By Les Gura
It took 14 calls and transfers to one local housing agency to get the information that Rev. Khelen Kuzmovich, Clinical Pastoral Education resident, was seeking for a 29-year-old leukemia patient in dire need of a place to stay.
And Kuzmovich was hardly a newcomer to working “the system.’’ Before obtaining her divinity degree and entering pastoral work, she’d spent several years with nonprofit organizations connecting people with legal help, housing and other types of assistance.
The maze Kuzmovich encountered on behalf of the leukemia patient demonstrates the urgency driving change for two anchor programs in the Division of FaithHealth at Wake Forest Baptist Medical Center.
The Clinical Pastoral Education (CPE) program and CareNet Counseling are transforming to meet what 21st-century medicine is proving to require — nontraditional means of assisting a population that, despite technology advances, is becoming more disconnected.
At stake may just be the future of community health.
Kuzmovich thinks of the Bible and the “two are better than one” verse when she considers the unique work she did to complete her CPE residency. Last summer, in addition to their regular assignments, she and fellow resident Rev. Maria T. Jones specifically identified and visited 33 patients at the Medical Center. They provided those patients with chaplaincy care, but also talked in depth with them about their needs and their fears.
Kuzmovich says patients often began with the “Why is this happening to me?” question typically asked when a chaplain stops by their bedside.
“We talked about the ‘why,’’’ Kuzmovich says. “But we also talked about the ‘what.’ What could we do to help?’’
Whether it was ensuring a patient received specific follow-up care, or obtained a ride to their next medical appointment or had a way to access healthier foods, Kuzmovich and Jones investigated and got answers. Often, they would connect patients with Division of FaithHealth employees who work in the community, so someone would advocate on the patient’s behalf once they were discharged.
“Most of the people I encountered were used to the system; they knew how to survive and how to get help,” Kuzmovich says. “But it’s so hard to do that when you’re sick and have given up. Or when you don’t quite meet the requirements for help. It creates high stress. To me it’s just not a good place to hang out.
“But then there’s this idea that two are better than one … so if someone is taking advantage of you or treating you poorly, you have someone else to say, ‘That’s not OK.’”
Getting into the community
When an initial class of five students began CPE training at N.C. Baptist Hospital in 1947, it represented the first pastoral care training program in the South, and one of the first such programs in the nation.
The CPE residents of today receive classic pastoral training and do rotations within the hospital. But just as Kuzmovich and Jones looked to provide more to patients last summer, the CPE program is assigning residents in several new ways.
Charolette Leach has been associate pastor of Morning Star Missionary Baptist Church in Winston-Salem for more than five years, joining when her husband, Dennis Leach Sr., was called as pastor. She’s also a CPE student who has been given a special residency assignment — she’s embedded in her church doing FaithHealth outreach.
For Leach, health ministry had been a spiritual calling long before she even considered attending divinity school. She has a master’s degree in Exercise Science from Georgia State University in Atlanta, where she met her husband, and has been working during her CPE assignment on initiatives aimed at improving the health of her church congregants and the Columbia Heights neighborhood in East Winston.
“To me, our food system is somewhat corrupt in this country in that we make the food as unhealthy as we can make it, which ensures that people are going to get sick,’’ Leach says. “It’s a big task to try to counteract that. But we had been talking for a couple of years about trying to start a community garden.’’
Creating the garden at Morning Star Missionary Baptist Church became more manageable thanks to the help of the Cooperative Extension Service of Forsyth County, which provided access to materials and good advice.
On a cold Saturday morning in March, more than 20 church members and volunteers busied themselves constructing four wooden frames. As uplifting music played in the background, they filled the beds with soil and surrounded them with wood chips, both donated by local businesses.
Shelia Bailey, a member of a church subcommittee involved with the community garden project, says Morning Star Missionary is located in a food desert, meaning there is not easy access to fresh vegetables and fruits. It’s important for the “low income, fixed income or no income” residents of the Columbia Heights neighborhood to “know what it means to eat fresh food,’’ she says.
Vegetables were planted at the end of April, and the goal is to be able to offer the organically grown vegetables and fruits — zucchini, tomatoes, peppers and more — free of charge to people in the neighborhood.
Leach sees even more in the garden.
“What I envision — and my prayer — is that however we distribute the food, it builds relationships between the members of our church and the community.’’
Rev. Emily Viverette, director of FaithHealth Education, is helping place CPE students such as Kuzmovich and Leach into these newer pastoral care roles.
One resident assigned to a team at the Downtown Health Plaza in Winston-Salem, which serves a poor population, encountered a patient upset because he didn’t have shoes that fit him properly. The resident was able to find a church to donate money so the size 16 shoes the man needed could be special ordered.
Viverette says this new, broader role for CPE residents has never been more essential.
“We have so many people falling through the cracks,’’ Viverette says. “Putting chaplains back in that role to integrate care and spirit in meaningful and practical ways provides opportunities for people to really get the care they need and make the world a better place.’’
Embedding in behavioral health
In 1974, a small, satellite counseling office opened in Fayetteville to serve a growing need for individual, family and group pastoral counseling to individuals outside of a hospital. From that modest beginning, CareNet Counseling has grown to include more than 35 offices; today, it is the largest hospital-based program of its kind in the United States.
Just like the CPE program, CareNet is finding that in the 21st century, ensuring good health requires new ways of doing business. In particular, the traditional model of having patients come to satellite offices doesn’t always work, says Barbara Saulpaugh, regional director of CareNet with oversight of offices in Winston-Salem, Kernersville, Mount Airy and Mocksville.
CareNet is beginning to embed counselors and licensed social workers into outpatient facilities to better reach people who might otherwise go without assistance.
For example, a CareNet counselor is available in the Downtown Health Plaza in Winston-Salem. Another is assigned to Wake Forest Baptist Health Medical Plaza – Clemmons to work with children and adolescents. And a counselor at Grace Clinic in Elkin covers three rural counties.
“The need exists everywhere in the community, so why shouldn’t behavioral health exist everywhere in the community?’’ Saulpaugh asks. “And the stressors around peoples’ difficult life situations — housing, food, paying the bills — produce a lot of physical symptoms. It’s all connected; it can’t be separated.’’
Will Eads, a North Carolina Fee-based Practicing Pastoral Counselor Associate, is the clinical resident for CareNet who works Mondays and Tuesdays at Grace Clinic. He believes being embedded in a primary care clinic will be a significant component of the future of behavioral health care.
Typically, patients arrive at Grace Clinic for medical appointments, and also see Eads for 15- to 20-minute counseling sessions.
If a patient presents with an emotional or psychological concern, we can address that here,’’ Eads says. “We don’t have to entrust they’ll reach out to someone when they get home. And because this is very much an integrated care model, it’s like they don’t look at it as counseling. There’s not a stigma to it. They’re just going to see the doctor. I think that’s what makes it so effective.’’
Leah Creel, LPCA, is embedded three days a week at Wake Forest Baptist Health Medical Plaza—Clemmons to offer behavioral health counseling to children and their families. She addresses problems including anxiety, anger and depression, issues that can be related to bullying, chronic illness, family issues or other causes, she says.
Being able to see patients at a medical practice makes sense, Creel says.
“It is more of a team approach to holistic care to be able to have access to the doctor and a therapist in the same location,’’ she says. “There’s a huge need for mental health care and it’s less intimidating for so many of my patients and families to see somebody in the doctor’s office, who they trust.’’
Saulpaugh took her position with CareNet after a career in marketing that included a long stint as a vice president for Lowes Foods. She’s personally familiar with the toll mental illness can take, having battled through severe depression several years ago.
She says she recovered from her 18-month fight against depression with “help from my graceful God, counselors who gave me hope, family support and a good physician.”
She also knows many people are not as fortunate as she was to have a health care plan and the means to seek help, noting that 70 percent of people who see a primary care physician with a physical problem have an underlying behavioral issue. Which is why having CareNet in outpatient facilities is a no-brainer.
“I think it’s an idea whose time has come,’’ she says, “to consider all the needs of a person physically, mentally, spiritually and socially.’’