Pioneering Neuropsychiatric Care

David Condos: Welcome to this episode of Recovery Unscripted. I’m David Condos, and this podcast is powered by Foundations Recovery Network. For today’s show, I’m happy to welcome Steven Airhart, CEO of Hartgrove Behavioral Health System in Chicago. He joined me via Skype to share some of the innovative ways they’re improving care for patients with trauma and other psychiatric conditions. Specifically, we discussed Hartgrove’s Neuropsychiatric Center and how they use quantitative EEG testing to get an objective detailed picture of the brain’s activity and tailor the evaluation and treatment to each person’s unique condition. Now, here’s Steven.

I’m here with Steven Airhart. Thank you for being here with us today, Steven.

Steven Airhart: Yes, my pleasure, thanks for having me.

David: All right, let’s open things up by having you tell us a little bit about your personal story and how you got started in the world of behavioral mental health.

Steven: As a young kid, probably junior high to early high school, I always had the natural predisposition to want to help people. When I was in high school I had a principal who encouraged me to meet with the school’s psychologist, the school’s social worker and get a better understanding of the helping field. Ever since then, I knew I wanted to be in the clinical field. From that process I started as a young professional working in an emergency shelter for abused, neglected and run away children ages 3 to 17 of age. From there, I was working on my master’s degree in counselling clinical psychology and decided that I wanted to do something more clinical.

At that point I went in and started in my first clinical study I was in a health setting. Worked on both the child and adolescent psychiatric units as well as a little bit on the adult psychiatric unit and realized that that was the setting for me. From there, I then went to my first poor profit psychiatric setting, from a clinical experience, it was incredibly rewarding because I had such an incredible opportunity to get such a diverse clinical experience but also to assist the patients again at some of the weakest lowest points of their life.

David: As you mentioned, you’re at Hartgrove Hospital in the Chicago area now, could you tell us more about your current role there at Hartgrove?

Steven: My current role as a group chief executive officers provides me the opportunity to assist the operations of scrolling Hartgrove Behavioral Health System, as well as in other hospitals here. Hartgrove is divided roughly about 50-50, with children adolescents and the other 50% with adults, in addition to the child and adolescent psychiatric program, in addition to the young adult and adult programs, we also have a very expensive partial hospital program, some refer to it as day treatment. We have both children and adolescent day treatment programs. We also provide an array of outpatient services. Traditional outpatient services for the full spectrum, child adolescent, adult, family individual. Our goal in working with the community is to do all that we can to identify the needs of our community, to always be a resource to our community and work with our community partners such as the emergency rooms, the community mental health centers, the law enforcement, the school system.

We are always happy to partner with multiple different clinical venues. We’ve currently partnered with the offline community school district where we are actually providing services within the school system. Instead of trying to assist families in coming to our clinics, it offered us an opportunity to bring the therapists and the clinicians to their school where the children already are. It provided us the opportunity to go and set up outpatient clinics within the school settings, it provided a great ease of access to the families, it meant the school administration can easily make referrals to the program. Being a partner with the school allowed us to be able to bring the services to them in their current setting. We also worked with several of the local emergency rooms, where they do not have psychiatric services and we’ve partnered with those emergency rooms and hospitals to provide a much needed service to their patients as well.

David: I want to dive a little bit deeper into some of the offerings that Hartgrove has at the hospital location. I read on your website that Hartgrove is the first hospital in the nation to receive specific joint commission certifications for both trauma informed care and neuroscience based neuropsychiatric care. What were the steps that Hartgrove took in the process of earning those designations?

Steven: Sure, I appreciate you bringing that up. Hartgrove is the host of the largest doctorate level psychology training program in the state of Illinois. With the plethora of resources within that department, a few years ago we charged them with the opportunity to identify some of the commonalities, some of the areas that we saw frequently within our emergency services department but also looked at the community to identify what services might not be readily available within the community.

What our psychology department brought back was a great presence of patients presenting with traumatic symptoms. What we did is we charged the psychology department with the goal to go out and investigate, identify research all the various trauma programs that are currently in practice. Once the psychology department brought back the best practices within the area of trauma, we designed our own programs to truly be the best of the best practices.

We’re proud of these services because we approach trauma as well as some other services in the same fashion that you would certain wholly complex systematical treatments. What we do is we design a team, there are a team of psychiatrists, nurse practitioners, social workers, therapists who all focus in that one specific area. Every single clinician is certified in trauma informed care, each trauma focused CBT and that has shown the greatest levels of success from a clinical philosophy to work with trauma patients. We’re incredibly proud of our trauma focus services.

David: Yes, and you brought up the trauma focused CBT, I wanted to touch on that for a second. What does that entail and could you describe how that’s different than regular Cognitive Behavioral Therapy?

Steven: Sure, when you approach a patient from a trauma focused CBT approach, it’s really a lot about the awareness. It has to do with making sure everyone on that team is fully aware of that individual’s trauma and their response to the trauma. Let’s take a case for example, where you have a child who is sexually molested repeatedly over a period of time at night in a dark room by a stepfather. What our team is keenly aware of are those triggers if you will to their trauma. A dark room, an individual who might enter the room without introducing themselves or acknowledging that they’re about to enter the room. From a trauma focused CBT perspective, we take the entire experience and make sure that all the staff are keenly aware and responsive to that kind of issue.

For example if a staff member needs to enter that room, they would knock, they would introduce themselves, they would ask permission to enter that room, so that it does not trigger that trauma experience of someone walking into the room unannounced and therefore they have a strong reaction to that stranger. That’s a very simple example of how one might respond differently to a trauma informed care program than a non trauma focused program. One of the aspects of our trauma focused CBT program it has a tear system. Our goal at Hartgrove is to always try to meet the patient where the patient is, if the patient is not clinically ready to discuss that traumatic experience or traumatic event, that’s what we respect. If a patient is at a point where they want to discuss, they’re ready to discuss that trauma and be able to work through some of those issues, then we meet that patient at that point where they’re at. With trauma patients, there’s a full spectrum, there’s a full range where patients can be on that mental health recovery’s process. Our ability to clinically meet that patient where they’re at in that tear, allows us to be able to make sure that the patient is most comfortable and most clinically ready to progress at the speed and at the time they’re ready to progress at. [music]

David: I wanted to get into the other program that we mentioned earlier, your neuropsychiatric center. Could you start by describing QEEG neuroimaging test?

Steven: Yes, exactly. We are incredibly fortunate to have one of about 50 neuropsychiatrists in the world with that credentials and experience, Dr. Teresa Poprawski. Our team of neuroscientists utilize the quantitative EEG as one of the main tools to assist in the diagnosis but also to assist in the treatment. If you think of what an EEG is, the EEG is much like an EKG, whereas the EKG measures the rhythm of the heart, the EEG measures the brain activity. Just as nonintrusive as an EKG is, we put electrodes up to the patient’s head. They sit there, they’re watching a video and what we’re able to do is monitor the brain activity of that patient.

The quantitative element then allows us to be able to measure that specific patient’s brain activity with hundreds of thousands of other patients. As a result of that quantitative opportunity, it provides us the insight of what medications or at the best dose to most effectively treat that patient when compared to hundreds of thousands of other subjects. What we utilize then is the quantitative information to be able to provide a very precise, very specific treatment regime based upon the success of other patients with that same brain activity.

It provides us an unbelievable look inside the engine of the human. Our brain is our engine, it controls every thought, mood, emotion, behavior and David what we see as a result of this early specialized program, is we’re able to diagnose more effectively and more importantly we’re able to treat more effectively. We are able to get patients through our program in a much more quick fashion than traditional methods and we are able to see that they sustain a much more positive mental health outside of that program for a much longer period of time.

David: Could you tell us a little bit more about how this scientific view of the brain helps you uncover the origins and the current state of someone’s emotional and mental health? Is it by looking at the quantitative examples or how does that work?

Steven: Sure, what the EEG does is provides us an opportunity to evaluate the brain if there’s any overstimulation, understimulation, if there’s any trauma. Let’s take for example an automobile accident where you might hit your head against the steering wheel or the side of the car, let’s take for example someone who might be attacked, they hit the wall or they hit the ground. That level of trauma will be identifiable through the EEG, it shows specifically where at in the brain the trauma took place.

As a result of that, based upon our neuroscientists they know then what behaviors are going to be evident as a result of that specific area of the brain being traumatized. Then they take that information and they know what medications at what dose, will help assist the brain to recovery or assist with the introduction of what medications will aid the brain in making up for it’s current deficiencies. From that aspect it truly gives us a scientific opportunity, it’s one of the first times that we have quantifiable data in the practice of psychiatry to treat patients with the most precise tool possible. It’s an incredible revolutionary opportunity in the advancement of psychiatry.

David: Then in a more big picture sense, how does using this neuroscience, very objective quantitative data, how does that challenge some traditional viewpoints about mental illness disorders and like you mentioned earlier, the stigma around them?

Steven: What we can do with the testing that we provide here at Hartgrove is be able to show a patient much like you would have an X-ray, it shows exactly where the damage is and it provides us an opportunity to also through the course of treatment David, show them the progress and the change that the brain endures as a result of the medications that we’re introducing. We take the measure of the EEG when a patient is first admitted to the hospital and we replay, we retake those tests through the course of their treatment, so the patient and or the family can actually see the brain’s response to that medication and the ultimate goal is to reach that level of normalcy, through trauma experience. That’s the beauty of what this program allows us to achieve. It is the scientific proof of their brain responding to the medication and if we need to tweak something, we have the evidence right there, the quantifiable evidence of the efficacy of that medication and obviously then the patient is able to describe how the mood might change, their behavior might change, the concentration et cetera.

David: Yes, and that’s a great point. It not only shows the medical stuff this objective data, but it also shows the patients and their families what you’re feeling is a real thing and here it is. You can see it in a visual scientific way right here and then see the improvement.

Steven: Absolutely, you think of patients who traditionally experienced psychiatric issues and you have a patient who is depressed or you have a patient who is highly, highly anxious, you have a child who is experiencing school phobia, where they’re so fearful to go to school, they can’t leave their home and they don’t want to be in crowd. Through the science and the advancement of neuropsychiatry, we can actually see the part of the brain that is causing that behavior or that mood or that emotion and we can more pinpoint the treatment. That’s something that historically, psychiatry has never been able to do. That’s been typically reserved more for the medical aspects where you can do blood work or you can take X-rays.

Now we have that science available and accessible in psychiatry that gives us an incredible opportunity to be much more effective and point it in the treatment that is provided and the families can see the response physically as a result of this quantifiable data. When you look at who is a prime candidate for our neuropsychiatric center of Chicago, it’s an array of patients. It’s not just those patients who perhaps have had a traumatic brain injury. It could be those patients who have experienced medication resistance where they’ve not responded well to various forms or trials of medication.

It can be patients who are chronic and they’ve been experiencing an issue for a long time and they’ve been to different hospitals, they’ve been to different psychiatrists, they’ve tried multiple different medications and nothing has worked. This is an opportunity for a patient to come to us and go through the testing which again is done very quickly and in a very nonintrusive manner and get the answers that often times have been long sought but never been able to answer. With the science and the advancement of neuropsychiatry, it provides us a glimpse inside the patient that we’ve not had the opportunity to in the past.

David: All right, we’ll just wrap up with this final question, you’ve devoted a lot of your life and your effort over the years to this field, why would you say that helping people find mental health recovery is important to you?

Steven: For me it’s an incredibly gratifying career. It has been an unbelievable journey, both personally and professionally to see the patients that come in, in such critical crisis where they’re actually not functioning and they’ve resorted to wanting to take their life or being so desperate that they’re wanting to take somebody else’s life. Being able to be a part of watching those patients own journey through recovery has been amazing.

What is incredibly rewarding for me as a CEO is to have the patient testimonials, to receive the letters of gratitude and thanks and acknowledgement to our front-line staff as well as our psychiatry, psychologists, nurses, therapists. To be able to be a part of helping and assisting them through some of the days of their lives, there is absolutely nothing that is more rewarding than that. That’s what motivates me every day to help improve and enhance the services and experiences of the patients of Hartgrove Behavioral Health System.

David: All right, well thank you for your time today, Steven.

Steven: It’s been my pleasure, thank you, David.

Speaker: Thanks again to Steven for joining us, now I get to introduce another installment of our ongoing segment called Minute of Mindfulness. Together we’ll take the next 60 seconds to slow down, take a deep breath and focus on this present moment. As always, I’ll open things up with an inspirational quote and then I will rejoin you to close out the episode. Today’s quote comes from Nobel Prize-winning French author Andre’ Gide who said, “Man cannot discover new oceans unless he has the courage to lose sight of the shore.”

This has been the Recovery Unscripted podcast. Today we’ve heard from Steven Airhart, CEO of Hartgrove Hospital in Chicago. For more on their services visit Hartgrovehospital.com. Thank you for listening today. Please take a second to give us a rating on your broadcast app and subscribe, so you won’t miss out on what we have coming up. See you next time.