Connecting on Mental Health Services and Health Equity in New Jersey

Transcript

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Amy: 

- Thank you so very much for joining me today, as you know, I'm Amy Mansue, CEO of Inspira Health. And today I have the honor of being with Anthony DiFabio, the President of Acenda Health. Dr. DiFabio has been one of the warm receptions that I've received since coming to South Jersey. And we've had great conversations about the work that Inspira and Acenda can do. And I just really am grateful for being here, but really look forward to talking about your story and Acenda's story. 

 Dr. DiFabio: 

- It is a pleasure to be here. I am looking forward to spending some time with you. 

 Amy: 

- And we are so grateful, obviously, for the tremendous work that you and your team have done, especially during COVID. It was not easy for any of us in healthcare, but especially for those in the behavioral health space. So, tell us a little about your journey. Did you grow up in the area? 

 Dr. DiFabio: 

So, I grew up in North Jersey, so the tale of two New Jerseys. So I was north of 195, so part of the New York, New Jersey side, as opposed to what is now my new home of the Philadelphia, New Jersey side. And grew up just outside of Newark. And my journey was tailor-made for me to be in the role I am today. And it involved me through my family experiences, having the impact that many families using our service today had. Our family was an amazing family, came over from Italy. My dad migrated over through Ellis Island. My mom's family was also Italian, she grew up in Newark. Very poor family, but no shortage of love in the family. But what was interesting was we were confronted with a lot of different challenges. 

My parents were young and working hard, but one of my sisters, who's an amazing mom now, had some significant medical challenges. When she had to go through many medical procedures, surgeries, she spent months in the hospital. And a lot of our play dates growing up were at the hospital, and a lot of our time as children were staying at different family members' houses, because my dad was always working.  

Another one of my sisters has neurodiversity. And so, we learned about seizures and what they mean and represent for someone where they are not hitting some of those milestones. And where they might progress through, a life of incredible value, and incredible purpose, and incredible impact. But maybe by other peoples' lenses or standards, maybe they might act or be a little bit different.  

The oldest was, and I don't know if she'll ever know, but she was my greatest inspiration, because she was the oldest with all this going on. And I think, you know, she was introduced to some of the wrong people. And as a result, she went down some paths with substances, you know, that really put her deeper into other complex challenges. And I think, you know, a lot of us have seen this story.   

Amy: 

- It's so interesting when you talk about the family dynamic, right? I mean, and how you then end up dedicating your life to people who you are now supporting through their own journey. 

Dr. DiFabio:  

- You know, what's interesting is, like, it really speaks to not only my development and evolution as a leader, but, in a very humbling way, the evolution of Acenda. Where we realize that the organization before Acenda, you know, was called Robins’ Nest. And they started as a group home for adolescent girls labeled ‘incorrigible’ because they were trying to protect themselves or run away from challenging situations at home. 

Amy: 

- So abuse, neglect, things that, you know, sometimes people find themselves in. 

Dr. DiFabio: 

- That's exactly right. And in the case of Robins’ Nest, they were given a loving home to be able to come to, and get support. Off that program, Robins’ Nest built in-home services, and we realized there was great stuff happening within that residential home. But then they went back into that household. And that household, the parents, the caregivers, were not given the tools to be able to really accept them back in, in a way that was going to be healthy. For most of those individuals that were, you know, working through Robins' Nest, the children that were in our services, the families that we were working with, at the root cause of that was, you know, no surprise—poverty, homelessness and housing instability, mental health challenges that the parents themselves are going through, substance use challenges, domestic violence. And so the vision that is Acenda was, and is, for us to be an organization in a more holistic way, in a more integrated way, is able to say, "We're going to be there with and for that child, with and for that adult, with serious persistent mental illness, with and for that family that is trying to navigate some of the challenges that life can sometimes put in their way." And we're going to do that in a way that is going to be non-stigmatizing, non-judgment, but is, you know, going to be focused on empowerment and compassionate care, that happens to be evidence-based and best-in-class care. But for them, we want them to feel valued. But in point effect, we have over 50 different locations.

Amy:  

- Wow. 

Dr. DiFabio: 

- We provide services to individuals from every county, but we have locations in 12 of those counties. 

Amy: 

- That's amazing, how many employees do you have now? 

Dr. DiFabio: 

- We are about 750 or so employees. This year we'll provide support and services to over 20,000. 

Amy: 

- 20,000 people, wow. Again, children and adults. 

Dr. DiFabio: 

- Children and adults, core community mental health programs, everything from outpatient to partial outpatient, intensive outpatient, psychiatric screening and crisis programs, residential treatment programs. You know, and then we were able to build out an exciting network, where we were able to get further into prevention services. And we were able to build out our maternal health programs. And at this point we have over 100 different programs- 

Amy: 

- That's amazing. So how do people access these services?  

Dr. DiFabio: 

- What we've tried to do is structure it in a way where we can have an access center model. So, if someone calls 844 for Acenda, they can speak to our staff, ask questions, and tell them what they're looking to get support with, and we can walk them through that. We also have a website, acendahealth.org, that has a lot of information for them. The truth though is that, in some instances, some of our programs are gatekeeped. 

Amy: 

- Right. 

Dr. DiFabio: 

- And I don't mean that to be derogatory, it's just-

Amy: 

- Yeah, reality. 

Dr. DiFabio: 

You're not going to have access to programs supporting children involved in a child protection and permanency program. 

Amy: 

- Unless they're in crisis. 

Dr. DiFabio: 

- Unless they're in that situation. Right. 

Dr. DiFabio: 

- And so there's a lot of questions, and I think one of the things, and I know your team has been working on this, we've been working on, we're working on it together at an unprecedented level. Is when they're experiencing that level of need, when they have the complex challenges that are confronting them, they're scared, and they're worried, they're fearful, they feel like they've lost control. We can't ask them to figure out how to navigate a system that might have 20 different providers, across a certain area that has different criteria for those. We wanted to say, "Make this call." Call our access center, call your access center. You know, and we'll walk them through how they can get the support and resources they need. 

Amy: 

- One of the things I just love about Acenda, and mostly about your philosophy, is how do we break down those barriers? Unfortunately, there's more than enough need. We don't need to compete for this. We need to figure out how to do this better. And by trying to create that seamlessness, I think we are trying to work on that together. But that philosophy of yours, and that you then permeate through the organization, has led to some recent success, in reference to the Robert Wood Johnson Foundation.  

Let's talk about the big award! 

Dr. DiFabio: 

- Yeah, and talk about a transformational opportunity. Really, and when I say that, I don't even mean for Acenda, I mean for New Jersey. 

Amy: 

- I agree. 

Dr. DiFabio:  

We are invited to be a part of something much bigger than ourselves and our organizations. And for us, the Robert Wood Johnson Award, for us to create and incubate New Jersey's first Public Health Institute, and the nation's First Public Health Institute that was created specifically to address health equity, is incredibly humbling. 

Amy: 

- Well, you start, though, with what you shared with us already, right? We exist in 21 counties, we have these hubs. So you've got a footprint everywhere, and it's different than an academic exercise. You're still gonna be evidence based, but you're looking at it from the lens of what you've just gotten done talking to us about, which is the family in crisis. Often those people who find themselves, as your parents were- 

poor, trying to make everything work, doing the best they can … And then medical challenges, disability challenges, all of these things. And then here you are, and now you have a platform to have that conversation. 

Dr. DiFabio: 

- Not to mention just how much work have we and our teams been doing on prevention. Not having it get to a point where they're going to need those more intensive services. Quite honestly, one of the things I know we both talked about, and our teams are talking a lot about, is we don't want, if possible, someone's entry into the system to be through an emergency room. But through a crisis program we wanna be able to give them education and engagement early on. And hopefully get them from, keep them from getting into that crisis state. And if, you know, and even if they're starting to see a sign or symptom of there being an issue, to get them access to that outpatient, you know, or those other levels of support. So we're not just a crisis-driven system. The Public Health Institute will allow us, in a full-scale way, to move the needle for our communities and state generally. And the heavy focus is going to be on health equity, it's always been an issue, and I think COVID just shined even a brighter light on it. But one of the most exciting things about this is, because, and I think Inspira is a little unusual under your leadership, in that you understand health not simply as access to medical care for someone who is sick, or who is injured. Your health, my health, all of our health, is defined based on our quality of life, and the quality-of-life experience we have. That's what public health is about. 

Amy: 

- So now this is where you and I geek out, right? I'm a social worker, you're a psychologist, so now we're going to go into those models of care. And we promise we won't lose the audience, but I think here's the fundamental issue. With the right tools, people who are, before they get to crisis, can see the signs of crisis, can access those services without fear of stigma. 

Dr. DiFabio: 

- That's right. 

Amy:  

- Right, it's not a sign of strength to gut it out. Which I think is how many of us saw mental health. They are practical tools, there are services and experts who you need to go to. And it's just like any other health condition. And maybe the fact that so many people experienced it through COVID, that will change some of it. But we both know, every single day, we see our own teams themselves still hurting and still coming to work and still feeling that care for others. How do we, as you think about the work that's coming out of this institute, it's not direct care, but about driving the conversation? Or how do you envision it? 

Dr. DiFabio: 

- First and foremost, it's what we talk about whenever we see each other. It's about acknowledging, as individuals and professionals, who've moved into mission-based work. That if we're about our mission, it must be bigger. We know we need it to be more seamless when you're moving through some of these different, you know, resources that are in our communities. And I think the most important first step is for us to, as I said a minute ago, is to say health is physical, but it's also social, and it's also emotional. It's not just access to treatment, but it's also those social determinants of health. Do you have access to a safe, stable home? You can have the best pulmonologist. They go in and see, have the right diagnosis and clinical path to get them to a healthy place. But then they go home, and they have mold spores in their house, because they do not have a roof that is repaired. 

Amy: 

- Right, so the lung doctor, you know, can't control the housing environment, but they keep medicating them, seeing them, but it just gets worse, because we can't change the environment. 

Dr. DiFabio: 

- That's right, and we see that with childhood obesity, and with kids that were given medicine, because they have high blood pressure, and high cholesterol and, you know, other myriads of challenges. And can we give them medicine for that? Yes, we can. But can we also talk about structuring an after-school environment, giving them access to, like, a healthy adult figure giving them healthy food, you know? And to be quite honest, break that multi-generational cycle of poverty, and of poor health outcomes, and, you know, quality of life that is not okay. I mean, they need and deserve to be able to express themselves in this world, and to grow and develop and blossom in this world. And we shouldn't be taking that opportunity away from anybody. And so I do think this is a time for us to be courageous. And I do think you raise a really good point, and it's one we made, and I'm so appreciative of the Robert Wood Johnson Foundation for hearing it. Urban areas need a tremendous amount of support in resources, and public health has a very real role to play there. But our suburban communities are hurting. And our rural communities, the barriers and access to care are profound. At least in urban areas, you have greater density and access to many different settings. If you're in Cumberland County, rural Cumberland County, Salem County, Cape May, even, you have real barriers to resources. And we must do something about that. 

Amy: 

- And it is going to require work and time. But the first step is got to be in the conversation. 

Dr. DiFabio: 

- 100% 

Amy: 

- So, if there's any organization that I know can begin to bring stakeholders together, and convene those conversations, and really set the path out, the Robert Wood Johnson Foundation did an excellent job in acknowledging the work that you do. There are lots of people, I've told you this already, who are already calling, "What is the Acenda thing, do you know him, can you connect me?" And it's an honor for us in our area to have, you know, your leadership and to partner with you. And so, I want to thank you so much for the time today. 

Dr. DiFabio: 

- Well, thank you. 

Amy: 

- I'm sure we're going to put up the number that you said, because I know people are going to want more information about Acenda, and we just wish you such great success. And of course, know that Inspira stands by you to continue this, our partnership, and our discussions on how we make our communities stronger and better. 

Dr. DiFabio: 

- Thank you, thank you for your support. Thank you for this opportunity to talk about this incredible organization and what we're doing. But also thank you for allowing us to be models of what it is that we are talking about today, which is true partnership. Where we are really in it together, and we're committed to, through partnership, to be more, and bigger, and more robust, and more impactful, than we could otherwise be independently. So, thank you for that.