Melina Davis 

Hello, I'm Melina Davis. I am the host of the JoyMed Podcast. And I'm thrilled today to have a really important employee of the Medical Society of Virginia with us. Catherine Ford is the program director for Health Haven's Adult Psychiatric Access Line. And I think she's going to tell us some important and encouraging things that I think are designed to help both patients, but also doctors. Welcome, Catherine. Glad you're here. 

Catherine Ford 

Thank you so much for having me, always a pleasure. 

Melina Davis 

Tell us a little bit about you. How did you come to MSV and why did you come to MSV? 

Catherine Ford 

Sure. Well, I came to MSV by way of the government affairs world. I got to interface with the Medical Society's GAP team in my capacity as a contract lobbyist for different specialty societies for physicians. So, I got to represent psychiatrists and pediatricians and anesthesiologists at the legislature. 

And of course, I got to meet the GAP team from MSV, and we worked together on a lot of important issues. And they loved where they worked so much and were such great friends and colleagues in and out of the legislature that when an opportunity to join the Medical Society came up, I had to jump on it. 

Melina Davis 

I love that. I love that. The GAP team is the GA and policy team for us, the Medical Society of Virginia. We call it the GAP team because it, of course, is the acronym, but it also, that team actually looks for where the gaps are in healthcare or in patient care or in regulation, all of those things that need to be fixed and need solutions around them. And they do that in concert with our program team. 

Catherine Ford 

Yeah, absolutely. 

Melina Davis 

And it's interesting to think about the fact that we solution on our foundation and program team and that the GA and policy team almost becomes the team of adventure or Avengers. Is that the right term? The Avenger team that goes out into the world and tries to, you know, fight to make it happen and bring resources and change and policy, right, to what's going on. 

Catherine Ford 

I think it's some of the most important work an organization like MSV does is take the concerns of their membership and hearing what they do every day and finding solutions and breaking down barriers at those regulatory and legislative levels and making sure our policymakers are educated on those issues and know what's in front of them. 

Melina Davis 

I think people don't know we do that. 

Catherine Ford 

I don't even believe that. 

Melina Davis 

I know. Some of the best work we do. It's some of the best work we do. It's almost like the quiet work that we do. And as our foundation, our 501c3 foundation, has become stronger, it's become a strong partner to that GA and policy team. 

Catherine Ford 

Absolutely. The foundation gets to house a lot of our health access programs, which are chiefly state-funded and strong partnerships with state agencies. So, the GAP team kind of helps us foster that and continue that relationship. 

Melina Davis 

I've said for a long time that doctors understand where the system is broken and not working for their patients. And they want so much to help people. And sometimes they're not allowed to because of the way it all works. And we get to talk to them about that and get creative to try to make it better. And the access line is one of those incredible ideas that came about because we started hearing about problems. 

Catherine Ford 

Yeah. I think, just to kind of get to the why of these programs and how some of these state partnerships have informed that, we know in Virginia that primary care providers are the first folks who can identify or interface with a behavioral health condition or a substance use condition. But those providers are also disproportionately inundated with patients and paperwork and prior authorizations and administrative time. 

That really means that they can't care navigate for those patients or spend the time with them that maybe they would like to address those issues. So, There's got to be a lot of decision fatigue that comes about through that. And these programs are designed to shore up some of those concerns. 

Melina Davis 

It's so hard for a doctor, PA, nurse to understand what is available for patients beyond their office because their heads down every day trying to help the humans that are walking in the door. 

Catherine Ford 

Sure. I, you know, I think behavioral health care is so complex and the adult patient is so complex. There's social and cultural and medication concerns that all intersect. And, we can't expect a primary care provider to be able to identify all of those things and know what to do about all of those things. And that's why, our programs are there to help navigate their patients to the specific resources they need. 

Melina Davis 

That's really neat. And you have this great background with so many specialties and doctors. What have you heard from them over time and specifically since you've been working on this program about their frustrations or why it's difficult or how its difficult? 

Catherine Ford 

I hear that they weren't trained on these things in medical school. I hear a lot of the things that patients say, which is it's difficult to find a psychiatrist or a specific provider or wait times are just so long or. 

Melina Davis 

Months in some cases. 

Catherine Ford 

I mean, the wait for an autism screening alone can be up to 18 months for a pediatric. 

Melina Davis 

And that child is missing every developmental milestone while they're waiting. 

Catherine Ford 

Right, that's a long time to wait for a two-year-old to get a screening, right? So, the same issues persist with adult patients. And, you know, adult patients have a ton of things going on. They can't always navigate themselves to the care that they need. And they look to their provider for that information. And it's got to be a real moral injury for a provider to not know what to do with the patient in front of them. 

Melina Davis 

And they want so much to help, but where do they turn when they're trying to help somebody? 

Catherine Ford 

Right, That's why we have the Health Haven program, which offers provider education as well as the Adult Psychiatric Access Line, APAL, which is a specific call line where any prescribing provider in Virginia can call and within 30 minutes or less, or whenever they'd like a call back.  

They can talk to an addiction medicine specialist, a psychiatrist, a peer recovery specialist, and a care navigator, all sorts of folks on a care team that can help them triage that case, case conceptualize, and kind of move that patient forward. 

Melina Davis 

And is it normal for a doctor to need that kind of help or a nurse or a PA? To need to call a colleague, and how would they know who to call if they were on their own? 

Catherine Ford 

Yeah, I think it's extremely common. A lot of, I gather anecdotally that a lot of these providers have informal and formal relationships with folks that are maybe down the hall or down the street. But what I think is so great about HealthHaven is we can house specialists that are so few and far between in the state that provider or that patient would never otherwise get to see. 

An addiction medicine specialist is double-boarded in addiction medicine and family medicine, and that's a very specific background and very specific care, and a patient may not know to seek it. 

Melina Davis 

When a patient says that they have an addiction and today's the day that they became brave enough to ask for help, I've heard Dr. Sterling Ranson, who practices out in Tappahannock area, say that's the day he needs to make a call and get that person help, not have them on a waiting list. 

Catherine Ford 

That's right. Every peer recovery specialist I talk to tells me that that's the moment we have to be able to respond. And HealthHaven's consultation line specifically with that 30 minutes or less, callback time means that provider and that patient get to have that clinical consultation, even a connection with that peer recovery specialist to help that patient kind of navigate a social or emotional process to get to recovery. So, you know, HealthHaven is designed to respond to that window and to that patient's needs. 

Melina Davis 

It sounds a little bit like the Virginia Mental Health Access Program, VMAP, which is for children, pediatric program. 

Catherine Ford 

Yes. 

Melina Davis 

Does it? 

Catherine Ford 

Yes. VMAP is our big sister program. It is, you know, we took that VMAP program model that's been so successful for pediatric patients, the model of provider education and the consultation line, and are applying it to the adult population. It's a bit of a steeper climb. 

The adult population is five times as big, five times as complex, but this program model has been so successful for providers and pediatric patients in Virginia in a time where pediatric mental health was such a, you know, top of mind concern coming out of the pandemic. And I think we're, you know, with HealthHaven, focusing on the adult population, we get to kind of round out VMAP's mission and create healthy families. 

Melina Davis 

We see so many times, do children grow when children turn into adult? Yes. And then there's this space where we recognize them as adults, but they still need that transition time as a young person. This, we do this now, right? With APAL, we can help somebody who's no longer officially a pediatric patient. get the help that they need as a young adult as well. 

Catherine Ford 

That's, yeah, the VMAP team and the APAL team work closely together. So if we have a patient in that transitional age, maybe an 18 to 23 year old, the child and adolescent psychiatrist on VMAP can talk to the adult psychiatrists and APAL and really kind of discuss that specific patient's needs and meet them where they're at. And so I think those programs getting to be right next to each other is a real benefit to that population, especially. 

Melina Davis 

I love this because in medicine, so many times people will hear about the fact that patients feel isolated and separated, but the provider also feels separated and isolated from their peers and from a network. And this actually creates a community and a care team that comes around the patient as they need it to ebb and flow. 

Catherine Ford 

Yeah, I'm so glad you said that. I really see, you know, the consultation line in particular as fostering that community among those providers and connecting them to those specialists that maybe they didn't even know existed, but now they have a conversational relationship with them. 

So we do have a lot of return users to VMAP and APAL who will call in and say, I want to talk to Dr. So-and-so, because they've really been able to foster that conversation. And I think, you know, infusing practice, the practice of medicine with consultation is a way for physicians to impact the entire system of medicine that is, that can be such a drag on them. 

Melina Davis 

Yeah, I love that. And it increases access for patients. And it just improves everybody's lives who's involved in the helping process, the healing process. Yes. It's rare that you see something that's a win-win-win. 

Catherine Ford 

I mean, this program model is so effective, and the commissioner of the Department of Behavioral Health and Developmental Services, Nelson Smith, describes it as a workforce multiplier. And I think that's so apt because a team is strong when it can rely on one another's strengths. and consultation inherently spreads those strengths around. 

Melina Davis 

Commissioner Smith has been a real advocate for expanding the VMAP model into the adult population and the team at the Department of Behavioral Health. They really care about this population, too. 

Catherine Ford 

They absolutely do it. They're very invested in the program model and the success and the reach of this program. So, they've been great partners. 

Melina Davis 

It's so new, though. When did we start APAL? When did that begin? 

Catherine Ford 

Oh my gosh, the call line will have its first birthday in October of 2025, but we began educating providers the summer of July 2024, and we've already educated over 300. providers in Virginia on substance use behavioral health issues. 

Melina Davis 

That's huge. Because we're building their confidence, we're building the information they have at their fingertips, and we're setting them up with a network to tap 300 people already. 

Catherine Ford 

That's right. That's right. They're educated, and that means their entire patient panel can benefit immediately, and they know that if a complex or especially difficult case comes across, that they have a phone-a-friend option. 

Melina Davis 

And so, it feels like it might be slow to start when we want to be at thousands tomorrow, right? Why does it take time and what was the process for growing the outreach in this program? And what are the limiters to that? 

Catherine Ford 

Sure. Well, this program is so unique in that we're not going out and buying desk chairs or pens. We are creating relationships. And that's what the consultation line is, a network of relationships. 

And that is what takes time is working with the partners who have access to those specialists, working with those specialists to get their buy-in, and then working through every legal and regulatory issue to make sure we're doing this in a way that is compliant, that is responsive to the provider's needs, and that will actually meet the patient where they're at and doing it all within budget. 

Melina Davis 

Budget, the big B word. Today's world, we're all having to look at the bottom line more and more. The Department of Behavioral Health and the General Assembly have really invested in behavioral health over the last few years through these kinds of programs. And APAL really got its first funding in the last year or so from the General Assembly. 

Catherine Ford 

That's right. We were started with a small CDC grant just to pilot the program and in partnership with the department, we were able to talk to the legislature and appropriators, and they've dedicated some state funding to it because they believe in this model so much and have seen the work VMAP has done, especially, and would like to see it happen for adults as well. 

Melina Davis 

Yeah, and so we're still at baby steps with this. Anybody in the Commonwealth, any physician, nurse, PA, any. 

Catherine Ford 

Prescribing providers in Virginia, can access this consultation line or education. That's right. 

Melina Davis 

That's great. And so, our goal, though, is to expand it, not just so we have more people in, but so we can educate on more topics, and we can connect different kinds of providers, right? 

Catherine Ford 

Yes. I mean, I kind of daydream a lot about what does APAL looks like at its biggest and best. And it's built to be responsive to every psychiatric concern or need an adult patient might have in their lifetime and equipping providers to be responsive to that. So whether that's trauma or, veterans issues, whether that's geriatric concerns and, on the flip side of that, caregiver fatigue, just taking care of adults in Virginia from birth to death with this continuum of care and putting specialists in geriatric psychiatry, putting specialists in women's health, putting specialists in trauma care on that consultation line will be just an incredible resource for providers to be able to take care of their patients no matter what they're facing. 

Melina Davis 

Can't we just train more psychiatrists and open more psychiatry practices and get people directly in there? What's the problem with doing that? 

Catherine Ford 

My gosh, it takes, I think, 12 years to become a psychiatrist all in. So, we have, the workforce development happening in Virginia with, more funding for psychiatry resident spots, that type of thing. But we need to encourage folks to get into those pipelines early, and we need to make it a rewarding career as well 

So, what I think is great is APAL's consultation line, Health Haven's Education, offers psychiatrists other ways for them to kind of impact patients and the practice of medicine. And I hope that it becomes kind of a tantalizing reason to practice in Virginia is knowing that they have this backup. 

Melina Davis 

Virginia is getting a lot of kudos nationally for the program like the Virginia Mental Health Access Program for Children. And then this is the next sort of foray. I think people will find it interesting, but it is working. It is working, and I think it is going to get Virginia more and more attention to some creative ways to improve access to care when we're limited by how many psychiatrists we have. 

Catherine Ford 

Yeah, I think that's right. I, you know, Virginia is trying to attack the mental health crisis from all angles. Governor Youngkin has been especially interested in mental health transformation with Right Help Right Now, and APAL has been a pivotal piece of that is really championing integrated care and making space for providers to be involved at every step. 

Melina Davis 

I put myself regularly in the shoes of a family physician and a PA and a nurse in these rural environments where they're supposed to be everything to every person from, let's not even get to pediatrics, but 18 to 80. Nine. I mean, maybe older. And they're supposed to understand how to help exactly what's needed for every part of the body and the mind. Yeah. Right. That's a lot of weight and it's a lot of people. 

Catherine Ford 

It's a lot of responsibility. 

Melina Davis 

It is the effect that I worry that it has, particularly on practitioners who are isolated or aren't surrounded by a large regional support system. I worry about them, the weight of that. And we've got to keep them in the system too. 

Catherine Ford 

Right, I mean, they're vital to those communities thriving. And I think a program like Health Haven is designed to keep them in the communities they want to practice in by still connecting them telephonically or over video or utilizing technology to connect them in a way that they wouldn't get to utilize otherwise. 

Melina Davis 

Yeah, most doctors, I think, think that family practitioners are sort of the soul of medicine. That's, I think that's right, but they're right there helping people and they can get burned out. In fact, some of the burnout rates that we're seeing among family practitioners are among the highest. 

Every specialty is burning out. There's no doubt. But among family and these kinds of programs make them feel empowered, right? Because one, we're teaching them, right? But then they can phone a friend. That's right. This hurts. I love that. I think we don't tend to think that we get to help the patient and the doctor at the same time. It's an interesting model that it's this twofer. 

Catherine Ford 

I think that speaks to the isolation we see in in our communities lately, but in healthcare especially, folks feel siloed and it feels adversarial sometimes. And what I think Health Haven does well is foster the trust between the patient and provider because you get to stick with that primary care provider with their extra training, with those extra skills, and you can kind of build that relationship and utilize that trust for that patient to stick with the treatment plan and improve their health outcomes. 

So, it helps the provider's burnout and decision fatigue by having a phone a friend, by fostering those skills and comfort level with these conditions, but also helps that provider foster and continue the trust with their patient. And I think that's building community as well. 

Melina Davis 

Wow, and it adds energy back in, right? It does help encourage people and empower people, both patients and providers. 

Catherine Ford 

Sure. 

Melina Davis 

So, when somebody calls in, talk about how a typical call will go. Help us understand when somebody calls, why would they call and what happened? 

Catherine Ford 

Sure. So a typical call, a provider would call in and the first person they talk to is a licensed mental health professional. And getting to talk to that person immediately means they can case conceptualize immediately and start getting a clinical perspective right away. And what that person does is help triage the case, talk a little bit about the patient's initial needs, does a little bit of an intake. And oftentimes some of the therapeutic suggestions that an LMHP gives is enough for a provider, but other times that LMHP can help them decide, okay, a more clinical higher level consultation is appropriate here and we can rope in a psychiatrist or an addiction medicine specialist or, you know, or both. 

And that LMHP can connect the provider with those folks. And then You get to talk to that clinical person, talk a little bit about medication issues, titration schedules. You know, these are things psychiatrists and addiction medicine specialists are trained on specifically that primary care providers aren't. So, they can, you know, walk them through what medication interactions might be, those types of concerns that happen after a patient goes home with a new prescription and what to look for in the next weeks and months ahead. 

And so that provider is kind of equipped right away with that consultation to know what to do when they see the patient next and what to look for in the weeks ahead. And then likely they'll be connected with a care navigator who's gotten to talk to those psychiatrists and that LMHP and hear more about the patient and helps determine what long-term resources they need. And our care navigators are trained to navigate insurance issues and yes, and break down those barriers and get the appointment faster, which I think is so critical and kind of cuts down on some of that wait time and some of that work a patient would have to do otherwise. 

Melina Davis 

And doctors don't have these resources in their offices, right? So we actually can provide them because of this funding that we've been able to get. 

Catherine Ford 

That's right. 

Melina Davis 

To help the patient directly and the doctor directly find what's needed and get it faster. Love that we're getting people help faster. 

Catherine Ford 

I mean, there's all sorts of resources out there and different types of therapy modalities, and we can't expect every provider to keep track of them. And thankfully, they're cropping up and they're innovative, and what HealthHaven gets to do is kind of house them in one place, and we can directly impact where that patient goes, and they may not have found that resource otherwise. 

Melina Davis 

What if the doctor down the line needs to call back or the PA needs to call back? Can they do that? Of course. How many times can they call? 

Catherine Ford 

They can call us as many times as they like. This is a completely free service to them. So they have access to these specialists, you know, 9 to 5, you know, Monday through Friday, all year, if they need it. And they can call us as much as they want. 

Melina Davis 

And why not a patient access line? Why a provider access line? 

Catherine Ford 

Provider-to-provider consultations are, you know, setting aside some of the legal protections that kind of houses and can shield some of the concerns. But, you know, curbside consults have been happening before these programs. 

And so it's really formalizing what providers had tried to do. But not a patient consultation line because it's important to equip the provider with these things to help their patient directly. They have the trust, they have the relationship, and they can impact an entire patient panel walking away with what they know from our consultation line or from our education. 

Melina Davis 

That's really the key. And you sort of we're teaching them to fish too, but medical is well said, well said. So not only can they call in and not only can they get the care navigation resource to help the patient with this specific issue, they can do continuing ed and they can learn more over time. And that matters so much. 

Catherine Ford 

Yes, I think this is the foundation of the program's model. You know, it's got such a lasting impact. The consultation line's an incredible resource and very innovative, but The education, kind of is often their introduction to the program and helps them see who is on the other end of that consultation line, which is great and really fosters some engagement in the provider community. But our education, offers CME at an extremely low or no cost to them, which is, I think, important to kind of get their buy-in and interest. But we also center physicians in developing those curriculums and developing those topics. 

So we actually put those providers at the center of what we're teaching so that we know what folks are actually curious about and what they actually need help with and what modality suits their schedule. So, is it a lunch and learn? Is it, you know, an intensive weekend-long course? Or is it enduring, education that we host on our website where we work on all of those modalities to kind of meet providers where they are? 

Melina Davis 

Because they don't have a lot of time when they've got it and they're interested in. extending their knowledge here and building their confidence to treat capably in this area. 

Catherine Ford 

They don't have a much time, but they've got the heart. And I'm, you know, I've gotten to sit in on some of our education and I see these providers eating lunch in their cars. You know, engaging with the curriculum, I see them on walking pads and on their Pelotons while they're in this education. Like they are making the time to learn about these things and get trained and That really tells me there's, the need, but the real appetite for it. 

Melina Davis 

They're so committed. They're truly committed. Yeah. Well, when you sort of look and envision the future of psychiatric support and primary care and how systems like this can be scaled to improve outcomes in clinician well-being, What do you see, particularly when other states might want to do this kind of work? How do you see that happening and how could we help encourage all of that? How could it happen? 

Catherine Ford 

This is such an exciting question. I think there's a lot we struggle with our current healthcare system, but it means there's opportunities. for us to fill those gaps. And that's what Health Haven is doing, particularly with centering physicians at, the core of our programmatic choices. 

But how do we scale it for the whole state? You know, I spoke a little bit ago about what does APAL look like at its biggest and best, and that is scaling it. And that, you know, being responsive to every psychiatric concern, every need an adult might need in their lifetime. And I think other states can learn from Virginia in that, fostering relationships at the state level has been critical. 

It's just, it's where so much institutional knowledge is about who good partners would be for a consultation line, who good partners would be for education. Such a great resource for knowing the regulations you need to navigate. And they're partners in funding, of course, in such a strong way. And I think states are going to have a special interest in this type of work. given so much of health care is administered at the state level, they have an inherent interest in integrating the care and expanding access. And that's what these programs do. 

Melina Davis 

I think this is right, but are we the only medical society in the country that marries this kind of programmatic work and these sort of mental health access program efforts with our known advocacy and policy work and gets involved in them like this. 

Catherine Ford 

I think, yes, it's actually very unusual for a program like this to be housed with a medical society. In other states, they're usually out of academic centers or of big hospital systems. And we've talked a bit today about the advantage that we have in one, we get to be really nimble in our choices and in our relationships and partnerships. 

Melina Davis 

Which matters because it's all broken, so we're having to move around boulders and logs and barriers of all kinds. 

Catherine Ford 

And laying train tracks where I should be laying a highway. It's just, it's just crazy, but we have access to the physicians that are experiencing these concerns, seeing these concerns, and we have access to the specialists that are needed so much on these consultation lines and in this education. So we get to, we sit at a really special place to connect, the stakeholders at the state and the providers that are on the front line. 

Melina Davis 

Yeah, it's so interesting. And I would just say, It's innovative not because other people haven't done similar things as they haven't done it this way and they haven't done it with the doctors in their house. 

Catherine Ford 

Yes. 

Melina Davis 

And with, you know, Henry Ford always said, you know, if you want to improve a process, go to the worker and look at the line and figure out what they think is broken because they're going to know better than everybody. And that's really what we're doing. And the Virginia legislature has been so vision forward in seeing that this kind of different approach with this different set of partnerships would make a difference. 

Catherine Ford 

Yeah, I think our legislators are very responsive to that. They also want to go to the worker and hear about what's broken. And the MSV does a great job at getting their members to the legislature to talk about those things. And what's great is they can talk about the problems, but they can talk about the solutions they can implement. And Health Haven really fits into that. 

Melina Davis 

I love it. 

Catherine Ford 

Yeah. 

Melina Davis 

Solutioning. Solution is what we're all about. Thanks for being here and thanks for sharing all about the Adult Psychiatric Access Line and HealthHaven. 

Catherine Ford 

Thank you so much for having me. It's a joy to talk about. This program is so rewarding. 

Melina Davis 

Here's to more!