhoods trusting of our
16:54
city.
16:55
>> Mhm.
16:56
>> of our city, we're more likely to be,
16:59
you know, socially engaged, civic
17:01
participation. We know that leads to,
17:05
you know,
17:06
higher tax or not taxes, but higher
17:08
income rates and things like that. So,
17:10
anyway.
17:11
>> Um
17:12
that's there's a real cycle and
17:15
um and and that's just so much in
17:17
community work, showing up authentically
17:21
and turning the narrative from
17:24
you're hard to reach to
17:27
I need to work at a different angle and
17:30
partner with you.
17:32
And then you'll you'll want to
17:35
work alongside with me, partner with me,
17:39
and it becomes natural and not
17:42
um, something I'm going to go make a
17:43
presentation about. Damn it. I'm being
17:46
hard to reach.
17:47
>> Listen, I love this because this is
17:49
segueing into something that I thought
17:50
about. Um, cuz I know that you spent uh,
17:53
I think it was like 6 months or
17:54
something from what I remember you
17:56
mentioning to me about recruiting girls
17:58
for a study here in Chicago.
18:00
>> Yeah.
18:01
>> And it wasn't and it wasn't
18:03
I would say it was wasn't particularly
18:05
working really well.
18:06
>> No.
18:07
>> Um,
18:08
what what happened when you kind of
18:10
finally brought the community advisory
18:13
board into it?
18:15
>> Yeah, so um,
18:17
you know, we we always start with a
18:19
community advisory board on almost
18:21
everything we do. And we had one of, you
18:24
know, stakeholders, uh,
18:26
girl serving organizations, and one with
18:28
youth.
18:29
>> And
18:29
>> Um, and we went through a lot of the
18:31
materials. They helped us with
18:33
recruitment materials and
18:35
and we really thought we've got it from
18:38
here. Recruitment is uh, you know, our
18:42
our specialty.
18:43
Um,
18:45
and it really sort of blew up in our
18:47
face, right? Like, we didn't know, you
18:51
know, we thought recruiting girls during
18:53
the summer would be easy.
18:55
>> Right.
18:55
>> Turns out it's not. You know, who could
18:57
have told us that? Our community
18:58
partners.
18:59
>> What did they know?
19:01
>> But
19:02
>> What did they know that you didn't?
19:04
>> Um, that, you know, girls have different
19:07
schedules during the summer and
19:08
different priorities. And so during the
19:11
school, they go to after school
19:13
activities. They go to libraries. They
19:14
go to places where you can find them.
19:16
But in the summer time, it's it's more
19:19
scattered. I mean, we
19:21
we spent hours at Oak Street Beach and
19:23
um South Side Beaches being like, maybe
19:26
we'll find people there. Um we stood at
19:28
bus stops. Like we did a lot of things.
19:31
And at the end of the day, our community
19:32
we just shifted the timeline. And then
19:36
September, October, we just hit our
19:37
numbers full throttle. And you know, we
19:40
did change some things. We changed some
19:42
language. We changed other strategies.
19:44
And so I think actually, I'm just
19:48
literally thinking of this right this
19:49
second, but
19:50
a probably a good lesson learned from
19:53
this is it's continual community
19:55
engagement, right? So we did this at the
19:58
start and we thought, okay, we have
20:00
everything. They approved the
20:01
recruitment materials, things like this.
20:03
But you know,
20:05
having them along
20:08
often is really important so that when
20:12
something's not working, you can change
20:14
directions sooner instead of, you know,
20:16
banging your head against the wall on
20:18
your own. Something I should know.
20:20
>> I mean, it's kind of like just having
20:21
like a continuous feedback loop, right?
20:23
You know,
20:24
build, test, measure, learn, right?
20:25
You're just continuously doing that that
20:28
feedback loop and that that's probably
20:29
an aspect that you're going to build
20:31
into your processes
20:33
>> Yeah.
20:33
>> moving ahead.
20:35
>> So one other thing that I always think
20:37
about community engaged work is that you
20:40
have to show up just as much as you want
20:42
people to show up for you. Um
20:45
I have this story where
20:48
we had a community advisory board for a
20:49
large survey we did back in like 2015.
20:53
There we had a pastor on our board and
20:55
he called me one day. This is back like
20:57
when you're office and you answer the
20:59
phone cuz you don't know who's calling.
21:01
>> Yeah.
21:01
>> I'm like, oh, hi Reverend Smith.
21:04
Melissa. Yes?
21:07
I realize you ask me to do things, but
21:10
I've never asked you. Well, I'm
21:12
preaching this Sunday and I'd like you
21:14
to come.
21:15
So, I don't know if you've been to
21:16
Missionary Baptist Church um
21:20
uh Sundays.
21:21
>> I've been to that particular church, but
21:22
I've been to a Baptist church and it's
21:24
lively.
21:25
>> It is not an hour
21:27
service. It's about 3 hours.
21:29
>> Yeah, yeah.
21:30
>> Um
21:32
but I came. My colleague came. We
21:34
brought our families, our little kids at
21:36
the time. And um and and so that's what
21:39
it is. Like you have to show up. It's
21:40
not
21:41
it's not like
21:43
a one and done. It's a continuous thing
21:45
and you know, I'm going to plug Sinai
21:47
again cuz I work there and I'm so proud
21:48
of it, but you know, you see Sinai
21:51
caregivers out playing pickleball with
21:53
community members. Right? Donating
21:56
pickleball pickleball paddles so that
21:59
community groups can play alongside
22:01
doctors and you know, participating in
22:04
runs the
22:05
uh triathlon that's now a through North
22:07
Mondale and
22:09
other events and you know, I and I'm
22:11
certain you see that everywhere, right?
22:13
I don't think that Sinai's unique in
22:15
terms of a health system. But what's
22:17
unique about it is that we're doing it
22:19
in the neighborhoods we serve. And and
22:23
and I don't think you got that from like
22:24
bigger hospitals.
22:27
And I love that pickleball, right? Like
22:29
those doctors don't need to be
22:31
inviting community members to play
22:33
pickleball with them, but like that's
22:35
what makes it so cool. And you know, to
22:38
round this back out is
22:40
um enhances the trustworthiness of this
22:42
system cuz it's not just health care
22:44
we're providing.
22:46
>> Yeah. Yeah, it's so much more.
22:48
>> Yeah, I know it.
22:50
>> It really is. It's It really is. You
22:52
know, you used a term with me It was a
22:54
while ago when we spoke in um that I
22:57
hadn't hadn't really like paid a ton of
22:59
attention to it, but for some reason
23:01
when you said it, like it just stuck in
23:03
my mind and it hasn't left since.
23:05
Inverse equity.
23:07
Explain that to me.
23:10
>> So the the thought process on inverse
23:13
equity is that um I think breast cancer
23:16
is the easiest example.
23:18
>> Yeah, give me the mammography example.
23:19
That's that's what I'm referring to,
23:21
yeah.
23:22
>> So
23:23
for a while we actually um
23:26
the the
23:29
breast cancer mortality, so the number
23:32
of women that die
23:34
from breast cancer was about three times
23:37
higher for black women than white women.
23:39
>> Mhm.
23:40
>> Now, why do people die of breast cancer?
23:43
Early detection,
23:46
treatment options.
23:49
So the question is
23:50
if there's nothing unique or different
23:54
about a black woman or a white woman's
23:57
breast,
23:59
it's access to care.
24:01
So anyway, these new technologies come
24:03
around for mammograms, right? And so one
24:05
of them is a 3D mammography machine. So
24:08
the individuals that got those first
24:11
tend to be private hospitals that can
24:13
afford them.
24:15
>> Right.
24:15
>> And so what happens is when you have a
24:17
hospital that
24:19
people with private insurance, which you
24:22
know, higher rates of them are white
24:24
individuals,
24:25
they get care through this new
24:27
technology, 3D mammography machines, and
24:30
can identify, you know, breast cancer
24:33
early on or early stage earlier on so
24:36
that they can address it and therefore
24:38
don't die. That when you use new
24:41
technologies widen the disparity gap,
24:43
right? But then like Sinai has one and
24:46
once you get it in um incorporated into
24:48
other hospitals, you start to see that
24:50
gap narrow. And so we've narrowed that
24:54
you know, breast cancer mortality gap.
24:56
And and we can see that being done in
24:59
Chicago
25:01
timeline of when other hospitals got
25:03
these technologies.
25:05
>> Yeah.
25:05
>> And it's a little scary, right? Because
25:07
tech is moving very fast in health care.
25:09
>> Yeah, it is.
25:10
>> And so we as leaders have to be beholden
25:15
to say are is every community getting
25:17
this?
25:18
I mean AI and health care right like
25:21
will all health systems and patients get
25:24
the same
25:26
um innovative new care and and if we
25:29
don't we're going to widen this life
25:31
expectancy gap and so that's the inverse
25:33
equity and you know, that's like for all
25:36
of us to say like hey
25:38
we got to pay attention this early on so
25:41
that we don't have the same huge gaps as
25:43
we did in breast cancer.
25:44
>> Just here's what bothers me about that
25:46
is like we can create something that you
25:48
know, objectively improves health care
25:51
and actually makes health inequity
25:55
worse.
25:56
Like
25:56
>> Yeah.
25:57
>> Does that mean that then the
25:59
from an innovation standpoint like
26:02
that's a distribution problem, right?
26:04
>> Yeah, and
26:06
you know, I
26:07
I think this is why bringing clinical
26:09
trials to safety net hospitals and
26:11
community hospitals is so critical.
26:15
You know, for new you know, much about
26:17
this but
26:18
I think Heather's been on your show.
26:20
>> Yeah, Heather. Yes, she's the best.
26:24
>> When we can bring these life-saving
26:28
technologies, devices, drugs to
26:31
neighborhoods, community members that
26:33
are not hard to reach, that want these
26:35
also and we present them in a way that
26:39
that is understandable, that they feel
26:42
safe and trusting to do them
26:44
we're going to save people's lives and
26:47
you know, if you think about that like
26:49
it
26:50
you know, this is not to be dramatic
26:51
here, but like that's someone's mom,
26:54
someone's kid, right? That you
26:57
got to have more, as I said, like
27:00
quality years with.
27:02
>> Mhm.
27:02
>> So, like that's why you bring it back to
27:05
that, you know,
27:07
that's someone's mom that you saved
27:10
through bringing these new technologies
27:12
to a place that maybe didn't have them
27:14
before.
27:16
>> Yeah, because it look, the way that
27:17
you're describing it to me, it sounds
27:19
like there is a difference between
27:22
bringing
27:23
a trial to a community,
27:27
and then there's sort of actually
27:30
building one with a community.
27:32
>> Yeah.
27:33
>> of two different things.
27:35
Subtle, but they're very different.
27:38
>> Yeah, and right, that's hard because
27:40
like, I don't know, we're putting
27:42
together a community a clinical trials
27:44
community advisory board right now. Um
27:46
that will help I sort of aid in Sinai's
27:50
clinical trial development, um
27:54
um advocacy,
27:56
I advocacy a word? Advocating for them
28:00
and really enforcing
28:02
>> Listen, it's your episode. You can make
28:03
up words if you want. It's fine.
28:04
>> Perfect.
28:07
Um
28:09
I
28:10
You know, so they'll they'll kind of
28:12
help guide us. And you know, we were
28:15
thinking about this and it's like, well,
28:17
they won't be picking the health
28:18
conditions that will be working on
28:20
because that you know, has some other
28:23
factors that are being involved. They're
28:25
like, well, what do they help us do
28:27
then? Um and it is getting their buy-in,
28:30
leaders in communities helping us know,
28:33
you know, again, what are these
28:34
recruitment strategies? Really bringing
28:37
them along on this journey with us.
28:41
Um and I think they're going to teach us
28:43
a lot more than we we bring
28:46
to them.
28:47
You know, my lecture on what a clinical
28:49
trial is is
28:51
not going to be the most fascinating
28:53
thing that happens during that year.
28:57
>> I want to I want to switch gears because
28:59
you're studying something that
29:02
um
29:02
This is like as a dad having younger
29:05
kiddos
29:06
caught my attention. So, you're studying
29:09
loneliness and mental health among girls
29:12
in Chicago.
29:13
>> Mhm.
29:14
>> Even though I have three boys, I still
29:15
think there's probably some similarities
29:17
there. What do you what are you seeing?
29:19
>> Yeah, um so actually
29:22
um so we did a large study on um female
29:25
identifying girls in the city of Chicago
29:27
around mental well-being and associated
29:29
factors. Um my area of research I
29:33
specialize in loneliness and
29:34
neighborhood characteristics and social
29:36
connection.
29:38
So
29:39
um I am going to plug we just released a
29:41
video on um the mental well-being of
29:45
black girls in the city of Chicago.
29:47
Um super cool and an innovative way of
29:50
like instead of data coming in a report
29:52
or spreadsheets, it's a little video the
29:54
information. So, super cool. I love it.
29:57
Um
29:58
>> Maybe when it goes live we'll put that
29:59
in the description. So, we'll share
30:00
that.
30:01
>> Okay.
30:02
So,
30:03
one of the I you know, I think this is
30:05
an interesting factoid is
30:08
after we collected this data, so we
30:10
found 60% of girls in the city of
30:12
Chicago are lonely. That's higher than
30:14
the national average, which is about 35.
30:17
>> Mhm.
30:17
>> Wow, 60. Damn.
30:19
>> Yeah, um and this was 12 to 18 um across
30:23
the city of Chicago. We have a very good
30:24
representation of white, black, and
30:27
Latina girls. So, our Asian population
30:29
we didn't have high enough numbers, but
30:32
nevertheless
30:33
um
30:35
but we wanted to unpack that a little
30:37
and when we met with girls um after we
30:40
had the data to contextualize the
30:42
findings,
30:44
you know, every adult wants to say
30:47
social media is the problem. Let's get
30:49
rid of social media.
30:51
And and we've just had some fantastic
30:53
wins in the social media um world um
30:55
with some money that will come from Meta
30:57
to hopefully um you know, improve mental
31:00
well-being.
31:01
But what the girls told us is that they
31:03
said, "That's all we've ever known. This
31:06
is all we've ever known. You cannot take
31:09
this away from us."
31:10
>> Right.
31:11
>> One of the things I'm sort of um coming
31:13
back around to this, but one of the
31:15
things we found is that
31:17
girls that um
31:20
when they are lonely, they turn to
31:23
social media
31:25
>> Mhm.
31:25
>> to avoid their loneliness. And the
31:28
problem with that is that these young
31:31
girls um
31:33
are turning to something else instead of
31:38
digging and dealing with some of these
31:40
emotions that are challenging. And we
31:42
want to learn how to deal with these
31:44
emotions when we're young so we don't
31:45
turn to these other you know, behaviors
31:48
like drinking and um other things as
31:50
we're older that are have worse
31:51
consequences.
31:53
So, the question then comes. We have
31:54
high rates of loneliness. We can't get
31:56
rid of social media. So, how do we work
31:58
with these girls to
32:01
develop other programs that we don't
32:03
take away social media. We work with
32:05
them. And the biggest thing we found um
32:08
to be impactful on various mental health
32:10
outcomes is having adult
32:13
in your life. It's the number one thing
32:15
we can do.
32:17
And that's solvable.
32:19
>> Mhm.
32:20
>> That's the cool thing about it. It's
32:21
like we can't stop social media.
32:24
Loneliness is an epidemic, but
32:27
we can we can get girls a trusted adult.
32:30
Whether or not that's a family member
32:31
and actually there was more important
32:33
that it wasn't a
32:34
>> Yeah, I was going to say does it I was
32:35
saying does it matter if it's a family
32:36
member or you're saying that it's better
32:38
off not being a family member in some
32:40
cases? Cuz is it because they can
32:42
confide in other of these adults or
32:44
>> You know, I don't I don't know the
32:46
reason why, so I'm not going to um
32:47
pontificate about it, but my data did
32:49
show that um having a trusted adult that
32:54
was outside of the family had a more
32:56
bigger weight and um
32:58
decrease in mental um
33:00
depression, anxiety, loneliness.
33:02
>> Mhm.
33:03
>> Um
33:04
and a lot of um
33:06
girls thought it could be a coach. It
33:09
was someone at school. Um a lot of girls
33:12
talked about after-school programs that
33:14
they were in that they had a trusted
33:16
adult um that they connected with
33:18
outside of school.
33:20
And this is the other thing, girls talk
33:22
a lot about third spaces, so wanting
33:24
places to engage with one another
33:27
outside of school and the home. So, you
33:30
know, that I just tossed a lot your way.
33:32
It's a lot going on, but I think the
33:35
cool thing is is like mental
33:38
health um
33:40
poor mental health is a problem in the
33:42
city of Chicago. It is worse for black
33:44
and brown girls.
33:46
People are turning to social media. We
33:48
already know that, but we have some ways
33:50
to solve it.
33:52
And that's the cool part, right? Like
33:54
cuz if there's no way if if we don't
33:55
know how to solve it, then you know,
33:57
it's just data collection, but uh for me
33:59
that's the exciting part and now we'll
34:01
take it to the next step and
34:03
um
34:04
try to find something meaningful for
34:06
organizations that's outside of my
34:07
realm.
34:08
>> I love that it's it's a trusted adult
34:11
because it's not necessarily having them
34:14
go back to the algorithm.
34:16
>> Yeah.
34:16
>> What does a trusted adult
34:18
you know,
34:19
give a kiddo
34:21
that the algorithm obviously is not?
34:24
>> Oh, um
34:27
I think there's face time. I
34:30
I think there's so much to be said about
34:32
looking someone in the eyes and having
34:36
you know, personal connection that
34:38
>> Yeah.
34:38
>> a human connection that we we don't get,
34:42
right?
34:43
>> Mhm.
34:43
>> Um, I think that adult gets to know you,
34:47
um, is really supporting your growth as
34:52
an individual, right?
34:54
>> Yeah.
34:54
>> And, um,
34:55
>> Yeah.
34:55
>> you know, we
34:57
coming back to the trustworthy is that
34:59
so many of these after-school programs
35:02
are run by these amazing girl serving
35:05
organizations
35:06
that I've I've had the pleasure of
35:08
working with.
35:09
And and and they show up for these girls
35:12
no matter who they are.
35:13
Right? Like no matter who walks through
35:15
their door, they have a program to put
35:17
them in.
35:18
They have someone that's willing to work
35:19
with them. And and that is so cool if
35:21
you ask me. So.
35:22
>> Yeah, that level of consistency. Um,
35:24
it's like the problem isn't that kids
35:26
have phones. Like you're like like
35:28
that's not going to go away like you
35:29
said. Um,
35:31
it's just how do we teach them
35:34
how to, you know, find resources, how to
35:37
connect with others when
35:39
when life hurts.
35:41
>> Yeah, and it's going
35:42
>> saying, like we we have to we got to
35:44
teach them that.
35:45
So, that's that's very, very interesting
35:47
to me. Before I forget,
35:48
>> Yeah.
35:49
>> can you maybe just do like a little
35:51
commercial for Sinai Urban Health
35:53
Institute? Where can people go to
35:56
to find out more information, to learn
35:59
about a bunch of the research and
36:00
studies? Just like
36:02
the floor is yours to kind of share all
36:04
that.
36:06
>> Yeah. Um, well, thanks for the plug. I'm
36:09
I I need to pull up the website, but,
36:10
um,
36:12
so, the Sinai Urban Health Institute is
36:14
the research arm of Sinai Chicago. Um,
36:17
but we're super unique, um, and
36:19
different than, um, academic
36:22
institutions that do research.
36:25
All of ours is community engaged
36:26
research. So, everything we do from
36:28
primary data collection of surveys to um
36:32
intervention implementation and even
36:34
evaluation, we do hand in hand with
36:36
community members.
36:38
We also have a large community health
36:40
worker program. We train community
36:42
health workers. Um so, if other
36:44
hospitals are interested in in hiring
36:47
community health workers, we train them.
36:49
People seem to like it. People have
36:51
hired us across the nation.
36:53
Um and we also have a really cool
36:56
evaluation team. So, a lot of funders or
36:59
organizations will um come to us and
37:01
partner so that they can see if what
37:03
they're doing is working. And not so
37:05
much is it working, but how do we make
37:07
changes? Um there's a social
37:09
epidemiologist. It's a
37:11
I highly recommend
37:13
um
37:14
people come uh and check us out.
37:18
Um and I think
37:19
>> sure we put the website in the
37:22
description. Not to put you on the spot.
37:24
>> He's a good
37:24
>> Or him. I'll I'll make sure we have it.
37:27
It's already going to be in there.
37:28
100% will be in there. And there's um
37:31
there is one more thing that I want to
37:32
bring up because you mentioned this.
37:35
You left Sinai.
37:37
And then you came back.
37:39
>> Yes.
37:39
>> And apparently that makes you a
37:40
boomerang.
37:41
>> Yep.
37:42
>> Why come back?
37:45
>> Uh it's just the best.
37:48
Um
37:49
you know, anytime So, I did leave. Um
37:53
I did some other things and I came back
37:56
to Sinai and the Sinai Urban Health
37:58
Institute and it's just it's a really
38:00
special place to work.
38:02
You know, for me
38:05
we, my team and I, are doing
38:08
cutting-edge research.
38:11
You would see that at other
38:12
universities, but I can daily see the
38:14
impact I am making on communities, that
38:16
we are making on communities. And you
38:19
just don't get that in other research
38:20
institutions, right? It's years. but I'm
38:23
watching it in people's lives and that
38:26
is so rewarding. And that's Sinai. And
38:28
then Sinai,
38:30
you know, um,
38:33
it's it's uh
38:35
you know, an organization that's been
38:36
around for a hundred years
38:39
that is dedicated to serving a medically
38:42
under-resourced area.
38:44
And you know, if that doesn't pull at
38:45
your heartstrings, I don't know what
38:47
will.
38:50
>> Melissa, it's been so nice having you
38:52
just on the show. Just just just like
38:54
just jamming out again feels uh
38:56
feels like we're at home. Uh just
38:58
drinking some tea and just catching up.
39:00
So,
39:01
for those of you that have tuned in, if
39:03
you're listening to this and you feel
39:04
like, you know, there was something in
39:06
here that resonated with you, please,
39:07
would you mind sharing it uh with with
39:10
trusted colleagues, with those that you
39:13
feel are entrusted, that that would do
39:15
something really great with this and for
39:16
them to share it. So, comment on it,
39:18
like it, all those great things.
39:20
Uh and if there is a topic that you
39:22
would like for us to explore
39:24
or even a leader that you want to hear
39:25
from, drop a note, let us know. We we've
39:27
got some huge huge plans this upcoming
39:30
year for more amazing episodes. You you
39:33
guys are you're not going to be
39:34
disappointed, trust me. And just
39:36
remember, this is this isn't a platform
39:37
about content. This is absolutely a
39:39
community. We do listen, we do want to
39:41
incorporate and make things better. So,
39:43
thank you so much again for listening.
39:45
Great to see you, Melissa.
39:46
>> Thanks for having me. Again, everyone.
39:47
Yeah, keep building with purpose, y'all.
39:49
And uh we're going to see you next time
39:51
on the Advancing Healthcare Innovation
39:53
Show.