One key to unlocking leadership opportunities in a health care setting is finding a high-level staff member with influence who shares your mission and is willing to advocate for psychologists as leaders, said Eboni Winford, PhD, MPH, director of research and health equity at Cherokee Health Systems in Tennessee. Winford was inspired by a leader from Cherokee Health who spoke at a conference about how Cherokee Health was providing comprehensive care to patients regardless of their financial status, gender, ethnicity, or racial background. During the conference session, Winford sent an email to the leader, clinical psychologist Parinda Khatri, PhD, asking if she could work for her.
Khatri, who is now CEO of Cherokee Health, hired Winford as a clinician, and the duo met weekly to discuss professional development goals and how to improve care for patients with low incomes. Winford joined the health care system’s quality improvement committee, a team that worked to reduce rates of depression, diabetes, hypertension, and other conditions by addressing social determinants of health. In 2020, Winford spoke to Khatri about her desire to dedicate more energy to reducing health disparities, and Khatri invited her to write a job description for this type of new role. Two weeks later, Winford became the first director of research and health equity at Cherokee Health, which includes 20 clinics throughout eastern Tennessee.
One of Winford’s especially significant accomplishments has been improving the health care system’s method of analyzing patient data—a skill she learned during her doctoral training. Winford started stratifying patient data based on race, ethnicity, gender, income, and preferred language. “Before, the data suggested that all the clinics were doing really well,” she said. “With the new method of analysis, the data started to tell a very different story.” For example, it became clear that the majority of the patients receiving obstetric care were Latine, and they were accessing care late in their pregnancies. The delays were increasing the risk of gestational diabetes, low baby birth weight, premature childbirth, and postpartum depression.
With funds from a $2 million grant from the Health Resources and Services Administration, Winford partnered with a local community organization to develop a prenatal support group for Latine women to learn about childbirth, postpartum care, commonly reported mood changes in pregnancy, warning signs for when to seek help, and more. They also meet with their OB-GYNs during the session. “These women do not need only medical care, they also need social support,” Winford said. “We provide transportation, childcare, and food to help them access care and reduce the chances of isolation.”
Like Winford, Angela Dugan, PsyD, LP, executive director of behavioral health for forensic services for the state of Minnesota, applied her expertise in research to create a more rigorous method of evaluating programs for patients. She was hired in 2017 when the medical director—a psychiatrist—and the CEO decided to expand the executive team to include a nurse, a psychologist, and a chief operating officer. Dugan’s division serves patients who have engaged in an overt act that was deemed dangerous by the court system and have serious mental illnesses such as schizophrenia, borderline personality, or bipolar disorder. She oversees 130 clinicians, including psychologists, mental health practitioners, social workers, physical and occupational therapists, and vocational rehabilitation and education staff.
“My background in research methodology, interpreting data, and monitoring outcomes was crucial,” she said. “I discovered that there was significant variability in how treatment was provided unit to unit.” Some units were unsure how to offer gender-affirming care, which created delays in patient services. Dugan helped rewrite the facility’s policies for transgender and gender-diverse patients, and she created a multidisciplinary gender-affirming care team that follows these patients across their stay.
She has also advocated for increased attention to the clinical needs of patients rather than focusing primarily on security, such as restraining difficult patients or sending them into seclusion. “I’m helping to lead an ongoing evolution in the division in which safety and good treatment are seen as mutually influencing one another,” Dugan said. Previously, nonclinicians could hold positions as program directors, but now applicants for these roles must have clinical training and licensure. With the new priority on clinical care, the department has also been more successful in recruiting and retaining mental health staff. The rates of physical interventions—such as restraint or seclusion—among patients have also dropped significantly.
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