Gruler Nation Podcast

Episode #93: The Importance of Integrated Health Care with Dr. Cara English

March 11, 2020 Robert F. Gruler Jr., Esq.
Gruler Nation Podcast
Episode #93: The Importance of Integrated Health Care with Dr. Cara English
Chapters
Gruler Nation Podcast
Episode #93: The Importance of Integrated Health Care with Dr. Cara English
Mar 11, 2020
Robert F. Gruler Jr., Esq.

Dr. Cara English is featured on episode #93 of the Gruler Nation Podcast. Dr. English has been a counselor for over 16 years, with specialties in women’s health, perinatal mood and anxiety disorders, infant and child development, and family wellness. She earned a master’s degree in counseling in 2002 from Northern Arizona University, and worked as a community and school counselor and behavioral health consultant in a wide variety of settings during her graduate work at NAU.  

 

Dr. English currently serves as a DBH in the birthing community of Phoenix. Dr. English collaborates care for mothers and families with physicians, nurse midwives, pediatricians, psychiatrists, IBCLC’s, and a variety of community organizations to improve health outcomes. Dr. English is the CEO of Cummings Graduate Institute, an online, non- profit university, which continues to help the behavioral healthcare field evolve in numerous ways. 

 

To learn more about other educational offerings, such as continuing education, work- force development, and partnership opportunities please visit cgi.edu.

#counselor #womenshealth #perinatalmood #anxietydisorders #childdevelopment #integratedhealthcare #counseling #education #behavioralhealthstudies #physicians #highereducation #passion #podcast #InspirationwithGrulerNation #inspire #gruler #inspiration #GrulerNation #GrulerNationPodcast #gnp #arizonapodcast #scottsdale #yesphx #phx  

 

The Gruler Nation Podcast is a show that focuses on conversations with interesting "Level 10" people passionate about changing the world with their work, relationships and ideas. The show is hosted by Robert Gruler, an attorney and founding partner of the R&R Law Group, a criminal defense law firm based in Scottsdale, Arizona focused on helping good people charged with crimes move forward with their lives.   

 

Interested in being on the show or have a guest recommendation? Email Robert directly at robert@rrlawaz.com or visit www.robgruler.com for more information.  

 

Show Notes Transcript

Dr. Cara English is featured on episode #93 of the Gruler Nation Podcast. Dr. English has been a counselor for over 16 years, with specialties in women’s health, perinatal mood and anxiety disorders, infant and child development, and family wellness. She earned a master’s degree in counseling in 2002 from Northern Arizona University, and worked as a community and school counselor and behavioral health consultant in a wide variety of settings during her graduate work at NAU.  

 

Dr. English currently serves as a DBH in the birthing community of Phoenix. Dr. English collaborates care for mothers and families with physicians, nurse midwives, pediatricians, psychiatrists, IBCLC’s, and a variety of community organizations to improve health outcomes. Dr. English is the CEO of Cummings Graduate Institute, an online, non- profit university, which continues to help the behavioral healthcare field evolve in numerous ways. 

 

To learn more about other educational offerings, such as continuing education, work- force development, and partnership opportunities please visit cgi.edu.

#counselor #womenshealth #perinatalmood #anxietydisorders #childdevelopment #integratedhealthcare #counseling #education #behavioralhealthstudies #physicians #highereducation #passion #podcast #InspirationwithGrulerNation #inspire #gruler #inspiration #GrulerNation #GrulerNationPodcast #gnp #arizonapodcast #scottsdale #yesphx #phx  

 

The Gruler Nation Podcast is a show that focuses on conversations with interesting "Level 10" people passionate about changing the world with their work, relationships and ideas. The show is hosted by Robert Gruler, an attorney and founding partner of the R&R Law Group, a criminal defense law firm based in Scottsdale, Arizona focused on helping good people charged with crimes move forward with their lives.   

 

Interested in being on the show or have a guest recommendation? Email Robert directly at robert@rrlawaz.com or visit www.robgruler.com for more information.  

 

Support the show (https://www.ericshouse.org/donate/)

Speaker 1:

This is episode 93 of the Guler nation podcast. My name is Robert ruler, joined today by dr Kara English from the Cummings graduate Institute for behavioral health studies. We're going to talk a lot about what she does there at the CGI a center. We're going to talk about what a DBH is because that was the first time that I've seen that acronym and we're going to talk a lot about healthcare and things like integrative medicine, but first, before we dive in, let me give you just a little bit of an overview of Dr. English. Let me tell you a little bit about her. So she has been a counselor for over 16 years. She's got a lot of specialties and women's health, perinatal mood, anxiety disorders, infant and child development, and overall family wellness. She's got a master's degree in counseling in 2002 from NAU, which is Northern Arizona university and she's just, she's done a lot.

Speaker 1:

The, the bio, the resume is very, very substantive. I can tell you that today she serves as a DBH. Was it, which is a doctor of behavioral health in a bourbon community in Phoenix that all sorts of services are provided. Things like primary care, pregnancy, postpartum, um, uh, dealing with postpartum mothers who are experiencing perinatal mood and anxiety disorders. Basically anything that sounds like related to birth is, is something that dr Carrie English can help with. And today we're going to spend a lot of time talking about the Cummings Institute and the background on that and why maybe it's time for a shift in how we think about healthcare. And so I want to thank you for coming on the show. Dr. English. Thanks for being here today.

Speaker 2:

Nice to be here. Thanks for inviting me.

Speaker 1:

Yeah. So why don't we talk, why don't we just start with kind of integrative care and integrative health care kind of a, you know, that word is thrown around a lot I think. I think it's kind of permeating into the mainstream a little bit more than than maybe five, 10 years ago. So can you just keep kind of, you know, give us an overview on that for people who do not know what that is or what we're talking about.

Speaker 2:

Sure. So integrated care means, um, services that are, we basically want to remove the silos between the different specialties of care. So for example, if you think about going to your primary care physician for your annual physical, some people may be already getting a depression screen. Like my grandmother who's 91 years old just told me that she went to her primary care doc for a good, you know, annual physical and she said, Oh, you know, he screamed me for depression. And I said, that's great. That's the beginning of integrated care. We're looking at not just your, you know, hypertension and, and what is your blood sugar and you know, what are the rest of your labs? And, um, you know, our, we're looking for moles, but we're also checking for mental health signs and indicators that you may have a behavioral health component that we need to look at as well.

Speaker 2:

So integrated care is really removing that gate that is imaginary between the head and the rest of the body. There's no gate there. As it turns out, everything that goes on with the organ in our head and in our skull affects the rest of our body and vice versa. So the idea with integrated care is to bring behavioral health practitioners who are really in screening, assessing, identifying and treating mental health issues into primary health and other medical specialties where you see higher incidences of depression and anxiety and maybe even things like, um, obsessive compulsive disorder or things like substance abuse so that we can treat the whole person and not make the person take a list of referrals for, you know, therapists in the community and then go home and it's on them, you know, to call people and see if they can get an appointment, which we know that the rate is less than 20% of people will actually follow through on one of those community referrals versus if we have a behavioral health person integrated in primary care or specialty care.

Speaker 2:

And you say, let me introduce you to Dr. English. She's just down the hall. She's real expert in this condition. That's what we call a warm handoff. You bring that person in, the person is over 80 to 90% likely to follow up with care with that person and so it just makes a lot of sense because it's patient centered. It's around what their needs are, what their time limitations are, and really what they're willing to do in terms of removing that stigma from, you know, Oh this is separate. It's secret, it's shameful. So we're really trying to do a lot of reducing that stigma of getting help for mental health issues because we're trying to explain the degree to which it affects physical health and put it in under the same roof and in the same place where the rest of your healthcare is being addressed.

Speaker 1:

Yeah, yeah. I, I, to me it feels like, or at least this is what I had thought. You know, when I go see my primary care doctor, I kind of feel like that's what he should be doing. And maybe that's, you know, in my mind it's this idea that that's, Oh that's what he is doing. You know, he's going through his checklist and he's, you know, he spends 15 minutes with me or whatever and you know, checks that checks this, looks in your ears, looks in your mouth, asks how you're doing, how's work going? And so you know, you kind of feel like they're doing all of that. But that's not the reality.

Speaker 2:

The reality is that it is really a very small percentage of primary care physicians who have integrated behavioral health care screening into their practices and even fewer who are actually able to do anything about it. If you do screen positive for depression, anxiety or really high stress, maybe even trauma. PTSD. Yeah. And so the idea is that with an integrated behavioral health provider that's your specialty, they have a colleague in their office on the medical team who is there to be able to address those issues because primary care physicians, other medical specialties do not have adequate training in behavioral health conditions in terms of identification, even even through screening, not to mention treatment. And so the first line of defense for most of them is a prescription and that's not what most patients want. Most patients would prefer to have psychotherapy over medication because there are few side effects with psychotherapy.

Speaker 2:

Sometimes people feel worse before they feel better with psychotherapy because you're into areas that a lot of people have been avoiding for a long time. So when you start to address those areas head on, it gets a little uncomfortable. So people might have that side effect, but you're certainly not going to have the weight gain or you know any of the other number of side effects that often come, which all of us are familiar with. If we've been watching TV in the last 10 years. Yeah. Then we've seen, you know the laundry list of side effects that go along with most medications, so the idea is if we can a teach a primary care physician to be a little bit more like a behavioral health clinician in assessment by giving a, you know, five minute screening tool like a depression screen and then if that screen is positive to do the warm hand off in their office to that behavioral health clinician who can say, you know what, we can do something about this. It's okay. The treatment can be brief or it could be a little bit more longer term, but we need to do a little bit more assessment just like you would do if you saw high blood sugar just like you would do if you had hypertension or just like you would do with any other chronic issue that was identified in that short 15 minute visit with your physician.

Speaker 1:

You've obviously been doing this for a long time. Do people really want that type of treatment? I mean in my, in my sort of just observation, I have no experience in it. People kind of want that pill. I would presume, you know, they want to go to the doctor because they, it's, it's, it's transactional. I go in, I've got a problem, I feel bad about my life or myself or I'm feeling suicidal or you know something and they want to go in and they want to go out knowing I'm just going to run down the street to the pharmacy and I'm going to have my solution. Right. And that's sort of kind of been conditioned in our culture. Now you can, one time, you're absolutely right about that. Press a button. You get an Uber dial, an app, you've got a pizza at your door in 30 minutes. So what you're proposing or what this movement is, is, is kind of championing, is sounds like a lot of work.

Speaker 2:

It is a lot of work. Um, but we also know that the outcomes are much, much stronger for patients who are willing to take that route. So the whole idea behind our integrated care movement is really to risk. Well, this part of the integrated care movement, there are lots of different aims. Um, but one of them for our doctors of behavioral health is to restore psychotherapy as the first line of defense when there's a mental health component. So for example, if a person with diabetes also experiences depression, it could be related to a lot of different things, stress in their life. It could also be related to the stress of having a diabetes diagnosis and the regimen that is involved with doing blood sugar checks multiple times throughout the day. Having to manage a different diet, which is stressful for most people to have to, you know, do dietary change, physical activity, adding it or changing it or increasing it is very difficult for most people to make that change.

Speaker 2:

And so without support they are much less likely to be able to effectively or successfully make those changes and sustain those changes in life. So the likelihood of them to have depression again or to have depression is much higher than if they are working with a behavioral health specialist who can help them with accountability, help them set some goals and work towards those kind of like a life coach would. So in a lot of practices, especially with um, what we call federally qualified health centers where you're seeing much more integration, it's the population of people who are eligible for Medicaid and Medicare. And so we're seeing behavioral health at increasing levels in those kinds of places because those populations have a higher risk for behavioral health conditions. So in those kinds of places, what we're seeing is that with behavioral health provided right there with the care that they're getting for other medical conditions, we're seeing a much better outcome in the long run as well as in the short term, short term from being able to actively address how do I reduce stress, what are my coping skills?

Speaker 2:

Are they adaptive as in helping me or are they maladaptive? As in I'm super stressed at work. I had a really long day, I'm going to come home and have a beer in a couple of weeks. That beer turns into two beers in a couple more weeks. That beer turns into three beers and a shot of whiskey, et cetera, et cetera. So you know, those kinds of coping skills that we use can be maladaptive or they can be adaptive. Maybe I come home and I try taking a walk with the dog instead for 30 minutes and I connect with nature. Maybe I say hello to a couple people on my street that I wouldn't have otherwise. Maybe I noticed that it's a beautiful sunset outside and my mind gives, gets a little bit lighter and so there, there are little changes that we actively advocate for that patients can make. It's not a huge dramatic change, but maybe even just a 1% change in the life that can lead to a huge long term quality of life difference that doesn't involve all the side effects that medication might.

Speaker 1:

Yeah. And as you were speaking, I was thinking about a situation that we had, I told you before we hopped on here that I am a 12 step guy. You know, the substance abuse stuff is important to me for a number of different reasons. You were kind of going through that example of, you know, somebody who kind of slowly starts to become, uh, an alcoholic. We talked. Yeah. And I've been there, you know, we talked about some of the stuff that I've been through in my life. The audience has heard about that in the past. And so it's, it was very interesting. We were working with this guy, and I'm of course not going to mention his name, but he was in our men's group and we meet every, uh, every single Tuesday. And he came and he, he was talking about one of our first meetings with him.

Speaker 1:

It's a sponsor, sponsee type of situation. And he was telling us about all these problems that he had in his life. And one of the biggest things that was sort of a thorn in his side was all of these doctor's appointments that he had. And so he had a hip guy and he had a kidney person and he had a a counselor and he had a, you know, all, all of these different things. Most of them were meant to address some sort of physical element that was going on. And so we said, well look man, I think if you, if you made an effort to cut out the alcohol, I would guess that about eight of the 10 would probably just go away in

Speaker 3:

a matter of months. But, but none of those doctors, Nope, they don't want to talk about,

Speaker 2:

it's not their training, it's not their specialty. It feels very uncomfortable to, a lot of doctors are very scared to confront patients with what is in their mind, common sense. And let's be real. A lot of doctors have the same problems themselves. A lot of doctors are under greater and greater amounts of stress. There's caregiver burnout that's going on. And so that burnout turns into I'm going to go home and have a drink and then that drink turns into two and three and then it's a bottle of wine and a shot of whiskey or you know, whatever else is involved. It just is a very easy pit to dig yourself into very quickly as a provider. And so a lot of providers come in and they're afraid to talk with their patients about these kinds of behavioral changes because they're dealing with it themselves and it's their own reality. So then that's scary too.

Speaker 3:

It is scary. And if that guy would've just, you know, if somebody would've just stepped in earlier or just shifted the mindset and said, look, we got to just cut out the alcohol. I'll let 90% of your problems are going to go away. Or got him the treatment that you needed. You know, maybe this guy would, would actually see some real progress.

Speaker 2:

I've had diabetic patients or prediabetic patients, you know, people who are, you know, flagged by their primary care doc during that annual physical with the blood work as pre-diabetic. And when they ask about their behavior and lifestyle, they find out while they're drinking, you know, close to a case of beer every couple of days and they've said, you can tell me to change my diet, you can tell me to exercise more. You can tell me, you know, walk the dogs but don't touch the drinking. I'm not willing to give that up. So they're, you know, like I said, it's a coping mechanism and it's often a part of a person's social connections with other people. So you know, if you're used to going out to happy hour with your group of coworkers on a Friday night and that's how you connect with other people, you start by, you know, having that happy hour and then it leads to dinner and more drinks. Then what happens if you're the only person who's no longer wanting to be around alcohol or to use that as a, as a way to connect with other people. You sort of have to think, boy, maybe I need a whole new group of friends. Um, and that kind of is a pretty big mountain to climb, especially with people who are already feeling socially isolated in this world.

Speaker 3:

Yeah. Yeah. And it is true. It's sort of an identity shift. You know, you're used to doing this. Your friends are used to doing it and especially with substance abuse. It's kind of one of those things that like you mentioned, nobody really wants to talk about because, because if you bring that in, if you show up to an event and you tell people now I'm not drinking tonight, everybody else, all of your friends are now wondering, Hey, maybe I'm drinking too much. Maybe this is a problem and they don't want to have that card.

Speaker 2:

No, no. Nobody really likes to be the person who comes in and says, I'm laying off the drinking right now. Cause everybody starts to go either it's Y why, ah, come on. You don't need to worry about that. Or you know, um, or like you said, it's, it's uh, Oh maybe I've got a problem. Wait if he thinks I've, if he thinks he's drinking too much and I drink more than he does, then what does he think of me? It's true. It's

Speaker 3:

very true. I mean, I've, I've, I've, when I, when I got sober in 2018 they, a lot of my friends stopped inviting me to things and, and it's good for both of us. We're still friends, you know, they're not inviting me, but it's like that awkward kid standing around going, Hey knuckleheads, maybe, maybe you should tone down on the shots. You're not 21 anymore.

Speaker 2:

That's right. That's right. Yeah, absolutely. It becomes a little bit of a tough issue for all of us, but I think it's healthy for us to talk about it in this kind of a format. And also I love that, you know, just that level of openness that you're willing to share your own, you know, realization. It's not from a place of judgment, it's from a place of health and, you know, being able to actively look at yourself and go, wow, this is really not helpful to me. And it's really not, you know, delivering on the quality of life that I want for myself. And if I, again, if I start to make that, you know, 1% change and some people need to do away with alcohol completely, you know, but if there's help available, get it. And if there's not help available, look for, well what are the resources that maybe I don't know about, but certainly making that change and then being proud of yourself and feeling like, okay, I'm doing this for my health.

Speaker 2:

You kind of get out of that shame and regret mindset and you start to really shift that focus to strengths and how you increase your own, you know, strength and empower yourself to make the changes you need to make. And that's with any chronic disease, right? It's hard. It's really tough. And so again, you know, the idea of having a behavioral health person right there in your primary care office who's not coming from a place of shame and judgment, who's coming from a place of how can I help support you make these difficult changes. And by the way, they are going to be difficult. And by the way, you're going to need more help than you think you will. It's a myth that if I can do it myself, I should, you know. Um, and you know, it's more supportive to have the resources than to not.

Speaker 3:

Yeah, I mean all of this sounds like a no brainer to me. I mean, it sounds like, it sounds like common sense and it sounds like something that I think probably a lot of people think they're already getting, which is, which was my point, you know, but you spend 15 minutes with your doctor and you know, by and large, you know, I, I, I'm the type of personality and I think a lot of people are where they can figure it out on their own or they don't need to go talk about those things. I told you about my brother. I never once brought that up to my, my primary care doctor. But this is a huge thing that happened in my life. My whole world changed. And of course that's going to have some physical ramifications and everything else like that. But it never, it never even came up know, it wasn't because I didn't feel like I could talk about it.

Speaker 2:

Right. And I really wish that it would. And I think that's kind of where when a person, when a provider has a full stack deck of patients for the day and a person, I can tell you that, uh, time and time again, whenever I've talked with physicians or nurse practitioners who, whoever it is that has that full stack deck of or fully stacked deck of patients, sorry, it took me a minute to get the words out there. But um, you know, they're looking at their day and they're going, I have all of these people to help today. And so if a person in and they start crying, tears is like a huge hashtag triggered moment for a physician because they're like, how am I going? They start looking at their watch. How am I going to get out of here in seven minutes? And so if you, again, if you have that behavioral health provider on deck and you can bring them in and say, help this person and we're glad to do it because it's our specialty and we know how to do it.

Speaker 2:

Um, not only are they having that better relationship and rapport with their person in their life that they're trying to help because that's what they're there to do. But they also know that the person isn't going to be shoved out of the office with a piece of paper with, you know, six or seven behavioral health providers names and numbers on there. And by the way, most of them probably don't take referrals anymore. May not take the patient's insurance. You know, the, there's a lot of different barriers to accessing mental health in the community. So integration is just absolutely, you're right. Common sense and it's really easy to do once you, once you started, there are some operational and financial like billing aspects that need to be looked at it. But the clinical integration is the easy part.

Speaker 1:

So practically for somebody, I mean, how do they, how do they, how do they make that switch? How do they jump from, you know, a current model that they're at, they've been doing for the last 20 years and say, well, there's probably a better way to approach my healthcare. How does, what does that look like?

Speaker 2:

There are a lot of really great guides that have been published by, for example, the substance abuse and mental health association. That's the national Samso organization. Also by the national council of behavioral health and by a lot of different, you know, big national organizations. So you can kind of Google integrated care guidelines or you know, competencies. Um, and there are some really great resources out there to look at. Okay, what does it take operationally, you know, like from, from the moment a patient walks in the door to the moment the patient walks out the door, what does this look like for my team? Because it affects everybody. So if it's, you know, the, the receptionist who greets the patient also hands them a behavioral health screening tool. Who's going to scream? Who's going to score it? Who's going to communicate the score to the physician.

Speaker 2:

If it's a positive score, what happens then? So it's a new clinical workflow that needs to, and it's also an operational workflow. And then you have to look at the billing. Unfortunately, we don't have national healthcare service, so it's not, you know, one insurance, um, a policy for every patient that walks in the door. Every single patient that I see has a different insurance policy and some of them don't have insurance at all. So it's how am I going to get paid is what every single provider, no provider goes, you know, to school for a professional degree to not get paid or volunteer their time. As much as we love the community service we do, we also have families to feed and mortgages to pay. So how are we going to make this work so that we don't have to close our doors so that we can keep treating the patients.

Speaker 2:

So we look at what are the business, what are the billing codes that are relevant that work in integrated care facilities? Um, and how do we build those? So will insurance companies pay them? And then beyond that, if we don't want to do a fee for service model, there are other integrated models such as a value based care or bundled payments that can be negotiated between the provider and the insurance company that says, for example, I'm a birth center and about 50 to 60% of the patients that I see have a behavioral health component and we want to integrate a behavioral health provider into a prenatal package. So insurance companies, they pay one rate for all the prenatal care that a woman needs from the time the pregnancy is confirmed to the time she goes into labor. All that prenatal care is in what they call a bundle. Why can't behavioral health be part of that bundle? We know that a woman who is in a pregnancy state is more vulnerable and at a higher risk of anxiety and depression during that time. So why not integrate behavioral health?

Speaker 1:

Yeah. Now I make it makes sense to me because you know, if the insurance company, going back to the, the, the prior hypothetical, the example I was explaining about, uh, the guy in my men's group who is running around to all these different providers, the insurance companies paying for all of that. If he would just go and deal with that one root cause, that underlying issue and I, it seems to me just on a, on a

Speaker 2:

their costs, total costs. Yeah. There's, there's a lot of what we call the medical cost offset research that was done by the founder of Cummings graduate Institute. Um, so in, he was the chief psychologist for Kaiser Permanente for about 40, 50 years in California and he did a ton of medical cost offset research. Looking at if a person comes to primary care and they seem like they have a behavioral health component and we integrate this psychology or this psychologist into the medical team and they get treatment, how much does it reduce the longterm costs? How does it resolve maybe the issue that they came in, you know, seeing this, because as we all know, depression and anxiety have physiological ramifications. Anxiety. We feel rapid heartbeat. We have heart palpitations, we sweat, we may feel faint or dizzy, we may pass out and those are all chief complaints in a primary care physician's office.

Speaker 2:

I also see with depression you have the aches and the pains. You have the chronic pain, you have bad lower back pain. Um, you definitely have people who you know are miserable, can't get out of bed, but there are tons and tons of physiological ramifications of depression as well. And so looking at those as chief complaints and being able to say, I will definitely do blood work. We want to look at your thyroid, we want to look at your blood sugar when we'll look at your hypertension. But we also want to look and see if this is maybe some depression that is connected with trauma. Is it connected with the stress in your life? And if so, how can we, again, treat you as a whole person? We're not just looking at this one sliver of your life because that's the only sliver we know how to treat.

Speaker 1:

Yeah. You had mentioned Cummings graduate Institute and that founder, I think it's a good time to transition into that. Can you tell me about what this is? I know you're just a CEO of a CGI and that that's about what I know.

Speaker 2:

I can tell you a lot more. Yeah, sure. So, um, I got, so the, the doctor behavioral health program was designed by Dr. Nicholas Cummings and his daughter in collaboration with his daughter, Dr. Janet Cummings. Um, so they had been offering behavioral health training for mental health professionals for quite some time. And what they were doing was trying to integrate a model of medical literacy. So being able to say for a behavioral health clinician, you're going to see patients who have cancer. You're going to see patients who have diabetes, you're going to see patients who have asthma and other chronic illnesses and you need to know more, or at least as much as you should know about the physiology and pathophysiology and neurology of what your patients are experiencing. So that you're not at a complete loss if part of that is a behavioral health indicator or if there's something that you can do from the behavioral health perspective to treat those conditions.

Speaker 2:

And so they started saying education and training programs for behavioral health providers are absolutely failing in the sense that they are not innovating in the direction of being able to treat the rising chronic illness tide that our nation and really globally has seen. People are living longer but they're not living well. Um, so with those rising chronic illnesses, we really need to be able to do something about it. And behavioral health is perfectly positioned to be able to address the behavioral and mental health aspects of those chronic diseases. So how do we do that? Well, it turns out that none of the education and training programs we're able to innovate or were willing to innovate because there are restrictions from accrediting bodies. Yeah, yeah, I was going to ask you about that. Yep. So with those restrictions, they have to stick to an approved curriculum and it's very difficult to make changes once you've been approved.

Speaker 2:

So what they said was, we're just going to start a new program altogether. It will be called the doctor behavioral health. Because in medicine you don't command as much respect when you come in with a master's degree as you do if you come in with a doctorate. It's just part of sort of the medical culture. And so Dr. Cummings said, we are going to create this training program that it encapsulates medical literacy and behavioral health interventions that are specific to medical settings, but we're also going to look at how can these behavioral health practitioners innovate from within the medical culture and be entrepreneurs or intrepreneurs basically. And so looking at that, he developed sort of a three pillar um, program. So medical literacy, behavioral health interventions in integrated settings or medical settings, and then entrepreneurship. And it's a 60 credit hour program. So he first tried it at Arizona state university and after a few years there were, you know, just some Phyllis philosophical differences about the way to deliver the training.

Speaker 2:

And so he said, you know what, I'm really, I just want to do this the right way by our vision. And so he decided to create a university that is entirely focused on integrated care, the study, the research, the practice, and the application of integrated care. What works, where, how, and how can we make it happen here and how can we continue to evaluate the quality of those programs and then continue to produce literature that, you know, shares that information out into rural and remote areas that don't have education and training programs. So that's really where the idea of online learning came in was this has to be an online learning program and it has to be 100% online so that people, no matter where they are in the United States or the world can get this training and put it into practice immediately. So the other part of our program is that as a hundred percent applied, every start, every student who comes in has a pretty specific population that they are interested in serving better.

Speaker 2:

So for example, if you were, you know, an interested person, you might say, I am dead set on making improvements within substance abuse within the medical community. People need to be, have better training, people need to have better access to care and it needs to be affordable and accessible to them, period. And so I want to focus my work in this program on that. So you would tailor your assignments and every single class towards that population and you would look for ways to improve quality. You'd be designing cases and excuse me, you'd be presenting cases and you would be designing care pathways that can be used and applied immediately. So most of our students come in the program and within the first term are already doing assignments that are making improvements in their communities. So it's a really exciting and innovative, it's kind of like a little incubator of, you know, integrated care innovation.

Speaker 2:

Um, and it's, it's a really exciting place to be for a student. So it's, it's fun to be the director of the program. And I'm also advising all of our students. And so one of the things that I get to do is I get to talk with them every single term about the work that they've done. They tell me about how, you know, they're getting all kinds of accolades in their community for making improvements, the difference they see in their own quality of care that they're able to deliver. So it's really exciting. But again, it's just one part of integration. Global integrated care looks like things. Um, I, I am, we are a member of the, uh, international foundation for integrated care. And that is a nonprofit organization based out of Europe that looks at research practice and application of the science of integrated care.

Speaker 2:

And so some of the presentations that I've attended at those conferences include a children's hospital in new South Wales, in Australia. Um, and they're looking for, okay. So when a child has a chronic disease and they come in and they're hospitalized, eventually they transition from level of care. So they might be really acute when they come in or they might come in and then get even sicker. And so if they do, what about their education? What happens? And so they might bring in educators into the hospital, but then what happens when they go back home? They're, they're homebound, but they can't go to school yet. And so it's just that idea of removing the silo because the human is in different places, but they still have life to do. They still have life that needs to go on. And so how can we make those transitions hurt less for the child and for the family?

Speaker 2:

How can we make sure that their education continues and that it's high quality and how can we help make their life better throughout the process? Um, so there are literally infinite numbers of, you know, things such as, um, social prescribing is a really interesting phenomenon that's going on in integrated care and that's where, okay, doctors and nurses can only meet so much of the, of the need. Where are our community resources? Where are our, you know, organizations and agencies and nonprofits that are truly representative of the kinds of treatment or even social needs, you know, that are, that are needed by these patients and how can we connect them with those resources so that they can get some of those health needs met within their own home community. So, you know, we're really looking at it from a very broad base and we're really inviting consumers and people to the table to help design this because we don't know everything. I mean, I'm a patient, I'm a caregiver, I'm a parent. Um, you know, and so I know from my perspective, but I don't know from their perspective. So let's all come to the table and let's all try to fix this pretty broken healthcare system.

Speaker 1:

Yeah, I was just going to say this sounds like a solution to the healthcare problem in a lot of ways.

Speaker 2:

One solution, there are infinite, infinite solutions and everybody kind of has to get to the point where they realize that their voice is important as part of that solution and part of a solution. And so if they speak up and then they really are passionate about it and they want to come to the table and help things get better, which would be great, then we get further farther. Right

Speaker 1:

as you were, I had so many thoughts as you were speaking there because there was, you covered a lot. And w w w w you know, the thing that really stood out to me, I love how it's innovative, it's different, it's entrepreneurial. It's saying that we see a lot of opportunities for uh, other really, you know, services other people who can come into the healthcare space and, and provide a lot of value. Now, you know, that type of change in an industry that is, I think the fifth of the sickest six biggest industry in the entire country is going to spark a lot of backlash and a lot of, of response from the entities that are already entrenched in, in the, in the process. So I'm talking about the AMA and you know, all these different governing bodies. I see a lot in law, you know, in law, we've got our own bar association, there's almost zero innovation in law, you know, outside of some of the tech companies that are trying to sell lawyer things. And it's very stagnant. It's very stale. And you know, in, in Arizona and a lot of places if you go out and try to practice law without a license or start sort of a competing governing board, they will charge you with a crime for that. It's called unauthorized practice of law. I mean, they'll put you in jail for that or for kind of stepping out and, and not following the status quo. So has that been sort of, I mean, sort of the experience with integrative medicine?

Speaker 2:

There've definitely been some, um, sort of regulatory pressures and, and what I being called levers, um, or leavers, um, in, in the European union. Um, so there, there's a lot, there's a big piece of policy, right? Like public policy that is connected with healthcare that I think we, we have seen the more of a player in places where a national health care service exists. Because, you know, if you're looking at legislation and something that is national, you're, you're looking at something where policy is an obvious player. But here in the United States, because we don't have national healthcare, we're not always a hundred percent clear on what the legislative or policy levers are in our States and localities. So here in Arizona we have a behavioral health board for masters level providers of mental health care. And then we have a board for psychologists, will a doctor behavioral health is a doctoral level provider but is not a psychologist.

Speaker 2:

And so insurance companies want to reimburse on a fee for service basis at the master's degree level, but they'll pay sometimes, you know, 75% more, maybe 50% more for that doctoral level. But we can't get licensed as psychologists in the state of Arizona because we don't meet the old traditional model of education that they have in their statute. So the state statute needs to that that needle needs to move. We're not seeing it there, but there's also not been a concentrated group of people who are advocating for that yet in the state of Arizona. And a lot of times we look to the educational institutions to do it, but that's not our mission. Our mission is to educate and train. But is that, is that level of care necessarily different? Sometimes it is and sometimes it isn't. So if you're looking at a person with a master's degree who has gone through the doctor behavioral health program, they have a lot of training in mental health theory, um, you know, doing diagnosis and assessment and maybe special populations.

Speaker 2:

And then as a DBH you have your medical literacy, so you know, pathophysiology, psychopharmacology and neuro pathophysiology, and then you understand the medical culture as well as the entrepreneurship lens. Psychologists on the other hand have like that advanced level of doctoral level work, but oftentimes a PhD is very academic and so it really trains a person to work more at the university level. Then in the community, there are certainly clinical psychology, but it is not, the kind of training is not the same training as a DBH. So certainly as a mental health provider, a psychologist and a master's level provider provide high quality services. A doctor behavioral health certainly provides high quality services, but there are differences among the three. So I think from the perspective of, for example, Doug doosey just pushed some legislation forward to say we are going to remove the barrier of licensure reciprocity for behavioral health, mental health providers.

Speaker 2:

So if you're coming to Arizona, we want you, we're not going to worry about reciprocity. So we're going to, you know, reduce and licensure issues there. Well, that's wonderful for the state of Arizona and for, you know, the population of Arizona because we want and need more mental health providers, but it doesn't help those here in the state of Arizona. Um, you know, as far as like being able to go to other States. So for example, if you provide tele-health, which is very wonderful and certainly for the population that I provide, I mean, I'm seeing women who've had a baby two, three days ago in their home through telehealth. I use my smartphone. It's easy peasy to leave the house. Yeah, we have it for our office here, but I can't, so if one of my patients moves to Colorado, I can't continue to see her because I'm not licensed in the state of Colorado.

Speaker 2:

So there's these weird state barriers that say somehow if you leave the state of Arizona, you just got stupider. Yeah, we have the same thing in law. So, you know, those kinds of things I think would be, um, you know, issues that we need to resolve as a nation. Um, certainly, you know, state rights versus national rights is, is a problem. But even in the state of Arizona, you know, the legislation just recently said that the insurance companies have to be held accountable to a law that was passed nationally, a federal law that was passed in 2008. What the heck? Yeah. So here we are, you know, literally more than 10, so 12 years later saying you have to comply with a federal law that was passed, you know, years ago. So for our patients, it's a win. And for our, you know, us as healthcare consumers and ne, you know, people who need healthcare, it's a win for us.

Speaker 2:

But why haven't we, you know, what's, what's the state law versus federal law issue? There were insurance companies in the state of Arizona have been able to say, Oh, you went and got mental health care counseling for six sessions, we're not going to pay it because you didn't call us first and you know, get the right pre-authorization. So it's just frustrating when those kinds of policy and legislative issues are behind way behind the times and they're not, you know, up to date with what our population needs. It fills in a lot of ways, like just a lot of red tape.

Speaker 3:

Yeah. So, and I wasn't trying to sort of, uh, downplay how psycho, you know, psychiatrists are or what they do. I'm just trying to identify a way that, you know, people, people can get healthcare that they need and if somebody can provide it and they don't necessarily have the same, you know, old school legacy credentials that the, you know, kind of the, the, the mainstream establishment wants you to have, but that person can still provide a very effective value and help somebody, you know, I'm, I'm open for the idea of innovation provided that the consumer knows what they're doing. And I think that's kind of a big part of, that's a big piece of the puzzle, right? I mean, you have to educate consumers that somebody with a DBH, uh, you know, letters after their name can still provide value to that person when people are sort of conditioned to look for MD.

Speaker 2:

Right? Absolutely. Absolutely. I think part of it, you know, and the impetus has always been on the provider to make sure that the, so I'm very careful about, you know, letting my patients know I'm not a prescriber, I'm not that kind of doctor. Um, you know, but from the perspective of mental health and behavioral health, I might know a little bit more about psychopharmacology than your physician does or then your, you know, nurse practitioner does. So let's have a conversation and then I want you to follow up with that person, you know? And so, um, you know, that's always been the ethical way to go about business as a, as a, you know, person who has a doctoral degree other than a physician. Um, it's part of most of our ethics codes.

Speaker 3:

Yeah. Yeah. It's, it's a complicated topic. I mean, I love this topic, but I can't stand it either, just because it is so complicated. I mean, it seems like every year or you know, every presidential election or every election, you know, it's always a problem. And like I thought we just solve this healthcare thing in 2008 but we're, you know, like you said 12 years later, it's, it's a, it's on the party platform. Again, we're talking about healthcare again and, and you know, it's just like, and people are frustrated and now, you know, we've got this, this virus that's kind of sweeping through the world. And so it's, it's a super appropriate topic, you know, cause people are now wondering, well, who should I trust? What, you know, what information should I get? Where should I get my treatment?

Speaker 2:

Yeah. And I think there unfortunately, you know, in, in the past, you know, about 10 years there, there've been so many attacks on media that now it's very difficult to really trust any form of, of media. And so it's really all about, and you know, for better or for worse, it's kind of about building that relationship. You know, with your patient population so that they can decide, you know, through an a one-to-one face to face or you know, tele-health conversation, whether or not they buy it, you know, and whether or not your, your recommendations are going to help them if they feel like it's best for them. And that's another thing that integrated care is really, really emphasizing is it's really about that shared decision making. So as a physician, you know sometimes there's an ego in the room that comes in and says I'm going to give you a prescription and you are to take it.

Speaker 2:

And if you don't then you are nonadherent or you are noncompliant with treatment and I don't have to treat you anymore. But we're saying that's really not what this is about. It's about if I say everybody in my population has to get vaccinated. So a lot of my patients are worried about vaccinations for their kiddos or they want to do delayed vaccinations and some pages or a lot of pediatric pediatric practices in the state of Arizona say, we will not allow you to come in with your newborn unless you are vaccinating on the schedule that we demand based on, you know, what the Academy of American physician says are, you know, based on the American Academy of pediatrics, et cetera. But some of my patients are saying, but that's not always what the evidence says. And I'm smart enough and I'm empowered enough to ask questions. And so as a provider you have to come to the table with your patient and you have to say, well, here's what I know. I'm going to share some evidence with you and you need to make your own decision instead of, I tell you to do this and you do it, or you're out.

Speaker 3:

Yeah. You're the CEO of of Cummings. And what, what is your, what is your mission? What is your primary focus here? I mean, I know, I know it's, it's an education platform. It's a, it's a, it's a graduate Institute. What, where's your big focus? Right now?

Speaker 2:

Our biggest focus is in filling the gap of education and training in integrated care for behavioral health providers, but also for medical providers. So we, uh, we do offer the doctor behavioral health program, but we also offer some, and we're, you know, getting gearing up now that we earned institutional accreditation, we're gearing up to be offering more and more continuing education, um, as well as some additional degree programs to help with leadership and management, the operational, financial and clinical aspects of integration. So our mission is really to fill those education and training gaps worldwide because they're, you know, again, we're part of the international foundation for integrated care. We see them all over the world. Our community is not different from others. And so we're really looking to fill those gaps, to provide the education to fill those solutions. But we're also hoping to in the, in the meantime, train up integrated care professionals so that they are out in the community actually innovating every single day.

Speaker 3:

Yeah. And who, who's kind of a target student or, or you know, somebody who wants to go into this field because I think there are a lot of people there who are interested in this type of, of practice your practice, but they're not maybe in love with the idea of going through the entire, you know, old school medical regimen.

Speaker 2:

Our primary student is going to be coming from a field of behavioral health. So most of our students who are applicants are social workers or counselors or masters in um, family, um, master's degrees in marriage and family therapy. Um, however, we also have nurse practitioners or psychiatric nurse practitioners who are coming into the program hoping for that advanced clinical operational, financial. The entrepreneurship bit of our program or pillar of our program is very attractive to a lot of people who have been in the field have lots of experience or maybe like mid career or even getting towards the end of their career and are just saying, I've absolutely had it. I can't just, you know, go and be a cog in the system anymore. I have to break out of this. I have to disrupt, I have to do something new and it's because every person that I talk to I feel I'm doing to just a service for. And so really, um, any medical provider or any allied health provider would be a good fit for the program depending on, you know, as far as you want to do a 60 credit hour doctoral program, some people don't want to do that. And so that's where our certificates and continuing education come in. If you're looking for something smaller and more manageable for where you're at with your career or your finances or how much time you have available to you, I would say go for the continuing education and certificate market.

Speaker 3:

How many or how long is it taking somebody to complete? Maybe the 60 credit hours.

Speaker 2:

We, we actually put a lemon on the program. We say you've got to get in and out in five years. And there's a reason for that. As fast as healthcare changes, you know, one psychopharmacology class that we offer this term is going to be, it's going to look different next term because there are always drugs coming out and always new drug interactions and you know, clinical trials take 18 months or more. Um, and so what we want is not just to make sure that a person who graduates within a specific amount of time has the most up to date knowledge to be able to innovate in the field, but we also need them to get out into the field with that doctoral degree. And so we put, we put that five year maximum timeframe on it. Um, the shortest amount of time that a person can go through the program is about two and a quarter years. Um, so I usually recommend to plan between two and a half and three. And that's if a person can take two classes per term and we have four terms a year.

Speaker 1:

Okay. And what, you know, in terms of practicalities, are these kind of live classes, does it go at your own pace? Is this a

Speaker 2:

it's, it's definitely, um, so, uh, we are a hundred percent online and so all of our activities and our webinars and our discussion boards and forums, all of that happens online. And so most of our classes have a weekly webinar for at least an hour. Students for the most part are really encouraged to login live and to use their video cam and their microphone because it builds community. And there's one thing we have to do is build community amongst doctors of behavioral health. If we don't have each other, we're islands. And that is very hard to be. Um, and so we're really working on that community aspect. So, um, that once a week login, um, if you have two courses, it's going to be a couple of times a week to login for that hour. Um, not everybody can make it. And so we record every single one of our synchronous webinars and then people can watch after the fact. Um, and so as far as, you know, all of the other discussions and everything, it's really, you have weekly modules that, you know, things are due by the end of the week, Sunday night, 11:59 PM. Um, but between, you know, during that week, it's really at your own pace. So it's, it's self-directed, but it's not self-paced.

Speaker 1:

Yeah. And then what about, uh, costs, you know what I mean? So if somebody, you know, for some people it sounds like, you know, they may already be sort of entrenched in their own careers in behavioral health or whatever they're doing, and so they may have to come out of pocket for this thing. Uh, can you just talk about what that might look like for them?

Speaker 2:

So for all of our courses, um, we typically offer three credit courses. There are some that are only one credit, and it's $350 per credit hour. And so what that works out to be is for the entire doctoral program about $19,500. So you're looking at between 19, 19 five and about $21,000 for the entire doctoral program. Um, so that is about a third of the cost of most doctoral programs nationally. Um, and so we really, really work on keeping the cost very low because we want it to be affordable. And we also know that the research on students who graduate with student loans cannot be, they just can't afford to be as risky. Um, as far as starting up new ventures if they are saddled with tons of student loan debt. So we actually do not offer student loans. We don't participate in federal student loans at all.

Speaker 1:

Yeah. And then, you know, can you talk

Speaker 3:

a little bit about, it sounds like, you know, it sounds amazing. Everything we're talking about sounds amazing, but what about people who go through the program now? You know, they're sort of responsible for generating business, right? And if the population doesn't necessarily know much about this, it sounds like that that may be a little bit of a risk for them to go through this, come out of pocket and spend this money in this time. And then now, you know, they're still dealing in a world that is very much tied to that past model. So how do you, how do you sort of mitigate those risks?

Speaker 2:

Well, there's a couple of different things that we, that we do. So for example, um, the biggest thing that our students do instead of a dissertation is they do a culminating project. And so, you know, after most of the credit hours of the required coursework, they pretty much know what they want to do and are really already doing it. Um, and so they, they create a business plan in, um, the entrepreneurship course and they launch it. And so, you know, during the course of the program, um, the vast majority of our students choose a business plan that is feasible because they understand they're, you know, we, we provide a ton of mentoring and coaching, um, because we want them to understand, we want you to go out and do this. We don't want you to do this as an academic exercise. That's not what this is about.

Speaker 2:

This is about change. This is about innovation. And this is about, you know, really helping you as a career person, but also helping the population that you're living in. Um, so how can we help you get there? And so the business plan for our students really looks like a partnership between, you know, some students work with a nursing home, you know, in their community and they're really looking at, okay, how can I provide the depression screening as well as the mental health services? Or, you know, how can I look at, um, you know, integrating into a birth center or an OB GYN office or, um, we do have students, we have a student right now who has been working in the insurance industry for quite some time and she has the support of the people within her organization to look at how can we look at financing differently integrated care.

Speaker 2:

Um, and so we have other students, one of our students has been, um, he's, you know, owned and operated a business as a employee assistance program. So they provide, you know, six free counseling sessions within their contract partnerships to the employees of, you know, large organizations. And he's looking at how can we help, um, people who have committed suicide or, or excuse me, have attempted suicide, how can we help them transition back into the workplace and maintain a low stress, you know, kind of relationships so that they can return to life and then build on that. Um, so we have a lot of different projects. Um, one of our students is, um, was born in Brazil, um, lives in new New York, but, um, because she speaks Portuguese and is a Brazil native, she was able to establish a relationship with the hospital in Brazil. Um, and they were looking at looking at, um, poly-pharmacy, which is prescribing two or more medications for one mental health or behavioral health condition.

Speaker 2:

And in her case it was schizophrenia. Um, and so they were looking at how can we reduce the rate of poly-pharmacy because it leads to drug interactions and pretty terrible side effects in a lot of cases. How can we reduce that rate? So through a simple email intervention, she was able to reduce that rate significantly in an 11 week intervention. So again, it's, it's looking at very simple ways to make improvements. And I mean, she's in hot demand in Brazil, but she's also in hot demand in New York. And so what again, what we really try to do throughout the program is really impress upon them. The, the opportunities are endless. Yeah. Um, so what are you going to do?

Speaker 3:

Yeah, it makes sense to me. I mean, it sounds, it sounds a lot more efficient than, than some of the other models. And my, you know, my understanding is with the, with the, you know, the healthcare scares and stuff that we have going on right now that, that, that sorely needed these, these, these, these positions are needed. I was reading an article that, you know, we have, you know, 300,000 hospital beds across the country or something, you know, some number like that. And then they were contrasting that with the expected need that we're going to see as a result of co covert or whatever you call it. And you know, the numbers are not even close. No. And you know, that tells me that there's a strong need for more people in healthcare, more resources, more, more, uh, and maybe not even more resources, as much as more efficient use of resources rather than, you know, just dumping money into a problem that everybody jacks up their rates and insurance companies get rich and the people don't actually get any treatment.

Speaker 2:

True. Yeah. That's in a lot of ways our system is set up for sick care, but it's not even effectively set up for that. Right. Um, and so it's really about how can we shift the focus to prevention and actual health care, you know, so again, a physician who provides those recommendations for substance abuse. How much alcohol are you using? Are you smoking cigarettes? Are you interested in smoking cessation? Can I connect you with a colleague in right here in my office who can help you quit smoking today? You know, um, and, and keep you out of the hospital and keep you out of like the, you know, person from your men's group that you were talking about, all those specialty care. So here's how much time we can save you if you just quit smoking. Right? Or here's how much time we can save.

Speaker 2:

You know, you, if you just quit drinking, like think about all of those hours waiting in doctor's offices and all of the transportation involved, the time away from work, the productivity loss, think about all of those losses that we can impact if we just do something simple, which is integrate the whole mind and body again in healthcare. Yeah. So it, it does it in a lot of ways. It does seem simple, but you're right, we do fight a lot of, you know, policy and legislative and sort of this is the way we've always done things kind of mentality and also what makes money for insurance companies and how resistant to change, you know, they can be in terms of reimbursing. We know that they love to deny those claims.

Speaker 3:

Yup. Yup. Well I love what you're doing. I mean it, you talked a lot about community and I think that's super important to it because you know, the shift, I think people, you know, again, it's anecdotal.

Speaker 1:

This is not my space. This is your space. But I just get the sense that people are asking more and more of the right questions. Yeah, it feels to me

Speaker 2:

[inaudible] I think that's true in a lot of ways. I think for better or for worse, the internet and having, you know, a supercomputer in your pocket, whenever somebody says something you don't understand, you Google it. Um, you know, for better or for worse, that has really improved the level of health literacy in a lot of people who have access to a smartphone. Um, and I do think people are being more thoughtful about the fact that they are sovereign over their own body. They do not have to take a prescription. They don't feel that they need or that they have questions about. And if the doctor is not answering your questions, find another one. You know, seems to be more and more the sort of, um, talk of the day rather than, well, my doctor told me to take it, so I'm going to take it even if it makes me sick. Um, and so I do think people are starting to get to the point where they are thinking a little bit more about what else other than a pill, um, is the answer to healthcare issues. I also think, you know, the internet can be a very dark place. And so I like to tell people you need to know when you've had enough. And you know, certainly if you start getting into the, Oh, I need to go and ask some Facebook group, you know, that can get pretty radical, right?

Speaker 1:

Pretty fast. We, we of course have the same thing in law people. Oh sure. Doctor, doctor, Google, doctor, attorney, YouTube, all that stuff.

Speaker 2:

Yeah. So I think it's about, you know, in every interaction and, and even if it is interaction by interaction, increasing that health literacy and, and you know, just that sense of self empowerment is really important to me. It's important to my family, you know, generations back and, and will be generations forward. And it's important to me as a professional. It's also important to me in the birth community because you know, I work with primarily women women who have been, you know, their fears and health needs have been, you know, sort of brushed aside or you know, mitigated and in a lot of ways by professionals for years and years. And so I'm definitely in a professional clinical environment now where women are being empowered to ask more questions and to think more about how they can impact their own health by the decisions that they make. And to ask for that shared decision making model.

Speaker 2:

I would love to see that happening more with men. I'm in a lot of ways, I have, you know, many interactions with women on a weekly basis and they're very worried about their partners. They're very worried because they see signs of depression, they see signs of anxiety. Men are drinking more, men are smoking marijuana. Um, bringing home edibles, you know, getting medical marijuana cards, looking at porn and these kinds of things are impacting the family. They're impacting the whole family. They're making them irritable, they're snapping at the kids are snapping at the wife. It's, it's creating a marital relationship problem. Um, but it's a coping mechanism. And for some reason, I don't know if it's, you know, well there, there are lots of different, you know, masculinity and, and psychology wrapped up in that. But if we can get to the point where men start to really become more empowered about health sovereignty, I would love, love to see that trend in that direction. Cause I am worried about our men.

Speaker 3:

Yeah, I saw him. I honestly, I mean we, you know, I, I speak at a lot of places. I told you about those recovery center talks that I, that I do. And it's, it's predominantly men. I'm not saying that women don't have substance abuse problems also, but by and large, it's mostly men. Um, you know, we're a criminal defense law firm. It's mostly men who are charged with crimes and our men's group, you know, there's something very powerful about what, you know, when, when men circle up and kind of address men's issues in a way. And I encourage, uh, women to do the same thing. We've got a women's group,

Speaker 2:

can't we get those men's groups in birth communities? So we have these, you know, we have breastfeeding moms group, we've got new moms groups, but we cannot, we have for the last five years we've been working on getting dads to come together and circle up in the same way and they're not coming. They're not, they don't see it as the same kind of magnet, you know, drawing to those communities to get that kind of support. As a new father, you're going through the biggest transition of your entire life probably since adolescence. You need that support. So I dunno if we can think about that and maybe find some solutions. I would really be excited about it.

Speaker 3:

Yeah. And I don't know. I don't have kids and I have not been through that experience, but I don't, you know, I don't know. I do think that it is important. You know about basically what the 12 steps are is like unraveling the internal trauma, going through, you know, addressing your resentments and making amends and clearing out all the wreckage that, you know, you've kind of been carrying around in your backpack that causes you to drink or causes you to act out or you know, you substances and things. So, you know, I think there's some parallels there, but I mean, I, I love, I love that you're even cognizant of that issue because I think it's often overlooked.

Speaker 2:

Well, I went to the postpartum support International's annual conference last year, last summer, and in the midst of us going, man, we just keep creating these dads groups and we can't get anybody to come. What are we doing wrong? You know, what is the missing link here? And of course people are like, I don't know, maybe if you do it at a brewery and you know, there's a fight on or something. And I'm like, that is not what we want it.

Speaker 3:

Yeah. Monster trucks and shotguns or something. Yeah.

Speaker 2:

Um, so, but the, the founder of postpartum support international, her name's Jane Honickman and she got together with a male psychologist and they did a presentation and it was really sort of revelationary to me that they, they talked about how postpartum support international was founded. It was her and her husband, they formed it together. It was a support group in their community where they invited couples to come and talk about the difficulties involved in bringing home a baby and perhaps experiencing perinatal depression or postpartum depression or anxiety. But as a couple, you're allied together, you're in this together. And we've really gone far field from that in focusing everything on the mom. Yeah. And so I would just love to see, you know, families brought back into focus and have it not just focus on, you know, one, one member of the family.

Speaker 3:

Yeah. It's an interesting thing. I had never even thought of that as being an issue, but I, you know, I don't know what it is, whether it's, uh, maybe it's just more of a, you know, people grow up and they're sort of conditioned to think that that's a woman's thing. That's what a woman does. I don't need to do anything like that.

Speaker 2:

Right. Right. And I think it definitely has a lot to do with how we were raised and sort of what we saw our parents do. Right. Um, but we definitely didn't see what our parents did the year after they had us. So there's not a lot of role modeling for that, you know? Um, unless we're just happened to be around our parents when they're having a baby, you know, 10 years after we're already here.

Speaker 3:

Right, right. Well, we could talk for days and days where, where can people connect with you? So, you know, you've got, you've got a couple things going on. Obviously you're the CEO of CGI. Why don't you throw out maybe some, some places they can find you and connect.

Speaker 2:

Sure. Our website, um, for the Cummings graduate Institute is cgi.edu. Um, and the website for terrorists place, which is the company that I formed with another doctor, behavioral health to serve maternal mental health and, and perinatal mental health needs is T as in Tom, E R R, a. S. a Z. Sorry. Excuse me, T E R R a S place a z.com terrorists place a z.com.

Speaker 3:

Awesome. Well, dr Kara English, uh, from the Cummings graduate Institute for behavioral health studies. Thank you so much for coming on the show. Thanks

Speaker 2:

so much for having me. I appreciate it. Great, great talk.

Speaker 4:

The ruler nation podcast is brought to you by the RNR law group, Arizona's premier criminal defense and personal injury law firm available@wwwdotrourlawaz.com or give us a call, four eight zero four zero zero one three.