Student-Run Free Mental Health Clinic Provides Care for the Uninsured

May 25, 2022 | Diversity and Inclusion, Inside Mount Sinai Psychiatry, Mental Health, Psychiatry

Student providers are trained in CBT and psychodynamic therapy, which has been shown to be an effective treatment for anxiety, depression, and other mental health concerns.

In the East Harlem neighborhood of New York City, residents without access to health insurance are receiving free outpatient mental health care, thanks to an innovative project at the Icahn School of Medicine at Mount Sinai. Part of Mount Sinai’s East Harlem Health Outreach Partnership (EHHOP), the student-run clinic offers no-cost, evidence-based mental and behavioral health treatments to patients in need.

Mount Sinai experts created the program from scratch more than a decade ago to meet the needs of the local population. “There was no model for this,” said Craig Katz, MD, Clinical Professor of Psychiatry, Medical Education, and System Design and Global Health at the Icahn School of Medicine and Faculty Director of EHHOP’s mental health clinic.

In 2021, the clinic served 75 patients, treating them on an outpatient basis for conditions such as anxiety, depression, and alcohol use disorder. Patients, medical students, and psychiatric residents are all benefiting from the program. As the clinic grows, it also serves as a model for other student-run health clinics to follow as they address the mental health needs of uninsured and underinsured communities.

Providing Mental Health Services for the Uninsured
EHHOP was launched in 2004 as a student-run free primary care clinic for uninsured adults in East Harlem. It has grown to incorporate a variety of services including women’s health, ophthalmology, and cardiology. The free mental health clinic was founded in 2009.

Patients are first enrolled in EHHOP primary care services. If they are identified as having a mental health condition not readily managed in primary care, they are referred for a consult at the mental health clinic. Trained medical student volunteers provide medication management as well as psychotherapy. The student providers also help connect patients to the on-site pharmacy, social workers, and an emerging alcohol use disorder buddy program, as needed. The majority of patients speak Spanish as their first language, and services are offered in Spanish, either by fluent medical students or through medical interpreters.

Overseeing the services are senior residents, who review each case and treatment plan with student providers. Patients are seen at least once a month, while those receiving psychotherapy and those who recently began medications have more frequent visits, either in person or through telehealth.

Early on, Dr. Katz and his colleagues made a decision to offer psychotherapy, even though it requires a greater time investment than psychiatric medications alone. “EHHOP is committed to offering care that is on par with the care patients with insurance would receive, to the best of our ability,” he said. “Research shows that for conditions like depression, medication plus psychotherapy tends to convey a more robust and lasting recovery, and our goal is to offer psychotherapy to any patient that wants it.”

Dr. Katz is also the founder and director of Mount Sinai’s Program in Global Mental Health, and he drew on practices from global mental health to train medical student volunteers in the principles of cognitive behavioral therapy (CBT). “Early on we wanted to offer individual therapy but didn’t have the person power. But global health research shows us that non-specialists can be trained to provide specific forms of psychotherapy,” he said.

Student providers are trained in CBT, in part because it’s manualized and relatively easy to train, said Cassandra Pruitt, a fourth-year medical student at the Icahn School of Medicine and a student provider active with the free mental health clinic. “There’s also a lot of excellent data about the efficacy of CBT for treating anxiety and depression, which are things we often encounter in EHHOP,” she said. Recently, the program began training student volunteers in psychodynamic therapy as well, an additional modality that’s been shown to be an effective treatment for anxiety disorders, depression, and other mental health concerns.

Evidence-Based Mental Health Services
The EHHOP free mental health clinic is an evidence-based program. Mental health clinic staff and volunteers collect data to monitor patient progress and ensure that the program improves outcomes. At each visit, student providers measure the magnitude of patients’ depression and anxiety symptoms using the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) scale.

In a paper pending publication, co-lead authors Alexandra Saali and Samuel K. Powell, both medical students and clinic volunteers, and colleagues found that the clinical service performance of the free mental health clinic was similar on most measures to outcomes for patients with Medicaid or private insurance. While HMOs in New York state had higher rates of acute-phase antidepressant medication management, the authors found no differences in performance in continuation-phase antidepressant management. What’s more, the free mental health clinic outperformed New York state commercial and Medicaid plans on optimal provider contacts for depression and follow-up care after emergency visits related to alcohol or drug use.

Outcomes data shows that patients in the free clinic get better with treatment. In addition to improvements in mental health symptoms, they also report improvements in various psychosocial domains, such as handling social situations, dealing with problems, and accomplishing goals. Patients also report high satisfaction with their clinic sessions.

Student volunteers, too, gain a lot from the program. “In a hierarchical structure like the medical school system, it’s incredible to have a place where we can be autonomous, and receive training in these psychotherapy modalities,” said Ms. Saali. “This has been such a rewarding experience. It’s a way to give back to the community by establishing long-term relationships with patients and serving people who otherwise couldn’t receive care.”

A Model for Free Clinics
Building on its successes, the free mental health clinic is launching new projects, including a CBT for diabetes program in which students trained in diabetes-specific didactics help patients with disease management, medication adherence, problem-solving skills, and managing the stress of a chronic illness. The program is also partnering with the humanitarian aid organization International Rescue Committee to provide EHHOP student providers to offer CBT sessions to Afghan refugees and asylum-seekers.

Meanwhile, Dr. Katz and other clinic contributors hope the free mental health clinic will serve as a model for other student-run free clinics to follow in offering mental health treatment to patients.

“The intention is for the design of our clinic, and the tools we use to measure outcomes, to be adopted among the hundreds of other student-run free clinics in the country,” said Ms. Saali, who brings experience to this effort as a former health care consultant with McKinsey & Company, the management consulting firm. “We also have an EHHOP consulting group that works with other programs interested in beginning or ramping up their student-run free clinics.”

The program is currently grant-funded, but it’s a relatively low-cost program since it relies largely on volunteers. “With the exception of medications, we’re extremely low-budget, and that’s because everybody gets something out of this: Patients get care they would otherwise not have gotten. Students get an opportunity to be primary mental health clinicians. And residents have a chance to play a supervisory role,” Dr. Katz said. “It’s a perpetual motion machine fueled by energy and need, and everybody is happy.”

Craig Katz, MD, is Clinical Professor of Psychiatry, Medical Education, and System Design and Global Health at the Icahn School of Medicine at Mount Sinai and Faculty Director of EHHOP’s mental health clinic.  

 

Samuel K. Powell is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.

 

Alexandra Saali is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.

 

Cassandra Pruitt is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.

 

 

Debunking Common Myths About Spinal Cord Injuries

Updated on Jul 7, 2022 | Community, Diversity and Inclusion, Featured

Richard “Woody” Wood enjoys wakeboarding, traveling, and other activities.

Among the top myths about people with spinal cord injuries are that they are to be pitied, that they always need help, and that they can’t lead independent and fulfilling lives. All of these were gently dispelled in a virtual talk led by Angela Riccobono, PhD, Director of Rehabilitation Neuropsychology; Richard “Woody” Wood, Outreach Program Coordinator in the Mount Sinai Spinal Cord Injury Rehabilitation program; and Yesenia Torres, Accessibility Outreach Coordinator of the New York City Taxi and Limousine Commission.

The talk, hosted by the Office for Diversity and Inclusion (ODI) at Mount Sinai, was titled “Debunking Common Myths about Spinal Cord Injuries” and may be viewed here. It was part of the second annual Raising Disability Awareness Virtual Talk Series, launched by ODI for Disability Awareness Month to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.

Yesenia Torres

Ms. Torres, who conducts training in disability awareness and etiquette, had two important tips:  If you wonder if a person with disabilities needs help “Just ask first,” she said. “Do you need some help, and how can I help you?  Those are the major questions.” And when referring to some with a disability, mention the person first, then the disability if it is relevant.

“We are us. We’re out there. We’re individuals. We do everything, maybe with a different form of doing it,” Ms. Torres said. “But our disability does not define us.”

Dr. Riccobono said while furthering diversity and inclusion, it was important to be both informed and socially aware of the issues that people with disabilities face. For example, those with spinal cord injuries often need more room to maneuver. With so many buildings having tiny bathrooms, narrow doorways, and stairs instead of elevators, life can be much more difficult for people with disabilities. In a health care facility, exam tables, mammogram machines, and even clothing racks may not be reachable for those with spinal cord injuries.

Ms. Torres and Mr. Wood recounted some of their own life experiences to dispel some common myths and point out the tremendous diversity within the community of people with disabilities.

Richard “Woody” Wood

One myth that people with spinal cord injuries face is that they are sad, depressed, or ill. “I’ve actually known someone who told me that they were sitting on the street and somebody just came and put money in their lap,” Dr. Riccobono said. Mr. Wood added that while he was waiting for a ride, a woman randomly gave him a dollar, even though he was talking on a brand new iPhone.

There is the mistaken belief that people who use wheelchairs cannot have fulfilling sex lives. “That’s the furthest from the truth,” Mr. Wood said. Ms. Torres added that her sex life is even better now. “Intimacy with your partner becomes very important and very powerful,” she said.

Angela Riccobono, PhD

The myth that people in wheelchairs can’t travel is also pervasive. “I travel a lot. And I’m actually organizing a trip to San Diego with my siblings, because I need a break. I’ve been doing too much,” Ms. Torres said, and described services that help with air travel. “Everything is out there for us. We go to the counter, and we say that we’re in a wheelchair. If we want, we can take our own wheelchair, or they could put us on a service wheelchair that’s very narrow and fits in the aisle of the plane. So, whoever wants to go out and travel, there are no ‘buts,’ because there’s help out there.”

Dr. Riccobono shared some recommendations, such as taking action by changing one’s beliefs and assumptions about people with spinal cord injuries, changing one’s behavior to include hiring people with disabilities to enhance inclusion in the workplace, and advocating for those who need it the most. “Listening to the needs of the community and working together to create positive change is an excellent way for experiences to get better,” she said.

 

Get more disabilities-related resources from Mount Sinai's Office for Diversity and Inclusion
View the webinar on life with spinal cord injury.

HOLA Volunteers Return to Help at Community Soup Kitchen

Updated on Jun 30, 2022 | Community, Diversity and Inclusion

Corporate Service Center Heritage of Latinx Alliance Committee and Members at The Father’s Heart Ministry in Lower Manhattan

Members of HOLA, the Heritage of LatinX Alliance Employee Resource Group at Mount Sinai Health System, in April once again partnered with The Father’s Heart Ministries for a community event.

HOLA member Paul Sanabria, Project Manager, Quality Operations, and Kelley Gonzalez, Trainer I, Application Training, Digital and Technology Partners, The Mount Sinai Hospital, arranged for volunteers to return on Saturday, April 23, to help at the organization’s soup kitchen and food pantry located in Lower Manhattan.

This time each HOLA member took on a different task in order to get a different experience while participating in the program. This experience has allowed the volunteers to meet many new people. They were able to serve 1,016 thankful guests.

“This initiative shows HOLA continuous efforts to give back to the community, while representing Mount Sinai Health System’s values of commitment to caring,” says Shawn Lee, Associate Director of Operations, Central Billing Office, Faculty Practice Associates. “The experience also reminds us that we should appreciate what we have and how important it is to help those in need of some assistance.”

The Father Heart Ministries offers a variety of programs, such as the soup kitchen and food pantry, tutoring, and job training programs.

HOLA members Ruben Rodriguez, left, and Regina Rivera hard at work in the kitchen prepping breakfast packages for guests

Graduate Students Helped Alleviate Staffing Shortages Caused by Omicron Surge

Updated on Jun 30, 2022 | Diversity and Inclusion, Featured

At the beginning of 2022 when the Mount Sinai Health System was experiencing a surge in COVID-19 patients, which included many members of its own staff, 60 students at the Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai stepped up to lighten the load of non-medical staff as part of a Student WorkForce.

It was the fourth time since the outbreak of COVID-19 that the Student WorkForce at Icahn Mount Sinai sprang into action to help alleviate staffing shortages. In the latest effort, they were part of a team of more than 200 medical, master’s, and PhD students who took on vital roles while many employees were out sick—staffing the waiting rooms and employee call center, coordinating employee testing, and even delivering food to patients.

The Student WorkForce was created in March 2020 as New York City hospitals became the national epicenter of the newly declared pandemic. Since then, tasks have been reshaped to meet new needs, and unlike in previous waves, the students received an hourly wage for their work.

“I was grateful for the opportunity to help,” says Yesha Dave, a second-year graduate student doing research in neuroscience. “I could somewhat understand the burden on health care systems after seeing it through the experiences of my sister and parents, who are all physicians.”

Ms. Dave worked in the Employee Health Services office at The Mount Sinai Hospital instructing staff on how to collect saliva samples for their own PCR tests and registering them for tests. She worked one or two shifts per week from early January through the end of February, seeing as many as 100 individuals per week. During a previous effort for the Student WorkForce in 2021, she had assisted elderly New Yorkers get their COVID vaccines, helping them navigate the lines and fill out the requisite forms. “I understood their occasional frustration and tried to make the experience as easy as possible for them,” she says.

Ms. Dave says she was attracted to Mount Sinai’s rich research opportunities, especially those related to COVID-19 and neuroscience when she enrolled in the graduate program. She expects to receive a Master of Science in Biomedical Science in June before starting medical school in July. “It’s awesome to be part of the Health System at such a historic time,” she says.

 

Oluwafunmilayo (Funmi) Oguns is pursuing her Master of Public Health (MPH) in global health, with a concentration in epidemiology and biostatistics. After graduation, her plan is to attend law school to focus on public health policy as it relates to social determinants of health. “When I received the email sent to medical school and graduate students asking for help to relieve staffing shortages brought on by skyrocketing COVID-19 cases after the holidays, I just knew I had to help,” Ms. Oguns says.

She and an MPH classmate, Spundan Davé, set up shop at Jane B. Aron Residence Hall and helped test hundreds of students who were returning to school following their holiday break, observing them self-swab, and offering whatever assistance was necessary to complete their testing. They spent 16 hours on this task the first week, while also taking classes. When Ms. Oguns herself tested positive for COVID-19 during the Omicron wave, she continued to work shifts after leaving isolation. In addition to this special project and her classes, Ms. Oguns is the editor of The Scoop, a Graduate School student newspaper.

Ms. Oguns lived nearly seven years in Nigeria, where she saw first-hand how lack of medical care impacts people’s lives. “All my grandparents in Nigeria passed away before the age of 65 due to limited access to health care and education,” she says. “That’s what motivated me to pursue a career in public health.”

Pamela del Valle is a fourth-year PhD student in neuroscience, where she is studying the sympathetic nervous system to shed light on the comorbidity of Parkinson’s disease and melanoma. She has been involved in a wide range of diverse organizations, both on campus and off, including the Student Council, where she focused on mental health and wellness for students; Students for Civic Engagement; and the Scientific Workers Collective, an organization dedicated to politically engaging the scientific community. She is also looking for ways to integrate her study of the brain with her passion for the arts.

So when the call went out for students to help deliver food trays to hospital patients during the Omicron surge, she says the assignment appealed to her and she found the experience moving. “I think it’s important for students to be exposed to all facets of the hospital, and I got to see a side of the hospital I don’t normally see,” she says. “It was eye opening to experience the camaraderie and the energy of the kitchen staff, to hear their music, and to see how lively it was while everyone was trying to work together to get their jobs done.”

Brian Soong, an MD/PhD student studying cancer immunology, had a different kind of inspirational experience. He served as an Emergency Department technician, filling in for the professionals who were among the hardest hit during the pandemic. Mr. Soong helped to check in patients, took their vitals, shadowed nurses conducting triage, and did whatever he was called upon to do.

“This was a once-in-a-lifetime opportunity to help our nation in crisis,” he says. “It was remarkable to hear the stories told by staff and patients and to understand how things have changed in the hospital since the first COVID-19 wave. I love doing research, but the patient interaction was entirely new to me, especially since our clinical experiences have been limited due to COVID-19. It was really fulfilling.”

Dina Doustmohammadi is pursuing her Master of Health Administration remotely from her home in southern California, so while she was eager to join the WorkForce, she was limited in how she could help. After a short stint clearing recovered COVID staff to return to work, she settled in as part of a two-person team scheduling asymptomatic testing at all Mount Sinai hospitals.

Working with a senior operations manager, she also coordinated the schedules of Student WorkForce participants and employees ensuring there was sufficient coverage where needed. “I liked the dynamic, fast-paced work environment that was always changing as testing demand and positivity rates ebbed and flowed and coverage needs constantly shifted,” Ms. Doustmohammadi says. She was also involved in verifying vaccine status for employees, ensuring all were compliant. All told, she logged close to 200 hours over six weeks.

Ms. Doustmohammadi is in a two-year program but is being fast tracked to complete her studies in one year so she can begin medical school this summer.

“I feel lucky that I was able to help,” she says. “This experience has taught me that the administrative staff have been the unsung heroes of the pandemic. Just as importantly, I really appreciate how helpful the entire Student WorkForce was and how they managed the demands put on the system. Had it not been for the students, it’s hard to see how the system would have been able to absorb the losses created by the staffing shortage. It was very inspiring to see everyone working together toward a common goal.”

An Employee’s Perspective: Living with a Disability—Advocacy and Support in the Workplace

Updated on Jun 30, 2022 | Community, Diversity and Inclusion

Bonnie Schwartz, an analyst for Mount Sinai’s Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program in the Department of Surgery, shared her experiences as a person with a disability.

Workers with disabilities should know their rights and be proactive in asking for interpreters or other accommodations, said Bonnie Schwartz, who is a Quality Improvement Research Analyst for Mount Sinai’s Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, and is deaf. “Mount Sinai always has honored and respected my requests,” Ms. Schwartz said in a virtual talk hosted by the Office for Diversity and Inclusion (ODI) at Mount Sinai. The session, “An Employee’s Perspective: Living with a Disability—Advocacy and Support in the Workplace,” may be viewed here.

The talk was part of the second annual Raising Disability Awareness Virtual Talk Series, launched by ODI for Disability Awareness Month. It featured speakers from around the Mount Sinai Health System and the community to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.

“Psychological, physical, and social barriers make it more difficult for employees with disabilities to be successful in the workforce,” said Ms. Schwartz, who shared her experiences as a person who identifies as having a disability. Only about 35 percent of people with disabilities in America are present in the workforce, she said, citing figures from the U.S. Bureau of Labor Statistics. She explained that fear of disclosure of a disability and how it will be perceived, communication barriers, and the stigma associated with having a disability are just a few of the obstacles.

Ms. Schwartz said her disability was especially challenging during the COVID-19 pandemic. Because masks are in the way, reading lips as a deaf or hard-of-hearing person is impossible. “Many people are not aware that a face mask can be considered a physical barrier for people like me, who rely on reading lips and facial clues,”
she said. During COVID-19, Ms. Schwartz made an effort to educate people about accessible options such as clear masks. Some masks are created with transparent screens in front of the mouth to allow for easier lip-reading.

Based on her experiences, Ms. Schwartz recommended that employers avoid making assumptions, educate themselves on different disabilities and accommodations, be flexible, and always use an approach that promotes diversity, equity, and inclusion rather than a “one size fits all” message. She also explained that employees should know their rights, educate themselves, ask questions, and research the company’s best practices and disability information before working for them.

For Mount Sinai employee accommodations requests, staff may reach out to Labor Relations at their site. To learn more about the services offered for patients, please visit the Language Services webpage.

Learn more about disabilities-related resources offered by Mount Sinai's Office for Diversity and Inclusion

Building Physician Skills and Competencies in the Care of People with Disabilities

Mar 16, 2022 | Community, Diversity and Inclusion, Rehab Medicine

Eliana Cardozo, DO, Assistant Professor of Rehabilitation and Human Performance, with a patient. Photo taken before the pandemic.

While it is important for physicians to skillfully and compassionately care for patients, specific competencies may improve the experience for patients with disabilities, said Jenny Lieberman, PhD, Senior Occupational Therapy Rehabilitation Specialist at the Department of Rehabilitation, Medicine, and Human Performance, who was the featured speaker for a virtual talk hosted by the Office for Diversity and Inclusion (ODI) at Mount Sinai. The session, “Building Physician Skills and Competencies in the Care of People with Disabilities,” may be viewed here.

The talk was part of the third annual Raising Disability Awareness Virtual Talk Series, launched by ODI for Disability Awareness Month. The series featured speakers from the Mount Sinai Health System and the community to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.

Patients with disabilities may face a wide range of neurological, orthopedic, or medical challenges, said Dr. Lieberman, who is an occupational therapist, researcher, and educator. “There are a varying range of diagnoses,” she said. “But many times the presentation will be similar when it comes to their disability. The worst thing that we could possibly do to any patient that comes through our doors is to make them feel invisible. This is their life. This is what they’re living on the day to day. So it’s really important to recognize them so they feel they are heard, and not invisible.”

Jenny Lieberman, PhD, Senior Occupational Therapy Rehabilitation Specialist.

The first key is knowledge, Dr. Lieberman said. Having awareness of specific secondary diagnoses that develop is key to providing good care—for example, knowing that a person with a spinal injury also could develop urinary tract infections, skin irritation, or autonomic dysreflexia, a sudden increase in heart rate blood pressure. Assessments and evaluations often differ for people with disabilities during medical appointments. For example, only 5 percent of people who use wheelchairs are weighed during their visits, which affects proper dosage of medication and management of their health, Dr. Lieberman said. The solution may be using a lift or an assessment table with a scale. Even if you cannot weigh them during the visit, you can validate their concerns by acknowledging your awareness that this is a problem that needs a solution.

Tasks like weighing patients, conducting secondary diagnoses, and administering medication might require different equipment and accommodations. Dr. Lieberman recommends to “be aware if someone is coming to you with a disability,” she said “The support services, access, and requirements should be in place beforehand to ensure that they get the treatment they need.”

People with disabilities often feel invisible or viewed as incompetent during their health care experiences. They also do not receive adequate information about treatments and interventions, often have access limitations, have to advocate for themselves, and may have trouble getting the financial or insurance support they need. Dr. Lieberman said clinicians can address these important issues if they are culturally competent and understand this population’s experiences.

Dr. Lieberman also discussed ways clinicians can ensure that patients with disabilities are heard: “Do a thorough chart review before you see the patient. Introduce yourself. Acknowledge their history, ask them if they’re still experienced the symptoms they were previously experiencing, and validate their concerns and symptoms,” she said. “While all of this seems very obvious to do, it doesn’t translate to our patients. They often don’t realize that we have looked into their chart and we actually have some backstory on them.”

In the end, Dr. Lieberman suggested that physicians and other providers always be empathetic and patient. They should create an environment that makes everyone feel safe and comfortable and speak to a person with a disability in language they are able understand so they can actively participate in their care plan.

Mount Sinai's Office for Diversity and Inclusion offers more disabilities-related resources

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