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Ep. 5 - Melissa Callahan
June 30, 2020
Melissa Callahan has, in a sense, been preparing for a pandemic her entire professional life. As Chief Nursing Officer at Retreat Behavioral Health, she has been at the forefront in planning and implementing their response to the virus. She’s with us on the Corner this time to run down where we are currently and what to prepare ourselves for going forward
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About Retreat Behavioral Health
Retreat Behavioral Health is a healthcare provider based in Palm Beach County, FL, operating large residential and outpatient treatment sites throughout Florida, Pennsylvania, and Connecticut. Retreat specializes in substance abuse and mental health care services.
For more information, please call 855.802.6600, or visit our website at
https://www.retreatbehavioralhealth.com, or connect with Retreat Behavioral Health on Facebook, Twitter, LinkedIn or Instagram.
For media inquiries or more information, please contact:
Marissa Hayes – Corporate Director of Communications
Email:
marissah@retreatmail.com
Episode 5 - Melissa Callahan Interview Transcript
Hi, and welcome. I'm Steve Martorano. And this is the Behavioral Corner, you're invited to hang with us, because we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while.
Steve Martorano
Well, you know, safe is a funny kind of idea these days might be a thing of the past. We're gonna take a look at whether that's true or not. Or maybe we're just trying to be safer. Look who we bumped into on the corner old pal, Melissa Callahan. Melissa has wears many hats. I'll give you a couple and she will fill us in if I've missed any. She's the president of specialty medical care services, as well as corporate director of nursing for Retreat Behavioral H ealth. She's a longtime contributor to this program and There's that we've done about behavioral health and substance abuse and treatment in nursing. And I gotta tell you right off the bat, Melissa, of all the people that I have had the occasion to talk to over the last couple of months, I know I've known you longer than that. No one has, in my opinion has been further in front of the curve on on the virus and best practices then you so it's always a real treat to have you hang in with us. So welcome to the corner.
Melissa Callahan
Thank you. And hello, I love to come and have conversation and try to look at what best practices and just have conversation about what's going on. And obviously there's some opinion in there and there's definitely some experts and experience so this is a very important conversation and I'm glad to be having it with you.
Steve Martorano
Well, you know, as I said, I can't think of anybody better than you you know, we we are learn all of us are learning on the go here. I mean, we're new new languages, new questions to ask is you said, you know, risk management is a big part of our lives now. And trying to be safer. So right now as you know what's going on is that we are being told that it is okay to begin to expand our quarantine circles. I love the word, quarantearm. I get a kick out that way. So we're, you know, incrementally we're supposed to do all that before we get into the nitty gritty of all that. I'll be the devil's advocate here now. I mean, why not just say now the heck with it. I'm not going anywhere. I'm still hunkering down. Why is that a bad idea?
Melissa Callahan
I don't think it's a bad idea. I think that there are many people that that does not seem like at all possible or reasonable in terms of their work life, some in terms of mental health. I think that you can go so long looking at the silver linings of slowing down and things definitely, you know, not being as busy and active as they normally are. And this is an unprecedented disease. This is a disease spread mostly person to person. It has to do with close contact. It's through droplets that are produced from sneezing, coughing and speaking. So being safe and just not going anywhere and continuing to quarantine, that is obviously the number one choice that people should have, if they can. But I also understand that for the economy, for people to have a livelihood, not all jobs can be done remotely or from home. So that has to be one conversation, we have to talk about. What can we do to still be as safe as possible, I reduce risk as much as possible, but letting up some of the restrictions and maybe not staying in quarantine?
Steve Martorano
Well, as I said, well, the learning curve is steep and it's it's almost on an individual basis. People have to really first get in touch with what exactly do they need and when In terms of expanding the social circle that they're in, and what's safe and and what's uncomfortable, what are some of the first things people should be thinking about? When they set out to expand their horizons?
Melissa Callahan
I think that and part of this is what what I'm doing personally, in addition to what I think is best for like returning to work, I think that you have to have a small groups as possible for a comfort, knowing how active the people you're going to be around have been, I think really can dictate a lot of your comfort level. So if you have someone who's been participating in marches and in organizing some of the things that have been happening recently, and they've been potentially in close quarters with multiple people, is that the first people you want to be around when you're coming out of quarantine? Probably not most ideal. I think that for the entire year of 2020, the thought of having physical distance of six feet and wearing a mask that is an absolute, that is not going anywhere for 2020.
Steve Martorano
In general, you mean we see it in stores where they, you know, put marks on the floor, but you're saying in general, that the public will have to stand safely six feet away from each other in any context?
Melissa Callahan
Yes, yes. And so let's speak of like a dinner party. So the first time you're venturing out, you want to go to a dinner party with another couple. I would try outside First, I would try outside quarters. It depends on what area you're in. So there's areas where the numbers are really low, and they're moving much quicker than the areas that you and I live in or the areas that we've been working in. And there is a comfort to go inside kind of quickly, I personally haven't been in an inside setting with anybody other than my family. Because I have that ability. It's nice out I've had the ability that if we're going to have a get together, we just recently saw another couple are so outside, six feet apart. We didn't handshake we didn't hug when we greeted each other and it was very comfortable. It was very nice. And it was enough.
Steve Martorano
Yes, at this point. It's enough. Let's, let's talk a little bit about the conversation. Okay. Someone wants to invite you, you haven't seen them in forever. Come on over. We want to have dinner. What are the questions you ask? It's awkward.
Melissa Callahan
Yeah, the questions I would ask. I mean, personally, first and foremost, we have to remember human kindness. Every person has experienced or interpreted the pandemic in a different way. Some people have not been exposed at all. They don't know anyone. Who's had it? They don't know anyone who's been sick. They don't know anybody who has died from it. And so they feel is this fake news or it's not really close to me. Others have been very real and health care or lost the closest person to them. They're very, very sensitive. And then there's others who are just abundantly fearful because there's so many unknowns. So we have to have human kindness and we have to put judgments aside, we have to be open, and we have to have a conversation. I would want to know before I'm having a dinner party, I would really want it to be outside. We don't know if this was on surfaces. You've seen so many different things out there. It lives for 24 hours on cardboard, it lives longer on metal. I don't know that we are savvy enough to really nail down how much is occurring from us touching objects and surfaces and then touching our eyes, nose and mouth. We know the eyes, nose and mouth are the vectors. So on I would simply say, Can we do it outside? That is my preference. If they don't want to do it outside, I would be like, you know, are you guys working virtually? Have you been into work? Are you traveling? Are you you know, where is your comfort with this pandemic? And then I would really weigh the risk on that. Because you don't know where people are, you don't know where they are. And if you're really anxious about it, it's probably not a good idea that you're not ready yet.
Steve Martorano
Is there danger of wrecking your relationship here? And should that be a factor people worry about?
Melissa Callahan
I'm sure it's a factor that people will worry about. But if it's a relationship that is really worth anything, I would hope that once again, human kindness, understanding that people have so many different experiences that you have to be open. You can't go from this red. They can't be near your grandchildren, to having a dinner party with two couples. indoors and feel really comfortable. It's, you know, we're over three months of a total life change, living in a manner that we have never lived it any of us pretty much here have ever lived in I hate the new normal, but it's true. It's true that things are going to be different. They're going to look different.
Steve Martorano
There's always a member of the family. At least I'm experiencing it. Who is it? Who is hyper concern, but just a little more cautious than everybody else in the family? And that can be isolating and that can lead to arguments. What do you tell someone like that? Do they do they yield to family pressure? Or is it better to stay? If you feel cautious, just go with it.
Melissa Callahan
I think people have to do what they feel comfortable with. If they're more cautious and nothing bad happens then what is the harm in that? Whereas if they succumb to doing something they're not comfortable with Then they get sick, or they even get a little cold. But then they go through this fear and anxiety. That is the worst case scenario. I think that we're being told by the powers that be what they recommend, based on all the experts that they employ around them and they enlist in to try to give them the best knowledge that they can. But we're going to make mistakes, we're going to find out that some things we move forward on, were not the best, we might find out that some of the restrictions were a little too extreme. But then once again, the way I look at it better to be safe and nothing come of it. I'd much rather tell someone to really be safe and go a little overboard, and nothing bad happen. Then say, Okay, it's time. And then, you know, a whole family gets sick or someone you know, it's just it's the worst. It's a big risk. And I feel like we're putting a lot of pressure on people who determine, you know, what is okay? And what's not To make decisions on something that we don't have any experiences with, and we definitely have not had enough time for science to dictate how it's going to go. And it's going to be years probably before they determine some of these things. But reliable sources like CDC and local department of health and OSHA, I think are working really hard to look at risk, look at safety, and try to get people where they need to be to have a quality of life to get back to working, if that's appropriate. Yeah, there are some businesses that will never go back into a brick and mortar, traditional style. We're going to evaluate the footprint of businesses and how they run because we've been thrown and forced to have to do it differently. So now that you've done that for so long, maybe things can be done differently and have a benefit and a risk mitigation that is appropriate during this time.
Steve Martorano
Yeah, I want to ask you a little bit about the practicality of all that but I still don't want to leave this issue of interpersonal relationships, because we like, you know what, what the behavioral corners really about. It's not so much about the clinical, it's often with clinicians and about specific treatments. But really, it's about how we live and the choices we make and how they impact our well being. How do you sort of navigate this social thing where you're going through your checklist or eating outside? How many people will be there? Should we wear masks? you're judging the other person. No matter how you get around, you're judging them. Their answers will determine whether you take the invitation or not. How do we get past that, Melissa?
Melissa Callahan
Well, I would look at it not so much as judging but more as if you're comfortable. It really has to come to comfortable I have. I have friends who are down in Florida and they said that, you know, it's pretty open so they attempted to go to a restaurant. They sat in the restaurant and their food, and they were so uncomfortable that when the food arrived, they boxed it up and went home to eat it. So they tried, but they just weren't comfortable. And I don't think we can push people to a comfort place. And it can be as simple as is it going to be an indoor or an outdoor dinner? And if they say it's indoors, I don't know that we're in a place depending on where you live, if the recommendation is to be indoors, or not.
Steve Martorano
Let me let me stop you for a second, though. That's another problem. And you're you're an expert in in the health field, and we get conflicting information every day. Somebody will publish something that's either wrong or contradictory. Where do we get good sources? Or is it just how we feel about our behavior that matters most?
Melissa Callahan
I think it's a combination of the two but I think you definitely cannot use the sources as Facebook and Twitter and Social Media and I think that you have to be really cautious about just the regular news. I think if you went on websites like CDC and your department of health, you're going to get probably the most accurate local information. And if you look into any health journals or medical base journals, you can get really good information and they're all sources online. But if it's getting pre populated to you, the possibility is, there's a bit of fact, with fiction, if you actually search for information, you really will get reliable sources. Harvard puts out a lot of stuff, NYU, puts out a lot of stuff and and they're really, I think, pretty reliable. They've been pretty accurate along the way with a lot of information that they've given out and I utilize those sources. But I think once you get the sources, you have to feel comfortable. If you read something, and it's you know, Facebook base, and that makes you feel comfortable, then you have to really go with it because people will get in their heads and create a story and create A situation that there matter if it's a reliable source, or if it's real, it's still real in their head. So people really have to come to a place where they have a certain understanding and a certain understanding of their risk and of safety and go with it. And if they're wearing a mask and washing their hands, and distancing, they could have a really high comfort that even when they're going to new situations and this new normal, that they're at the safest presentation that they can be.
Steve Martorano
Yeah, you know, you know where I get I come down on a lot of this stuff, because, you know, I try to read as much as I can and listen, listen to the conflicting information that's out there. I'll use a really dumb example here. Lots of lots of people think bungee jumping is terrific and safe. And they do it recreationally and we all see the videos and you go Wow, that's really cool. There's no way on earth I'm sure That I don't care what your statistics say about safety. I don't care anything about it. I'm just not doing it. I mean, that's kind of the that's kind of the rule of thumb here, isn't it at the end of the day?
Melissa Callahan
It is. It really is. I mean, okay, it's a little bit different. Because, yes, you may be taking your life, you know, into your hands, but the risk is much higher to bungee jump than it is to go outside or to go to a restaurant or sit across your friends, but a risk still very real. And people have to be comfortable. I think education is very important. And it's a piece of the situation, I think people will start doing things. And they will get a little bit of a false sense of security, because they'll go to a dinner and they wake up the next day and say, I don't feel sick. And then they count their seven days and say, I don't really have any symptoms, and then they get all the way to day 14 and they realize I'm pretty good. And that's only one part of it, though. The other part of it is you could have been exposed and you could be a coward And just be asymptomatic. So part of the conversation that you're having, not only is you know where these people bed, what are they doing, but what are you doing? What is your risk of passing on? So, if you're thinking about meeting, you know, with your elderly, friends or someone who has higher risk, so be mindful of yourself when you've been out and about, have you been following physical distancing and wearing your mask and washing your hands and, you know, so it's a two sided situation that we need to look at and it's just looking at overall risks.
Steve Martorano
Melissa Callahan is our guest hanging on the corner here the behavioral corner, Melissa is corporate director of nursing for Retreat Behavioral Health. They of course, are sponsors of the program. She's also president of specialty medical care services and we love having her hang with us on the corner. We're talking about, you know, risk management and what feels right.
The BehavioralCorner BehavioralCorner
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Steve Martorano
Well, let's let's talk about some of the specifics now of expanding the circle when parents want to Have playdates kids are saying, you know, I haven't seen my friends, are there different considerations that one must make if the expansion has to do with children?
Melissa Callahan
Yes, I think that there definitely is different considerations. Early on, we were very cautious for children. There was also a little bit of a comfort that children did not seem to be affected the same way adults and other vulnerable populations were recently, there have been some cases very minimal, but cases of a presentation of a strain in children, that there were some loss of life and I definitely don't know the statistics, and it's definitely a much lower level. But we definitely cannot test any of this on our children. So I think that the caution is going to be much higher and having conversations about children socializing, everything that my children in my area in Pennsylvania have been doing is just in the past week, not prior to this this week for my circle and what I'm exposed to, and predominantly outside interactions. There have not been a ton moving to the indoors. And that's going to be coming because school is just getting out now. And it's going to be much more of a conversation. And I think it's the same conversation. The parents have to talk to each other. They have to have open conversation. This is where we've been and what we've been doing. What do you guys been doing? What are your thoughts? You know, can the kids come together a big conversation or sports, you know, I have children, they play a ton of sports. And every day I'm getting new updates about getting a season started and a lot of people thought baseball, it's very simple. We should be out there playing. And there's still a lot of thoughts that we have to look at and see what makes sense. I think sometimes people Still anxious to get them back. But they're not fully looking at it. They're putting some parameters that don't even make sense. If you're going to put some of these parameters, then we shouldn't be back doing it yet. We should wait out. Yeah. And if the professionals aren't doing it, why are we going to send our 12 year olds and to do it?
Steve Martorano
I know there's I know people in school systems that are struggling with that right now. And all of us read what's going on in the pro levels. You're right. For the for the psychological well, being of the of the population would be great to have baseball on even in an empty Stadium, but you look at it, it's not easy. It's not easy to do that.
Melissa Callahan
It really isn't. It isn't. And like, there's a lot of coaches who were like coming up with this idea, like maybe we'll just do three, four kids at a time. But there's this confusion for the children like okay, we can't go to school. We can't see our friends. We can't see that. We can't do that. But if we go over to a field or someone's backyard, and throw for a little while. This is okay. Even though we're not supposed to wear our uniform, because they're not doing it to them, like you're asking your child to kind of break the rules. And then when is it okay to break the rules and windows in it? It creates a moral decision as a parent, and then kids have had a lot of fever. They aren't always talking about it. Or maybe we think that they don't realize what's going on. But there's a fear when they come outside. Look at everybody wearing a mask. They might not say anything, they might say things like, this is so strange, but that's a lot to process for a little mind.
Steve Martorano
Yeah, it's a it's it's a lot for all of us to process. I want to ask you another specific question about expanding this circle of safety. If someone says to you, no, it's okay. I had I was sick. I was I tested positive I was sick. It was bad, but I'm better now. Is that like, okay, you're Okay, come on over.
Melissa Callahan
This is definitely another area. that we're trying to get as much information as possible. So there's a lot of questions can someone be infected twice? I definitely don't think that has been out there. I have not heard that confirmed that someone who has had it gets it a second time. The hope is that they have a level of immunity that they either don't get it a second time or if they were to get it, their body has already been exposed so they have less of a reaction to it. I think that in a lot of settings, there's a little more of a comfort if somebody already has it like they're kind of safer. It's kind of you know, at least you know, your body has fought it you have the ability to work against them, but we really don't know yet what that means. You don't know if they had it already. Now if I know somebody has it, and you know, it was a month ago. I'm not worried about being around them. I have not seen anywhere that they carry it past, you know, pretty much that 14 day number I think it's good information to have I don't know if we fully know what to do with that.
Steve Martorano
Yeah, it's it's somebody used the example of measles you know, not all viruses and the antibodies that result act the same way. I mean, you can get measles more than once. We don't know about this virus yet. So again, something else you just gonna have to gauge on an individual basis whether you're comfortable with somebody saying no, I'm okay. I can't get it again. Let me ask you about you in your professional work. telemedicine is a big part of that now, right. You're doing a lot of telemedicine, right?
Melissa Callahan
Absolutely. Absolutely. telemedicine is huge, and all of behavioral health specifically, and it was huge, really before the pandemic. Now it has come to the forefront that there is such a great benefit to it. And during this timeframe where people are really isolating. They can't dress skip appointments. They need to speak to their providers. They need to be maintained on their medication. A lot of people needed to have their medications adjusted to adjust to the life that they're living, which was different prior to around March 17. So telehealth is such a fantastic opportunity for medicine. For patients. There is this ability that there are a lot of people who are vulnerable population, whether that be the elderly or people who are immunocompromised, if we can really create this telehealth system to be as dynamic as possible. We are creating a safer environment with less risk for these patients who chronically probably need to have visits. But do they have to all be in person? Yeah, we can really convert a lot of them to tell how and decrease their exposure to all the things that are going on around them. So I think that we have a new world of medicine in front of us. We have the ability now. To look at so many more opportunities and until we stopped and we're forced to, it's been on the table telehealth has been on the table for quite a while from the ERs and psychiatry has used it pretty well. But there is definitely a ability for expansion.
Steve Martorano
I think it was always going to be in the future of, of healthcare. This is just accelerated I had my first experience with it. I had a problem with my wrist and delaying having somebody tell me what to do about it and I had I had a telemedicine meeting with with the doctor and I thought went flawlessly it mean it beat the hell out of sitting in his office, wait, you know, and his waiting room waiting to get in and see him. It was the same process. But this was a pretty straightforward thing. It's probably a carpal tunnel deal. If you're somebody who people often call and go, you know, I don't feel good, I don't know. And they're kind of vague. You're confident that in most cases you can look you know, on a zoom or FaceTime and get a diagnosis and get them help.
Melissa Callahan
There's definitely some stuff that I don't think should be telemedicine. I think that there's, you know, acute illness visits, I think that they definitely should be in person getting a set of vital signs and being able to do a physical assessment on a patient, I think is pretty important. And that definitely should not be telemedicine. If it's something like skin assessment, if it's mood assessment, if it's other things that don't require some result from the physical exam to point in the right direction. I think that telehealth is very appropriate. So behavioral health clearly, there's so much of the exam is observation and conversation, right? That telehealth is really appropriate. You can really observe someone go through questions and have conversation and kind of know Where persons at, there's some scales that you can do that personal assessment questionnaires. And that is all very tellavideo based. We're not having acute sinusitis versus a flu or whatever, you kind of need physical evidence to point in the right direction because you definitely don't want overuse of antibiotic at the wrong medication. So, you know, I don't think everything will go tell a video but I think there's, there's quite a few things that can go in that direction and alleviate some of the systems like you said, I hear from televideo, the appointment time is prompter. It's pretty focused. You get your results and move on your way...
Steve Martorano
That was my experience.
Melissa Callahan
...providors have been happy with it because they can sit and go right through right through and go pretty quickly and succinctly do it visit and feel good about it. Whereas when you're in the office, I feel like you know the phone rings and a receptionist has a question and delivery comes in. There's multiple places for interruption that I think gets taken out of the equation.
Steve Martorano
How far away are we from being able to do a patient's vital signs blood pressure temperature electronically is that I mean, I'm sure some of that can be done now, but...
Melissa Callahan
We're not very far there is actually a lot of technology that can scan and come up with a lot of results from blood sugar's to pull some blood pressures, you know, many patients do have machines at home, they can simply take it while they're speaking to their provider on the phone. They have their monitors at home, they can take it while they're at home and go through with a provider. And, you know, I definitely hear there is technology as well that, you know, you can do some forums and assessments, you can clearly look at a person's skin and their outer part, technology I do not think is far away. And I think that just with the changes of 2020 that will be a focus for so much technology to just start seeing what are the opportunities
Steve Martorano
You have hard to imagine sitting here right now facing all this, there may be some very positive outcomes of this crisis. So, just a moment or two to talk, I know you're going to do a big presentation very soon it's going to cover a lot of this. We've talked about the personal of sort of family aspects of it, for the most part, you're also going to deal with with going back to work, can you give us a thumbnail of what employers and business have to consider when bringing their workforce back?
Melissa Callahan
You know, they're calling it "business recovery" creating strategies to adapt to this new norm. I think that businesses, what they're going to have to look at just like the same as personal and social safety and risk. So I think that they need to look at risk assessment not only of the environment, the brick and mortar environment of where their job function is, but then also the risk of vulnerable So it's two separate issues. One, they have to look in the environment and find out how successful have people been working from home, if that's an opportunity in their work that they're doing, and if they've been pretty successful, keep doing it as much as you can. telework is good for a police agency. It's good for reduction of transmission of everything. But it's also been proven to be pretty good for morale. And it's definitely both ends. I mean, there's people who have young children at home want to scream and say "no, let me back in the office!" But I think a lot of strategies like staggering work hours, staggering work days, reducing staff interactions. There is a lot of talk of getting rid of break rooms, social areas where people go and eat together, just doing away with them together. Prior to all of this happening. It was like focusing on open concept offices and not having your doors closed. We are jumping right back to that. The recommendation is cubicle styles, you know, Plexiglas all the way to the ceiling. If you're in your office space, closing your doors, businesses and the brick and mortar function now have to look at ventilation systems. air circulation. If people have shared items or spaces or equipment, as simple as fax machines, on the other end of that actual environment, it's actually looking at vulnerable employees and seeing if you have sick policies that are pretty robust and build that back in to your system because we now want sick people to stay home. A lot of employers for a long time were like, oh, tough it out, you know, get the office. It's too hard to not have someone here, but now that we have telework as an option, if you're sick stay home, because the risk of transmission and the risk goes up so much and then high risk employees, maybe changing their role changing what they're doing to decrease their interaction with people and and being conscious and proactive that someone who's vulnerable? Do they have to come back into the workplace? Or can they function at a high level? Remotely?
Steve Martorano
Melissa, thanks so much. It's always it's always great because you're such a great resource on this. I mean, at the end of the day, we got to get the country back working again, obviously, in a safe environment. But on the more personal level, this notion of expanding your social circle, doing it safely is also important. Thanks for your, you know, sound advice and opinions on how to do that. We come back and hang with us on the corner sometime soon?
Melissa Callahan
Absolutely. I want to see how these next couple of months go and continue to have a conversation and how successful people are having relationships and social relationships and the work environment again.
Steve Martorano
Well, I look forward to seeing you because I think back now you were the last person who has I interviewed for the program that was actually in the studio with me. So when we when we when we break through and can get real comfortable being together again, you're going to be the first one back. Thanks Melissa Callahan.
Melissa Callahan
No problem. Thank you for having me.
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