Guests: Jessica Vadovicky, Amy Milroy, and Paloma Juarez | Season 9, Ep. 371
Jessica graduated from California State University Long Beach.
She has worked as a neuroscience bedside nurse with children and young adults in a psychiatric residential treatment center.
She is a clinical instructor to nursing students during their psychiatric rotations.
Jessica is also the director of clinical services with Foresight Mental Health Clinic.
She believes in finding a balance between lifestyle interventions and medication.
Foresight Mental Health Clinic just opened offices in Kansas City, MO.
The goal of Foresight is to leverage technology with mental health services to help make people healthier and happier.
During the second part of the show, Dr. Robin chats with Amy Milroy, Director of the B.E. Smith Family Center at AdventHealth in Shawee, Kansas, as well as Paloma Juarez, who has two children that attend the Britain Development Program at B.E. Smith Family Center.
As they continue the conversation on mental health and kids, Amy shines a light on why their programs are praised by the Kansas City community. The B.E. Family Center encompasses two unique programs – the first being the Early Learning Program which benefits AdventHealth employees’ children. The second is the Britain Development Learning Program, which benefits children all over the Kansas City area with special needs such as autism and other developmental delays. Both programs help children ages 0-5 prepare for kindgarten and that next stage along their journey with successful learning opportunities that incorporate occupational therapy, speech therapists, music therapy, feeding therapty, aquatic therapy, and so on.
Paloma Juarez also shares why this center has become part of their family, and why this has been the best place for even her own well-being as she navigates parenthood.
- “So, our mental health landscape in the US is very much cash pay, and only 56% of psychiatrists take insurance all across the US. To me, that’s so absurd. If you were to break your leg, you would not be hard-pressed to find somebody who takes your insurance to fix it.”
- “I think that’s really great advice to meet people where they’re at. And so, anybody listening today, it’s kind of like if you get in a car accident and your bone is hanging out of your skin, please go to the ER, don’t come to the chiropractor.”
- “This a tough road because you’re responsible for these tiny humans. My biggest advice is giving yourself some grace. The fact that you’re worried that you’re struggling means that you care a ton and you’re probably making a lot of awesome tough choices for your little one, and know that you aren’t the only one.”
What You’ll Learn:
Difficulties in access to mental health care and innovative ways that Foresight Mental Health Clinic is changing those difficulties.
This Episode Includes:
- Jessica became a nurse because of the diversity of care they can offer.
- While working as a nurse, Jessica saw there was a stigma for those patients who came in with a mental health diagnosis. She decided to go into psychiatry to help put an end to that stigma.
- Jessica talks about the beginning of Foresight Mental Health Clinic and what makes it different from other mental health clinics.
- One of the goals at Foresight is to provide greater access to patients through the acceptance of as many insurance companies as possible. They also create custom cash pay plans for patients.
- Foresight also provides more data collection and analysis compared to other mental health clinics.
- According to statistics, Missouri is in the top five states with poor access to mental health care. Foresight decided to address this statistic by opening a new clinic in Kansas City, Missouri.
- Jessica shares a few lifestyle interventions that someone who is feeling down can implement to boost their mood. However, she also notes there are different levels of mental health. Someone at a level one may benefit from lifestyle interventions while someone at level five may not be able to implement any changes on their own just yet.
- There are several different ways to access care with Foresight. Going to their website will give you the most up-to-date information.
- Find out more about how a hospital in the Kansas City community is helping their employees’ children ages 0-5, plus how they are helping a larger outreach of children ages 0-5 with special needs such as autism or other developmental delays.
- Learn how the B.E. Smith Family Center was founded, why it’s the largest childcare facility in the Kansas City area, and the impact its programs are having in our community from Paloma’s story.
Three Takeaways From Today’s Episode:
- Consider how unplugging from technology can help your mental health and your quality of sleep.
- Nutrition and exercise are two great lifestyle interventions that help support mental health.
- Give yourself grace no matter what you are going through – it’s needed along the journey.
Mentioned In The Episode:
Click Here To View Written Transcript of Episode
Welcome back to Small Changes, big shifts, building rhythm and resilience. Today’s guest, her name is Jessica Vadovicky and she’s a psychiatric mental health nurse practitioner, which I’ll let her tell us what all that means in just a minute. Seven fun things about her. She graduated from California State University in Long Beach. Jessica, fun things about me. I actually spent some time in Southern California as a young person, so I know exactly where that’s at. She has worked as a neuroscience bedside nurse with children and young adults in a psychiatric residential treatment center. She is a clinical instructor to nursing students during their psychiatric rotations. Jessica is also the director of clinical services with Foresight Mental Health Clinic. She believes in finding a balance between lifestyle interventions and medication. That’s one reason why we’re having her on the show today.
Foresight Mental Health Clinic just opened offices in Kansas City, Missouri, in our own backyard here in the Metro. The goal of Foresight is to leverage technology with mental health services to help make people healthier and happier. Hey, Jessica, just curiosity. If you look in the dictionary underneath well being, you know what it says? Happy? I don’t know that I do. Yeah, happy. The definition of wellbeing is happy. So I love that. That’s one of the seven fun facts about you.
So first of all, first of all, what is a psychiatric mental health nurse practitioner?
That is a great question. I started my education and went to nursing school. I have my bachelor’s in the Sciences, nursing, and that makes me an RN. And then I went back to get my master’s degree as a nurse practitioner, and I specialize in psychiatric as a nurse practitioner can well, it varies by state, but in most States we can diagnose, treat and prescribe medications the level to which we can do. So it varies by state.
So, hey, why did you pick nursing?
Oh, this is a good question. There’s a lot of different reasons I picked nursing in general. I’ve always wanted to be somewhere in the field of medicine, and I wasn’t sure exactly where that was. Bounced around between different things. I wanted to treat kids. I wanted to do some sort of giving back program. Really loved the idea of Doctors Without Borders. Thought about going to medical school. And then when I found out what nursing was and what it entailed, the enticing part about nursing is that you can do a different career every year and just kind of find all these different avenues to help people.
And that’s what really made me decide on nursing when I wasn’t exactly sure what I wanted to do and the population I wanted to serve, I absolutely loved it. And getting into psychiatry is a whole other story. But finding that population has really felt like home to me.
I wonder what the word nurse means in the dictionary. I’ve never looked at it before. That’s interesting. I truly think that the ultimate health caregivers are the nurses that bedside day in, day out. So I want to commend you for picking such an awesome profession. So share with me a little bit about why you chose mental health.
I have always been interested in and kind of followed read books about mental health in general, the human existence, however you want to put that. And when I got into nursing, I was working bedside and I worked on a Neurotrauma unit and we had a lot of people who had mental health conditions or had brain injuries that made them have some mental health symptoms, psychiatric symptoms. And I found even among my peers who were nurses, who were colleagues, who were these people that I felt had similar ideals.
There was a lot of stigma for people that came in with mental health diagnoses. And I felt drawn to these patients and I feel like I was able to care for them in a way that made a difference. And it was seeing kind of the way that everyone else felt about schizophrenia diagnosis and how it was a big deal.
And all these ideas that happened before the patient ever even got to the floor that made me realize there’s such a need here. And I already am really interested in this arena. And when I found out that it was something I could go specialize in as a nurse, I never looked back.
It’s so great when you find your calling, isn’t it? Yes. So talk to me a little bit about foresight, integrative technology and mental health services. Tell me a little bit about the who, what, where, when, why.
Sure. Foresight originated when our co-founders, Matt and Doug, were in College together and looking at more of the engineering side of psychiatry in general.
There’s not the same level of diagnostics and science kind of tools as there are for other disciplines. So they were looking at how to kind of make these algorithms and things based off data. And long story short, I won’t Butcher their story too much, hopefully, they were finding access issues.
In doing so, they were finding that places they were going to try and get this data were either paper charting or they didn’t take insurance. And they found that there was this bigger gap in care than what they were trying to provide. And they wanted to start mending some of that gap first.
So they started horizontal in a small office in Berkeley. And we’ve really grown from there and really grown since the pandemic as well. And part of the inception is this technology piece and offering more tangible things. So technology integrated. So we have things like software engineers, data scientists, researchers.
And I should preface this by saying, when I say data collection, I think that’s kind of a buzzword for some people. And it’s not that we’re storing data, doing these kind of things, anything outside of what another doctor has. They collect your demographics, they collect your survey scores.
But it’s what we do with it that’s different. So we do offer genetic testing. It’s not something we do for everyone. It can be expensive and not everybody needs genetic testing, but we do offer it and help interpret those things if people want it.
Our electronic health record is proprietary, and there’s a spot where you can hook up your wearable so your Apple Watch or Fitbit, whatever it is that you wear. And we can track things like exercise and sleep and track that in response to mood and anxiety and see if they’re helpful. We know those things are helpful, but being able to graph it and chart it and see what kind of exercise has been helpful or people sometimes think, I get fine sleep, and then we look at their data and it’s not restful sleep.
So kind of tracking those things. We also use survey scores and measure that against the outcomes and measured against the treatment. So say somebody’s in therapy and they’re doing CBT work and they’re just not getting through with the CBT work. And we can see that on their PHQ nine. And we switch it.
We switch them to EMDR, they have PTSD or something a different modality. And then we could see improvement also trying to see if there are any patterns, if there are any trends. We have clinics of therapists, we have clinics of therapists. And if we see this one clinic is doing amazing. They have off the charts improvements. All their members are doing fantastic. We want to look at what are they doing differently and how can we apply that to everyone else?
So you said you have clinics, you have technology, you have clinics. You also sounds like you’re gone more global, not just in the Berkeley area. Correct. So talk to me about your clinics and how do people access them? And I heard you say the word members. Do they pay a monthly fee to be a member?
As you well know, access becomes huge. I get SOS almost every single day for somebody in a mental health crisis. So it is a big deal. So tell me, what are you offering?
Yeah, great question. We call the members just a nomenclature. Patients, clients, whatever you’re used to. We do not charge a monthly fee. We just call members because there’s this stigma to patients in mental health. Everyone has their own feelings about it. I think it goes both ways, and there’s definitely good points on either side. Client. We found it pretty specific to therapy. So members was kind of where we landed in an inclusive term, but not by any means. A monthly fee. And access is our number one mission.
And to talk about access, you need to talk about access because unless you’ve tried to really access mental health care for yourself or a loved one. And even then, I don’t know if people understand how widespread that issue is.
In preparation for this, I kind of was able to grab some numbers for the things that I know. And with access, there’s one in five Americans have a mental health disorder condition, and the amount of money someone can spend trying to find help for that is astronomical. One statistic. This is all from an article on CNBC from 2021. Someone with MDD can spend an average of upwards of $11,000 a year on health costs in comparison to someone whose insulin-dependent diabetes is closer to 5000 a year to manage their condition, almost double for major depressive disorder.
And historically, looking at insurance, mental health has not been reimbursed equally to physical health. We’ll separate them for now. I think it’s all health, but our physical health position counterparts are reimbursed at higher rates for the same services with similar education, similar backgrounds.
Psychiatrists are reimbursed lower. And there is the 2008 Mental Health Parity and Addiction Act that’s supposed to negate that. But there’s still loopholes. There’s car bouts of insurance. And what you see isn’t always what you get when it comes to your mental health insurance.
So our mental health landscape in the US is very much cash pay, and only 56% of psychiatrists take insurance all across the US.
To me, that’s so absurd. If you were to break your leg, you would not be hard pressed to find somebody who takes your insurance to fix it. And therapy even can cost $65 to $250 a session. And evidence shows weekly therapy, weekly is the best outcome, but most people can’t afford that.
So what our biggest mission is to provide access. And by doing that, as simple as it sounds, we take insurance and we take as many insurances as we can. And every day we’re working on more insurance carriers. I think right now we take 14, and that includes even like student insurance in Berkeley, because that’s where we started.
And we found that access to mental health care when you’re in College was difficult. And we’re looking at more and more insurance, too. We do single case agreements if by chance, we don’t take your insurance. So, we’ll work with your insurance to pay us. So you can be seen here. It’s so interesting.
Well, you said the word we talked about members and clients and patients. And once again in the dictionary, the word patient means one who suffers. And we know people are suffering right now. But there’s also something about regaining power and the use of words, which we’ve talked a lot about on the show, small changes, big shifts. What made you foresight come to Kansas City?
There are a lot of things Kansas City. Just so you know. I know I heard you say you spent some time in Southern California. My husband born and raised Kansas City, and we actually maybe neighbors. One day we’re thinking of coming to the Midwest, getting out of California.
But Missouri is one of the highest States for lowest access to mental health. I mean, there is per capita, so much less mental health services. I think it was in the top five of poor access. I’ve got some statistics here too, that one in ten adults has a serious mental illness. 40% of those cases are untreated. And this is Kansas City, specifically Missouri. Statewide, 5% of all adults rounded up to five had serious thoughts of suicide. Five of all adults had serious mental illness. Only 45 with that mental illness received any kind of help or counseling. It’s less than half.
Why do you think that is? What’s your why behind those stats? Any idea? I have theories. One is access. We don’t have access to a stigma. I live in California where things are a little bit more progressive, but that’s not always the case across all of the United States. We see in different markets, different areas.
There’s a lot of things that prevent access or reaching out. And when we talk about mental health, there’s a lot of this. If I could just stop being sad, I’m too weak and I need to get help and there’s not this weakness put on physical conditions like there is on mental conditions. And I think that stigma still exists. I think we’re making a shift.
The younger generations seem to be more open and more willing to talk about these things and it’s so amazing to see. But there still exists that little bit. And culturally too, for a lot of cultures, mental health isn’t as recognized. And I know I’m going to have to wait a few years, but really excited to see what the landscape is when my children are my age and what mental health looks like in those conversations. And bringing out to the open and reducing the stigma.
That’s one reason why we’re delighted to partner with Advent Health, because they do believe that you’re a whole person and that’s one of the areas they like to focus on as well. So what is different about the way Foresight offers mental health services compared to other mental health clinics?
A couple of different things we do that aren’t fully unique but unique that we do them together, one of them being access. We talked about the 56% that are the only ones that take insurance. We take insurance across all of our providers. We also have this technology piece which is up and coming, growing.
We do a lot of this charting, so that’s unique and it’s helpful for members to be able to see their own progress. I think there’s a lot of subjective in mental health and psychiatry, which is just the nature of it. But being able to put a little bit of objective measures is helpful there’s also for getting as big as we are, a lot of quality assurance.
We still hold our providers to a high standard. We expect them to provide good care. And on the other balancing end of that for us as a company, another thing that’s very important to us is our culture for our providers. We think happy providers provide better care. And we don’t pigeonhole anyone into certain specialties that they’re not comfortable with or that they don’t love doing.
We don’t require people to see adolescents. We don’t require people to do certain modalities. We say, come as you are, come to us to do what you love to do and provide that kind of care to people.
That’s awesome. So when you think about the things people can do on this show, small changes, big shifts. We move by the philosophy of quadrants of, wellbeing, mechanical, chemical, energetical, psychospiritual. And so there are things that people can do in all those quadrants to really help them live more well being or more happiness. What are a couple of things that you’d like to share with our audience today that could help them with their mental health, especially as people are going back into the new normal. And some people have enjoyed being at home, working, some people have maybe gotten a little bit more lonely and they’re kind of comfortable there. They’re kind of like, well, wait a minute. I really don’t want to go back into the world. So what are some lifestyle interventions that you guys like to recommend for mental health?
Yes, I love lifestyle interventions. Couple things I want to say prior to lifestyle interventions, is there’s levels of mental health?
I always have to say this coming from a psychiatry background, there’s levels just like with diabetes, sometimes you can change it with diet, sometimes you’re insulin dependent. So for all these things really meet people where they are, sometimes you can make small changes and they’ll do big things.
Some people are not able to do things. So if you tried these things before and they didn’t make a difference, I see you and just these are general without having a certain person in front of me to suggest.
yes. Before you answer that question, I think that’s really great advice to meet people where they’re at. And so anybody listening today that it’s kind of like if you get in a car accident and your bone is hanging out of your skin, please go to the Er, don’t come to the chiropractor.
Exactly. So I think it’s a level of being aware of really where they’re at and what are some signs that they know that they’re elevated. So maybe before the prevention is how do you know how to stage yourself? Let’s say one to five. And one is lifestyle will help. And five is I need to get to the hospital because I’ve got suicide ideation. Are there some clues? It differs per diagnoses, but for some of these things we’re going to have in the pandemic, we’ve seen a lot more of exactly as you mentioned, social isolation, maybe a little bit more blue may be difficulty in concentration, focus, not reaching out to friends as much.
All of these things are. If you’re still able to find some joy in things, if you’re still doing some of the things you usually like to do and they still bring you enjoyment, maybe you’re at that lower level, but you’re still feeling like yourself, you’re not having suicidal thoughts, even thoughts of death, reoccurring death without thinking I want to die, but just thinking of death all the time, those are starting to move towards a more moderate level, anything like hallucinations or panic attacks or mania or that’s a big conversation on what mania is for some people.
But any of those symptoms or a chronic diagnosis. I always say this Disclaimer because for some of these things, like exercise, just getting outside, going for a walk. But I know some people, even on the more severe side of depression, have a hard time getting out of bed to brush their teeth.
So I always have that Disclaimer because I know that there’s a lot of this get on exercise, sleep better, do these things and you’ll feel better. And sometimes it’s not attainable at those levels.
So just saying that’s okay, if you’ve done these things and it hasn’t worked and it’s okay to ask for help and need more help than some of these little more instant changes you can make.
Give me some of the instant changes that you think can make a difference if somebody’s on that lower level right now. But once again, if you’re listening to podcasts, right. First of all, if you’re listening to podcasts, you’re probably not at the higher level. Number one. Sure. Number two, if you are listening and you are at the higher level, feel free to figure out how to seek help. And we’re going to talk about some ways to do that in just a little bit. But I’d like the average person that I see.
By the way, Jessica, as a wellness chiropractor, one of the top five reasons people come to see me is because of anxiety and depression. So it is a big deal. And so what are some lifestyle things that you recommend?
Yes. The first one is nutrition, diet. And I don’t mean change your whole diet tomorrow, go paleo, whatever it is, but just small healthy choices or small choices. Some people are skipping meals, things like that. There is so much research out there and up and coming things about the mind gut connection.
We know that there’s a lot of serotonin in the stomach. We don’t know. And another thing about psychiatry is we don’t know everything. We don’t know all the time what causes these neurotransmitter, imbalances, everything in psychiatry still theories because we can’t put a blood pressure cuff on you and have it show your level of depression. We can’t do a lot of those tests that show us some of the other physical ailments.
So we do know that there is a mind gut connection. So diet nutrition studies have shown that people who eat more fruits and vegetables have lower incidence of depression. And the Mediterranean diet is very good for depression, anxiety as well. That’s one of them especially important in today’s world.
Just unplugging for a little bit. Getting outside, being in nature, being away from screens, computers indoors, all of those things. Getting back to just that more mindful present feeling of being outside, even for short periods. I know it’s cold. Some places exercise and not exercise like go run a marathon, train for a marathon. But simple walking. Yoga is wonderful. Everyone should do some form of yoga. It’s amazing how helpful yoga can be. Meditation is great. Some people meditation isn’t as possible.
We find that people with a lot of trauma do better with yoga and get the same benefits from yoga as they would from meditation and that it helps them. They’re more able to get that benefit from yoga than they are from meditation.
Taking care of your physical health, regular checkups, making sure your labs are okay, seeing your primary. Those are all big things. So much of that physical health ties into the mental health as well. Smoking, drug use, alcohol use, those are another big things loaded thing because those could need more help as well. Those could be masking other things that could be a big tie in there.
But just in general speaking, moderate use, light use, sometimes those things are causing more problems than they’re solving. Those are kind of my surface level. General lifestyle changes and sleep. I forgot sleep. That one’s the most important.
Sleep hygiene is so big, even people who feel like they get enough sleep might not be getting restful sleep. And when you really dig into some of these more like anxious depression, there’s so much sleep difficulties and sleep issues.
And one of those unplugging things is we all are glued to screens nowadays. People use their phone right before bed or they leave the TV on. And the melatonin imbalance and the lack of sleep, sleep alone can cause a lot of anxiety and depression. Just that one factor. Being off can cause so many different shifts. We need sleep, and I think we lose sight sometimes of how important that is or how much that can be affecting our mental health.
Well, sleep definitely is a big deal. We’ve talked a lot about on the show, small changes, big shifts. Jessica, you’ve given us a lot of insight today. And for those of you that are suffering with monkey mind or negative thinking or doubt or fear or just playing out, just don’t know how to put the next foot in front of you, I’m sending you extra love today. And I know what it’s like to have that.
Sometimes I’ll just get a mantra and I’ll repeat it over and over to try to shift my thinking. Shift my thinking for sure. So how can people plug into foresight now? What’s the best way for them to reach out and get help? Can they do virtual visits? Can they do group visits? What do you offer with the pandemic?
We have all of our services offer virtual. Right now we are watching numbers and places, watching laws and places to see when we go back to office. So we will be offering both depending on the covered restrictions in your area. But everything is different. We have neuropsychology testing virtually. We have psychiatry virtually, therapy, dietician services. And the best way to access it is through our website and through the website, you can book straight through there with a therapist and look at their modalities, their insurances that they take psychiatry. We do have a live visit or live intake just to make sure it’s the right setting.
Well, I love that you mentioned modalities because some people just like going to the dentist. They may go to a dentist and think they have all their needs met where they may need a paradox or another type of specialist that can go in and do a deeper cleaning or maybe take a tooth out or do some different things.
So that’s so true with mental health. There’s different modalities, whether it’s an EMDR or CBT or maybe some therapists that use Hypnotherapy or they may do some touch. So there’s many ways and I love that. Do you guys describe this on your website, the different types of modalities?
Yes, I believe so. And then we also have therapy. They all have their allies listed. So if you’re looking for somebody who has specific experience in working with someone in the LGBTQ community or we have all kinds of specific modalities and allies listed as well.
Well, that’s awesome. All right, Jessica, we’re coming to the end of our show. I love learning about you and foresight today. I’m curious, do you have a favorite song, quote or book that kind of keeps you rolling through life?
I do have favorite books. If I could do maybe so it would be an injustice if I ever said favorite books and left this one off because it’s really I feel like what started me in my fascination in the human experience. But the first memoir I read was in high school, and it was Glass Castle by Jeanette Wells. And it’s really about her and her experience with her very untraditional family. There’s definitely some alcohol abuse, substance abuse, and potentially some undiagnosed mental health conditions.
And since reading that book has maybe read less than five pieces of fiction since then. And I read a lot. So I love the human experience. I think it’s really interesting what people go through and how that forms them, shapes them and I think it’s so much more interesting than fiction.
Well, I love reading I actually picked a song for my favorite today and I picked a song called People Need People. And it’s with a movie with a true story based out of St. Louis, Missouri, where a young boy drowned and came back to life and talk about people need people. And so those of you suffering today, I hope that you feel called to reach out to somebody to get some help. Whether it’s foresight, maybe you already have a therapist, maybe you have a doctor you work with, maybe you have a neighbor, maybe it’s a pet. But I just encourage you if you feel like you need some deeper connections to reach out and make that and sometimes it could be a song, it could be a word, it could be a book, it doesn’t have to be a physical person. Anyhow, I’ll be listening today. I’m sending you out really big hugs. Thank you for listening to smaller changes, big shifts, building rhythm and reliance. Thank you to our guest Jessica.
Thanks for having me.
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