Bridging Care Gaps: Hartford Hospital's Institute of Living Young Adult Medical Track Program

[00:00:00] David Bendor, PsyD: One time we had a world class swimmer, who had Olympic aspirations and then physical health conditions kicked in. And then, subsequently mental health conditions kicked in and she'd gotten away from swimming altogether. And it was such a passion of hers and she loved it. And even if she knew the Olympics had passed that she just, it just made her feel so much better, but she was so distraught at the toll that her physical health conditions took on her. [00:00:21] And it could rob, in her mind, robbed her of the chance to compete for the Olympics. She just got away from swimming altogether. And we were all quite proud and quite touched when she told us while in program that based on the encouragement of her peers and staff, you know, she got back into the pool. And by the, her discharge ceremony that we had, uh, she was tearfully telling us how glad she was that, you know, thanks to us, she, she said she rediscovered the waters. [00:00:43] [00:00:44] Introduction to Find Empathy Podcast --- [00:00:44] Meghan Beier, PhD (2): Welcome to Find Empathy. This episode introduces something new. In the past, we have delved deep into topics like MS and rare neuro immune disorders. We also have episodes that present the audio from live didactic webinars. We will now be interspersing single episode topics where we interview experts that are doing unique and exciting clinical or research work that integrates physical and mental health. [00:01:11] Today's podcast introduces the young adult medical track program led by Dr. [00:01:16] David Bender at Hartford hospital Institute of living. A program designed for individuals aged 18 to 26, dealing with both physical and mental health issues. Dr. Bender describes the program's origins, mission, and structure. He shares patient success stories, highlighting the unique challenges faced by young adults with co-occurring conditions, and details the therapeutic models used in the program. Dr. Bender also discusses the program's logistics, insurance considerations, and potential for future expansion. I was really excited to learn about this unique program. [00:01:54] I hope you enjoy the conversation and subscribe so you can be alerted when new episodes and topics are published. [00:02:02] Introduction to Dr. David Bender and the Young Adult Medical Track Program --- [00:02:02] Meghan Beier, PhD: Today I'm happy to introduce Dr. David Bender, a psychologist from the Harford Hospital Institute of Living. He'll be sharing insights into the Young Adult Medical Track Program, a specialized initiative for individuals aged 18 to 26 dealing with both physical and mental health issues. [00:02:20] Dr. Bender, thank you so much for being here today. [00:02:24] David Bendor, PsyD: Thank you for having me. [00:02:26] Meghan Beier, PhD: I wanted to start off by Asking you to provide a little bit of information about the Young Adult Medical Track Program. Can you just give me an overview of its mission and how it supports individuals with physical and mental health issues? [00:02:42] David Bendor, PsyD: Yes, I can. [00:02:43] Origins and Development of the Program --- [00:02:43] David Bendor, PsyD: And if it's okay, I'll give a little bit of a history of how we got started. Um, the, um, several years ago, uh, this is all prior to COVID several years ago, some, uh, donors had actually reached out to our system and, and we're looking for, uh, places they could help out. And they, uh, obviously several of us across the state, you know, submitted some ideas and, and they, you know, they were really keen on, on this program where we proposed, um, Offering a young adult program, an intensive outpatient program, a 3 day a week day treatment program where we could treat young adults with co occurring physical health and mental health conditions. [00:03:24] This came about because for years I had been in what we call the young adult general track, which was is a young adult program, similar ages, 18 to 26 with any mental health condition that's impacting their quality of life, impacting their ability to do school or work. And so, um, as you can imagine, we see a whole, you know, a whole host of young adults coming through all different backgrounds, but what we were consistently seeing and about. [00:03:50] I'd say maybe 10 percent of them pretty consistently that these, there were young adults coming through with, in addition to their mental health conditions and diagnoses had pretty significant physical health conditions and diagnoses, uh, especially, uh, you know, I can, off top of my head, like Crohn's and chronic pain and diabetes. [00:04:08] Um, and, uh, we thought, well, wouldn't it be interesting to have a program that really focuses on these young adults? And can offer them something unique that we didn't know of in the area. So I put this all in the proposal to the donors and, and obviously they went with our project in addition to several others. [00:04:26] Program Launch and Initial Success --- [00:04:26] David Bendor, PsyD: Um, and so we launched a, a young adult IOP, um, in, I'd say the fall of 2019. Um, and we had health psychology and nursing and psychiatry. And I was there as the role of clinical coordinator of the program, a psychologist as well. And and that's really how we launched and we came up with a unique and what I think is a quite robust curriculum. [00:04:52] Um, and, um, launch, like I mentioned in the fall of 2019, um, of course, a few months later, um, COVID came through and change things pretty significantly. But I'm happy to say that even prior to COVID hitting, we were at capacity. Um, so we were clearly meeting a need that was there in our community. [00:05:13] Meghan Beier, PhD: Excellent. This is such a great program. [00:05:16] Unique Challenges and Success Stories --- [00:05:16] Meghan Beier, PhD: I mean, I've come across multiple patients that I've worked with specifically who need intensive outpatient programs and who ideally would love a program where they, the people involved understand both their medical condition as well as the mental health side. [00:05:34] And I just don't know a lot of programs. Like, I, I actually. I can't find one similar to yours. [00:05:41] Unique Aspects and National Context --- [00:05:41] Meghan Beier, PhD: And I'm just wondering, are there other programs like yours around the country, or is this pretty unique? [00:05:47] David Bendor, PsyD: Well, I know, and again, my what I'm about to tell you might be a little dated because I was doing this research right back in 2019. but in terms of our model, uh, in terms of kind of who could I go to who could kind of mentor me on this process of launching and staffing and developing a curriculum. Um, we went to the other coast. [00:06:07] Uh, we went all the way over to California, literally the furthest point from Connecticut. Um, and we, we reached out to some colleagues or who are, I can now call them colleagues out at Loma Linda, uh, and they had a young adult program. Uh, no, sorry, not a young adult program. They had a, they had a young person's program, like, like a child adolescent program. [00:06:28] Uh, for young adults with these, uh, co occurring conditions. So that's one. They told us about one in Chicago. I never connected with them. So that's two, uh, mind you were, you know, we're all in Connecticut. Um, and then interestingly, there is a co occurring condition, you know, for physical health and mental health, uh, in Rhode Island, uh, where I had done some training. [00:06:49] And it's a PHP, uh, for, for kids with, with these co occurring conditions. And coincidentally, the psychiatrist there had trained and done his training and at the Institute of Living where I am. So that was a very easy connection to make. I had some ties to the area. Of course, the psychiatrist had some ties there. [00:07:05] So, so that was a connection as well, but You know, we're talking about as of 2019, I learned a four in the country, ours being the fourth. [00:07:14] Meghan Beier, PhD: Yeah. I mean, I did some extensive research recently and, uh, for a few of the people I'm working with and I, I really came up empty. So this is such a, a valuable resource. [00:07:25] Common Mental Health and Medical Conditions --- [00:07:25] Meghan Beier, PhD: Um, can you share some of the common mental health challenges that you see in the individuals that are coming into your program? [00:07:33] David Bendor, PsyD: Yes, I definitely can. And what's interesting is, you know, we get young adults where, and they'll use their own terminology, but basically they, uh, during their time in the program, they're leaning a little more heavily into their physical health conditions and how those are impacting their mental health. [00:07:46] And then we have other young adults who come through and talk about their mental health conditions and it's making it harder for them to manage their physical health. So kind of both sides of obviously a connected story. It is very interesting because. When I talk to new young adults coming in, um, I'll tell them that and they'll say, great, you know, I have this physical health condition. [00:08:06] I've been dealing with it. It's been chronic. Um, I know it's taking a toll, but I'm really here to talk about my anxiety and my depression. And those are, I think, are the primary diagnoses that come through. Um, whereas others will say, I just got this diagnosis, this physical health condition. It's really thrown me off. [00:08:20] I was never depressed or anxious before. All of a sudden I am. Thanks. Please help so very different presentations, but fortunately, they find a lot of common ground once they come into our program. So I'd say primarily it's it's depression and anxiety. We do like in the regular population. We do get folks with bipolar disorders and psychotic disorders who come through who have. [00:08:41] Those physical health, you have those mental health conditions as well as their existing physical health conditions. But I would say, primarily, we're looking at various types of depressive disorders. Maybe for those new diagnoses, we might might see adjustment disorders with more of a depressed presentation. [00:08:58] Meghan Beier, PhD: Yeah. [00:08:59] David Bendor, PsyD: And obviously the anxiety disorders. [00:09:01] Meghan Beier, PhD: Okay. [00:09:02] Common Medical Conditions --- [00:09:02] Meghan Beier, PhD: And what about, I know you mentioned Crohn's, but what are some of the most common medical conditions of the individuals that join your program? [00:09:10] David Bendor, PsyD: Yeah. So, so we get a lot of referrals from GI. Um, and, and they're, they're often pretty good. The folks who come from them have already heard from their docs, you know, about the mind body connections and how their anxiety can cause flare ups and, and, and things like that. Um, We get a lot from endocrinology because we have young adults coming through with, with type, diabetes type one. [00:09:33] Um, and they've really struggled due to, you know, the, the fluctuations in their mood and how they're doing emotionally. They've really struggled at times with managing that. And obviously at times when they don't manage it well, uh, they end up in ERs and in pretty dire situations. And so we get a lot of referrals from endocrinology. [00:09:50] We get a lot of referrals from oncology with patients who have, um, um, You know, ongoing cancer diagnoses as well as cancer and remission or fully in remission. Um, but maybe those treatments, you know, took a real toll on them on their physical cells as well. Um, so those are probably my top three. I get a lot from neurology, uh, because we get young adults coming through with, uh, seizure disorders and migraines, uh, disorders. [00:10:14] Uh, we'll get, So those are probably my top four, uh, but then, you know, as I'm looking, you know, we'll get folks from transplant, uh, we'll get folks from, um, cardio, um, and, and, and, um, and like I mentioned, chronic pain kind of, uh, is fairly pervasive, um, among all the young adults who come through. [00:10:34] Meghan Beier, PhD: Right. And, and maybe this is just a personal interest of mine, but you mentioned neurology. Um, uh, do you have any limitations in terms of individuals who have some cognitive impairment for seizure disorders or other neurologic conditions? [00:10:51] Screening and Admission Process --- [00:10:51] David Bendor, PsyD: Yeah, so really the, the way we do, we do, we'll do a couple screens and, and, and, you know, I'll do it in my role as clinical coordinator. Frankly, I really enjoy this being kind of the first point of contact. I'm, I'm happy to talk about the program. I'm happy to answer any questions. I'll talk to family members, like, you know, for a couple of reasons. [00:11:07] 1, because I just want to Make the connection with these folks. I'm very proud of the program. Um, and, and want to, you know, tell them all about it, answer any questions they might have before they make the decision to make a significant commitment. And then, in addition to that, we do more of a formal intake. [00:11:22] Um, and then, you know, if everybody, all parties agree, then we move forward with an admission. Um, and really what I tell them is. You know, the criteria, they have to be able to participate in groups. Um, and there can be more didactic groups, skills based groups, cognitive behavioral groups, some, some more insight oriented groups, but if they're able to participate in groups, and I tell people, they don't have to be the most vocal vocal. [00:11:45] They don't have to be the most articulate. They just need to be able to. You know, understand what's going on and participate. And ideally, you know, not feel more overwhelmed by the content or by, you know, the way the groups are being carried out. But, but that's primarily it. And then even the age, you know, I gave you gave the age of the beginning and it's the age that we have on our. [00:12:04] Um, on our brochures, you know, that 18 to 26, but we've even taken some folks who are a bit older than that, um, because developmentally they fit with the meal. You, um, I'm, I tell them, you know, I tell them what's going on and, uh, what the, you know, the typical ages are, or even what the current ages are, and I leave it up to them. [00:12:21] Uh, but what's neat for me in this role is at the Institute of living where I am, uh, we have a number of young adult programs. So when I screen folks, I'm of course thinking about my program, but if it's thought they're not a great fit. I can move them along, uh, if they're interested to any one of several other young adult programs, which including others with specialty tracks. [00:12:41] I mentioned the general track that I was a part of for several years. We also have an early psychosis slash major mental illness track. We have LGBTQ track. Um, we have a. Co occurring for substance abuse track and you know, we leave it up to the young adult saying this is what's available any one of these perhaps, you know, two or so could be a good fit. [00:13:01] What do you think you'd be most comfortable in? And then we leave it up to them. [00:13:05] Meghan Beier, PhD: Great. That's a great way to start, get somebody involved and participating even from the beginning. [00:13:11] Program Structure and Services --- [00:13:11] Meghan Beier, PhD: Um, so you mentioned you have a really robust curriculum and so I'm wondering if you can expand on that a little bit more, kind of identifying what some of the key services are that are offered by the program, um, and, and just sort of what's involved from a psychotherapy standpoint too. [00:13:27] David Bendor, PsyD: Yep. Yep. So we, you know, so it's a, it's a group program. We run three days a week, Tuesdays, Wednesdays and Thursdays. Um, we start in the morning at 10 a. m. Um, and go till about 1 p. m. and then actually have it set up so the young adults can, uh, grab lunch with one another if they'd like, which is another way to, you know, increase the connection that they feel with one toward one another. [00:13:48] Um, some, some could take that lunch to go, but, but that's a typical, you know, day. It's, it's, it's, it's a three hour day. Um, Um, and in the course of that day, we have three group sessions. Um, and in between, they may opt to meet with the lead clinician for some one on one. They may opt to, or the psychiatrist being looked to meet with them about what's going on in terms of psycho farm. [00:14:10] Um, they might meet with our nurse slash case manager because they're working on some young adult life stuff in terms of, you know, first jobs are returning to work or school or school loans or housing. So we want to make sure we're covering kind of any number one of any number of situations that could come up. [00:14:27] For young adults, um, not solely focusing on mental health and physical health, but also the, you know, quote unquote, what I call the doing life stuff. Um, and then in addition to that, depending on where the young adults are, and maybe their relationships with their family members or significant others, we can do family sessions. [00:14:43] And so we might do those at the end of the day at that 1 o'clock time, or before program starts at 9 in the morning, and that's a chance for them to, um, you know, have family meetings, um, Not necessarily ongoing, such as, you know, you'd find in family therapy, but, but periodic family meetings to talk about, you know, what the family members observations are of the young adult, if they're seeing improvements, maybe they have some concerns that they'd hope we'd want to address, um, that the young adult didn't think to bring up, um, and, and as you know, family members can just share a perspective that a young adult can't share, uh, on him or herself. [00:15:17] Um, and so, um, we find those very valuable. Um, and and, you know, provide a lot of data. Um, And so that's, you know, a typical young adult when I'm describing to them the program, that's what I'll tell them about in terms of their experience. The three groups a day, three days per week, the opportunity for individual check ins, the opportunity for psychiatry and psychopharm and the opportunity for family meetings. [00:15:38] And we also tell them, because a lot of times they have this question if they want to continue with their outpatient psychiatrist or prescriber. Okay. We say absolutely ours may just, you know, admit them on day one and check in from time to time. But the cycle farm continues in the community. Same with the one on one therapy. [00:15:54] You know, we are our lead clinician can offer, you know, traditional psychotherapy sessions weekly or biweekly to all the young adults who are in the program at a given time. So we often encourage them if they wish to continue with their individual therapists, and we make sure to all stay connected. So we can talk about what some of the goals might be in the 6 to 8 weeks that they're with us. [00:16:13] Meghan Beier, PhD: Okay. Um, so that's a good way to kind of transit, transition people out of the program too, if they stay connected with their individual providers in the community. [00:16:23] Transitioning Out and Aftercare --- [00:16:23] David Bendor, PsyD: Yep, and then what we'll also do if they don't, if they come to us and they don't have them in place, maybe this is a first experience with mental health, uh, or maybe that, you know, they, um, just, it's not a first experience, but they haven't had any luck in, in identifying as you and I know about shortages in the community. [00:16:39] Um, pretty much from go when they come, if they, if we know about that, we start looking and tapping into the resources we have just by being a part of this community for as long as we all have. Um, we start looking at, um, know, some, some resources for disposition planning. Uh, so that they ideally, if they're going to start with a new therapist or psychiatrist, they would start having those initial sessions while they're still with us and, and start the transition out of our program. [00:17:05] Um, in addition to that, because a lot of the young adults make a real connection to us and our, campus. Um, we have an at what we call an aftercare group. Some call it the graduation group. Um, I think I, I don't know what we have down as formally, but it's the same concept where we're young adults who've gone through the program and thought they, you know, that not only the program really helped them, but especially they really responded well to group therapy. [00:17:28] Um, we have an op, they have an opportunity to continue. Um, within a young adult aftercare group, and that meets weekly, um, just for one hour a week. Um, but again, a chance for them to continue with other young adults, um, at whatever frequency they wish. [00:17:44] Meghan Beier, PhD: Okay. [00:17:45] Unique Needs of the Population --- [00:17:45] Meghan Beier, PhD: And can you tell me a little bit about what you think is unique about this population? I mean, you worked in the general track, you've built this track, what, what is unique and what do you usually need to really pinpoint, um, for the individuals who come through this program? Mm hmm. [00:18:00] David Bendor, PsyD: yeah, that's, that's a great question. So really, the reason we, you know, we started this program is, as I mentioned before, you know, seeing about 10 percent of these young adults coming through when I was in the general track with physical health conditions, and their stories were always unique. And I'll give some examples. [00:18:15] You know, there might be a young adult who is off, uh, freshman year of college. And like the other young adults on their floor, um, there's some jitters about first year stuff and learning the ropes and, and, you know, what you have to do, um, and to let off some steam. Some of the young adults who all live on the same hall, maybe like to take, I don't know, a drive to the beach or a mountain or go for a hike. [00:18:35] Uh, but, but the young adult that I'm talking about also suffers from Crohn's. And unlike the others, the young adult has, that young adult has to think about, you know, is it okay to go? What if I need the group to stop several times because I need to find a restroom and will there be an available restroom? [00:18:50] And when we get there, will there be facilities? And what if I have really bad, you know, cramps or whatever it might be? And what is their comfort in sharing that? So what we were finding is some young adults, uh, would just pass on opportunities that they would really like to participate in because they were, uh, fearful of their, uh, Um, symptoms flaring up and not necessarily knowing how to relay that to the folks that they may have just met. [00:19:13] And so a lot of times we will get folks in the program who are again, as I mentioned before, you know, maybe freshmen in college who, you know, have these concerns and these conditions. Um, and what we find they're doing is they're isolating rather than going out and doing what they can. They're isolating out of fear of having any of those situations arise that I just. [00:19:32] Uh, describe to you, um, we, we might get a young adult and I, I mean, I, I know this one quite well. What we have a young adult who comes from several generations of firefighters, for example. Um, and a grandparent was a firefighter and a father was a firefighter, and he had always thought he'd be a firefighter. [00:19:47] Um, but then he got a, a cancer diagnosis at, at a, at a younger age and in full remission now, but the treatment, uh, took such a toll on him. He just physically can't. You know, carry the pack on his back and he can't do a lot of the things. So, you know, someone who went, you know, the first, you know, we'll say 15, 20 years of his life thinking this is what you do. [00:20:07] It's, there's a family legacy and it's what he always wanted to do. And it's kind of, it's completely just taken away from him or as he says, robbed. For no fault of his own, um, that's a young adult who, you know, we want to, we want to, if they're really struggling with that dramatic shift in terms of what they're, uh, they envisioned for themselves, um, you know, that's quite a unique story. [00:20:28] And we'll want, you know, someone like that to come into our program and do our best to help them. What I say, develop a plan B or a plan one a we're not trying to say, you know, it's gonna be just as good as what you always envisioned. But could we come up with something help you come up with something that you would still find very fulfilling and interesting? [00:20:45] Meghan Beier, PhD: right. Absolutely. I mean, I think that's so valuable and maybe that's something that I have a few people who have gone through traditional PHP or IOP programs and they feel like it is sometimes missed in those programs. They don't always feel connected to other people who are who are there, um, and are struggling for, you know, You know, different reasons, but maybe purely more mental health challenges. [00:21:10] And, and, um, so it's a different animal for sure. [00:21:14] David Bendor, PsyD: It is. And I'm sorry. I was, I just wanted to add, because I think you said it, you kind of quoted inside exactly what we were finding where these young adults would go through maybe other programs and say, yeah, You know, wow. You know, the other young adults I met, they were, they were kind. They're empathic in the program. [00:21:30] They were, you know, sharing it and, and, but they couldn't really relate to me. Excuse me, they, they could say, you know, that they were sorry to hear I was going through that, but they, but the, the young adult would say, but I knew they, they were not going through it. And, and. That, you know, it made a difference for them in terms of connection again, nothing to do about, you know, the, the kindness that they were showing each other, but just that they knew that they, none of them were going through that experience. [00:21:54] So to come to a program, um, where they know that all the other young adults, while they all have different conditions, um, and different, different levels of acuity all do have those conditions. And so they would come to our program and say, like, literally on day one, they just, you know, breathe this deep sigh of relief that this is a group they can really relate to. [00:22:13] Meghan Beier, PhD: Yeah. You know, I've seen that in so many different places. I, I work, uh, do some consulting for, uh, can do multiple sclerosis. And then I recently did an interview with a few individuals, community members with rare, uh, medical conditions. And. the theme I heard was, I just didn't want to feel so isolated and alone. [00:22:33] And so I think you're, you're sharing that similar theme that people want to feel connected and understood. [00:22:40] Therapeutic Models and Curriculum Development --- [00:22:40] Meghan Beier, PhD: Um, I, my follow up question in terms of the curriculum is, are there any specific therapeutic models, um, uh, like acceptance commitment therapy or DBT or CBT or others, um, that your program uses and kind of how is that implemented in the group programs? [00:22:58] David Bendor, PsyD: Yeah, no, great question. And so the answer to all of that is yes. And, and I would say to diff to differing degrees. And so, you know, if you took a look at our, if anyone took a look at our curriculum, you know it, there's an eclectic quality to it, and that's intentional. And so to answer your first question, yes, we have, um, groups in the day, or sorry, groups in the day or groups in the week that do lean into more. [00:23:17] You know, acceptance and commitment therapies, dbt, cbt. Um, so the answer is unequivocally. Yes. What the challenge is, is because we have young, all these young adults coming through what I, you know, what is a single track program, meaning all the young adults who are admitted, um, are in the same, Same nine groups a week. [00:23:34] And so, as you can imagine, there's some who are going to really respond to different modalities more than others. Um, and so what we try to do is give them kind of a sampling. Um, and I'll say it to them at times, or the group leader will say to them at times, you know, we're going to do this today and explain what this is and and acknowledge that some of you will, you know, might really respond to this. [00:23:52] Some of you might say, sorry, been there, done that. Some of you will just be puzzled, but what we ask them to just keep an open mind. And I'll say, you know, even if you tried mindfulness three years ago, and you said didn't do anything. Anything for you. I'd encourage you while you're on this program, try it again when we run the group, you know, give it a real try because you're a different person three years later and your maturity's shifted in, et cetera, et cetera, et cetera. [00:24:11] So we absolutely lean into all those different therapeutic modalities We have, as I mentioned, like insight oriented groups in terms of, uh, interpersonal process groups and identity process groups. You know, what kind of person. Am I with these diagnoses? And and also, how do I present myself to the world and interact with others? [00:24:29] And how much of this do I want to share with people? And how much do I keep this to myself? Um, as well as obviously, you know, the check in groups that are common to many programs in terms of starting off the week or closing out the week in terms of how people are doing. Um, and then, um, You know, all the other topics I can think of, you know, we will do more didactic groups explaining what the biopsychosocial model is. [00:24:51] We'll have groups explaining why nutrition might impact physical health and mental health, uh, why the importance of sleep hygiene. Um, and then we'll also, as you'd mentioned, maybe later in that same day, have a group where we're doing dbt skills and talking about how they, that can help them out interpersonally. [00:25:06] Meghan Beier, PhD: Yeah. Absolutely. That's great. Uh, how did you develop the curriculum for the program? [00:25:12] David Bendor, PsyD: So there was, I took the input of several people. I reached out to folks. Um, you know, as I mentioned, I'd been a part of, uh, the young adult services in the general track for several years. And so, in those years, you know, we, our curriculum had been, uh, you know, tweaked and modified. And we like to think improves, you know, over the years, based on feedback we got from young adults, um, and, and other group leaders or group co leaders. [00:25:35] Um, and so we had, I thought I had a very solid foundation of what. Young adult programming would look like and then leaned into, um, my health psychology colleagues. And, of course, the health psychologist I brought on board when we started the program to, to both tweak and also insert where appropriate, you know, uh, groups that are very specific to this population. [00:25:58] So we have groups that apply to young adults because we never want to lose sight of the fact of despite these diagnoses, they are young adults, like every other young adult. Um, but also we wanted to make sure to make our program unique that we address the specific concerns that a young adult might have with physical health conditions, um, as well as mental health conditions. [00:26:17] Meghan Beier, PhD: I'm kind of thinking about the transition into outpatient, um, do the people that you refer to have a health psychology background or something similar? And if they don't, so for example, if somebody is listening to this and somebody coming from your program were to enter their clinic, what do you think you would want those outpatient therapists to understand or know or implement into their practice. [00:26:43] David Bendor, PsyD: Yeah, that's that's a great question. So there are a number of health psychologists I have on my on my short list right that either my cell phone or I guess I don't know if I can use the term Rolodex anymore. That might be too dated. But But yes, definitely on my short list. I have some very competent health psychologists in the community. [00:26:58] Um, but but absolutely, as you know, there's, you know, like with many, there's there's always a shortage and there's never enough. And so there are plenty of clinicians we will reach out to who You know, they're not necessarily health psychologists by training, uh, but they have been around, uh, young adults enough in this. [00:27:16] Qualities of Effective Clinicians --- [00:27:16] David Bendor, PsyD: In our case, young adults we're talking about, um, and just by virtue of treating young adults for 10, 15, 20 years in the community, they've, of course, encountered young adults who have, you know, co occurring physical health conditions. And so if they are, if these are solid clinicians and they are open minded, they're empathic and compassion and especially curious. [00:27:35] I really want clinicians who are going to. Ask the young adult, you know, well, what has, you know, really try to get a sense of what their experience has been living with these co occurring conditions and not making any assumptions about what that's been like. So if I get, you know, bright, thoughtful, insightful, curious clinicians, they're on my shortlist as well. [00:27:53] Um, and, and I, and I look for feedback and often when we do, uh, you know, follow up calls where we'll reach out to a young adult who's discharged from our program a month out or three months out or six months out, just to check in how it's going. Often those those young adults that we've paired with those clinicians I described to you are quite happy and will tell us that things are going quite nicely. [00:28:13] Transition to Virtual Programming --- [00:28:13] Meghan Beier, PhD: Um, now is your program, uh, primarily or fully in person or do you also offer virtual options? [00:28:21] David Bendor, PsyD: Right, so we've gone back and forth. Obviously, I was going to say in 2019, before anyone knew what a virtual program would look like, right, we were all in person until March of 2020. And then we were actually one of the first programs on our campus to shift quickly to virtual. [00:28:35] Navigating Virtual and In-Person Programming --- [00:28:35] David Bendor, PsyD: Um, and then over the subsequent several years, you know, depending on the hospital guidelines were and. [00:28:41] D. D. C. And all that, you know, we're kind of shifting between completely virtual programming to in person, hybriding it where we'd have hopefully with little lag. A few people might be on the screen in the group room, while others were sitting around the room, 6 ft apart with mass. It's quite a sight to behold. [00:28:59] And again, only this day of Covid. [00:29:01] Challenges and Adaptations During COVID-19 --- [00:29:01] David Bendor, PsyD: We were, we were, we had, uh, our, the aftercare group I described to you was virtual, uh, and, and continues virtual for quite some time until there's kind of a chorus of young adults in the program saying, you know, look, we want to get back in the building. We want to see each other in 3d and the flesh and blood and whatever terms they use. [00:29:19] And so that's gone back to completely in person. Um, and the program as well, we started to put out feelers for a virtual IOP in addition to this in person IOP. And. You know, we reached out as best we could and reach out to providers, and we were getting fairly consistently. The feedback was, you know, COVID was so hard. I want nothing else but to get back in person. [00:29:42] In-Person vs. Virtual Options --- [00:29:42] David Bendor, PsyD: So, as of right now, we are fully in person. That being said, though, I'm always concerned about the young adult who. Can't drive or can't go for rides that are more than 30 minutes. Right. Or are just a part of the state where it's just not realistic that they're going to come do round trips to us three days a week. [00:29:58] So if the demand is there and you know, we track the calls we get, we track the people who I screen. And if they say, Oh, I was really just looking for virtual. I make a note of that because I want to track how many calls I'm getting that unfortunately we're turning away because we don't have virtual. [00:30:13] Cool. But as of now, we're solely in person, but I'm absolutely open to, and we learned during COVID that we can adapt our curriculum to a virtual model. [00:30:24] Meghan Beier, PhD: Right. Absolutely. Yeah. I mean, I could imagine, uh, even, you know, with PSYPACT, although there's probably a licensing and, uh, Um, also insurance barriers there, uh, but the, even people from out of state might be interested in a, in a program like this [00:30:42] David Bendor, PsyD: We've actually had people from out of state, uh, come to us and they've stayed with a handful that I know have stayed. Uh, with relatives have stayed in temporary housing. So we've had a number of folks come to us who took leaves from school, for example, who come to us from out of state. But yes, to to to our shared point, they were physically in person to do that. [00:31:00] Um, and, uh, uh, again, like I said, you're right with side pack and maybe the other disciplines will will head in this direction shortly. You know, kind of the sky's the limit is my hope. Um, but for now, anyway, we are we are in person. [00:31:16] Meghan Beier, PhD: So if people are coming from out of state, does the program or the hospital help with finding, um, temporary housing or is that kind of on the person or the family? [00:31:26] David Bendor, PsyD: No, we can help. I mean, we have some options for, you know, because we're part of a large hospital system, you know, there are obviously there's times when family members might come in for any of these physical health conditions that, you know, you and I have talked about for treatments or long, you know, so, so fortunately, you know, but when I launched this program, I was able to learn more about what just Hartford HealthCare offers that I just Wasn't aware of because I didn't really have a need to learn. [00:31:49] And so I did learn about where, um, you know, more affordable temporary housing is offered. And so when there is a possibility that someone wants to come in and we'll need a place to stay and they don't have family, you know, I do tell them about some of the options. So, so that's something again, I look forward to doing in my role as coordinator and that first contact. [00:32:07] And I like being able to tell people, yeah, we do have a few options. It may not work for everybody, but at least I can tell them more than just that. Good luck. You're on your own. [00:32:16] Meghan Beier, PhD: Yeah. Absolutely. That's great. That's great to know. [00:32:18] Success Stories from the Program --- [00:32:18] Meghan Beier, PhD: Um, and obviously you've shared a few, uh, like kind of snippets of case stories, but I'm wondering if, um, you know, keeping obviously HIPAA in mind, uh, would you mind sharing, um, a case or some examples of people who've gone through the program and, and have benefited from it? [00:32:37] David Bendor, PsyD: Sure. You know, I think, um, some of the ones that, you know, we collectively are quite proud of are the ones who've taken a leave from, I like to call it when I tell others who asked the question you asked, it's a lead. They took a leave from blank. All right. So that could be, that could be grad school. It could be senior year of high school. [00:32:54] It could be undergrad. It could be a job. And, and we've had a lot of success helping those young adults during their time off. Um, Obviously providing them structure so they're not just sitting at home for, you know, the seven days a week that they now have freed up, but we're providing them structure and providing them treatment and, um, we have had quite a lot of success helping those young adults transition back either from whence they came or a different school slash job that is a better fit. [00:33:24] At this stage in life. Um, and so, you know, we'll have folks who are, and as I mentioned, you know, we, as you and I are talking, of course, we're, you know, a mental health program, uh, program. We have a lot of folks, obviously, with significant physical health problems, and we're very clear that we are a mental health program and that the mental health treatment we do often helps. [00:33:43] Aspects of living with the physical health conditions they have. And so, as I mentioned to you earlier, you know, at times we have young adults who are, you know, quite profoundly depressed or quite profoundly anxious or, or, you know what, I left this out when you asked me at the beginning, uh, or have clear cut symptoms of, of PTSD, uh, related to the diagnosis, the treatment, the experience of the treatment. [00:34:03] Um, and, and so for those young adults, there's a lot of, uh, ambivalence. Uh, about getting back into work and getting to that higher functioning where more is asked of them and more would be demanded of them. And they're ambivalent about, you know, sure, they would like that. They want to get back on that trajectory they had. [00:34:20] But at the same time, they might be terrified that, you know, will they be up to it? And can they, you know, can they maintain, um, While taking on so much more. Um, so as I was saying before, I'm quite proud of how well we've done, uh, helping young adults and addressing their symptoms of PTSD, their symptoms of depression, symptoms of anxiety to get back to what they want to go to, or I'm sorry, to get back to what they think is in their best interest at this time. [00:34:45] Um, and I know that's, that's a fairly general statement, but I think that's where we're, we're often quite successful and we're often quite successful because we have so many staff, you know, able to help. These young adults where they're saying, you know, I left this I left a I don't want to return to a, uh, You know, can we come up with something that might be better for me? [00:35:03] That's still structured still demanding, um, but won't maybe have as many of the tolls that a took on me And so we're looking at a b for them, right? We're looking at a location b and we've had a lot of success that of reinventing the wheel a little bit and saying, you know You were at that school for that reason. [00:35:19] Might there be something? You know You know, maybe closer to home if they're realizing that's important or has, uh, maybe closer to a medical facility that has, you know, you know, uh, world class treatment. So we've done a really good job there as well. And another thing that I think that we've done quite well at is. [00:35:36] Helping young adults, uh, get back to doing some of the things they were enjoying before and didn't think they could do before. And now I'm not talking about school or work, but I'm talking about one time we had a, you know, a world class swimmer, um, who she was, you know, excelled and, and even had Olympic aspirations and then physical health conditions kicked in. [00:35:55] And then, you know, subsequently mental health conditions kicked in and she'd gotten away from swimming altogether and it was such a passion of hers and she loved it. And even if she knew the Olympics had passed that she just, it just made her feel so much better, but she was so distraught at the toll that her physical health conditions took on her. [00:36:11] And it could rob in her mind, robbed her of the chance to compete for the Olympics. She just went, got away from swimming altogether. And we were all quite proud and quite touched when she told us while in program that based on the encouragement of her peers and staff, you know, she got back into the pool and it and she remembered fairly quickly how much she enjoyed it and how good it felt and how good it felt to start her day swimming. [00:36:31] And by the, her discharge ceremony that we had, uh, she was tearfully telling us how glad she was that, you know, thanks to us. She, she said she rediscovered the waters. Um, and, and that was just a great story of someone who, you know. Thought she would never go back to that. And then based on, you know, through her, after her time in the program, she was able to return and remembered how important, what an important part of her life it was. [00:36:54] Meghan Beier, PhD: I love what you're sharing here because I often think, you know, as a rehabilitation psychologist, you know, many times I feel like I'm half a therapist working on traditional sort of depression and anxiety and the other half is really, you know, problem solving the world, right? Like, how, what, what are your values? [00:37:13] How do we get back, um, to living a life that is, you know, um, in Marsha Linehan terms, worth living? But like, how, what, what are your goals? What are your values? And how might that have shifted because of your medical condition, but can you still engage in many ways? And so some of that is problem solving and, um, and being flexible and, and, you know, almost kind of, you know, Playing a little bit of a part in social work as well, you know, in the sense of like, what are the resources that are out there? [00:37:41] So, sounds like your program is also picking up on, on that side of things as well. [00:37:47] David Bendor, PsyD: very much. I'll often say to the young adults I'll challenge them maybe on a friday to like share with the group, you know What are your goals or what are the updates to the goals you might have had? you know, so maybe concrete goals and again, like just like you said not necessarily like Related to depression and i'd like to socialize more which tells me and others i'm less depressed, you know, not just that um that kind of but also Um, you know if I use the you know, swimming pool or any other i'll say, you know What is something that you would Would like to get back to, you don't know how to go about doing that, but you just know you'd like to get back to that or some version of that. [00:38:18] And then let us and by us, I mean, your peers, the staff, the program, let us try to help you get back to that place. So, you know, again, going back to the swimmer, you know, she was initially. Looking to have times like she had prior to her significant physical health condition, but just getting back to the water was so important and so rewarding and so fulfilling. [00:38:36] And we'll do that with others very much to your point. You know, can we, can we be a little flexible? Can we introduce some flexibility into their thinking so that it doesn't have to be the way it was before or bust? It can be okay. It's not quite the way it was before, but gosh, it's still fun. Or it still feels good. [00:38:52] Or it's still great to do it at 90 percent 80 percent of what I did, what I did before. Yeah. [00:38:58] Meghan Beier, PhD: Absolutely. I love that. [00:39:00] Um, now I'm, I'm kind of thinking of the outpatient therapist here. [00:39:04] Identifying Candidates for Intensive Programs --- [00:39:04] Meghan Beier, PhD: Um, What are some of the signs that you think, uh, they should be looking out for that would signal hey, you know, um, the person I'm working with, this young adult that I'm working with, um, might benefit from something more intensive like this program? [00:39:20] David Bendor, PsyD: Yeah, that's a great question. And, and I also, it's something that I have to think about myself because in addition to this work I'm telling you about, you know, I have my own, what you and I would call traditional psychotherapy, outpatient practices, well, in the community. And so I have, uh, referred, you know, young adults here to any one of the number of the young adult programs I mentioned, uh, to you earlier, uh, that we have. [00:39:40] And so really I'm looking for, I, I, I would want the clinicians to think about are there. Has there, you know, have the improvements plateaued? Um, are they, you know, maybe the rapport is still there, but the gains are no longer coming. And that's acknowledged by both the therapist. And in this case, we're talking about young adults. [00:40:00] So by the therapist and the young adult, the gains aren't happening. Um, and, and the thinking kind of collectively is just more is needed. Um, I'd encourage those people to take a look at IOP. Uh, of course, if the person is decompensating where what they were doing before was maintaining the person, um, and now no longer, and the person is just struggling or suffering more, I'll encourage people to take a look at IOP, what I, what I'm always telling people anywhere where I talk about this or any other program is. [00:40:28] I don't want to wait until someone needs to be evaluated for suicidality, or someone needs to be seen in an emergency room on a Saturday night at two in the morning. I don't want to wait for that, but we will definitely take those folks into our intensive outpatient programs, um, and, and, and we can do a very nice job with them. [00:40:46] But the person doesn't need to be suffering that much before they're appropriate for IOP. If they're saying that they're, um, They're doing okay in many ways, but it's just gotten harder and harder to go into work or they're missing more and more classes. Um, we'll have them consider an I. O. P. One of the things all of our young adult programs have done very nicely is partner with the counseling centers for a lot of the area colleges. [00:41:11] Because it's a real win win if we can get a young adult to stay enrolled in campus and not stay enrolled in college and not have to take a semester off or a year off. Whereas you and I know they may go home, but have zero structure in place. And if we can work with these colleges and college counseling center to say, hey, could we shift their course load a little bit so they can come to us those 3 days a week, uh, you know, 3, 3 hour blocks a week. [00:41:34] Um, and maybe they drop a class, but not a whole semester, and they can stay engaged in school and with their friends on campus and yet still come to us for treatment. We've been really successful there with a lot of the area students coming from area colleges. [00:41:48] Insurance and Admission Criteria --- [00:41:48] Meghan Beier, PhD: And, and what are the admission criteria for the program? [00:41:51] David Bendor, PsyD: Really, I mean, you know what I mentioned before, in terms of, you know, as long as. And I often say this in that initial screening call, if you know, if the young adult, uh, or, or if the referring provider thinks that the young adult has a physical health condition and the symptoms of the physical health condition are exacerbating their mental health or their mental health is exacerbating, um, uh, their ability to care for, I should say, is affecting negatively their ability to care for, uh, their physical health. [00:42:20] Um, and if it's one of those, um, or both of those, um, and they're in that 18 to 26 range, and, and, and all parties think they can participate in the groups such as the ones I described to you, um, they're, they're an appropriate referral to our program. [00:42:35] Meghan Beier, PhD: Okay, that's great. And, um, you know, got to ask this. Are there any insurance barriers to people participating in the program [00:42:42] Insurance and Accessibility Considerations --- [00:42:42] David Bendor, PsyD: So, one of the things I really like is that we are affiliated with, uh, Hartford HealthCare, and that means that, you know, we take, Every insurance that Hartford HealthCare takes for any physical health procedures, um, you know, we take uh on this side of the campus as well for our mental health program and so Fortunately most of the young adults the vast vast majority of the young adults who come through Their insurance is accepted. [00:43:08] Um as you and I know some of the some some of it that means now that may mean that You know, sure. But if you're looking at a six week program, three days a week, you're looking for 18 IOP days. Some of the insurance providers, as you and I know, they're great about saying, absolutely, we know what IOP is, and we've authorized 18 days. [00:43:25] Others say, well, we're going to want to do a review every three days. So, so that can be a challenge, um, but at least we take all the insurances. Um, we've even been able to work out kind of case by case contracts and agreements for folks who come in with out of state insurance that the hospital doesn't normally accept. [00:43:40] We can work out something with those, um, And, and giving you that, you know, I give you that a second ago, that scenario where, you know, we have some really tough insurance reviewers folks, and they're really, uh, making it hard for us. We're never going to discharge someone who needs our level of care, um, prematurely because the insurance company is pushing back so much. [00:43:59] If they need to be here, they need to be here. Um, but, uh, like I said, knock on wood, we've been very fortunate. We have very good folks and you are on our side and they can really, uh, you know, advocate for our parents, uh, parents, uh, advocate for our patients, uh, with the insurance companies they're dealing with. [00:44:17] Meghan Beier, PhD: Now, I'm, I'm just wondering about sort of sharing your message. [00:44:21] Consulting and Expanding the Program --- [00:44:21] Meghan Beier, PhD: Um, wider and farther, do you or your program do consulting with, um, other hospital systems or clinical programs or things like that to try and, um, build more models like yours around the country? [00:44:36] David Bendor, PsyD: Yeah, we've had other, uh, programs reach out to us about launching something like this, either this very specific program or young adult treatment in, in, in, in more broadly speaking, uh, because as you and I know, you know, a lot of places might group young adults. Yeah. With their 18 and up population, which is adults and just adults and a lot of the adults say to us, they'll either drop out prematurely or not go at all because they're just not comfortable being grouped with people in their forties and fifties and sixties, you know, their words. [00:45:11] Um, and so, uh, we, we do do a lot of consultation with other. Uh, places, uh, frankly, across the country who are interested in developing young adults. And then for those who are interested in developing specially tracks, especially tracks, you know, we can talk to them about the track. You and I are talking about as well as several of the other specially tracks. [00:45:28] I mentioned, um. And, uh, you know, that that's always, um, a good conversation. You know, I'm excited and improving access, uh, to folks who, you know, have these conditions I described, but just coming to Hartford, Connecticut or California or Chicago is just not feasible, um, and they're in a part of the country. [00:45:46] So I'm always, uh, interested. And I always welcome people reaching out to me and saying, Hey, we'd like to develop a co occurring, uh, Program like yours. Um, and I will say we've gotten a number of calls already. A lot of calls, actually, since we opened now almost five years ago about people saying, wow, what a great program. [00:46:03] Or they'll say, I wish I had something like that for myself when I, you know, I was a young adult. Um, and people asking, you know, what about doing something for children and adolescents? What about doing something for adult adults? And so, both internally and in that more consultative role, we're having conversations about that as well. [00:46:20] Meghan Beier, PhD: that's great. I would love to see more of this across the country for sure. [00:46:24] Future Goals and Research Opportunities --- [00:46:24] Meghan Beier, PhD: Um, do you have any future goals for this program? Um, are there any plans for expanding it, improving it, changing it? Um, you know, kind of what, where, where do you see the future for this program? Mm [00:46:37] David Bendor, PsyD: So we're always up for improving it. And we do that based on a lot of it is based on the feedback of the young adults who come through our program. Um, and in terms of, you know, future goals that, you know, if the demand is there, um, you know, we can always expand both on this campus. We could expand here in Hartford. [00:46:54] Um, we could, you know, we're part of a larger system. So in the future, what I would like to see, um, is an in person program in maybe a part of the state. That's a person there. Who lives in that part of the state? It's just too far to come to Hartford, uh, three times a week. But, but they're, you know, just geographically speaking, they're maybe closer, much closer to New York border. [00:47:14] And so, you know, the, the, a program in that, you know, part of the, the state would be great. And again, just any part of the state where it's just too far to come to us, but the demand is there. Um, and then, as I mentioned, another interest of mine is definitely the virtual because I want to get I do want to reach those folks where there's neither a in person. [00:47:31] Well, there's just not an in person option, either currently or in some dream of expansion. Um, and so what do we do for those folks? Um, and how do we reach them? And again, during covid, we did have some of those folks where they were, uh, you know, bed bound, and they were propping themselves up and participating 3 hours a day, 3 days a week. [00:47:50] Um, and and I'm sad to tell you that, you know, we've lost. I know we've lost folks like that because they just can't come to us right now. So I would say, uh, to answer your question, my hopes would be for in person expansion as well as, um, as well as a robust virtual option. [00:48:06] Meghan Beier, PhD: Yeah, yeah, that makes sense. I mean, I have, I can think of two people off the top of my head, one person who, um, really needed full assistance to get into the hospital and it was almost a full day of, different kinds of transportation getting her from her house into the hospital system. And that, [00:48:25] Lended to her ending therapy pretty quickly, and then another person who, has,seizures and, so can't drive, doesn't have somebody to drive them, and that kind of person, you know, probably wouldn't be able to make it [00:48:38] So again, I can see that there's like a certain subset of individuals that would really benefit from the virtual side. [00:48:45] David Bendor, PsyD: Yeah. And when you mentioned and you mentioned driving just now what we were very fortunate. I just want to preface by saying we're very fortunate. We know this is unique, but we had another donor family who was. Uh, very impressed and and touched by what, you know, the work we're doing in this program. And they gave us a donation that allows us to provide lift rides. [00:49:04] Um, you know, lifter Uber rides to folks, um, who want to come. We're good candidates to come. But as you mentioned before, they either can't drive themselves, don't have access to a car. There's no one who can drive them. Um, and so we have a number of patients who come through, um, Uh, who are able to take advantage of these donors generosity, um, and they are taking and they're getting transportation, uh, because in this state, there's, you know, as far as I know, it's only the state insurance, uh, and particular types of the state insurance that provide medical cabs for transportation, but all the folks with commercial insurances, um, the most of them, I don't think I know of any, uh, none of them provide transportation. [00:49:42] So, um, it's just, we're incredibly fortunate to know that we have this fund. That allows us to provide, um, like I mentioned, Lyft or Uber rides to folks. [00:49:51] Meghan Beier, PhD: That's great. Now I know, um, your program is primarily focused on young adults. You did mention kind of adult adults. Um, are there programs similar to yours that are for those that are 26 and older that you're aware of around the country or even, um, within your hospital system? [00:50:09] David Bendor, PsyD: Yeah, not, not like ours within our hospital system. You know, ours is the only one. This is the pilot program, which is this young adult population because it's the population I was most familiar with. Um, so I know for a fact within our system, there's not a child version or nor an adult adult version. [00:50:25] Okay, I might even ask you, did you find any adult adult ones? Because, excuse me, I'm not, I'm not aware of any. I mentioned the one in California. I think that's for kids. I mentioned the one. Uh, in in the Providence area, I know is for kids. It's more intensive. It's a PHP. Um, I'm actually I am not aware of an adult adult one. [00:50:43] And I don't know if you came across any in your search. [00:50:47] Meghan Beier, PhD: No, no, I, I haven't, you know, I've come across kind of intensive rehab programs, um, for people who've had like a brain injury or a stroke, um, which might include some psychotherapy options kind of, um, as part of it, uh, but not for somebody who's sort of medically stable, if you will, um, but having mental health challenges, um, And needs to go back to something more intensive. [00:51:16] Uh, yeah, it's been a bit, it's been a challenge kind of searching for that and I've primarily referred people to your traditional PHP or IOP programs, um, which have had varying success depending on the person. Yeah. Um, so I know we're coming kind of towards the end of our time here. I wanted to sort of end with a question about, you know, are you aware of any resources or training opportunities, um, or other ways that individuals, um, who are working I guess, uh, therapists who are working with these individuals in the community can gain, uh, knowledge or skills, uh, about this, uh, dual diagnosis of both physical and mental health concerns. [00:51:58] David Bendor, PsyD: So I'm often encouraging clinicians who are interested and I'll include myself in that to, you know, to check out what kind of, uh, talks or grand rounds or seminars are being given, um, even if it involves travel. Um, because this is kind of such a niche population that we're talking about. Um, a lot of the health psychology literature has been very helpful. [00:52:20] You know, you mentioned it right off the start, you know, in terms of acceptance and commitment therapies and DBTs. Um, you know, that, you know, if they're not versed in those therapies, that can be, Very helpful and very useful if they want to take on patients, such as the ones you and I are talking about. [00:52:35] Um, so I'd say that that's and to not be shy about collaborating and reaching out to those who've been doing this or doing this longer or as I did myself, you know, when we hired our in our 1st iteration, you know, when we hired our health psychologist, um, you know, pretty much right out of her postdoc year to start this program with me, um, you know, she just had expertise that, you know, You know, despite my having 15 plus years on her, she just had an expertise that I did not have. [00:53:00] So I would pick her brain the way she picked my brain. And so people should not be shy about reaching out to colleagues and looking for, um, you know, mentoring opportunities, uh, et cetera, et cetera. [00:53:11] Meghan Beier, PhD: Absolutely. Yeah. Um, I, I mean, I found a, a lot of resources going to different conferences, um, you know, part of the APA division conferences like the Society of Behavioral Medicine or Rehabilitation Psychology and all of those. Um, communities tend to have, uh, individuals who really know this stuff, um, inside and out, which is fantastic. [00:53:34] Um, is there anything else that you think I should have asked you that, uh, that I didn't? [00:53:40] David Bendor, PsyD: No, I think this was, this was a lot of fun. I really appreciate you having me on and very comprehensive. [00:53:44] Final Thoughts and Contact Information --- [00:53:44] David Bendor, PsyD: Um, And, uh, no, I think I would just say, you know, that I want to, you know, make myself available, not only to people who are interested in maybe sending a potential patient to us, but as you said, several asked several minutes ago, I would love to be able to, uh, connect with those in, uh, Different parts of the country, uh, or even different parts of, of, you know, New England, uh, as well as different parts of the country who would be interested in setting up a program like this. [00:54:08] And, you know, a lot of what we do, you know, could, you know, versions of this could work with children. Adolescence version of this could work with, as we've talked, call them adult adults. Um, and so I think a lot of this, what we do here, and we've got to know in our young adult program is very transferable to those populations as well. [00:54:24] And so if someone said, you know, we'd really like to start an adult adult over here in Nebraska. Uh, not necessarily young adult. I'd be more than happy to talk to them about what we're doing. And if someone down in Florida said we want to do a child adolescent version of what you're, you guys have been doing, I'd be delighted to talk to them as well. [00:54:39] Meghan Beier, PhD: That's great. Oh, wait, you know, I have one more question, actually, if you don't mind. [00:54:42] Research and Collaboration Opportunities --- [00:54:42] Meghan Beier, PhD: Um, are you running any sort of, uh, research programs or have you in the past, uh, for, for your program? [00:54:50] David Bendor, PsyD: So we haven't, uh, we haven't yet, but we, we always, you know, we're, we're open to that. And if, and if, you know, a student wanted to come through even for like a dissertation project, because we get a lot of trainees coming through, I think, you know, they, like you and I are talking, I think they're very intrigued by this. [00:55:05] So we get a lot of psychiatry residents coming through, we get a lot of psychology, uh, Practicum students as well as interns and postdocs doing rotations with us. Um, but absolutely. If someone was interested in doing, you know, more formal research or dissertation related research, we'd be happy to work something out. [00:55:21] Meghan Beier, PhD: Fantastic. Okay. It was so wonderful to meet you and learn about this program. It really excites me just because, you know, I myself has, have run into so many people that would benefit from your program or something similar. So I really appreciate you taking the time to talk with me and, and, uh, Give us more information about it. [00:55:41] David Bendor, PsyD: Yeah. As I said, thank you again. I mean, this has just been great and thank you for letting me, you know, share with you a little bit about what we've been doing and what we're so proud of, uh, that we've been doing and, and thank you again for having me on. [00:55:53] Meghan Beier, PhD: Absolutely. [00:55:55] Meghan Beier, PhD (2): I hope our discussion today sparks further dialogue. I'd actually love to learn more from our community and listeners about this important topic. If you have any questions about today's episode or would like to share a comment or resources, please feel free to reach out to me via [email protected]. We also have a Facebook group for mental health professionals called let's talk about health psychology. [00:56:21] If you like our show, please like subscribe or leave a review. This helps others find out about us. Find empathy provides continuing education. 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