/ en Wed, 30 Jul 2025 08:11:01 -0500 Wed, 25 Jun 25 08:44:27 -0500 /advancing-health-podcast/2025-06-25-healing-healers-bmcs-bold-move-support-resident-mental-health <p>Medical training is intense, and the toll it takes on emotional well-being is often overlooked. In this conversation, Boston Medical Center’s (BMC) Jeff Schneider, M.D., the associate chief medical officer, designated institutional official, and chair of the Graduate Medical Education Committee at Boston Medical Center, and Simone Martell, director of the employee resilience program, discuss how BMC is flipping the script on resident wellness. By providing early access to behavioral health resources and destigmatizing mental health, future generations of medical caregivers at BMC are prioritizing their well-being so they can continue caring for communities in need.</p><hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br> </h2> </summary> <p> 00:00:01:02 - 00:00:23:19<br> Tom Haederle<br> Welcome to Advancing Health. Today's medical residents and fellows are tomorrow's doctors. In this podcast, we hear about Boston Medical Center's innovative program to provide mental and emotional support during the rigors of medical training, and to address the tendency of many medical trainees to deprioritize their own health. </p> <p> 00:00:23:21 - 00:00:53:21<br> Jordan Steiger<br> My name is Jordan Steiger, and I am the senior program manager for Clinical Affairs and Workforce at the AHA. I'm joined today by Simone Martell, who is the director of Boston Medical Center's Employee Resilience Program, and Dr. Jeff Schneider, the associate chief medical officer, designated institutional official and chair of the Graduate Medical Education Committee at Boston Medical Center, and the assistant dean for graduate medical education at BU Chobanian & Avedisian School of Medicine. </p> <p> 00:00:53:23 - 00:01:16:04<br> Jordan Steiger<br> So just to set the stage a little bit, in 2022 and 2023, the AHA received some funding from the CDC to identify the leading interventions for preventing suicide in the health care workforce. And we got to know the Boston Medical Center team through this learning collaborative that we hosted that focused on implementing these practices at hospitals and health systems across the country. </p> <p> 00:01:16:06 - 00:01:20:04<br> Jordan Steiger<br> So, Simone and Jeff, thank you so much for being here with us today. </p> <p> 00:01:20:06 - 00:01:21:18<br> Simone Martell<br> Thank you for having us. </p> <p> 00:01:21:20 - 00:01:22:22<br> Jeff Schneider, M.D.<br> Thank you. </p> <p> 00:01:22:24 - 00:01:35:03<br> Jordan Steiger<br> So to get us started, I'd love for the audience to just learn a little bit more about your roles at BMC, and how the two of you work together to support workforce well-being. So Jeff, let's start with you. </p> <p> 00:01:35:05 - 00:01:53:09<br> Jeff Schneider, M.D.<br> Sure. Thank you very much for having us. And, happy to share what we have done and also what we've made to do moving forward. By training, I am an emergency medicine physician, and I still work clinically in our emergency department. And then the other part of my job is I oversee all of our residency and fellowship training programs across the organization. </p> <p> 00:01:53:09 - 00:02:15:02<br> Jeff Schneider, M.D.<br> So it's more than 750 residents and fellows across roughly about 70 training programs. And I really oversee those residency and fellowship programs from a bunch of different perspectives, everything from operations, to finance to accreditation. Obviously, working very closely with our program directors and our program administrators, and the educators and teachers that we have here at BMC. </p> <p> 00:02:15:04 - 00:02:16:20<br> Jordan Steiger<br> Great, Simone? </p> <p> 00:02:16:23 - 00:02:44:06<br> Simone Martell<br> So I joined BMC in June of 2023. My background is I'm an LICSW, licensed independent clinical social worker in Massachusetts. And, the program here is to provide mental and emotional support and resources to all of our workforce, clinical and non-clinical, in the realm of mental health, emotional well-being, stressors around the workplace, occupational stress injuries. </p> <p> 00:02:44:08 - 00:03:04:10<br> Simone Martell<br> And we have a couple of initiatives that target residents and medical trainees in particular. One of the first I was also introduced to was this initiative that had started the year before I joined, which are these wellness chats for incoming trainees at the beginning of the academic year. </p> <p> 00:03:04:13 - 00:03:28:28<br> Jordan Steiger<br> That's great. So I know that health care workers overall can experience barriers to receiving mental health services, can experience challenges around well-being and taking care of themselves. I think everybody listening to this podcast probably knows that. But we also know there's a lot of research that shows that residents have some kind of special challenges and adjustments that they need to make as they're starting residency. </p> <p> 00:03:29:01 - 00:03:33:29<br> Jordan Steiger<br> But could you tell the audience about some of those maybe special challenges that face residents? </p> <p> 00:03:34:01 - 00:03:55:21<br> Jeff Schneider, M.D.<br> The genesis of our program really actually goes back probably 6 or 7 years now, when we realized that our residents and fellows really deprioritized their own health on many occasions, given the choice between learning something clinical, or learning how to do something or gaining experience and taking care of their own health. Residents across the country tend to deprioritize throughout health. </p> <p> 00:03:55:24 - 00:04:13:08<br> Jeff Schneider, M.D.<br> So one of the things that we did very early on was trying to understand what are the barriers for our residents taking care of themselves? If they're not taking care of themselves, how can we expect them to take care of patients, to learn and to grow? So we had an idea that we would introduce primary care appointments during intern orientation. </p> <p> 00:04:13:08 - 00:04:37:11<br> Jeff Schneider, M.D.<br> Again, this is probably 6 or 7 years ago now. And we set up a process, a mechanism really carved out an afternoon that was protected for residents and fellows, where those that wanted to get primary care appointments could have them here at Boston Medical Center. Our goal again really, just a little bit around reducing stigma, reducing barriers and normalizing the conversation around taking care of your own health is very, very important. </p> <p> 00:04:37:14 - 00:04:56:23<br> Jeff Schneider, M.D.<br> I will admit that when we started this I had no idea if anyone was going to show up. We put a lot of time and effort, operations and planning into organizing this, but not really knowing frankly how well it would land. And we were pleased to see that even after year one, the majority of our residents and fellows were very interested in participating in this. </p> <p> 00:04:56:23 - 00:05:22:18<br> Jeff Schneider, M.D.<br> And we continued to grow the program a little bit, to learn, to iterate. And a few years later we said, well, if we're introducing primary care, maybe we should do the same thing with behavioral health or mental health to really, really try to accomplish three things. The first was we really wanted to normalize the conversation. It is totally normal for residents and fellows who need any behavioral health support, any behavioral health or mental health contexts. </p> <p> 00:05:22:20 - 00:05:42:28<br> Jeff Schneider, M.D.<br> How can we help them do that? To really normalize the conversation? It's as normal as in anything else that we do. And then really trying to reduce the stigma around it. Talking about it in the wide open, not behind closed doors or at hush voices. It was something we talked about very early on, when these new residents and fellows were coming and really tried to make the conversation part of what we do. </p> <p> 00:05:42:29 - 00:06:01:14<br> Jeff Schneider, M.D.<br> It's an expected part of what we do. And then really trying to figure out how we decrease the barriers, how do we make it as easy as possible for residents and fellows to take advantage of the wonderful resources we've had here? And Simone and her team have really taken an idea and grown it so that it's flourished. I'll let Simone talk a little bit more about some of the details of how she's actually executed. </p> <p> 00:06:01:15 - 00:06:32:27<br> Simone Martell<br> Yeah, yeah. Thank you. So I do also want to give credit to the team that preceded me as well, because I inherited this. And so the first year that the behavioral health component was launched was in 2022. So now we're going into our fourth year doing it. I think the whole framework, at least as how I view it in our approach, is like this philosophy of preventative care, which I think, you know, as trainees who are going to be, fully practicing doctors would preach to their patients. </p> <p> 00:06:32:27 - 00:07:06:14<br> Simone Martell<br> We want them to be able to and have it, or embody that themselves as well. The way that it's been structured right now through a couple of key learning points over the past couple of years is that we use different tools for signups. So in the welcome letter that gets sent out by, Dr. Schneider's office in April, welcoming folks, there is a portion of the letter that talks about the PCP visits and a portion of the letter that talks about signing up for these wellness resource chats. And they're 15 minute chat sessions. </p> <p> 00:07:06:20 - 00:07:32:06<br> Simone Martell<br> They're not therapy, but they are really focused on an opportunity to talk about any concerns somebody might have, letting them know about the resources that are available to them, helping them kind of highlight what are some anticipated stressors or things that they can do ahead of time again, from a preventative standpoint. So oftentimes we'll talk about what are some coping skills that got me through medical school. </p> <p> 00:07:32:08 - 00:07:56:09<br> Simone Martell<br> What are some things and ways we can augment that knowing that you're going to be in a new situation, a new territory now, maybe away from the support community that you'd established and been a part of and need to kind of configure here. So sometimes, you know, it might come up where somebody and I think, generationally there's a stigma which has been really lovely to see and kind of capitalizing on that. </p> <p> 00:07:56:09 - 00:08:22:05<br> Simone Martell<br> So some folks might come in and they've had, experiences with mental health supports before, but they might not realize, oh, that person doesn't have a license to practice in Massachusetts. So I need to be able to keep that going and find the resources locally and work within my insurance, because now my insurance plan is moving from what I had previously to BMC is now their employer and putting on the network that that's here. </p> <p> 00:08:22:07 - 00:08:47:15<br> Simone Martell<br> And so we want to set it up so that it can be something where again, coming from how do we anticipate what some of those barriers might be? What are those challenges going to potentially be? And a big piece is about access point because it might be early on, there's a lot of excitement. They're still riding the wave of having just graduated, you know, and starting out their new program. Which is a stressor in itself. </p> <p> 00:08:47:15 - 00:09:06:06<br> Simone Martell<br> You know, sometimes there are positive stressors and this is a positive stressor. But at the time when, you know, mental health challenges potentially do arise or distress does arise, we don't want it to be, oh, now I'm having to start from scratch at the time where I'm already struggling. We want the groundwork to already be laid for them. </p> <p> 00:09:06:06 - 00:09:10:24<br> Simone Martell<br> So that's really sort of the framework, by which we're trying to approach this. </p> <p> 00:09:10:26 - 00:09:35:24<br> Jordan Steiger<br> You both hit on so many important things that I feel like we could dig into forever on this podcast, but I think, you know, addressing that stigma piece, I think is so important. Bringing that to the front of the table, the front of the room, the second a resident starts at BMC and saying, this is okay, we expect that you're going to be stressed because residency is hard and you're learning and there's a lot of things going on for you. </p> <p> 00:09:35:26 - 00:09:56:19<br> Jordan Steiger<br> I think just getting out in front of it is so important. I think one thing you mentioned, Simone as well, is that, it's not therapy. You know and I wonder sometimes if people kind of shy away from these programs or thinking about mental health because it's they don't want to be providing those therapy services, but it really sounds like it's just more connecting people to those services. </p> <p> 00:09:56:21 - 00:10:22:00<br> Simone Martell<br> Yeah, it has a lot to do with the awareness and the access piece. So what we've done with the chats is that, in addition to myself, some of my colleagues who are, you know, doctors level will be able to join in and hold the discussions. Also, they won't have to have the pressure of going into to anything that's outside of their territory. </p> <p> 00:10:22:00 - 00:10:58:12<br> Simone Martell<br> We also don't want to give a false impression to the residents for this session, either. I'll say residents or fellows, because we do this for fellows as well. But it's more about here are the different resources that you are eligible for and have access to, and here's the route with which to do it. And here's at least, you know, through our internet source, our fliers, our point of contact, so that you have an easy way of - you don't have to remember all of this - but there's just, a streamlined way to think about how do I set up what I might need. </p> <p> 00:10:58:15 - 00:11:19:17<br> Simone Martell<br> And then again, for, you know, folks that maybe have had experiences before or are just saying, like, you know, coming into this, I know that this is something that was difficult for me in med school or something that I've found challenges with. So I want to kind of be thinking ahead. We can roughly just touch upon what are some coping strategies that have been helpful for you. </p> <p> 00:11:19:17 - 00:11:39:24<br> Simone Martell<br> Again, this being a new territory, a new framework, what do you think that you might need in anticipation and have you think through ahead of that without it being anything that would delve into the territory of therapy per se? That said, trainees are able to schedule confidential appointments with a licensed clinician in the resilience program at any point through their tenure. </p> <p> 00:11:39:27 - 00:11:47:18<br> Simone Martell<br> And we also help them navigate how to get connected to a therapist through their behavioral health benefits, if that's something they'd like to pursue. </p> <p> 00:11:47:21 - 00:12:10:09<br> Jeff Schneider, M.D.<br> I think another really important piece of this is getting the residents and fellows to normalize a conversation amongst themselves. So for every resident or fellow that Simone or her team meets with who goes through or has their eyes open to some of the resources that we have here, my hope, my deep hope is that even if you know, maybe it's not applicable to them today or tomorrow or the next day... </p> <p> 00:12:10:12 - 00:12:26:24<br> Jeff Schneider, M.D.<br> but if they see a colleague, if they see a friend, if they see someone, a resident or fellow who maybe they don't even know all that well and they just look at them and say, I'm worried about you. Are you okay? Like, that's always the right currence. It's always the right question to ask. It's never the wrong question to ask. </p> <p> 00:12:26:26 - 00:12:41:21<br> Jeff Schneider, M.D.<br> And then also so they can start arming themselves and say you know what, at the very beginning I went to this talk and I had this resilience chat, I learned a little bit about some of the resources we have at Boston Medical Center. I don't remember all the details, but I know that there's help out there. And I remember here's how you can help access it. </p> <p> 00:12:41:21 - 00:12:53:16<br> Jeff Schneider, M.D.<br> So again, the more we can start normalizing these conversations, I think for every resident fellow that Simone touches, the hope is that that spreads almost virally so that they can help themselves but also help their colleagues. </p> <p> 00:12:53:19 - 00:13:19:24<br> Jordan Steiger<br> Absolutely. I think the program and the work that you are doing at Boston Medical Center is setting such an incredible example for our membership, and we're so happy that we get to share your story with everybody today. Simone and Jeff, thank you so much for being here with us today. I think the work that you have shared and the work that you're doing and continue to do to support your teams is really setting such a strong, incredible example for our membership. </p> <p> 00:13:19:24 - 00:13:30:03<br> Jordan Steiger<br> And I'm just so happy that we get to share your story and hopefully others will get to learn from it and start to maybe, implement some of the things that you shared today. </p> <p> 00:13:30:06 - 00:13:31:00<br> Jeff Schneider, M.D.<br> Thank you. </p> <p> 00:13:31:02 - 00:13:33:03<br> Simone Martell<br> Thank you so much. </p> <p> 00:13:33:06 - 00:13:41:17<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </p> </details></div><p> </p> Wed, 25 Jun 2025 08:44:27 -0500 Behavioral Health Workers /costsofviolence <div class="container"><div class="row"><div class="col-md-8"><div class="panel"><h3 id="findings"><span><span>KEY FINDINGS:</span></span></h3><ul><li>Violence, including workplace (in-facility) and community violence, abuse, and threatening behavior, is a significant public health issue affecting the U.S. health system and communities.</li><li>This incidence of violence has significantly increased in the U.S. over the past decade, with rising rates of assault, homicide, suicide, and firearm violence, which were further exacerbated during the COVID-19 pandemic.</li><li>This study sought to estimate the financial costs and other impacts associated with workplace and community violence.</li><li>Hospitals experience substantial financial impacts from violence.<ul><li>The total annual financial cost of violence to hospitals in 2023 is estimated at $18.27 billion U.S. dollars (USD).</li><li>Pre-event costs associated with violence in the community and within facilities are estimated at $3.62 billion (USD), primarily for prevention measures.</li><li>Post-event costs for health care, work loss costs, case management, staffing, and infrastructure repair are estimated at $14.65 billion (USD).</li><li>The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</li></ul></li><li>Additional impacts, like public perception, staff recruitment and retention, legal concerns, job satisfaction, and psychological harm to health care workers, are significant but difficult to quantify due to limited data</li></ul></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h2 id="summary"><span><small class="sm">EXECUTIVE SUMMARY</small></span></h2><p>Violence is a major public health problem impacting our health system and communities.<sup>1</sup> Over the past ten years, rates of violence have increased in the United States (U.S.), including rates of assault, homicide, suicide, and firearm violence.<sup>2–5</sup> Further, violence increased during the COVID19 pandemic including rates of intimate partner violence, suicide, firearm violence, and workplace violence towards health care workers, and have not yet returned to pre-pandemic levels.<sup>6–10</sup> Violence directly impacts hospitals via millions of emergency department visits and hospitalizations for fatal and nonfatal violence-related injuries each year.<sup>4,11</sup> In addition, the impact of workplace and community violence is seen within the broader health care system leading to staff turnover, absenteeism, loss of productivity, high insurance and workers’ compensation costs, and an increased risk of depression, post-traumatic stress disorder, and suicide.<sup>12–15</sup> The ���������� Association (AHA) engaged the University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) to estimate the financial costs and other impacts to hospitals from all types of violence, abuse, and threatening behavior within their facilities and communities. <strong>Through comprehensively characterizing the impacts of violence on hospitals, this report highlights the magnitude of violence as a public health problem and informs future policy and research efforts to address violence impacting U.S. hospitals and the health care system.</strong></p><p>We used mixed methods that incorporated multiple data sources, including existing federal and state data sources, published literature, and primary data to quantify the impacts of violence on hospitals. Our estimates were guided by an analytic framework developed by the study team, experts in the field, and published literature. The framework incorporates financial costs and other impacts of violence, broken down by pre- and post-event costs. Beyond pre- and postevent costs, we analyzed financial cost estimates by violence type and examined other impacts resulting from violence, including staff satisfaction and productivity, staff retention and recruitment, psychological impacts, and legal and ethical concerns.</p><p><strong>Overall, we estimate the total annual financial cost of violence to hospitals in 2023 to be $18.27 billion (U.S. dollars, USD). This estimate includes pre- and post-event cost components.</strong> Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care, staffing, replacement and repair of infrastructure and equipment, legal costs, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p>There are additional impacts of violence to hospitals that cannot be quantified at this time due to limited data availability. These far-reaching consequences include the impact of workplace violence on public perception, staff recruitment and retention, legal concerns impacting hospitals, job satisfaction for health care workers, and the psychological impacts on health care workers who experience or observe violence. These interconnected effects underscore the complex and pervasive nature of violence beyond immediately measurable costs to hospitals.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="intro"><span>1. INTRODUCTION</span></h3><h4 id="1.1"><span>1.1 BACKGROUND AND RATIONALE</span></h4><p>Violence is a major public health problem impacting health systems in the United States (U.S.).<sup>1</sup> In the past ten years, there has been an increase in the incidence of assault, homicide, suicide, and firearm violence in the U.S.<sup>2–5</sup> Communities are highly impacted by violence, particularly in highpoverty and under-resourced neighborhoods.<sup>16–18</sup> Additionally, the COVID-19 pandemic declared in March 2020 had direct impacts on increasing rates of intimate partner violence (IPV), suicide, firearm violence, and workplace violence (WPV) against health care workers.<sup>6–10</sup> In 2022, there were 2,105,245 nonfatal and 73,989 fatal violence-related injuries that occurred in the U.S.<sup>11,19,20</sup> Violence also occurs in hospitals, where health care workers experience significant rates of violence from patients and visitors.<sup>12,13</sup> This leads to staff turnover, absenteeism, loss of productivity, high costs in disability and indemnity, and an increased risk of depression, posttraumatic stress disorder, and suicide.<sup>14,15</sup></p><p>The ���������� Association (AHA) engaged the University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) to estimate the financial costs and other impacts to hospitals of all types of violence, abuse, and threatening behavior within their facilities and communities. The Human Subjects Review Committee at the UW Institutional Review Board approved this study (STUDY00019266; STUDY00019881). The goal of this report was to rigorously characterize and quantify the financial costs and other impacts of workplace and community violence to hospitals and their health systems, thus producing valuable information regarding the current impact of violence as a public health problem to inform policy and future research. We used mixed methods that incorporated multiple data sources to inform this report.</p><p>This report:</p><ul><li>Estimates the financial impact of violence to hospitals using published estimates, publicly available data sources, and primary data collection.</li><li>Identifies other impacts of violence to hospitals using published estimates, publicly available data sources, and primary data collection.</li><li>Identifies policy and research implications for addressing the impacts identified in the report.</li></ul><h4 id="1.2"><span>1.2 ANALYTIC FRAMEWORK AND METHODS</span></h4><p>For a more comprehensive review of the financial and other costs of violence, we used the World Health Organization’s definition of violence: “intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” <sup>21</sup> Figure 1 below illustrates the analytic framework used to estimate the cost of violence to U.S. hospitals and health systems. This framework was developed by the study team and was guided by input from experts in the field and by review of current literature. The framework illustrates financial and other components used to derive our cost estimates, broken down by pre- and post-event costs. As illustrated in the framework, several components encompass both financial and other costs (i.e., Infrastructure and Equipment), and pre- and post-event costs (i.e., Staff Retention and Recruitment).</p><p>Mixed methods were used to estimate the financial costs and other impacts of violence to U.S. hospitals. We conducted a scoping review of the literature to ensure we captured a comprehensive overview of existing research, knowledge, and data related to the financial and other impacts of violence to U.S. hospitals. We included articles in our review that were published after 2016, focused on the U.S. health system, and published in English. Peer-reviewed studies and government reports were prioritized. Identified studies and extracted data were managed in Covidence online systematic review software. This review informed estimates reported here of the financial and other costs of violence and gaps in knowledge about cost components meriting future research.</p><p>We further used a socioecological framework to guide rigorous synthesis of existing literature, synthesis of recent national data describing direct and indirect costs in a diverse sample of care settings and health care workers (HCW), and in primary data collection to increase understanding of the true violence-related financial and operational pressures facing U.S. hospitals and their employees and patients.<sup>22</sup> The scope of this report focuses on hospitals and their related health systems, heretofore referred to as “hospitals” unless otherwise indicated.</p><div> <div data-entity-type="media" data-entity-uuid="16389403-c8be-4030-963e-138a97e08a4e" data-embed-button="media_entity_embed" data-entity-embed-display="view_mode:media.full" data-padding-top="20px" data-padding-bottom="20px" data-padding-left="20px" data-padding-right="20px" data-margin-top="10px" data-margin-bottom="10px" data-margin-left="10px" data-margin-right="10px" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <article> <div class="field_media_image"> <img loading="lazy" src="/sites/default/files/2025-05/costs-of-violence-figure-1-analytic-framework-for-estimating-burden-violence.png" width="729" height="415" alt="Burden of Violence Figure 1: Analytic Framework for Estimating the Burden of Violence to U.S. Hospitals & Health Systems"> </div> </article> </div></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="financialcost"><span>2. FINANCIAL COST OF VIOLENCE</span></h3><p>Violence is a major public health problem in the U.S. As hospitals are directly impacted by workplace and community violence, understanding the financial costs to U.S. hospitals associated with violence is essential to guide cost-effective prevention efforts and to educate administrators, policymakers, and the public about the importance of prevention. Successful prevention relies on a comprehensive understanding of the many sides of a problem and designs complementary interventions from many angles; we have similarly structured our analysis of the financial cost of violence to hospitals to enable a comprehensive understanding of the many areas in which violence results in a financial cost, and the estimated magnitude of those costs. Although hospitals cannot address all workplace and community violence in the U.S., they are in a position to potentially have a significant impact on violence prevention in their facilities and surrounding communities.</p><table><caption><strong>Table 1. Estimated 2023 Annual Cost of Violence to U.S. Hospitals & Health Systems by Cost Category.</strong></caption><tbody><tr><td rowspan="2"><strong>Cost Category</strong></td><td rowspan="2"><p class="text-align-center"><strong>In millions of USD</strong></p></td><td colspan="2"><p class="text-align-center"><strong>Location of Violence</strong></p></td></tr><tr><td><p class="text-align-center"><strong>Community</strong></p></td><td><p class="text-align-center"><strong>Workplace</strong></p></td></tr><tr><td><span><strong>Pre-Event Financial Costs</strong></span></td><td><p class="text-align-right"><span><strong>3,620.5</strong></span></p></td><td> </td><td> </td></tr><tr><td>Training costs</td><td><p class="text-align-right">1,403.7</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Security personnel and staffing</td><td><p class="text-align-right">404.3</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Violence prevention programs*</td><td><p class="text-align-right">959.2</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Policy and procedure development</td><td><p class="text-align-right">8.6</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Outreach to build public trust</td><td><p class="text-align-right">79.7</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Facility modification to prevent and mitigate harms</td><td><p class="text-align-right">306.0</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Investments in technology to monitor possible events</td><td><p class="text-align-right">459.0</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td><span><strong>Post-Event Financial Costs</strong></span></td><td><p class="text-align-right"><span><strong>14,648.8</strong></span></p></td><td> </td><td> </td></tr><tr><td>Health care costs for fatal and nonfatal injuries</td><td>13,165.6</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Work loss costs for workers in the health care setting</td><td>79.0</td><td><p class="text-align-center"> </p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Case management</td><td>252.5</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Staffing</td><td>541.3</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Replacement & repair of damaged infrastructure & equipment</td><td>584.8</td><td><p class="text-align-center"> </p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Community interface and public relations</td><td>25.6</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td colspan="4"><small class="sm">Note: Values may not sum to totals due to rounding. </small><br><small class="sm">*Relates to expenses other than training</small></td></tr></tbody></table><p> </p><p>Overall, we estimated the total financial cost of violence to hospitals to be $18.27 billion (U.S. Dollars, USD) (Table 1, Figure 2). This estimate includes pre- and post-event cost components. Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, prevention programs, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care, staffing, replacement and repair of infrastructure and equipment, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p> </p><div> <div data-entity-type="media" data-entity-uuid="71a3be84-13ba-4e0b-94aa-6a22eb335a21" data-embed-button="media_entity_embed" data-entity-embed-display="view_mode:media.full" data-padding-top="20px" data-padding-bottom="20px" data-padding-left="20px" data-padding-right="20px" data-margin-top="10px" data-margin-bottom="10px" data-margin-left="10px" data-margin-right="10px" class="align-center embedded-entity" data-langcode="en" data-entity-embed-display-settings="[]"> <article> <div class="field_media_image"> <img loading="lazy" src="/sites/default/files/2025-05/costs-of-violence-figure-2-percentage-breakdown-estimated-2023-violence-costs.png" width="752" height="512" alt="Burden of Violence Figure 2: Percentage Breakdown of Estimated 2023 Vilence Costs to U.S. Hospitals & Health Systems (by Pre- & Post-Event and Component Costs)"> </div> </article> </div></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="pre-event"><span>3. PRE-EVENT FINANCIAL COSTS</span></h3><h4 id="3.1"><span>3.1 TRAINING COSTS</span></h4><p>Preparation for violent events in the health care setting requires training of workers at each clinical location. The estimated costs associated with this pre-event violence-prevention training are summarized below. Training-related costs were divided into six categories of component costs corresponding to distinct types of training occurring within hospitals and health care facilities. Together, we estimated training costs at $1.4 billion annually, with most of the cost stemming from training staff on de-escalation, emergency preparedness, and institution-specific violence-related policies and procedures (Table 2). Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–35</sup></p><table><caption><strong>Table 2. Estimated 2023 Annual Cost of Trainings within U.S. Hospitals & Health Systems in Preparation of Violence or a Violent Event.</strong></caption><tbody><tr><td><strong>Cost Category</strong></td><td><strong>In millions of USD</strong></td></tr><tr><td>Total training costs</td><td><p class="text-align-right">1,403.7</p></td></tr><tr><td>Active shooter training</td><td><p class="text-align-right">61.7</p></td></tr><tr><td>Training to respond to lateral violence</td><td><p class="text-align-right">148.0</p></td></tr><tr><td>Training in emergency and medical surge preparedness</td><td><p class="text-align-right">369.5</p></td></tr><tr><td>Training in de-escalation in hospitals</td><td><p class="text-align-right">377.4</p></td></tr><tr><td>Training on violence-related policies and procedures in the hospital</td><td><p class="text-align-right">261.9</p></td></tr><tr><td>Training for providers to identify violence-related trauma</td><td><p class="text-align-right">185.2</p></td></tr></tbody></table><p> </p><p><span><strong>3.1.1 Active Shooter Training.</strong></span> Hospitals are not immune from experiencing WPV, including active shooter events. A study identified 88 hospital shootings in the U.S. from 2012 to 2016 noting emergency departments were the most common site (30%), followed by patient rooms (21%) and parking lots (15%). <sup>36,37</sup> Additional studies described perpetrators as those with a personal grudge against their victims and of 235 victims, at least 60-80% were bystanders to the violent event, 13% patients, 5% nursing staff, and 3% physicians. <sup>36,38,39</sup> Since most events transpire within 15 minutes, before law enforcement can arrive, the Joint Commission urges hospitals to prepare staff, particularly recommending the development of a communication plan, establishing processes and procedures to ensure patient and employee safety, training and drilling employees, and planning for post-event activities (e.g., establishing debriefing procedures). <sup>40,41</sup> Hospital training sessions often recommend the “Run-Hide-Fight” strategy and deliver other educational content through annual online modules or computer-based simulations.<sup>42,43</sup> To estimate the cost of providing active shooter trainings in U.S. hospitals, we assumed that across all hospital employees, trainings employ a dual learning approach (online virtual e-learning as well as in-person sessions with trained instructors).<sup>44</sup> We identified estimates from 2018 that indicate costs of blended types of training were approximately $32,100 (educational setting).<sup>45</sup> In the absence of formal cost estimates for this type of training, we estimated that costs for this type of training vary by hospital size, wherein larger hospitals have higher costs due to having more staff. Assuming a starting annual cost of $6,000 for the smallest hospitals (6-24 beds) and increasing costs incrementally by 20% according to hospital bed size (8 tiers) to $21,499 for the largest hospitals, we estimated that all U.S. hospitals (N=6,120) pay approximately $61.7 million<a title="* $61,743,166">*</a> annually for active shooter training, independent of other trainings described in this report. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><p><span><strong>3.1.2 Training to Respond to Lateral Workplace Violence.</strong></span> Stressors that arise in the hospital workplace, combined with hierarchy and behavioral norms, can create environments that enable lateral violence. Lateral violence is a type of workplace violence, defined as workplace conflict arising from interpersonal relations between employees. In the U.S., up to 76% of health care workers have reported experiencing violence, with over 80% experiencing verbal violence and 33% experiencing physical violence.<sup>46</sup> Unfortunately, some of this violence is lateral violence arising from employees perpetrating abuse towards their colleagues via repeated behaviors of physical, psychological, or sexual abuse.<sup>47</sup> There are a multitude of interventions available to decrease the prevalence of workplace incivility, lateral violence, and abuse and bullying.<sup>48</sup></p><p>The Joint Commission Standard HR.01.05.03 requires that leadership, staff, and licensed practitioners participate in ongoing education and training in WPV; however, the content for each audience is determined by the hospital.<sup>49</sup> Additionally, individual states’ requirements for sexual harassment training (one component of lateral/workplace violence) vary considerably.<sup>50,51</sup> The length of training session and requirements can also vary by occupation.<sup>52,53</sup> To account for this variation across hospitals, occupations, state requirements, and content, we assume that 60% of the hospital workforce engage in some sort of lateral violence prevention training annually. In the absence of data on duration of training across professions or occupations, we estimated that annual training lasts an average of one hour across all hospital occupations, an estimate that also accounts for the fact that this training may be bundled with other employee training (e.g., training on policies and procedures related to violence). To estimate the cost of training, we utilized workforce and wage data for occupations employed in hospitals (NAICS Sector 62-2000)<sup>54</sup> (see Appendix).</p><p>Per these assumptions, we calculated costs as follows: ∑<em><sup>21</sup><sub>i=1</sub></em> 𝐸𝑖 x 𝑊𝑖 x 𝑇𝑖  , wherein i is the index representing each type of occupation group (Appendix Table 1), Ei is the national employment estimate for the i th occupation, Wi is the estimated mean hourly wage per employee for the ith occupation, Pi is the percentage of institutions with lateral violence training annually (60%), and T is the time spent per year in training for the i th occupation (1 hr). Based on this approach, we estimated that training on WPV prevention (lateral violence) costs hospitals $148.0 million<a href="#" title="* $148,035,403">*</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><p><span><strong>3.1.3 Training in Emergency and Medical Surge Preparedness.</strong></span> Medical surge preparedness describes the ability of health care systems to manage a sudden influx of patients following unplanned, large-impact events, such as mass casualty incidents, natural disasters, or a pandemic. While not all these events may involve violence, training in medical surge preparedness is also necessary to respond to large-scale events that do involve violence (e.g., mass shootings, bombings). Estimating costs of training personnel in preparing for medical surges (or for emergency preparedness in general) vary widely across the literature.<sup>55</sup> To estimate the costs of medical surge preparedness for U.S. hospitals, we estimated the average duration of the training as two hours per health care staff member per year, and two hours per protective services staff member per year. This estimate of duration is based on Department of Homeland Security Center for Domestic Preparedness Medical Surge Management course.<sup>56</sup> We recognize the duration of training may vary by occupation. For cost estimations, we assumed a training session would take staff away from regular duties for those hours. The patient-facing hospital workforce was defined as health care practitioners and technical occupations (Standard Occupational Classification [SOC] 29-0000) and health care support occupations employed in hospitals (SOC 31-0000) (Appendix Table 1).<sup>54</sup> The protective services workforce (SOC 33-0000), including security guards, was also included in this calculation. Assuming 2 hours of annual training for the occupations above, we estimated that hospitals spend a total of $369.5 million<a href="#" title="* $369,543,838">*</a> on medical surge preparedness training each year. The cost of preparing and offering the training internally was not incorporated into this estimate; therefore, we believe this is likely a conservative estimate of the total (true) costs for this training. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><p><span><strong>3.1.4 Training in De-Escalation.</strong></span> De-escalation skills help mitigate the deleterious impacts of conflicts within the health care setting. De-escalation training is particularly common in the hospital setting and is listed as a requirement by the Joint Commission (HR.01.05.03).<sup>49</sup> To calculate the national costs of de-escalation training for the patient-facing hospital workforce, the duration of training was estimated at an average of two hours per health care staff member per year and eight hours per protective services staff member per year.<sup>57–59</sup> We recognize that the extent of annual training likely varies by clinical specialty and location. For cost estimations, we assumed a training session would take staff away from regular duties for the training time. The actual cost of the training was not incorporated because costs vary widely and many training sessions may be developed and offered internally by health care institutions for little/no cost; our estimate is likely conservative as some hospitals may engage outside agencies to provide this training for an additional cost. See Appendix Table 1 for details on patient-facing and protective services workforce in hospitals (SOC codes 29-0000, 31-0000, and 33-0000). Assuming two hours of annual de-escalation training for patient-facing occupations and eight hours of annual training for protective personnel, we estimated hospitals spend a total of $377.4 million<a href="#" title="† $377,362,634 ">†</a> on deescalation training each year. Activities in this section fall under Joint Commission Standard HR.01.05.03 EP 29.<sup>26</sup> </p><p><span><strong>3.1.5 Training on Violence-Related Policies and Procedures in Hospitals.</strong></span> Training on violence-related policies and procedures is critical to ensure that the health care workforce is prepared to respond to violence within U.S. hospitals and is required by accrediting bodies such as the Joint Commission and federal agencies such as the Centers for Medicare & Medicaid Services.<sup>49</sup> Awareness of, and compliance with, policies help employees promote safety during violent events. Training covers zero-tolerance policies, reporting mechanisms, and appropriate staff roles and responsibilities in the event of a violent incident. The general policy/procedure training described here encompasses training on institution-specific policies and procedures and does not include specific training summarized elsewhere in the report (e.g., de-escalation training). We estimated the hospital management workforce (SOC 11-0000) engages in two hours of policy and procedure-related training related to violence prevention<sup>57–59</sup> (e.g., monitoring, reporting, and investigating events) and all other hospital employees engage in 0.5 hours of training annually (e.g., how to report events). Based on these assumptions and wage and workforce estimates (Appendix Table 1, 21 occupations), the estimated cost of training specifically on violence-related policies and procedures in hospital was calculated as follows: ∑<em><sup>21</sup><sub>i=1</sub></em> 𝐸𝑖 x 𝑊𝑖 x 𝑇𝑖 wherein i is the index representing each type of occupation group (see table below), Ei is the national employment estimate for the i th occupation, Wi is the estimated mean hourly wage per employee for the i th occupation, Ti is the number of hours spent per year in training for the i th occupation (described above). Based on this approach and 2023 mean hourly wage data reported by the Bureau of Labor Statistics, we estimated that training on violencerelated policies and procedures cost U.S. hospitals $261.9 million<a href="#" title="* $261,906,280">*</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–28</sup></p><p><span><strong>3.1.6 Training for Providers to Identify Violence-Related Trauma.</strong></span> Educating hospital personnel to recognize trauma linked to violence is crucial for interrupting the cycle of violence and helping to ensure patients receive the care they need.<sup>60–62</sup> Conditions of note include child and elder abuse, neglect, or maltreatment, and screening for self-harm/suicide, domestic violence, human trafficking, and intimate partner violence. We estimated that the patient-facing hospital workforce dedicates, on average, one hour annually for these trainings. This estimate of time commitment is based on mandated trainings for related conditions<sup>63</sup> (e.g., 6 hours every 6 years for suicide prevention training in Washington State) with the assumption that each year, providers engage in at least one hour of training related to mandated reporting or child and elder abuse, neglect, or maltreatment, and screening for self-harm/suicide, domestic violence, and intimate partner violence. (This is likely an underestimate.) The patient-facing hospital workforce was defined as health care practitioners and technical occupations (SOC 29-0000) and health care support occupations employed in hospitals (SOC 31-0000). Additionally, we estimated four hours per year for human resources managers (SOC 11-3121) to organize and monitor the trainings and related compliance. Hourly wage estimates for 2023 were obtained from the Bureau of Labor Statistics.<sup>54</sup> We used the following equation to calculate the total cost associated with training for providers to identify violence/violent injuries: (𝐻<sub>𝐻</sub><em><sub>R</sub></em> × 𝑁<sub>𝐻</sub><em><sub>R</sub></em> × 𝑊<sub>𝐻</sub><em><sub>R</sub></em>) + (𝐻<sub>𝑃</sub><em><sub>F</sub></em> × [(𝑁<sub>29</sub> × 𝑊<sub>29</sub>) + (𝑁<sub>31</sub> × 𝑊<sub>31</sub>)] wherein H<sub>HR</sub> is the hours per year human resources managers spend providing and monitoring trainings, HPF is the hours per year the patient-facing hospital workforce dedicate to this training, NHR is the estimated number of human resources managers, N<sub>29</sub> and N<sub>31</sub> are the estimated number of patient-facing providers (for each SOC group, 29-0000 and 31-0000, respectively), WHR is the estimated mean hourly wage of human resources managers, and W<sub>29</sub> and W<sub>31</sub> are the estimated mean hourly wage of each patient-facing provider group (see Appendix Table 1 for values). We estimated that each year, U.S. hospitals spend $185.2 million<a href="#" title="† $185,156,223">†</a> to train patient-facing providers in recognition of abuse, risk for violence, and violence-related trauma. Activities in this section fall under several Medicare Conditions of Participation Standards.<sup>23–25</sup></p><h4><span>3.2. SECURITY PERSONNEL AND STAFFING</span><span> </span></h4><p>Hospitals employ security personnel to respond to incidents of violence and monitor the safety and security of the facility. Security personnel are trained to manage emergencies and work closely with health care teams to maintain a safe and secure environment. Their purpose is to prevent potential events by detecting/deterring threats while fostering a reassuring, safe environment. According to the Bureau of Labor Statistics, U.S. hospitals employed 49,280 security guards in 2023 (SOC code 33-9032). Annual mean wages for security guards in this setting is $45,080, equating to a total wage expenditure on security of $2,221,542,400. Based on previous work, assuming 18.2% of this cost is attributable to local crime rates, we estimated staffing security personnel in response to violence costs U.S. hospitals $404.3 million. <sup>64</sup><a href="#" title="* $404,320,717"><sup>*</sup></a></p><h4><span>3.3. VIOLENCE PREVENTION PROGRAMS </span></h4><p>In recent years awareness of the importance of proactive action to prevent violence, and the role of hospitals in that prevention, has grown. This focus on prevention has taken two forms; one focused on patients and keeping them safe from further violent injury while addressing psychological sequela from their current injury, and one focused on keeping employees safe. Below we described these two types of programs and estimated their costs, totaling $959.2 million annually (Table 3). However, it is important to note that we were unable to estimate the potential cost-savings these programs may create by successfully preventing violent injury. It will be important in future work to include emerging evidence about the efficacy of these programs to prevent injuries to paint a full picture of the potential cost-effectiveness of the programs.</p><table><caption><strong>Table 3. Estimated 2023 Annual Cost Associated with Violence Prevention Programs within U.S. Hospitals and Health Systems in Preparation of Violence or a Violent Event.</strong></caption><thead><tr><th><strong>Cost Category</strong></th><th><strong>In millions of USD</strong></th></tr></thead><tbody><tr><td>Violence prevention programs (expenses other than training)</td><td>959.2</td></tr><tr><td>Hospital-based violence intervention programs</td><td>270.5</td></tr><tr><td>Workplace violence prevention programs</td><td>688.7</td></tr></tbody></table><p> </p><p><span><strong>3.3.1 Hospital-based Violence Intervention Programs.</strong> </span>There has been a growing awareness among health care providers that only treating physical wounds is insufficient to prevent downstream effects following victimization, and health care staff can and should do more to address the psychosocial needs of patients by integrating violence prevention into the delivery of health care. <sup>65,66</sup> Hospital-based Violence Intervention Programs (HVIPs) seek to mitigate and prevent recurrent violent injury (trauma recidivism) by identifying and offering victims of violent injury (stabbing, gunshot wounds, assault) a range of support services while in the trauma unit. <sup>67</sup> Following recovery or stabilization of the index injury, HVIPs then seek to link patients to community-based organizations and programs external to the hospital upon discharge with the goals of preventing the patient from experiencing a subsequent violent injury, breaking the cycle of violence, and addressing social needs. HVIPs are comprised of multidisciplinary teams including trauma surgeons, nurses, social workers, and other credible messengers. These programs operate from a trauma-informed perspective reflecting a “fundamental shift in thinking from the supposition that those who have experienced psychological trauma are either ‘sick’ or deficient in moral character to the notion that they are ‘injured’ and in need of healing”.<sup>67</sup></p><p>A unique feature of HVIPs is that the team members approach patients at the bedside instead of waiting for patients to contact them for support. HVIP staff endeavor to engage victims of violent injury within the “golden hour”: the period in which victims of violent injury are most likely to agree to engage in services. HVIP staff are trained to engage patients of violent injury and build rapport with them. According to the 2022 AHA Annual Survey, an estimated 1,143 hospitals reported having violence prevention programs for the community. (This is likely an underestimate due to survey response rate; we also assume that more hospitals would have HVIP programs in 2023, given the increasing investment and interest in these programs. However, the most recent data are 2022, thus we relied on this estimate.) To estimate the costs of these programs borne by hospitals, we relied on estimates that HVIP programs cost approximately $10,798 per participant.<sup>68</sup> Assuming that each hospital with a HVIP serves proportionally as many participants as the size of their hospital, we estimated that the smallest institutions (6-24 beds) serve two participants annually and midsize institutions (300-399 beds) serve 100 participants annually.<sup>68</sup> The number of participants per hospital was thus scaled accordingly across 8 levels of hospital bed sizes (e.g., hospitals with 25-49 beds served an average of 20 participants; those with 400-499 beds served an average of 120 participants). Assuming each HVIP program will cost an average of $10,798 per participant (recognizing that the cost per participant in smaller hospitals will be higher than larger hospitals), we summed the products of overall HVIP cost per participant across all hospitals in the U.S (see equation below). These terms were used to calculate total cost as ∑ 𝐶𝐶 × 𝑃𝑃𝑛𝑛 × 𝑁𝑁𝑛𝑛 8 𝑛𝑛=1 wherein C is the average cost per participant, Pn is the number of participants per hospital scaled according to 8 levels of bed size (n) and Nn is the number of hospitals at least level of bed size. Nationally, the costs of staffing, transportation, crisis support, and operations for HVIP programs total to $901.8 million each year.<sup>68</sup> Evidence suggests expenses for HVIPs are shared across hospitals, foundations, local communities, charities, philanthropy, and federal funding.<sup>69</sup> Accordingly, we assumed that 30% of the costs of HVIP are the responsibility of the hospital, thus the total cost to hospitals for HVIPs annually is estimated at $270.5 million.<a href="#" title="* $30,060,502">*</a> Our estimate exceeds previous per-hospital HVIP costs reported in the literature, and recent investments in community violence-prevention and inflation likely account for this difference.</p><p><span><strong>3.3.2 Workplace Violence Prevention Programs.</strong></span> Programs to prevent WPV are becoming a standard practice in health care. Distinct from HVIPs, WPV prevention programs consist of strategies and policies implemented by institutions to prevent and manage violence in the workplace and foster a culture of safety.<sup>70</sup> Key components of WPV prevention programs may involve risk assessment, reporting mechanisms, incident response plans, support services, and monitoring and evaluation. They can also include several component costs discussed elsewhere in this report, such as policy development and training and education (those costs are not duplicated here). The Joint Commission requires hospitals to have a WPV prevention program (LD.03.01.01 EP9)<sup>71</sup> “led by a designated individual and developed and supported by a multidisciplinary team.”<sup>72 </sup>Multiple states also have requirements that hospitals have WPV prevention programs.<sup>73</sup> Given these requirements, we assume that all U.S. hospitals have a violence prevention program. <a href="#" title="* Although the 2022 AHA Annual Survey suggests that only 2,894 hospitals reporting having a violence prevention program for the workplace">*</a></p><p>The cost of staffing time to lead and support hospital WPV prevention programs, including completing risk assessments, establishing and maintaining reporting mechanisms, developing and disseminating incident response plans, providing support services, and overseeing monitoring and evaluation, are not publicly available. As an estimate, we assume that one coordinator will lead the program (e.g., emergency management director, SOC code 11-9161, mean annual salary of $106,670).<sup>54</sup> This individual is supported by a threat assessment team with representation from public safety, social work, physician administrators, and nursing administrators.<sup>74</sup> This team reviews threat assessment protocol workups and identifies recurring issues, as well as discussing plans, programming, and program needs. We assume the threat assessment team will meet for one hour monthly. In addition, the WPV prevention coordinator is assumed to be supported by a collaborative WPV prevention committee, which will meet quarterly to discuss incidents, review data, and discuss trends, challenges, and root causes. The membership of this committee can include leadership from across the hospital.<sup>74</sup> For this estimate, because not all hospitals have representation from all of these areas, we assume representation in the committee will include one chief executive, one medical/health services manager, a human resource manager, an emergency medicine physician, a behavioral health provider, an occupational health and safety specialist, and an operations specialties manager. This selection accounts for a wide range in member salaries (i.e., $32.65 to $192.26 per hour) in order to account for variation in hospital and committee structures across the U.S.<sup>74</sup> We estimated staffing cost based on salary estimates from the Bureau of Labor Statistics for health care providers in hospitals (NAICS code 62-2000)<sup>75</sup> (See Appendix Table 2). Overall, we estimated the average cost of staffing a WPV prevention program is $112,532 per hospital per year, totaling to $688.7 million<a href="#" title=" $688,693,637">†</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><h4><span>3.4 POLICY AND PROCEDURE DEVELOPMENT</span><span> </span></h4><p>An important aspect of prevention and response to violent events in hospitals is the development of facility-specific policies and procedures. This process involves the creation of comprehensive guidelines describing the steps to be taken before, during, and after a violent incident or event. Developing these policies and procedures includes the following tasks, which require time and effort by hospital leadership: conducting risk assessments to identify potential threats, developing reporting protocols, defining personnel roles and responsibilities, and establishing protocols for post-event support services (e.g., counseling).<sup>30</sup> Effective policies and planning should involve regular training and drills (the costs of which are covered elsewhere in this report (e.g., training and violence prevention programs)). Estimates for initial policy development and revision are approximately $3,000-5,000. <sup>76</sup> After policies are in place, maintenance is approximately $1,000/year.<sup>77</sup> We assume most hospitals in the U.S. have policies developed (90%) and are in the maintenance phase; 10% still require further policy/procedure development. Assuming policy and procedure development costs $5,000, the estimated annual hospital cost for policy and procedure development and maintenance is $8.6 million. <a href="#" title="* $8,568,000">*</a> Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards. <sup>24,27,31–33</sup></p><h4><span>3.5. OUTREACH TO BUILD PUBLIC TRUST </span></h4><p>Proactive engagement with the public through transparent communication, educational programs, and community partnerships helps to establish trust and credibility in the hospital and its status as a place of safety in the community. This process includes engagement with not only the surrounding communities, but also building strong relationships with law enforcement and community agencies. </p><p>To estimate these costs, we used cost data from nonprofit community hospitals as these hospitals annually report to the Internal Revenue Service (IRS) on the benefits they provide to their communities. From a review of 2020 tax filings, nonprofit community hospitals spent on average 0.1% of their total expenses on community building activities. <sup>78</sup> These community building activities could include university/school partnerships, engagements in community relations committees, environmental improvements, workforce and job development, violence prevention, childcare programs, and partnerships with local law enforcement agencies. A prior report by the AHA estimated 8.1% of community building activities were generally related to programs and activities directed to prevent violence in the community. <sup>64 </sup></p><p>Using data from the 2022 AHA Annual survey, there are a total of 2,987 nonprofit community hospitals in the U.S. Given the total facility expense for these community hospitals ($984.2 billion), it is estimated that $984.2 million was spent on community building activities (assuming that the mean community investment of 0.1 percent holds across all hospitals). <sup>79</sup> Assuming that 8.1% of hospital expenses for community building and related activities, accounting for inflation from 2022 to 2023, we estimated that $79.7 million<a href="#" title="† $79,722,995">† </a>dollars were spent on community building activities generally related to preventing violence. We excluded for-profit, psychiatric, long-term care, and federal government hospitals from this estimate given the lack of publicly available reporting on these expenditures. Thus, the actual amount hospitals spend on communitybuilding activities related to preventing violence is likely greater than estimated here.</p><h4><span>3.6 FACILITY MODIFICATION TO PREVENT AND MITIGATE HARMS </span></h4><p>Another pre-event cost component is the modification of hospital facilities to prevent violent events and mitigate harm. These costs may include structural changes such as redesigning floor plans to eliminate isolated areas and ensure clear lines of sight, reinforcing entry points, and creating designated safe areas. Additional components may include improving lighting and visibility in vulnerable areas, implementing secure access controls to restrict unauthorized entry, and modifying patient rooms and common areas (public spaces) to minimize the risk of weapon use. These facility-level physical modifications are important to creating a safe environment and ensuring that health care facilities are prepared to respond effectively to potential threats. <sup>80</sup> Facility modification engineering solutions include, for example, two exit routes for rooms and an alternative route for employees in case of an emergency. Providing areas for de-escalation and ensuring lighting is not harsh or causing undue glare is important. Barrier protection includes deep counters, lockable and secure bathrooms for staff members, and enclosed receptionist desks with bulletproof glass. While data on the costs of facility modification are not available, we estimated that facility modification associated specifically with the incorporation of violenceprevention modifications in the design would amount to a mean of 0.5% of a hospital’s reported capital expenditures. The 2022 AHA Annual Survey data reports a total of $61.2 billion in capital expenditures; thus, the estimated cost of incorporating violence-prevention facility modifications would be $306.0 million<a href="#" title="* $305,983,684">*</a> per year for U.S. hospitals.</p><h4><span>3.7. INVESTMENTS IN TECHNOLOGY TO MONITOR POSSIBLE EVENTS </span></h4><p>In addition to modifications to physical facilities, hospitals and health systems must make investments in technology to predict and monitor possible events. <sup>80,</sup><a href="#" title="† This report does not include the cost of cybersecurity, as that is outside the scope of the report. Cyber-attacks have been called “threat-to-life crimes,” and the AHA is leading efforts elsewhere to address this issue.81"><sup>†</sup> </a>Costs associated with technology investments are primarily comprised of maintaining and upgrading security systems, such as installing surveillance cameras, body-worn cameras, and alarm systems. Additional costs may be associated with installation of panic or duress alarms or similar equipment and communication devices, weapons detection technology and the cost associated in operating the technology, artificial intelligence to identify patients at high risk for violence, and information technology infrastructure to identify or predict risk of violence.<sup>82</sup> Estimates of costs of individual technology approaches (e.g., metal detectors) are available; however, comprehensive data on the violence-prevention technology investments made by all hospitals in the U.S. are not available. Focusing solely on hospitals, where most violent events in the health care and social assistance industry occur, we estimate that ongoing technology expenses amount to 3% of hospital operating costs. <a href="#" title="‡ This is an estimate derived from research team affiliated hospital as this data is not publicly available.">‡</a> We assumed an investment of 1% of reported hospital capital expenditures for half of hospitals for the expense of new violence-prevention technology installment annually. <sup>83</sup> Additionally, we assumed that hospitals dedicate an additional 0.5% for maintenance of this technology. This amounts to $459.0 million<a href="#" title="* $458,975,526">*</a> per year for U.S. hospitals. Activities in this section fall under multiple Joint Commission Standards.<sup>34,35</sup></p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="post-event"><span>4. POST-EVENT FINANCIAL COSTS </span></h3><p>This section outlines financial costs incurred following a violent event. Beyond the specific component costs detailed below, a hospital’s ability to provide patient care may be compromised immediately or shortly after such an incident. This disruption can result in unmet patient needs and a potential loss of revenue for the hospital. Although challenging to quantify, this impact should be considered in conjunction with the other costs discussed in this section.</p><h4><span>4.1 HEALTH CARE COSTS FOR FATAL AND NONFATAL INJURIES </span></h4><p>Total health care costs associated with violence borne by the hospitals were generated as the sum of the following components: costs from uninsured injuries and costs due to underpayments for patients with public insurance<a href="#" title="† While other insurers may underpay, estimates of underpayment rates are variable and not easily accessible. We have included the best available data for this analysis, and estimates here are considered conservative">†</a> . We estimated 23.6% of violence-related injuries treated in hospitals and emergency departments were among uninsured patients and thus hospitals would be uncompensated for this percentage.<sup>84</sup> This estimate is consistent with recent national estimates of violence-related emergency department visits and hospitalizations. <sup>85</sup> </p><p>In addition to violence-related costs borne by the hospital resulting from uninsurance, underpayments associated with set payment schedules for public insurers also generate costs borne by the hospital, rather than the patient or payer. We estimated a 12%<sup>86, </sup><a href="#" title=" 88 cents for every dollar"><sup>‡</sup> </a>underpayment rate for Medicaid and an 18%<sup>87,</sup><a href="#" title="§ 82 cents for every dollar"><sup>§</sup></a> underpayment rate for Medicare, based on reporting from the AHA. We recognize these estimates are somewhat dated (2020 for Medicaid and 2022 for Medicare); however, they are the most recent data available from a reliable source. We estimated 39.8% of victims of violence were insured by Medicaid and 7.8% were insured by Medicare. <sup>84</sup> </p><p>For health care cost estimates for treat-and-release emergency department visits, nonfatal hospitalizations, and fatal injuries due to violence, we relied upon estimates from the Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS). Methodologies used to generate WISQARS estimates are reported elsewhere.<sup>88</sup> Briefly, the total health care costs are based on statistical modelling of observed injury-related medical cost data; fatal injury medical cost estimates include treatment costs as well as coroner/medical examiner costs and costs associated with ambulance transport, nursing home care, or hospice care.<sup>88</sup> Because the coroner and medical examiner costs are typically the responsibility of the patient’s family and not covered, for example, by public insurance, we excluded coroner/medical examiner costs from our estimates. It is expected that all violencerelated deaths should involve coroner/medical examiner services and the average estimated cost per exam was $3,000, which is a conservative 2018 estimate based on the U.S. Bureau of Justice Statistics reporting; the cost is likely higher now.<sup>89</sup> The estimated medical examiner/coroner amount was removed from the calculations.</p><p>The estimates for costs and total number of fatalities due to violence are derived from CDC WISQARS, which generates 2021 USD estimates. These values were adjusted for inflation to 2023 USD using the Bureau of Economic Analysis Index annual change estimate (for health).<sup>90,</sup><a href="#" title="* U.S. Bureau of Economic Analysis, "Table 2.5.4. Price Indexes for Personal Consumption Expenditures by Function" (accessed Friday, October 11, 2024)."><sup>*</sup> </a></p><p>Based on these data and assumptions, total health care cost borne by U.S. hospitals was estimated using the equation below (variable definitions and sources in Appendix Table 3). <em>1 × {[𝐶<sub>hospital</sub> + 𝐶<sub>𝐸D</sub> + (𝐶<sub>fatal</sub> − (𝐶<sub>examiner</sub>))] × [(𝑚 × 𝑢<sub>𝑚</sub>) + (𝑐 × 𝑢<sub>𝑐</sub>) + (𝑛 × 𝑢<sub>𝑛</sub>)]}</em> Using this approach, the total estimated health care costs borne by hospitals for fatal and nonfatal injuries is $13.2 billion† in 2023 USD. This estimate represents only the costs for which the hospital is responsible due to un/under-reimbursed care and comprises 29.8% of the total estimated treatment costs for violence-related injuries in 2023 ($44.2 billion, Chospital + CED + Cfatal as reported by CDC WISQARS and adjusted for inflation to 2023 USD). </p><p>We also calculated costs associated with medical care for violence-related injuries for three types of violent injuries: cut/pierce, struck by/against, and firearm-related injury. Cut and pierce injuries involve an incision, slash, perforation, or puncture by a pointed or sharp instrument, weapon, or object (e.g., stabbings).<sup>91</sup> Injuries classified as “struck by/against” involve a strike by or against an object or other person.<sup>92</sup> The costs associated with these injuries which contribute to the total estimate of $13.2 billion are $4.1 billion for struck by/against injuries, $3.3 billion for firearm injuries, and $2.5 billion for cut/pierce/stab injuries. (Other injuries could be attributed to falls, inhalation, ingestion, suffocation, poisoning, or other causes.)</p><h4><span>4.2 WORK LOSS COSTS FOR HOSPITAL WORKERS</span></h4><p>The health care field accounts for approximately three-quarters of all nonfatal violence-related occupational injuries and illnesses in the U.S.<sup>93</sup> The total cost to hospitals associated with time away from work for violence-related injuries among health care workers was estimated based on the Bureau of Labor Statistics data for the U.S. health care workforce.<sup>94</sup> In 2022, an estimated 16,990 workers in hospitals had a violence-related nonfatal occupational injury or illness that involved days away from work. Another 8,740 hospital workers had days of restricted work activity or job transfer due to violence-related occupational injury or illness.</p><p>Across all industries, occupational injuries or illnesses from intentional injury resulted in a median of 7 days away from work. The distribution of days away from work is as follows: 1 day – 14.9%, 2 days – 11.9%, 3-5 days – 19.4%, 6-10 days – 12.9%, 11-20 days – 11.4%, 21-30 days – 6.4%, 31 or more days – 23.1%.<sup>94</sup> Assuming that time loss within the health care field due to these injuries is similar to time loss across all industries and 2022 rates are similar to 2023, we estimated the costs of missed work based on the mean hourly salary for workers in hospitals: ∑<em><sup>7</sup><sub>i=1</sub> </em>(𝑤 × ℎ × 𝐷<sub>𝑖</sub> × 𝐼 × 𝑃<sub>𝑖</sub>), wherein w is the mean hourly wage for workers in the health care and social services fields, h represents the assumed number of hours in a workday, Di is the days missed at the ith interval, I is the number of violence-related occupational injuries, Pi is the percentage of workers reported above at the ith interval. For the days away from work with ranges, we used the highcentral digit (e.g., for 21-30, we used 25 days). Together, this sums to $52.7 million<a href="#" title="* $ 52,731,466">*</a> in costs associated with time away from work due to violence-related occupational injuries and illnesses within the health care field. This estimate includes the entire workforce, including security guards.</p><p>As noted above, 8,740 hospital workers had days of restricted work activity or job transfer due to violence-related occupational injury or illness. No published estimate exists of the cost of changes in jobs or transfer due to violence-related occupational illness or injury. For this analysis, we are assuming a minimum cost of $3,000 per employee required to restrict work activity or transfer jobs (including vocational rehabilitation) due to violence-related occupational injury or illness.<sup>95,96</sup> This estimate is thought to account for the wide range of possible restrictions and the cost of retraining employees and amounts to a total of $26.2 million.<a href="#" title="† $ 26,220,000 ">†</a> </p><p>Together, we estimated work loss costs for the hospital workforce injured due to violence and missing at least one day of work is $79.0 million<a href="#" title="‡ $ 78,951,466 ">‡</a> per year. This is likely to be an underestimate and does not account for reduced productivity or time loss due to untreated elements of injury, such as psychological harm, work missed due to post-traumatic stress disorder (PTSD), or unreported injuries. The experience of violence is common in the hospital workplace and underreporting frequently occurs for myriad reasons.<sup>97</sup></p><h4><span>4.3 CASE MANAGEMENT</span> </h4><p>Case managers are unique health care professionals who work directly with patients to provide personalized support and guidance, including connecting to community resources and coordinating care and services. By efficiently coordinating care, case management is associated with improved outcomes, shorter lengths of stay, and lower readmissions rates. By overseeing the care of patients with violence-related injuries, hospitals can also optimize the use of resources. Previous work estimated that utilization management accounted for 2.1% of all patient care costs for hospitalized patients.<sup>64</sup> Based on an annual estimate of 1.43 million nonfatal hospitalizations due to violence-related injuries amounting to $12.0 billion (inflation-adjusted from CDC WISQARS estimate to 2023 USD),<sup>90</sup> this equates to a national inflation-adjusted hospital cost of $252.5 million.<sup>98</sup></p><h4><span>4.4 STAFFING</span> </h4><p>Violence in the workplace impacts workers beyond injuries and illnesses. WPV can be associated with employee absenteeism, loss of productivity, and turnover. Each of these component costs is summarized below. Together, these costs equate to an estimated $541.3 million annually (Table 4).</p><table><caption><strong>Table 4. Estimated 2023 Annual Cost Associated with Staffing in U.S. Hospitals and Health Systems in Preparation of Violence or a Violent Event.</strong></caption><thead><tr><th><strong>Cost Category</strong></th><th><strong>In millions of USD</strong></th></tr></thead><tbody><tr><td>Staffing</td><td>541.3</td></tr><tr><td>Absenteeism</td><td>139.2</td></tr><tr><td>Loss of productivity</td><td>183.8</td></tr><tr><td>Turnover</td><td>218.3</td></tr></tbody></table><p> </p><p><span><strong>4.4.1 Employee Absenteeism.</strong></span> Exposure to violent incidents can lead to not only physical injuries, but also emotional trauma, heightened levels of stress, reduced morale, and burnout. These effects may contribute to an increase in employee absenteeism. Costs associated with employee absenteeism include increased expenditures on temporary staffing or overtime to account for absent workers and potential loss of revenue. Absenteeism associated with time loss for an occupational injury or illness was discussed earlier; this estimate focuses on health care worker absenteeism resulting from exposure to violence within the workplace or in the community, including within their own circle (e.g., IPV). This absenteeism can take place in the form of sick days or unpaid days, both of which impact the health care system. Estimates of absenteeism for victims of violence range from 5 to 25 days.<sup>99</sup> According to the Bureau of Justice Statistics at the U.S. Department of Justice, the rate of violent victimization (including rape, sexual assault, robbery, aggravated assault, or simple assault) was 23.5 victimizations per 1,000 persons in 2022.<sup>100</sup> Specific occupations, such as patient-facing occupations (e.g., health care practitioners or health care support occupations) face higher rates of exposure to violent events. For this estimate, we assumed a 2.35% WPV exposure rate for most occupations in hospitals.<sup>100</sup> For patient-facing occupations and security/protective services occupations, we assume an exposure rate of 62%.<sup>101</sup></p><p>Based on an estimated 6.2 million people working in hospitals in the U.S. and WPV exposures rates noted above, we estimated 146,515 hospital workers may be exposed to/victims of violence each year. Assuming that among those who experience violence, approximately 15% have 8 hours (1 day) missed from work annually.<sup>102</sup> This is a conservative assumption: some research suggests up to 5 days.<sup>102</sup> We estimated that the cost of absenteeism due to violence is $139.2 million.<a href="#" title="* $139,217,404">*</a></p><p><span><strong>4.4.2 Employee Loss of Productivity.</strong> </span>A frequent outcome of exposure to violence is loss of productivity in the workplace, which can be characterized by poor decision-making and attitude, disengagement, and overall low morale. In the health care setting, this can also result in poor patient outcomes. Costs associated with loss of productivity include the need to increase staffing to account for loss of revenue. Given the complexities of occupations and job tasks within hospital settings, loss of productivity is challenging to estimate. Among the estimated 2.8 million hospital workers estimated to experience violence annually, we conservatively assume one in twenty experience a reduction in productivity of 3% on average (approximately 60 hours per year for a full-time worker). Based on estimated annual salaries specific to each occupation and anticipated exposure to violence (varying by occupation time), we estimated that costs due to lost productivity amount to $183.8 million<a href="#" title="† $183,761,981 ">†</a> annually. </p><p><span><strong>4.4.3 Employee Turnover.</strong> </span>Similar to employee absenteeism and loss of productivity, the physical and psychological toll of exposure to violence in hospital employees can contribute to high absenteeism rates, which can in turn strain remaining staff. Increased staff burden can lead to further burnout and turnover, ultimately impacting the quality of patient care and overall operational efficiency of the health care facility.‡ Research reveals that exposure to WPV impacts turnover intention among health care providers.<sup>103</sup> This is only one factor contributing to turnover, and it is challenging to estimate the sole impact of violence in the workplace or community on health care professional turnover, despite recognizing that this extrinsic influence exists and contributes to decision-making. We calculated the estimated turnover rate for employees in the health care sector as the average monthly total separation<sup>104</sup> divided by the average monthly employment.<sup>105</sup> For 2023, the turnover rate was calculated as 3.31% (712,250 ÷ 21,525,325). This estimate was used for all workers except health care practitioners and technical occupations (SOC code 29-0000) and health care support occupations (SOC code 31-0000), which tend to have higher rates of turnover. For these occupations, we assumed a turnover rate of 5%106 which is likely an underestimate given that home health and nursing home employees have higher turnover rates.107,108 Based on these turnover rates, we estimated 1.1 million people working in the health care and social assistance fields in the U.S. will leave their jobs annually. We assume that a small percentage of these are associated with violence (1.5% based on previous research and increases in the incidence of violence over time)<sup>109</sup> for all occupations other than health care practitioners and technical occupations, health care support occupations, and protective services occupations (SOC code 33-0000), which we assumed had a higher rate of violence exposure and thus a higher contribution of violence to turnover (3.0%). On average, the cost of turnover in health care equates to approximately 6-9 months’ worth of workers’ salaries.<sup>110</sup> Using occupationspecific mean estimates of monthly salaries,<sup>111</sup> this would equate to a range of costs from $174.7 million to $262.0 million (using 6- and 9-month salaries as cost multipliers, respectively), averaging to $218.3 million* annually.<sup>111</sup> This estimate relates specifically to turnover among hospital employees exposed to in-facility or community violence.</p><h4><span>4.5 REPLACEMENT AND REPAIR OF INFRASTRUCTURE AND EQUIPMENT </span></h4><p>Violent events and incidents result in damage to hospital/health care facility infrastructure and equipment (i.e. security equipment, walls, furniture, medical equipment, and supplies), requiring their replacement or repair.<sup>112</sup> Estimates of the actual costs of damage to infrastructure are not available. However, research has shown that rates of violent crime increase in proportion to population size.<sup>113</sup> Assuming this pattern extends to hospital facilities within communities, we estimated that damage to hospital infrastructure varies by location. Specifically, we project that metropolitan hospitals (n=4,231) experience proportionally more damage than micropolitan (n=859) or rural (n=1,103) hospitals (values based on 2022 AHA Annual Survey estimates). We estimated that each year, metropolitan hospitals are responsible for replacement and repair of infrastructure and equipment equating to 1% of their reported capital expenses. We estimated that micropolitan and rural hospitals are responsible for 0.5% and 0.25%, respectively, of their capital expenses for repairs and replacements resulting from violence within the facility and surrounding community.<a href="#" title="We confirmed that capital expenses are correlated with hospital bed size (overall and within each level of urbanicity).">†</a> Accounting for this differentiation across hospitals, we estimated that the annual cost of replacement and repair of infrastructure and equipment due to violence is $564.6 million in metropolitan hospitals, $16.8 million in micropolitan hospitals, and $3.5 million in rural hospitals, equating to a total cost of $584.8 million.<a href="#" title=" $584,846,515"> ‡</a></p><h4><span>4.6 COMMUNITY INTERFACE AND PUBLIC RELATIONS</span> </h4><p>Hospitals, as pillars of their communities, have a public health responsibility to address violent events that occur within and outside health care facilities. This may include post-event debriefing, public health communications, relationship building with communities, and media relations. Public relations managers and specialists at hospitals play key roles in these duties. In 2023, there were 1,340 public relations managers and 4,290 public relation specialists working with hospitals, with average annual salaries of $141,820 and $75,000 dollars, respectively. 114 Assuming 5% of public relations managers’ and specialists’ time is spent on duties relating to post-violent event public relations,<sup>115,116</sup> the cost to hospitals for community interface and public relations due to violence was $25.6 million<a href="#" title="§ $25,589,440"><sup>§</sup></a> dollars.</p><p>In addition to public relations managers’ and specialists' time spent on community interface and public relations addressing violent events, there are also costs attributed to materials (i.e., print and digital materials), equipment, and infrastructure for these public relations. These hospital costs are incorporated in the other cost estimates above.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="other-impacts"><span>5. OTHER IMPACTS OF VIOLENCE </span></h3><p>Data limitations restricted our ability to provide financial estimates for all identified areas in which violence affects U.S. hospitals and health care workers using the comprehensive definition of violence provided above. Most importantly, we were not able to quantify financially the full toll of violence on the psychological and emotional health of workers beyond the outcomes of absenteeism, productivity, and staff turnover. The presence of such broader mental health effects are apparent in a multitude of studies documenting correlations in exposure to violence and various mental health and workplace satisfaction outcomes in workers. In lieu of providing financial estimates for the following components, we describe more comprehensively the incidence of workplace violence in different settings to provide the best available understanding of the magnitude of exposure in health care workers. We then provide summaries of data currently available describing associations between exposure to violence, mental health, and employee satisfaction in U.S. health care settings. While we were not able to generate reliable comprehensive financial estimates of associated costs for these components, an understanding of the incidence of exposure to violence and data on related mental health outcomes yields valuable insight and comprises an essential part of a comprehensive evaluation of the true burden of violence to U.S. hospitals and hospital workers.</p><h4><span>5.1 INCIDENCE OF WORKPLACE VIOLENCE</span> </h4><p>In hospitals, WPV most often occurs in psychiatric departments, emergency departments (ED), waiting rooms, and geriatric units, with rural areas having higher prevalence rates than urban areas.<sup>117,118</sup> However, HCWs from across different geographic and clinical locations, specialties, and roles can all experience WPV. One estimate suggests WPV prevalence ranges from 24.4% to 59.3% for physicians, 9.5% to 62.1% for nurses, 15.1% to 68.4% for receptionists, and 24.5% to 40.0% for technicians.<sup>118</sup> Prevalence rates ranged from 14.0% to 57.4% for threats, 2.5% to 5.7% for bullying, 0.5% to 15.9% for physical assault, and 0.2% to 9.3% for sexual assault and harassment for HCWs in this study.<sup>118</sup> Registered nurses (RNs), nursing assistants, and patient care assistants experience particularly high rates of WPV.<sup>119–121</sup> At a South Florida community hospital, certified nursing assistants were found to experience the highest rates of workplace incivility compared to RNs and other clinical and non-clinical staff.<sup>119</sup> According to a 2024 report, half of U.S. nurses have reported being either verbally abused, physically assaulted, or both by a patient or a patient’s family member within the previous two years.<sup>122</sup> More than one in four of these nurses reported being likely to leave their positions as a result.<sup>122</sup> Additionally, among 9,150 RNs in Michigan surveyed in 2022 regarding WPV concerns, 43% reported emotional abuse, 26% reported workplace bullying, 22% reported physical abuse, and 10% reported sexual abuse in the past 12 months.<sup>120</sup> In another study that surveyed 138 RNs and patient care assistants, respondents experienced higher rates of verbal aggression than physical aggression by both patients and staff.<sup>121</sup> </p><p>Medical residents, nurses in training, and other health care trainees are also impacted by WPV. Out of 119 emergency medicine residents in New York state, 66% reported experiencing at least one act of physical violence during an ED shift. Of that sample, 97% experienced verbal harassment, 78% endorsed verbal threats, and 52% reported sexual harassment.<sup>123</sup> Female medical residents and nursing trainees experience higher rates of sexual harassment and nonphysical WPV than their male counterparts.<sup>124,125</sup> Out of 195 junior- and senior-level nursing students in the midwestern U.S., 82.6% had experienced verbal aggression, 60.5% experienced sexual harassment, and 52.3% experienced physical violence at some point during their training.<sup>125</sup> These experiences can lead individuals to question their decision to join the health care workforce and negatively impact their psychological well-being.<sup>126–128</sup> In fact, among 7,409 general surgical residents from 262 different general surgical residency programs, 30.2% had experienced verbal abuse, 38.5% reported experiencing burnout symptoms at least once a week, and 4.5% endorsed having suicidal thoughts in the past year.<sup>127</sup></p><h4><span>5.2 PSYCHOLOGICAL AND EMOTIONAL IMPACT OF VIOLENCE</span> </h4><p>Witnessing or experiencing violence in the hospital can lead to short and long-term psychological and emotional effects, including compassion fatigue, PTSD, and other mental health concerns, in addition to general satisfaction with one’s job. (We describe below compassion fatigue and PTSD, while acknowledging that the mental health impacts of exposure to violence may extend beyond these conditions.)</p><p><strong>5.2.1 Compassion Fatigue. </strong>Compassion fatigue occurs when HCWs experience burnout and secondary traumatic stress and can result in low job satisfaction and emotional detachment from one’s work.<sup>129</sup> Frequent exposure to WPV has been found to increase levels of burnout among HCW. Burnout adversely impacts workers’ physical and mental well-being, and often impairs their ability to effectively carry out workplace duties.<sup>130,131</sup> Secondary traumatic stress is a stress response to hearing or witnessing the traumatic experience of another. The symptoms mimic that of PTSD and are intricately connected with those of burnout.<sup>132</sup> In fact, high levels of distress, compassion fatigue, and low perceived institutional support have contributed to higher levels of stress among HCWs who experience mistreatment from patients.<sup>133</sup></p><p><strong>5.2.2 Post-Traumatic Stress Disorder.</strong> According to Hou (2024), experiencing violence in any form can lead to the development of PTSD, characterized by sleep disturbances, irritability, difficulty concentrating, feelings of frustration and powerlessness, intrusive recollections of the traumatic event, and emotional distress.<sup>134</sup> Among 132 ED staff surveyed in McGuire et al., 21.3% respondents had experienced symptoms of PTSD due to WPV, and 18.5% reported considering leaving their position as a result.<sup>135</sup> Similarly, Konttila et al. reported that psychiatric nursing staff who were repeatedly exposed to various forms of violence, including sexual attacks, non-verbal intimidation, and verbal threats, experienced significantly increased psychological distress and fear.<sup>136</sup></p><p><strong>5.2.3 Employee Satisfaction.</strong> In addition to the psychological, emotional, and physical impacts of exposure to violence, HCWs also experience reduced job satisfaction.<sup>137–140</sup> For example, HCWs can experience a decreased desire to interact with patients and their families after experiencing WPV.<sup>137</sup> This effect was found to be more pronounced among those working in an inpatient versus outpatient setting.<sup>137</sup> ED nurses, in particular, have reported that continuous exposure to aggressive patients has negatively impacted their attitudes about their profession, affecting their ability to care for and desire to interact with patients.<sup>138,140,141</sup> Lateral violence between health care worker colleagues also contributes to job dissatisfaction.<sup>119,141,142</sup> Out of 91 ED attending physicians, residents, and mid-level providers in Detroit, 22.2% reported a specific instance of lateral violence in the preceding 12 months that negatively impacted their ability to provide care for their patients.<sup>142</sup> Over 10% reported that lateral violence affected their personal health, led them to consider quitting their job, made them feel unsafe at work, or caused them to dread going to work due to fear of bullying.<sup>142</sup></p><h4><span>5.3 LEGAL AND ETHICAL CONCERNS</span></h4><p><span><strong>5.3.1 Legal Costs.</strong></span> Costs related to abuse or violence within hospitals, such as patient abuse, legal expenses for addressing community violence, and regulatory compliance issues are significant. However, comprehensive data on legal costs and citations are not publicly available. </p><p><span><strong>5.3.2 Reporting Workplace Violence.</strong></span> Underreporting WPV remains a significant barrier for understanding its true prevalence.<sup>118,134,135,138,143,144</sup> A common reason HCWs do not report WPV is due to unclear and unstandardized reporting channels.<sup>118,145,146</sup> Additional reasons for not reporting WPV include fear of retribution or not being believed and not wanting to get involved in litigation.<sup>126,143,146</sup> It is essential for HCWs to have access to resources that prepare them to respond to WPV and to ensure workers are empowered to report it.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="limitations"><span>6. LIMITATIONS</span> </h3><p>All financial costs in this report are estimates and may not reflect the true cost of workplace and community violence to U.S. hospitals and health systems. Many cost calculations include assumptions as there is limited published literature and data on interested cost components; the study team had to rely on the most recent data available or related data to calculate cost estimates. Assumptions for each cost calculation are included in the corresponding cost component section in this report. It is important to note that all assumptions were made so to be largely conservative in nature, suggesting that the actual financial burden of workplace and community violence to U.S. hospitals and health systems is likely much greater.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="discussion"><span>7. DISCUSSION </span></h3><p>This report estimates the financial and other impacts of violence on hospitals in the U.S. The total financial cost of violence to hospitals is estimated to be $18.27 billion (USD). This estimate includes pre- and post-event cost components. Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, violence prevention programs, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care (namely workers’ compensation and unreimbursed costs), staffing, replacement and repair of infrastructure and equipment, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p>Beyond the financial burden, there are many other costs of violence to hospitals and health care workers. Health care workers who experience or witness violence can experience many psychological impacts that affect their well-being as well as impact the health system. These psychological impacts lead to reduced workplace satisfaction and productivity, and recruitment and retention challenges, further impacting the burden of violence to hospitals. </p><p>Overall, violence is a growing public health problem affecting our communities and health systems. In the current report, we estimated a significantly higher cost of violence to U.S. hospitals compared to a 2016 report which estimated that violence costs $2.7 billion (USD).<sup>64</sup> Reasons for the large increase in costs estimated in this report include use of a more expansive definition of violence and components costs than the prior report, and an increase in violent event incidence which impacts post-event costs. Overall, this updated estimate demonstrates the significant burden born by hospitals as a result of violence and costs attributed to treat and prevent violent injuries in the U.S.</p><p class="text-align-center"><a href="/system/files/media/file/2025/05/The-Burden-of-Violence-to-US-Hospitals.pdf#page=26"><strong>REFERENCES</strong></a></p><p> </p></div><div class="col-md-4"><p><img src="/sites/default/files/2025-05/costs-of-violence-report-cover.png" alt="The Burden of Violence to U.S. Hospitals PDF Page 1" width="604" height="786" title="click to download research report: The Burden of Violence to U.S. Hospitals"></p></div></div></div> Wed, 28 May 2025 08:50:13 -0500 Behavioral Health Workers /advancing-health-podcast/2025-05-21-evolving-roles-chaplains-health-care-well-being <p>The role of chaplains continues to evolve in health care organizations, with chaplains being integrated into large-scale well-being initiatives. In this conversation, Jason Lesandrini, Ph.D., assistant vice president of Ethics, Advanced Care Planning, Spiritual Health and Language Access Services at Wellstar Health System, and Kelsey White, Ph.D., assistant professor and chaplaincy faculty researcher at the Department of Patient Counseling at Virginia Commonwealth University, discuss real-world examples of how chaplains reduce clinician and patient stress and address emotional and well-being needs in some of the most challenging moments in health care.</p><hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br> </h2> </summary> <p> 00:00:01:27 - 00:00:24:23<br> Tom Haederle<br> Welcome to Advancing Health. Tending to the overall well-being of a patient often has emotional and spiritual dimensions as well as medical. In today's podcast, we hear from two experts about how chaplains are helping people of all backgrounds in the health care setting as part of an interdisciplinary team, making sure care is focused on the whole person. </p> <p> 00:00:24:26 - 00:00:50:06<br> Elisa Arespacochaga<br> I'm Elisa Arespacochaga, vice president of clinical affairs and workforce at the AHA. Today, I'm joined by Jason Lesandrini, AVP of Ethics, Advanced Care Planning, Spiritual Health and Language Access Services at Wellstar Health System; and Kelsey White, assistant professor and chaplaincy faculty researcher in the Department of Patient Counseling at Virginia Commonwealth University. And this is a discussion I've been looking forward to for a little while. </p> <p> 00:00:50:06 - 00:01:09:27<br> Elisa Arespacochaga<br> We're here to really discuss how they have worked to integrate chaplains into well-being programs in health care, and really make those connections across both their research and their organization. So to start off, Kelsey, why don't you start, just tell us a little bit about the work that you do and who you are. </p> <p> 00:01:09:29 - 00:01:33:07<br> Kelsey White, Ph.D.<br> Yeah. Thanks for having me. I'm a professor primarily these days. But my career started out as a board certified chaplain working in outpatient, a very large outpatient center as well as oncology. Fell in love with chaplaincy to the extent that I wanted to figure out how to do research about it. And from there I went to do a Ph.D. and really focus on expanding the research and the integration of chaplains in my efforts. </p> <p> 00:01:33:09 - 00:01:37:27<br> Elisa Arespacochaga<br> And I'm guessing that's how you got to meet Jason. Jason, can you tell us a little bit about your work? </p> <p> 00:01:37:29 - 00:02:08:20<br> Jason Lesandrini. Ph.D.<br> Thank you. Thank you both for being with me today. So, like you said, I work at Wellstar Health System, which is a large integrated health care system in Georgia. I've been here for about ten years and really my focus on the work I was doing originally when I came was on ethics. That's where my background is. I'm a Ph.D. in healthcare ethics from Duquesne and spent a number of years at another local system doing ethics work and as I got here to Wellstar noticed there was a need, sort of in conversations with the executives to really take spiritual health as a team and have an executive representative. </p> <p> 00:02:08:20 - 00:02:12:23<br> Jason Lesandrini. Ph.D.<br> And so I've been doing that eight years now is what we're going on. So I'm really excited for it. </p> <p> 00:02:12:26 - 00:02:24:11<br> Elisa Arespacochaga<br> Kelsey, just to level set with our audience. Can you describe a little bit the role of a chaplain within a health care organization? I think everyone may have a little bit of an idea, but not fully understand what that role means today. </p> <p> 00:02:24:13 - 00:02:49:15<br> Kelsey White, Ph.D.<br> Yeah, absolutely. So to kind of step back, they aren't just the folks that go in and pray, but really they're members of the interdisciplinary team who really help make sure that the health care that we provide is focused on a whole person. So they typically have a graduate level of education, clinical training, over a year of clinical training typically, board certification or certified eligible. </p> <p> 00:02:49:17 - 00:03:28:08<br> Kelsey White, Ph.D.<br> And then they have this expertise to attend to individuals emotional, spiritual and that interpersonal well-being. So they are trained typically to talk to all people, whether it be staff or patients or family members, about spirituality, but not just what we think of as this like religious type of topic when it comes to spirituality. But spirituality really encompasses the way we make meaning of the world around us, how we find purpose and connection, and then to deal with kind of the tough things that happen in our life that make us ask why? </p> <p> 00:03:28:10 - 00:03:36:07<br> Kelsey White, Ph.D.<br> And so chaplains are trained to really have those tough questions, but also to really support folks in really difficult situations. </p> <p> 00:03:36:09 - 00:03:57:24<br> Elisa Arespacochaga<br> As I usually say, one of the challenges and opportunities in health care is that we are with people at what may be some of the most difficult moments in their lives, and so being able to not only support their physical health and their mental health, but their emotional health and their ability to connect with them and support them as they wrestle with some of those questions I think is key. </p> <p> 00:03:57:27 - 00:04:21:16<br> Kelsey White, Ph.D.<br> Yeah. And I also add like because of the extensive training they've had, they're equipped to work with people from all different backgrounds and regardless of faith tradition. And I think they're really touching on these like core existential topics that are just part of everyone's natural being and that when those things are out of whack, they can end up impacting one's health, too. </p> <p> 00:04:21:18 - 00:04:34:09<br> Elisa Arespacochaga<br> Jason, how are you actually incorporating this amazing set of skills and resources and humans in your organization into well-being initiatives? And, you know, Kelsey, I'm sure you have ideas as well. </p> <p> 00:04:34:11 - 00:04:59:13<br> Jason Lesandrini. Ph.D.<br> Yeah. So it's a great question. Kelsey definitely has a lot to share about this as being a chaplain, not being a chaplain, but leading chaplains. I get to see the great work that they do. And I think here in my own organization, we have a program called CARES. It's an acronym that basically it's a sort of a response system that when sort of some type of critical incident happens, our chaplains are available 24 hours a day, seven days a week, 365 days out of the year. </p> <p> 00:04:59:15 - 00:05:22:24<br> Jason Lesandrini. Ph.D.<br> No holidays, no breaks, no nothing. They are there to respond. The chaplain is the first person who gets that call. And the beautiful thing about our chaplaincy program is that our virtual care providers are on the ground, right? We're not in a telecenter responding to our team. We're actually on the ground and can be with another person, which we think is really important to, sort of, staff's overall well-being. </p> <p> 00:05:22:24 - 00:05:41:16<br> Jason Lesandrini. Ph.D.<br> Now, how you get in touch with them, of course, is electronically, but it's that physical presence that we think is important. You know, to Kelsey's point earlier about how do you care for this person? We care for them in the moment with them and to be by their side. And so our team, this is one big thing that we've been pushing as our team is there for others when they need them during those critical times. </p> <p> 00:05:41:19 - 00:06:18:02<br> Kelsey White, Ph.D.<br> At VCU we do a whole lot of different things. I like to think about them in kind of two buckets. So we've got like chaplain efforts that really focus on in real time reducing stress levels, helping manage distressing situations whether it be debriefing or giving them a moment of respite. So some people have heard of, like tea for the soul or cheek hearts, where chaplains will push them around and offer clinicians these moments to just breathe and to be reminded that they're cared for and that they're supported and that they're not alone. </p> <p> 00:06:18:04 - 00:06:46:12<br> Kelsey White, Ph.D.<br> And sometimes that can make a big difference in a busy day. And then there's this other group of ways in which, chaplains, I think can really impact well-being is thinking about a specific way that a chaplain can alter a workflow or a process that really shifts the burden off of other clinicians. So a really concrete example of this is, a program that was actually developed here at VCU called the Family Communication Coordinator. </p> <p> 00:06:46:15 - 00:07:17:23<br> Kelsey White, Ph.D.<br> And this intervention is really focused on those individuals that qualify to donate an organ. And so the chaplain comes in and to relieve some of the stress on the nurses and the physicians and the clinical team will facilitate the process between the family and the organ procurement organization. Which really can just, I mean, decrease the stress, decreases role ambiguity and helps kind of minimize all of the things that are that can be exacerbated in those moments. </p> <p> 00:07:17:25 - 00:07:44:01<br> Elisa Arespacochaga<br> I think that's so key. One of the challenges we keep seeing broadly in the workforce space is that need to unburden some of our team members from having to do all of the things, and how can we find those roles that and those activities that don't require a physician or a nurse to be doing it, but someone has to be part of the health system and, and be able to provide that support. </p> <p> 00:07:44:01 - 00:07:56:29<br> Elisa Arespacochaga<br> So I love the idea of taking advantage of that amazing set of skills and connections and really, bringing them to bear on what has got to be one of the those difficult times. </p> <p> 00:07:57:01 - 00:08:33:03<br> Kelsey White, Ph.D.<br> Yeah. And they're actually I talked to some chaplains recently who were part of their organizations efforts to assess for the social determinants of health. And that could be done by a lot of people. There's something about the way in which a chaplain is able to build that trusting relationship that not only helps with a specific process, but it's one less thing that the nurse has to screen for or attend to, but also those chaplains have the skills to get at really sensitive topics for patients and families. </p> <p> 00:08:33:06 - 00:08:47:23<br> Elisa Arespacochaga<br> Jason, talk to me a little bit about how you're connecting this great work not only to you make it available to your patients, but to the organization's mission and overall well-being for your team, for those who are doing the caring. </p> <p> 00:08:47:25 - 00:09:11:11<br> Jason Lesandrini. Ph.D.<br> Yeah. So here at WellStar, our mission is to enhance the health and well-being of every person we serve. And we're focused on something called People Care, which is about providing care that's unique to whoever. So it's Kelsey care, it's Jason care. It's all of our care. And look, I know this sounds silly, but I can't think of anything more people focused and thinking about how individuals deal with, mind, body and spirit. </p> <p> 00:09:11:13 - 00:09:29:16<br> Jason Lesandrini. Ph.D.<br> Right. And thinking about what are those individuals who have expertise in that space, and in some of the spaces that we often forget of to sort of attuned to that. And so while most of our work tends to focus on patients and their families at the bedside, there's also this other side of people care, which is about the people who care for the people care. </p> <p> 00:09:29:19 - 00:09:50:28<br> Jason Lesandrini. Ph.D.<br> And so, you know, we need to think a lot broader about this. Kelsey's earlier comments made me think of, you know, something that's really fascinating about working with chaplains. Sometimes it's just about being there. So, yes, the issue might be called up because of, you know, a family or a patient may be having some spiritual distress or something that's going on. </p> <p> 00:09:51:00 - 00:10:10:11<br> Jason Lesandrini. Ph.D.<br> But I'll tell you that the beautiful thing is when you just watch it happen, it doesn't have to be anything magical. It's Kelsey as a chaplain coming to my bedside or talking with a patient, a family. And then what do they do? They go out to the nurses station or they see the doctor who's documenting, you know, in the chart or whatever it may be, or the EDS worker and just being with them. </p> <p> 00:10:10:11 - 00:10:27:19<br> Jason Lesandrini. Ph.D.<br> I think that means a lot. And so when I think about how we focus on people care here and how we care for the people who care for the people that we care about, you know, that we're trying to tune to. I can't think of anything more connected than sort of the great work that our special care providers do across the entire enterprise. </p> <p> 00:10:27:21 - 00:10:48:22<br> Elisa Arespacochaga<br> It's just so heartwarming to see the taking that moment, because, I mean, health care is a hard place to be. It's a hard place to work, but it's one that is so rewarding. And so hearing the opportunity that the chaplains can take to really sort of reground everyone in that work. Kelsey, let me ask you, I've got, sort of two options here. </p> <p> 00:10:48:22 - 00:11:07:19<br> Elisa Arespacochaga<br> One share a story of something that surprised you as you've been involving chaplains in this work or -otherwise it may actually be both - advice you'd give to other organizations who are looking to tap into their chaplaincy programs to support well-being. And then, Jason, I'll ask you the same thing. </p> <p> 00:11:07:22 - 00:11:40:07<br> Kelsey White, Ph.D.<br> The thing that I think surprises me the most when I have conversations with folks across the country is this level of innovation that chaplains are really living into in these efforts. They recognize the highly specific nature of the stress and distress they see, and can adapt in a way that focuses on their localized contexts. So if there is a certain challenge that is very... perhaps it was a community shooting, right? </p> <p> 00:11:40:11 - 00:12:04:08<br> Kelsey White, Ph.D.<br> So the chaplain able to really adapt and address those tensions that are arising right there, and how that affected the clinicians because they're part of the community, too, right? They're not just there at the hospital, but they live there. And then I'd also add just the way in which chaplains care for the employees and the non, like at the outskirts of health care institutions. </p> <p> 00:12:04:08 - 00:12:33:21<br> Kelsey White, Ph.D.<br> So there's stories about chaplains caring for security workers, teaching them how to be resilient, teaching them how to cope with intense situations. Or teaching community health workers how to engage in authentic conversation. You know, Jason talked some about just being there. And I really, I would even take it a step further. And there's something about being both physically available and emotionally available that is not unique in our everyday relationships. </p> <p> 00:12:33:23 - 00:13:04:18<br> Jason Lesandrini. Ph.D.<br> I think the most surprising thing that I know in the work with chaplains is this misnomer about chaplains coming to pray. So Kelsey talked a lot about this. When I've asked my colleagues across the country about it that's what they tell me, that, you know, well, we call the chaplain to come in and pray. And I just think that selling them short, just really short of the work and scope, you know, we're all trying to work together every day to operate to the fullest extent of our capabilities because everyone in health care needs it. </p> <p> 00:13:04:21 - 00:13:21:24<br> Jason Lesandrini. Ph.D.<br> So I think just thinking about chaplains, as folks who come up and pray with people is just way too narrow. They can do that. But man, they can do so much more if we just open the door. You know, I live by this principle about being a helper. I think they're helpers. I think that's what they actually are. </p> <p> 00:13:21:24 - 00:13:44:21<br> Jason Lesandrini. Ph.D.<br> And they can help people across the spectrum: the religious, the non-religious, the spiritual, the non-spiritual. My experience has shown me that spiritual care providers are probably some of the best listeners and man, I can tell you this, I need an ear more frequently than I'd like to admit. It's not a judgment, it's not a religious context, it's just a really good listener. </p> <p> 00:13:44:23 - 00:14:04:22<br> Jason Lesandrini. Ph.D.<br> Your second point, Elisa, maybe I could just chime in here because I got lots to say. And if people who know me across the country know that I have a hard time being quiet. So I'll say this about advice to other organizations. You know, you'd mentioned that. I think the biggest piece of advice I'd give other folks is please just ask them, that's the biggest piece of advice, is ask them for help. </p> <p> 00:14:04:24 - 00:14:23:10<br> Jason Lesandrini. Ph.D.<br> I think that's the biggest problem we have across this country is that spiritual care providers, chaplains, all these folks who sit in this space are not being asked to assist with this work. And wow, if they are, the evidence is just not even you can't doubt it that they can help. But they got to ask. You got to ask them. </p> <p> 00:14:23:10 - 00:14:35:21<br> Jason Lesandrini. Ph.D.<br> And we have to, you know, we're doing work on this on the other side is we got to have the chaplains and folks speak up. That's the other piece. You got to speak up. So we need to ask, you got to ask them what's the work that they can do? What can they do? And then hold them accountable for it. </p> <p> 00:14:35:21 - 00:14:45:24<br> Jason Lesandrini. Ph.D.<br> Because I think that's part of the value that chaplains can do. The literature is clear, they can help. You got to ask them to do it and then just hold them to it because it will come out, I promise you. </p> <p> 00:14:45:27 - 00:15:10:00<br> Elisa Arespacochaga<br> Jason and Kelsey, thank you so much for joining me, sharing a little bit about your world, and hopefully through this podcast, we're sharing with others the opportunity both for chaplains to raise their hands and for those around them to say, hey, you got a moment? Can I bend your ear? Because I think that is something we all need very much to get through health care and to be able to help others. </p> <p> 00:15:10:02 - 00:15:12:01<br> Elisa Arespacochaga<br> So thank you again for joining me. </p> <p> 00:15:12:03 - 00:15:13:03<br> Kelsey White, Ph.D.<br> Thank you. </p> <p> 00:15:13:06 - 00:15:14:24<br> Jason Lesandrini. Ph.D.<br> Thank you. </p> <p> 00:15:14:26 - 00:15:23:07<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts. </p> </details></div> Wed, 21 May 2025 02:54:52 -0500 Behavioral Health Workers /older-adult-behavioral-health <div class="raw-html-embed"> <div class="row"> <div class="col-md-8 col-sm-8"> <p> Older adulthood often comes with mental health stressors, such as physical and/or cognitive decline, deaths of family and friends, and isolation. These stressors can contribute to behavioral health conditions, including substance use disorders. With approximately 10,000 Americans turning 65 every day, older adults’ behavioral health is an area of significant concern — particularly when you consider that chronic conditions common in older adults such as diabetes, stroke, hearing loss or heart disease can put them at greater risk of depression and anxiety. </p> <p> There are ways that hospitals and health systems can support behavioral health and mental well-being in their older patients. </p> <div> </div> </div> <div class="col-md-4 col-sm-4"> <div> <div> <h4 class="text-align-center"> Older Adult Behavioral Health Infographic </h4> <p class="text-align-center"> <a href="/system/files/media/file/2025/04/older-adult-behavioral-health-infographic.pdf" title="Click to open The Realities of Behavioral Health in Older Adults infographic in a new window"><img src="/sites/default/files/2025-04/older-adult-behavioral-health-infographic-cover.png" data-entity-uuid data-entity-type="file" alt="2025 Behavioral Health in Older Adults Infographic. The Realities of Behavioral Health in Older Adults" width="250" height="323"></a> </p> <p class="text-align-center"> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/04/older-adult-behavioral-health-infographic.pdf" title="click here to download Infographic: The Realities of Behavioral Health in Older Adults">Download Infographic</a> </p> </div> </div> </div> </div> </div> Fri, 09 May 2025 11:25:20 -0500 Behavioral Health Workers /other-resources/2025-02-26-we-are-aha-behavioral-health <div class="container"><div class="row"><div class="col-md-8"><p>Behavioral health providers that are members of the ���������� Association add their voice and influence to the nation’s leading advocate for hospitals and health systems. The AHA provides its behavioral health members with valuable benefits, including <strong>advocacy, resources and initiatives designed to improve access to and strengthen the delivery of affordable, high-quality behavioral health care.</strong></p><h2><span>Advocacy</span></h2><p>We are working with Congress and the administration to enact policies to support behavioral health hospitals and service lines, and to solidify a policy environment that protects access to care, advances innovation and invests in behavioral health treatment.</p><h3><span>2024 Results</span></h3><h4><span>Legislation</span></h4><p>The AHA supports the <a href="/2024-11-12-aha-urges-congress-act-key-priorities-lame-duck-session" target="_blank"><strong>extension of Medicare telehealth programs</strong></a><strong> </strong>which have expanded access to care for patients and eliminates originating site restrictions. Congress included a 90-day extension of these flexibilities through March as part of a bill to fund the government passed at the end of 2024.</p><h4><span>Regulatory</span></h4><p>The Drug Enforcement Administration and Department of Health and Human Services responded favorably to the AHA’s request to extend telehealth flexibilities, which <a href="/special-bulletin/2024-11-18-dea-and-hhs-extend-waivers-prescribing-controlled-substances-through-telemedicine" target="_blank"><strong>will waive an in-person visit requirement prior to the prescribing of controlled substances virtually</strong></a> through 2025.</p><h4><span>The Administration</span></h4><ul><li>The Departments of the Treasury, Labor and Health and Human Services issued a final rule in 2024 implementing AHA-supported amendments to existing standards <a href="/special-bulletin/2024-09-10-administration-finalizes-enhanced-mental-health-parity-regulations?utm_source=newsletter&utm_medium=email&utm_campaign=bh-newsletter&mkt_tok=NzEwLVpMTC02NTEAAAGV8htmojsDNTwbod7zQq2dwKUPGI77ow9r7O2wAfG9sWn_1yy2QnT2LyJgiJg_Sj3aHa80ELdYu_N93tNiBNk2e9_FQgwY5_RnLpuKFb0XRKLTaA" target="_blank"><strong>that will support coverage parity</strong></a>, preventing insurance plans and issuers from placing greater limits on access to mental health and substance use disorder benefits as compared to medical and surgical benefits. </li><li>Following years of advocacy from the AHA, the Substance Abuse and Mental Health Services Administration in 2024 finally <a href="/special-bulletin/2024-02-09-hhs-finalizes-changes-information-sharing-requirements-addiction-treatment" target="_blank"><strong>issued</strong></a><strong> modifications of provisions of the law that governs sharing of patient records regarding treatment for substance use disorder</strong>, aligning requirements with those already in effect under the Health Insurance Portability and Accountability Act (HIPAA). </li><li>Upon AHA’s <a href="/lettercomment/2024-01-05-aha-comments-cms-proposed-medicare-advantage-policies-2025" target="_blank"><strong>urging</strong></a>, the Centers for Medicare and Medicaid Services (CMS) finalized provisions to address gaps in access to behavioral health services for Medicare Advantage beneficiaries. </li><li>As a direct result of AHA advocacy, CMS <a href="/news/headline/2024-10-22-cms-releases-final-guidance-hospital-respiratory-data-condition-participation-reporting-requirements" download="file" target="_blank"><strong>updated</strong></a> guidance detailing reporting requirements for the hospital respiratory data collection condition of participation and will allow psychiatric hospitals to report this data annually as opposed to weekly</li></ul><hr><h2><span>Sharing Solutions & Innovations from the Field</span></h2><p>In addition to a daily news bulletin and advocacy alerts on key issues, AHA members receive the <a href="/bibliographylink-page/2017-12-11-behavioral-health-updates" target="_blank"><strong>Behavioral Health News Update</strong></a> – a monthly communication on recent behavioral health advocacy initiatives, resources and educational offerings.</p><p> </p><h4><span>Grant-Supported Work</span></h4><p>The Centers for Disease Control and Prevention has awarded several grants to the AHA to support work in behavioral health, including a <a href="/suicideprevention/health-care-workforce" target="_blank"><strong>program to address health care worker suicide</strong></a>, and hospital and health system initiatives to address opioid and stimulant use disorder along with infection prevention and control.</p><h4><span>Health Care Worker Well-Being</span></h4><p>A wealth of resources on <a href="/physician-alliance-be-well" target="_blank"><strong>building and sustaining</strong></a> health care worker well-being programs are frequently being updated and shared with the field including <a href="/be-well-case-studies" target="_blank"><strong>case studies</strong></a> and podcasts. Information on a health system’s <a href="https://www.youtube.com/watch?v=qU1dwaAzh1E" target="_blank"><strong>peer support program</strong></a> and commentary on the importance of <a href="https://www.youtube.com/watch?v=ahEZfOS-4mk" target="_blank"><strong>stigma reduction</strong></a>among health care workers suffering from mental health challenges are among content recently released to the field.</p><p><span>AHA’s website for Behavioral Health is regularly updated with information and resources. These include:</span></p><ul><li><a href="/aha-search?search_api_fulltext=behavioral%20health&f%5B0%5D=type%3A5705" target="_blank"><strong>Podcasts </strong></a>featuring conversations with behavioral health professionals on innovations and solutions to challenges. </li><li><a href="/system/files/media/file/2024/12/integrating-physical-behavioral-resources-2024%20final.pdf" target="_blank"><strong>Insights on integrating behavioral health</strong></a> with physical care, including a new <a href="https://www.youtube.com/watch?v=Xv7-sxVKmzU" target="_blank"><strong>educational video</strong></a> aimed at trustees. </li><li>Best practices to <a href="/behavioral-health-community-partnerships" target="_blank"><strong>improve access to behavioral health care through community partnerships</strong></a>. Resources include an assessment checklist and an evidence-informed summary of effective partnerships. </li><li>Centralized resources to address the challenges of<a href="/child-and-adolescent-mental-health" target="_blank"><strong>youth</strong></a> and <a href="/maternal-mental-health" target="_blank"><strong>maternal</strong></a> behavioral health service delivery. </li><li>AHA’s <a href="/people-matter-words-matter" target="_blank"><strong>People Matter, Words Matter</strong></a> initiative – helping to reduce the stigma of mental health and addiction conditions and treatment, one word, one person at a time. </li><li>An AHA members-only <a href="https://membercommunity.aha.org/communities/community-home?CommunityKey=d8e79990-e8f4-4402-9239-e511752bab7b" target="_blank"><strong>professional online network</strong></a> for behavioral health leaders. </li><li>Curated resources to enhance your organization’s participation in <a href="/mental-health-awareness-month" target="_blank"><strong>Mental Health Awareness Month.</strong></a></li></ul><p> </p></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/02/2025_WeareAHA_Behavioral_Health_Final.pdf" target="_blank"><img src="/sites/default/files/2025-02/weareaha-bh-2025-cover.png" data-entity-uuid data-entity-type="file" alt="We are AHA Behavioral Health Cover." width="691" height="893"></a></p></div></div></div> Wed, 26 Feb 2025 12:20:53 -0600 Behavioral Health Workers /aha-workforce-scan/scan-presentations-members-only <div class="raw-html-embed"> </div> .bannerHero { background-image: /*linear-gradient(rgba(0, 0, 0, 0.5), rgba(0, 0, 0, 0.5)),*/ url("/sites/default/files/2024-11/2025-workforcescan-Banner-1170x500.jpg"); background-position: center; background-repeat: no-repeat; background-size: cover; position: relative; height: 1000px; max-height:500px; max-width: 100%; margin: 0 auto; overflow:hidden; } .bannerHero .contentBottom { position: absolute; bottom: 0; background-image: linear-gradient(-180deg, rgba(46,46,46,0), rgba(46,46,46,1)); width: 100%; /* left + right + border */ padding: 15px 100px 50px 100px; /*! border: solid 2px green; */ color: #fff; } .bannerHero .contentBottom h1{ font-size:2.5em; } .bannerHero .contentBottom p{ font-size:2em; line-height: 1.2em } @media (max-width:568px){ .bannerHero { max-height:350px; } .bannerHero .contentBottom { padding: 15px 15px 15px 15px; } .bannerHero .contentBottom h1{ font-size:2em; } .bannerHero .contentBottom p{ font-size:1.5em; } } <div class="row"><div class="bannerHero"><div class="contentBottom"><h1>AHA Health Care Workforce Scan — Presentations (Members Only)</h1></div></div></div><div class="row spacer"><div class="col-md-12"> .field_lead p{ color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } <div class="col-md-7 field_lead"><p>View the Health Care Workforce Scan Presentation and archives that will help you better understand the latest forces and trends affecting health care human resources. Based on a review of reports, studies and other data sources from leading organizations and researchers, it provides workforce insights you can use to guide your organization forward during this time of uncertainty and continued transformation.</p></div><div class="col-md-5"><div class="panel panel-default"><div class="panel-heading"><h3>Latest Health Care Workforce Scan</h3></div><div class="panel-body"><p><a class="btn btn-wide btn-primary" href="/aha-workforce-scan" rel="noopener noreferrer nofollow" data-view-context="top-level-view">Latest Edition</a></p></div></div></div></div></div><div class="row"><div class="col-md-8 col-md-offset-2"><div class="col-md-12"><h2 class="text-align-center"><u>View the Latest Presentation</u></h2></div><div class="col-md-4"><a href="/presentation-resource/2024-11-13-2025-aha-health-care-workforce-scan-presentation" title="2024 AHA Health Care Workforce Scan - Presentation"><img src="/sites/default/files/2024-11/2025-workforcescan-PPT-Cover-196x113.jpg" alt="AHA Health Care Workforce Scan" width="196" height="113"></a></div><div class="col-md-8"><h3>2025 Health Care Workforce Scan Presentation</h3><p>This downloadable PowerPoint presentation highlights key talent management trends to consider in your workforce planning.</p><div class="spacer"><a class="btn btn-wide btn-primary" href="/presentation-resource/2024-11-13-2025-aha-health-care-workforce-scan-presentation" title="2024 AHA Health Care Workforce Scan - Presentation">Get the 2025 Presentation</a></div></div></div></div> Wed, 13 Nov 2024 07:00:00 -0600 Behavioral Health Workers /aha-workforce-scan <div class="raw-html-embed"> </div> .bannerHero { background-image: /*linear-gradient(rgba(0, 0, 0, 0.5), rgba(0, 0, 0, 0.5)),*/ url("/sites/default/files/2024-11/2025-workforcescan-Banner-1170x500.jpg"); background-position: center; background-repeat: no-repeat; background-size: cover; position: relative; height: 1000px; max-height:500px; max-width: 100%; margin: 0 auto; overflow:hidden; } .bannerHero .contentBottom { position: absolute; bottom: 0; background-image: linear-gradient(-180deg, rgba(46,46,46,0), rgba(46,46,46,1)); width: 100%; /* left + right + border */ padding: 15px 100px 50px 100px; /*! border: solid 2px green; */ color: #fff; } .bannerHero .contentBottom h1{ font-size:2.5em; } .bannerHero .contentBottom p{ font-size:2em; line-height: 1.2em } @media (max-width:568px){ .bannerHero { max-height:350px; } .bannerHero .contentBottom { padding: 15px 15px 15px 15px; } .bannerHero .contentBottom h1{ font-size:2em; } .bannerHero .contentBottom p{ font-size:1.5em; } } <div><div class="bannerHero"><div class="contentBottom"><h1>2025 AHA Health Care Workforce Scan</h1><p>Latest insights and trends to consider in your workforce planning</p></div></div></div> @media (min-width:768px) { .sp_CTA1b_holder { top: -15px; } } @media (max-width:767px) { .sp_CTA1b_holder { top: -50px; /*margin: 0px 50px;*/ } } .sp_CTA1b_holder { background-color: #fff; padding: 15px 0; position: relative; overflow: auto; border: solid 2px #307FE2; } .sp_CTA1b h3 { color: #002855; font-size: 1.4em; margin: 0px; float: left; padding-top: 17px; } .sp_CTA1b span { display: block; margin-top: 10px } .sp_CTA1b span a { color: #d50032; } .sp_CTA1b span a:hover { color: #651d32; } <div class="row sp_CTA1b"> <div class="col-lg-4 col-lg-offset-4 col-sm-6 col-sm-offset-3 col-xs-8 col-xs-offset-2 sp_CTA1b_holder"> <div class="col-xs-6"> <h3>Sponsored by:</h3> </div> <div class="col-xs-6"> <a href="https://www.relias.com/" rel="noopener nofollow" target="_blank"><img alt="Relias Logo" src="https://aha.org/sites/default/files/2022-03/aonl-cta-sponsor-relias.png"></a> </div> </div> </div>--><div class="row sp_Resource1"> .sp_Resource1{ padding:25px 0 0px 0 ; } .sp_Resource1 h3{ margin:10px 0 0 0; color:#555; font-size:.7em; text-transform:uppercase; font-weight:400; letter-spacing:3px; } .sp_Resource1 h4{ color:#002855; line-height: 1.2em; font-size:30px; margin: 10px 0 15px 0 } .sp_Resource1 p, .sp_Resource1 ul li{ font-size:16px; } .sp_Resource1_holder{ background-color:; padding: 0; overflow: auto } .sp_Resource1 .sp_Resource1_holder img{ padding-bottom: 15px; margin: auto; display: block } @media (max-width:768px) and (min-width:340px){ .sp_Resource1 .sp_Resource1_holder .col-xs-3{ width: 40%; } .sp_Resource1 .sp_Resource1_holder .col-xs-9{ width: 60%; } } @media (max-width:500px) and (min-width:361px){ .sp_Resource1 .sp_Resource1_holder.col-xs-3{ width: 100%; } .sp_Resource1 .sp_Resource1_holder .col-xs-9{ width: 100%; } } @media (max-width:360px){ .sp_Resource1 .sp_Resource1_holder .col-xs-3{ width: 100%; max-width: 150px; /* margin-left: calc(50% - 75px);*/ margin-right: } .sp_Resource1 .sp_Resource1_holder .col-xs-9{ width: 100%; padding: 0 25px } } @media (max-width:500px){ .sp_Resource1 .sp_Resource1_holder center .btn{ width:250px; right:calc(25% - 115px); } } .sp_Resource1 .btn { margin-top: 20px; } <div class="col-md-1"> </div><div class="col-md-12 sp_Resource1_holder"><div class="col-sm-4 col-md-3"><a href="#ahaLeadershipScan"><img src="/sites/default/files/2024-11/2025-workforcescan-Cover-Image-247x320.jpg" alt="Cover image of 2025 Health Care Workforce Scan" width="247" height="320"></a><p><a class="btn btn-wide btn-primary" href="#ahaLeadershipScan" data-view-context="top-level-view">Get the Health Care Workforce Scan</a></p></div><div class="col-sm-8 col-md-9"><h4>Peer-Proven Approaches and Expert Insights to Enhance Your Workforce Strategies</h4><p>Health care professionals continue to provide selfless, dedicated, high-quality care to our patients and communities despite the emerging and enduring challenges and stressors they face. Solving near-term and long-term workforce challenges calls for us to develop fresh ways to nurture and support our current staff while attracting the workers we need to meet the demands of today and tomorrow.</p><p>For innovative steps to enhance the overall workforce experience to help you refresh, retain and recruit health care workers, look to the 2025 AHA Health Care Workforce Scan. Based on a review of the latest reports, studies and other data sources, it offers valuable insights into the workforce landscape and practical guidance from experts and your peers to help your organization navigate the future of the health care workforce. Real-world examples from a host of organizations, from Ochsner Medical Center to Texas Children’s Hospital to Chicago’s Northwestern Medicine, provide actionable ways to:</p><ul><li>Embrace technologically integrated care models and innovations.</li><li>Engage clinicians in technology strategies.</li><li>Boost access through partnerships, training and upskilling.</li><li>Rethink engagement to build a more flexible, engaged workforce.</li></ul><p>For a high-level, two-page overview of the state of the health care workforce, download this <a href="/system/files/media/file/2024/11/2025-Health-Care-Workforce-Scan-Executive-Summary.pdf" target="_blank" title="Download the Executive Summary">Executive Summary</a> of the 2025 AHA Health Care Workforce Scan.</p><p>Access <a href="/aha-workforce-scan/scan-presentations-members-only" target="_blank" title="AHA members-only presentations">AHA members-only presentations</a> to share key points from the AHA Health Care Workforce Scan with your colleagues or other audiences.</p></div></div><div class="col-md-1"> </div></div> .SponsorMarketoForm { background-color: ; 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MktoForms2.whenReady(function(form){ if(form.getId() == 4088 ) { form.onSuccess(function(values, followUpUrl) { form.getFormElem().hide(); document.getElementById("successAndErrorMessages").innerHTML="<div><p>Thank you.<\/p><br /><p><a class='btn btn-wide btn-primary' data-view-context='top-level-view' href='https:\/\/www.aha.org\/system\/files\/media\/file\/2024\/11\/2025-Health-Care-Workforce-Scan.pdf' target='_blank' rel='noopener noreferrer nofollow'>Download 2025 Health Care Workforce Scan <\/a><\/center><\/div>"; return false; }); }; }); <div id="successAndErrorMessages"> </div></div></div></div></div></div></div><div class="row"> .CenterProgram { background-color: #f6f6f6; /*margin-bottom:25px;*/ } .CenterProgram .CpHeader{ padding-top:15px; } .CenterProgram .CpHeader h2 { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 30px 0; text-align:center; } .CenterProgram .CpHeader h4 { margin: 25px 0 0 0; color: #555; font-size: .7em; text-transform: uppercase; font-weight: 400; 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In this conversation, Stacey Ouellette, director of Behavioral Health Integration with Maine Behavioral Healthcare, discusses the positive impact integrated care has had on workplace productivity and satisfaction, and how it's made their teams more connected across the organization.</p><hr><div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> <span>View Transcript</span><br>   </h2> </summary> <p>00:00:00:18 - 00:00:29:05<br> Tom Haederle<br> Behavioral health specialists are in short supply pretty much everywhere. But health care leaders are finding out that knocking down the traditional walls between physical and mental health care not only benefits patients, but also helps with the recruitment and retention of the behavioral health specialists that so many providers and patients need more of.</p> <p>00:00:29:07 - 00:01:00:28<br> Tom Haederle<br> Welcome to Advancing Health, a podcast from the ���������� Association. I'm Tom Haederle with AHA communications. These days, integrating physical and behavioral health care is increasingly a seamless part of the overall care experience, what health professionals call a "warm handoff" between physical and behavioral health providers for those patients who need both. This integration is good for patients and is also a significant factor in keeping many health care workers, both in physical and behavioral health, engaged and much happier in their jobs.</p> <p>00:01:01:00 - 00:01:20:23<br> Tom Haederle<br> In today's podcast hosted by the AHA's Rebecca Chickey, senior director of Behavioral Health Services, we hear from Stacey Ouellette, director of Behavioral Health Integration with Maine Behavioral Health Care, on her organization's experience with the positive impact integrated care has had on workplace productivity and satisfaction.</p> <p>00:01:20:25 - 00:01:49:13<br> Rebecca Chickey<br> Thank you Tom. Indeed, it is an honor to be here with Stacey today from Maine Health and Maine Behavioral Health. We are going to discuss the value of integration. I know you've heard this from me before, but she's here with us today specifically to talk about how integrated physical and behavioral health care can improve workforce productivity and perhaps even more important, worker satisfaction.</p> <p>00:01:49:15 - 00:02:20:12<br> Rebecca Chickey<br> We all know that hospitals and health systems have been struggling to recruit and retain qualified workers across a variety of clinical areas, but in behavioral health, that was a challenge even prior to the COVID pandemic. So, Stacey, can you share with the listeners what are some of the specifics that you've experienced around the challenges of recruiting and retaining health care workers in behavioral health?</p> <p>00:02:20:14 - 00:02:46:29<br> Stacey Ouellette<br> Yeah, absolutely so it's always been a little bit of a challenge. The work pool is not that deep really. But definitely with the pandemic it worsened. It wasn't uncommon for us as a program in Maine Behavioral Health Care to have a few positions vacant at a time. But when the pandemic hit, it jumped up quickly to around 20, we're a program of about 100,</p> <p>00:02:46:29 - 00:03:16:23<br> Stacey Ouellette<br> so put that into context there. But it was a shock really, having that many positions to recruit for. And the challenge was there just weren't many applicants out there. And the ones that were out there, you know, that we interviewed, were really looking for that work-life balance. So as a program, we needed to at the time consider how we were, you know, bringing people in and providing them with this sort of work-life balance so that we could keep them right?</p> <p>00:03:16:24 - 00:03:45:29<br> Stacey Ouellette<br> Retention is key. Some of those vacancies were due to growth, not because everybody was leaving. So the demand grew at the same time. And so we needed to, continuously work on recruitment so that we could have the adequate staffing to support the needs and the practices. In terms of the retention piece, really trying to lean in to integrated care can offer people in the role.</p> <p>00:03:46:01 - 00:04:11:12<br> Stacey Ouellette<br> I'll often hear, you know, having access to the primary care provider, it just makes the job better. It makes it easier because you can really coordinate that care. And it's the care team working together for the sake of the patient. Having the role integrated into their primary care and or specialty care practices that we're in can definitely make a difference in terms of that satisfaction with the work.</p> <p>00:04:11:14 - 00:04:39:12<br> Rebecca Chickey<br> So if I may, integration in primary care is something that I think has really caught on across the United States. While it is not in every community or every county, it is something that we're seeing grow each and every day, thankfully, because as we know, particularly early on in an individual struggling with a psychiatric or substance use disorder, often they're seeking care from their primary care physician first.</p> <p>00:04:39:14 - 00:05:03:02<br> Rebecca Chickey<br> So it's very important that that primary care office have access to behavioral health clinicians so that they, too, can be more excited about their job each and every day, as well as feel more comfortable in providing the holistic care that the patient needs. But I'm wondering, you mentioned specialty care. I hear a little bit about this across the country.</p> <p>00:05:03:04 - 00:05:15:08<br> Rebecca Chickey<br> Would you mind sharing what specialties you have gone into? Sometimes people consider pediatrics as a specialty, while others define it as primary care. So what does that mean for Maine Health?</p> <p>00:05:15:10 - 00:05:45:04<br> Stacey Ouellette<br> For us currently, yes, we are in all of the pediatric practices. We are also in practices such as neurology, cardiology, weight management programs, aka bariatrics, pain management programs. So a lot of the diabetes and endocrinology, a lot of the specialties, where patients get their care outside of the primary care home, we're starting to integrate into as well.</p> <p>00:05:45:05 - 00:06:19:28<br> Stacey Ouellette<br> Women's health is another one that we're in. And so it's just it's the same, just that we're integrated into these specialties, providing that support there. Similar to that of primary care you mentioned, you know, you alluded to the patients and trusting their provider. Right? So when the provider identifies or the patient identifies a concern or a need and they're able to do a handoff, a warm handoff with the behavioral health clinician right there on site, it just gains access to care, right?</p> <p>00:06:19:28 - 00:06:35:29<br> Stacey Ouellette<br> And that trust is there because the provider recommended it and usually patients trust their providers. So by us entering some of these specialty practices we're also to be able to support the patients there at those sites as well.</p> <p>00:06:36:01 - 00:06:56:28<br> Rebecca Chickey<br> I'm going to add a little bit of a personal story here because, phrase that you said a "warm handoff" has a really strong meaning for me. My older son, who is now doing incredibly well and in fact is going diving in Bali in October - not that I'm nervous about that at all - but, nonetheless, he's doing much better.</p> <p>00:06:56:28 - 00:07:20:06<br> Rebecca Chickey<br> But he suffered a major depressive episode while he was in undergraduate school. And, you know, he was screened and diagnosed with depression. The handoff was to send a 19 year-old male in college an email with the contact information for two therapists that they wished him the best of luck to see if he could get an appointment.</p> <p>00:07:20:08 - 00:07:59:02<br> Rebecca Chickey<br> That is the opposite of a warm hand off just for those of you wondering. I have a great depth and appreciation for the true value and importance of a warm handoff. Meeting the next person, knowing that you are, not just being put on hold per se. So what I'm hearing, if I can summarize to date: there are a number of important success factors related to integrating physical and behavioral health as it relates to recruiting and retaining qualified health care workers, particularly in the behavioral health field, but also in other specialty areas.</p> <p>00:07:59:04 - 00:08:26:20<br> Rebecca Chickey<br> I think you alluded to this, that, primary care physicians or the clinicians in many of the specialties that you mentioned: cardiology, neurology, women's health. I don't want to assume so I'm going to ask you to validate this: Have you also heard from those clinicians who are not trained in behavioral health that is something that they value that has added value and, improve their satisfaction, in their day-to-day work.</p> <p>00:08:26:22 - 00:08:50:10<br> Stacey Ouellette<br> We as a program, do a provider satisfaction survey every year to 18 months to get some feedback on how things are going. And that is one of the questions that we ask overall, you know, their satisfaction as well as does having an integrated clinician in their practice help make their job easier? And unanimously, all pretty much agree with that,</p> <p>00:08:50:10 - 00:09:02:28<br> Stacey Ouellette<br> strongly agree with that concept that having an integrated clinician in the setting helps make their jobs easier, but also just it helps support them, right? And managing the complexities of the patients.</p> <p>00:09:03:00 - 00:09:43:01<br> Rebecca Chickey<br> For the listeners, I'm going to read a statistic, related to the real challenges and struggles for all health care workers in terms of recruitment and retention. Since 2020, one in five health care workers have quit their jobs. And surveys suggest that up to 47% of health care workers not just behavioral health, but health care workers in general, because this integrated care impacts not just behavioral health care workers, but even more so the other clinicians who often struggle because they may not have recent training in how to diagnose or screen for anxiety disorder or bipolar disorder.</p> <p>00:09:43:04 - 00:10:23:18<br> Rebecca Chickey<br> But 47% of health care workers plan to leave their positions by 2025. And we all know that the recruitment costs, the turnover costs, are significant and often that leads to other sort of hidden cost. And that is the domino effect, when one person leaves an organization, then several others may follow. So just emphasizing not only is this important for each individual who's happier, more satisfied in the work that they do every day, but this can have a positive impact on the bottom line of hospitals and health systems across the country.</p> <p>00:10:23:21 - 00:10:45:21<br> Rebecca Chickey<br> I'm going to put you on the spot here a little bit, Stacey, and ask you to personalize this. I mean, we've seen a lot of studies, for instance, the University of Michigan's Behavioral Health Workforce Research Center, you know, they've come out and they've said, when we've done this research, it's, you know, increased employee productivity. It's stabilized primary care physicians workloads.</p> <p>00:10:45:28 - 00:11:16:03<br> Rebecca Chickey<br> It better allows them to refer patients more effectively and in a timely fashion. But sometimes research seems so impersonal when the listeners are sitting here thinking, could I really do this at my organization? Can you share just a story or two about how you have seen this play out? I know you've talked generally, but how if you, you know, maybe a personal story of how this has impacted, or maybe quotes that you've heard from clinicians at Maine Health.</p> <p>00:11:16:06 - 00:11:40:27<br> Stacey Ouellette<br> One quote that always will stay with me is from that provider satisfaction survey, where one provider, said, this is better than Christmas morning, having behavioral health in our practice because they have access to that support. You know, we've worked to make ourselves available and accessible to support the primary care or specialty care teams and managing the complexity of the patients.</p> <p>00:11:41:00 - 00:12:04:23<br> Stacey Ouellette<br> They're in the moment. And so when we're able to respond, when a patient presents with a concern...we hear time and time again, that just helps them to feel confident, right? The medical providers to feel confident like they know how to respond. Their response might be let's get the behavioral health clinician and get them connected to you so that they can they can help us out.</p> <p>00:12:04:25 - 00:12:26:02<br> Stacey Ouellette<br> I have personally been working, when I worked in one practice was pulled in this will stick with me for probably a very long time, but I was pulled in for a warm handoff. Patient was suicidal, and together the medical provider and I had a conversation with the patient. I did some assessing. We made a safety plan. Patient.</p> <p>0:12:26:09 - 00:12:54:05<br> Stacey Ouellette<br> I provided some education, some validation as to why this person was feeling this way and together as a team, patient included in that team, we all felt good about next steps, and patient left with a plan and came back and continued some treatment. And I think like those examples just demonstrate how having integrated behavioral health in the practices can help improve productivity of the whole care team, right?</p> <p>00:12:54:10 - 00:13:24:03<br> Stacey Ouellette<br> Can help improve confidence and competence in the work that we do. And to the patient, it hopefully helps with patient satisfaction, right? Like it improves their confidence. Like this team's got me, right? They they're all wrapped around. They're working together. They all are on the same page. So those types of examples just demonstrate how integrating behavioral health can have an impact on multiple individuals and outcomes.</p> <p>0:13:24:05 - 00:13:48:25<br> Rebecca Chickey<br> That's phenomenal. Thank you. And thank you for making it personal to you as well. Truly meaningful. Well, as we begin to look towards the end of our podcast here, I'm going to ask two questions. One is thinking back over the last several years as you built out this integrated care system, what are a couple of the things that you think made this successful?</p> <p>:13:48:28 - 00:14:05:10<br> Rebecca Chickey<br> Where do I start? You know, what do I what are the two anchors that I need to have in place in order to replicate what Maine Health has done? What would you say, to the listeners? And the other one is, do you have a call to action for the listeners?</p> <p>00:14:05:12 - 00:14:38:17<br> Stacey Ouellette<br> Use a team, right? So identifying perhaps a provider champion to help support the initiation of this, have leadership on board, which requires perhaps educating, informing of how integrated behavioral health care can be useful for the organization. Give them resources and studies that have demonstrated utility of the role within the primary care settings. It is a whole team approach. It is the medical champion.</p> <p>00:14:38:17 - 00:15:10:01<br> Stacey Ouellette<br> It's behavioral health. It's your billing and finance folks at the table and being flexible, really being willing to try things and adjust. Doing perhaps like a PDSA cycle, so that you can learn and grow and adjust. I would say use resources out there. There's a lot of great people doing this work across the country. The Collaborative Family Health Care Association, CFHA is one group that I, belong to, and they have helped me tremendously</p> <p>00:15:10:01 - 00:15:29:15<br> Stacey Ouellette<br> just as a collective group. They help with questions, they help provide guidance. There's a lot of people out there doing this, so you're not alone. Use your resources. Connect to people, ask questions. People doing this usually really love to share and help others because we believe in it.</p> <p>00:15:29:17 - 00:16:09:01<br> Rebecca Chickey<br> I will add on, you added, you may have to educate, and one of the reasons we're doing this podcast is to continue to draw attention to an issue brief that we released, the AHA released last fall. Basically, the short version of the title is "Integration - The Time is Now." It's only four pages. It has almost 30 references of evidence-based research, showing the multiple ways in which integrating physical and behavioral health can provide value in a multitude of ways, just as you have shared many of them with us here today.</p> <p>00:16:09:01 - 00:16:30:03<br> Rebecca Chickey<br> So I would point to that as an educational resource and an easy read. Four pages. Most of us can do that, and, you know, skim that in a minute. So thank you so much, Stacey, for, again, as I started for your willingness to share your time and expertise, you are doing champions work. We greatly appreciate it.</p> <p>00:16:30:05 - 00:16:36:17<br> Rebecca Chickey<br> I know our listeners do too. You've just inspired someone to start on this journey. So thank you.</p> <p>00:16:36:19 - 00:16:38:05<br> Stacey Ouellette<br> Thank you.</p> <p>00:16:38:07 - 00:16:46:16<br> Tom Haederle<br> Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.</p> </details> </div> Wed, 11 Sep 2024 06:00:00 -0500 Behavioral Health Workers /rural-behavioral-health <div class="row"><div class="col-md-8 col-sm-8"><p>According to a 2022 policy brief from the <a href="https://www.ruralhealth.us/getmedia/cf3c3922-25cb-49a0-bb04-0bad81d634f9/NRHA-Mental-health-in-rural-areas-policy-brief-2022.pdf">National Rural Health Association</a>, rural areas can experience a severe lack of access to and availability of the full range of behavioral health care services, challenges with mental health workforce recruitment and retention, and technology barriers impacting telehealth visits. These challenges, combined with additional social challenges like stigma, a potential lack of anonymity when seeking care, geographic isolation from services, and cost, can deter patients and families in rural communities from getting the care they need.</p><p>Hospitals are the cornerstones of their communities, serving as principal access points to care for the nearly 60 million people or 20 percent of Americans who live in rural areas and may need behavioral health services. The AHA is committed supporting its members as they strive to provide high quality, accessible behavioral health services in America’s rural communities through the following advocacy priorities:</p><p><strong>Telehealth.</strong> The pandemic demonstrated telehealth services are a crucial access point for many patients. AHA supports legislation to make permanent coverage of certain telehealth services made possible during the pandemic, including lifting geographic and originating site restrictions, allowing Rural Health Clinics and Federally Qualified Health Centers to serve as distant sites, expanding practitioners who can provide telehealth, and allowing hospital outpatient billing for virtual services, among others.</p><p><strong>Graduate Medical Education</strong>. We urge Congress to pass additional legislation to increase the number of Medicare-funded residency slots, which would expand training opportunities in rural settings and help address health professional shortages.</p><p><strong>Loan Repayment Programs</strong>. We urge Congress to pass legislation to provide incentives for clinicians to practice in rural HPSAs. We support expanding the National Health Service Corps and the National Nurse Corps, which incentivize health care graduates to provide health care services in underserved areas.</p><p><strong>Behavioral Health</strong> <strong>Policies</strong> that authorize, expand and better integrate behavioral health programs in rural communities.</p> For more information, visit <a href="/rural-advocacy-agenda">AHA’s 2024 Rural Advocacy Agenda</a>. </p> --><h4><span>Latest Behavioral Health Podcasts</span></h4><div></div></div><div class="col-md-4 col-sm-4"><div><div><h4 class="text-align-center">Rural Behavioral Health Infographic</h4><p class="text-align-center"><a href="/infographic-realities-behavioral-health-rural-communities" title="Click to open The Realities of Behavioral Health in Rural Communities infographic in a new window"><img src="/sites/default/files/2024-11/rural-behavioral-health-infographic-cover.png" data-entity-uuid data-entity-type="file" alt="2023 Behavioral Health Fast Facts Infographic. The Realities of Behavioral Health in Rural Communities" width="250" height="325"></a></p><p class="text-align-center"><a class="btn btn-primary btn-wide" href="/system/files/media/file/2024/11/rural-behavioral-health-infographic.pdf" title="click here to download Infographic: The Realities of Behavioral Health in Rural Communities">Download Infographic</a></p></div></div><h4> </h4><div class="panel module-typeC"><div class="panel-heading"><h4><span>Featured Resource</span></h4></div><div class="panel-body"><ul><li><a href="/news/blog/2024-11-04-aha-committee-chairs-come-together-increasing-access-behavioral-health-services-rural-communities"><strong>Blog: AHA Committee Chairs Come Together for Increasing Access to Behavioral Health Services in Rural Communities</strong></a></li></ul></div></div><h4> </h4><div class="panel module-typeC"><div class="panel-heading"><h4><span>For More Information</span></h4></div><div class="panel-body"><ul><li><a href="https://www.ruralhealth.us/">National Rural Health Association</a></li><li><a href="https://www.ruralhealthinfo.org/topics/mental-health">Rural Health Information Hub</a></li></ul></div></div></div></div> Wed, 03 Jul 2024 13:25:26 -0500 Behavioral Health Workers /news/headline/2024-06-28-aha-video-series-highlights-careers-behavioral-health <p>AHA June 27 released the first three of a series of videos highlighting various behavioral health roles and career paths in a hospital or health system, as well as the commitment and passion of current health care workers. The initial videos feature a community health worker, a psychiatrist and a psychiatric nurse. <a href="/behavioral-health-workforce-perspectives"><strong>WATCH NOW</strong></a></p> Fri, 28 Jun 2024 16:13:45 -0500 Behavioral Health Workers