Breaking the Cycle: Melissa Skahan on Transforming Lives at Mercy Hospital

It's my great pleasure to have with me Melissa Skahan, who is the Vice President of Mission at Mercy Hospital, and I'm intrigued by this title. I mean, it's pretty fantastic, Melissa, that you get to be the vice president of Yeah, it truly allows me to be involved in all kinds of different things. I have had the privilege of being involved in both inpatient and outpatient services, but also very focused on vulnerable populations. So I have a lot of freedom to influence not only the patient experience, employee experience, but also the lived experience of a lot of our patients, which is wonderful. So I've been a big fan of Mercy Hospital for many years. In particular, I delivered two of my children there and the Old Mercy Hospital. So one of them also, she was pretty much delivered in front of, it was probably Sister Catherine McCauley in the hallway. She almost didn't make it to a room. This is my little Sophie who's now 23. But Mercy's done a lot of changing in the last, well, since I delivered those babies. There's a big beautiful campus that's over on Four River and it's kind of expanded. There's, there's the outpatient footprint. How long have you been with Mercy and how long have you been doing the work you're doing? Yeah, absolutely. I've been at Mercy for 17 years, so have been very much a part of a lot of the transformation and growth. The beautiful thing about Mercy is the core of it has not changed. We're still sponsored by the Sisters of Mercy. We still are very, very focused on each encounter and the person that we're serving. So as you mentioned, we have big, beautiful campus that really brings to life a lot of the environment that really is a therapeutic relationship with patients. So that notion of light and being able to see potentially the ocean, the four river from your room and having private space with beautiful artwork in the hospital. So really tried to enliven all the good things that we know about healing and also bring forth that core mission and values of mercy. Well, I can tell you it also personally meant a lot to me because when I went through my own breast cancer diagnosis and surgery, I had surgery there, my surgeon was at Mercy, still is at Mercy. It's been now a decade. So it was such a great experience to be working not only with the people, but also with that atmosphere. The healing atmosphere is really so important to patients, and I really like this idea that you're connecting with people, but you're connecting with them in a way that is important to them at the time. So for me, during that experience, it was I needed to be in a surgical suite with a nice waiting room where my family could be or I needed to be with a place where I could deliver my babies. But Mercy is so much more than that. Mercy has Macaulay House, for example, and so many other things where you're connecting with people where they need that care. Talk to me about what specifically you've been doing. Yeah, so you mentioned Macaulay residents and the beauty of the work of Mercy is it's truly always focused on systems change and holistic care. So at the height of the opioid crisis, so really 2009, we were beginning to see a dramatic impact to women specifically. They were more likely to overdose, more likely to get a prescription for pain medication and really were highlighted nationally as a vulnerable population. Mercy Hospital had a transitional housing program that was formerly of the Sisters of Mercy called McCauley residents, and I've redesigned it after watching the lived experience of a lot of women with opioid use disorder to become solely focused and expert in that space. So what began as a small house with three apartments has consistently refined itself and paid attention to data and outcomes and to the people that we serve to really today be expanding statewide. We have in Portland now we have the ability to serve 25 families. So it is a two year length of stay includes housing. When you think about very vulnerable people, housing is often one of those really foundational needs to allow them to heal. So we partner with community housing of Maine and those 25 families are provided seamless access to care, substance use, treatment, mental health, as well as their physical health. And then we focus on parenting education. And another interesting component, we watched the dynamic of removal of children from home. So we continue in the state of Maine to see an increase in the number of children removed from homes secondary to substance use disorder, and today 52% of those removals are secondary to substance use disorder. So the ability to really get upstream and be that healing, that therapeutic presence for a group that we know that we can have consistent outcomes with. We launched in 2009 and 10 and fast forward to today, our outcomes are remarkable. We take highly complex families, children are as complex. They really have comprehensive health needs, behavioral health needs, and the ability to really address all of those seamlessly helps people stabilize these incredibly highly acute families with chronic, relapsing, developmental concerns and unmet health needs get to a place where at the end of their stay they're able to thrive. Kids are at grade level, they're highly engaged in school. We deliver college courses on site. We focus very much on breaking that cycle of generational addiction and poverty. So we have two locations in Portland, two in Bangor and Community Housing of Maine received a $15 million award from Congressionally directed spending from Senator Collins leadership to advance into four additional counties. So really excited to see how we can impact directly the struggles of these families. It would be wonderful to get to a place where we didn't have increased removals from these homes and you saw women and their children thrive. What I find so interesting about what you're describing is, is the nature of going upstream and whereby in medicine, at least the type of medicine that I've been exposed to in a traditional sense as a physician, is very much downstream. It's very much we'll meet you at the hospital if you have an urgent issue. And you're talking about let's try to get people before they even need to go to the hospital. Agreed agree. Let's try to help them with their mental, emotional, physical health so they don't actually need to get to the place of urgency and emergency in substance use disorder or other ways. But it's incredibly complex as you're describing it. How do you decide kind of where to start? One of the fascinating things I watch is, and I've just spent significant time with a variety of families who will be coming into our new program on Winter Street in Portland, and many of the women that I spoke with have had 10 years of high risk behavior of active substance use disorder and involvement of a variety of different groups, be it child protective, be it the medical community and the opportunity to get, instead of allowing those 10 years to unfold, to truly seek that level of engagement early on. So ideally it would be wonderful in that first interaction with the family to lean in a very comprehensive way because we really know what works. I think the critical component that we provide these families is how to navigate a lifelong of substance use disorder. This is not something that there is no quick cure. It's truly a lifetime of actively remaining in recovery. So we teach folks that if they do return to use, they know how to stand right back up and lean into the treatment and all of the supports they need. We teach them how to really create and live healthy lifestyles to create this incredible home for their family. So I would love to have us get to a place where we had that first encounter with Child Protective Services or other groups that we are tapped and we have the ability to really serve the family. It is interesting because I mean child protective services once they're called, I mean that is a moment of crisis for that family. It may be crisis in a different way that's perhaps not medical yet, but it is crisis and it's something that children will remember. Most of them are old enough to have some memory that's going to move into the next phase of their life. It could impact the lives down the road. So this idea of breaking the cycle of intergenerational, I guess disruption is really important because you're not just dealing with the people that are in front of you right now, you're dealing with future generations. Absolutely. And the children, as I mentioned, are incredibly complex. That tenure of use often gets them very close to high risk behavior. They most often have significant trauma. They may have a variety of different diagnoses associated with mental health or medical health. I think it's really ensuring that their needs are met and that we pay deep attention to their trauma and that reunification is incredibly deliberate. I think that another critical component is moms have incredible guilt and shame around use and around use that influences their children. Many of the women that we have served over the last decade were in the system. They were potentially foster children. So the ability, so they know how it feels, and so with that, there's significant guilt and shame. The beauty is really giving voice to that with the right behavioral health support and that full family systems work as well as healing. Just watching these women transform complete their college education, they're often first in their family to consider that. It really is fantastic to watch. I'm wondering if you and I have maybe similar reasons for being interested in families, being that we both come from large families, you're at the end of a large family of origin. I'm at the beginning of a large family of origin and for me the beauty of that was just to see the interplay amongst family members and how different everybody was. If you come from a family of two and there's one other person, you have that person and yourself. You come from a family of 6, 7, 8, 9, 10, and you're like, how could all of these people have come from the same parents in the same household? Do you think that that actually did impact your interest in the work that you're doing now as being from a large family? Yeah, absolutely. I think when I think about my family, not only do I have six children in my family, but we had several cousins and all of those also had that same size. So you have this little community of people that you adore you and have your back and would always be there for you. What I watch with some of these families that I serve, they may not have anything healthy to draw forth. So what would it look like if we interrupted that? What's it going to take for these families to have the same experience we did where they have a loving growing family? It doesn't mean that we were perfect in any ways. There were certainly trials and tribulations, but at the end of the day, that love, that unconditional love you have in families is really important. Critical piece that we help families understand is how to navigate with healthy boundaries. That relationship, I think it's very, when you look at a lot of the research around foster families or just a lot of work with vulnerable families, much of it acknowledges that they will reconnect with their family of origin. That is a deep draw for all of us. So the ability to help people develop those healthy, healthy skills so that they can do that with ease and then also remain in recovery and healthy themselves. Another area that I think you have an interest in and background in is education and the importance of education. You've already mentioned this with these families and with these women, but how for you, did this end up getting you to the place where you are now if you previously were more focused on more specifically education? Yeah, I think an underlying question I'm always asking. So certainly while in education, I was drawn to children who learn in alternative ways who really may not thrive unless it is experiential, unless there are different ways for them to express themselves. And so service learning, character education, a lot of these different modes were a passion of mine. Similarly, as I work with families today, it's truly that notion of how do we as a system, healthcare or education need to adapt so that these people, this population with a certain profile can have the most consistent outcomes. And that's been the beauty of the work that I'm doing at McCauley, certainly work that I did in education, and most recently we repurposed a former convent to serve homeless, pregnant, immigrant women. And that piece has also held up a great opportunity to understand from a cultural humility space, how do we as a system, both of those are in play, education and healthcare need to adapt so that we can be successful with the population. So again, it comes back to meeting people where they are and understanding what they're telling you that they need versus making assumptions about what people need. And I would think that if you're somebody who does not currently have a home and is also not currently from Maine, then a lot of the support structures probably have been torn away and you're really rebuilding from the very, very foundational level. And I think two critical things that I've observed there is just the human resilience, just that notion of spirit and that power to connect even when you don't share language. That's been fascinating to watch as we bring together pregnant women from all over the world, often we have five plus languages in play, and yet that sisterhood or that connection is remarkable to watch because they offer in very different ways, connections that I didn't predict. I really assumed that we would have to have a lot of interpreters in play, but we certainly do that just to ensure that understanding is there, but also just that human connection. I think when it comes to pregnancy also, one of the things that I know that I felt myself as somebody who gave birth to three children is that there's simultaneously this vulnerability and also this fierceness where you feel you have this very precious thing that you are going to bring into the world and you feel like somehow you need to protect it, but also that you're going to protect it. You're going to make sure that this little thing comes into the world and becomes a human creature. And so I wonder if that's also part of that resilience that you're describing is the fierceness around being a mother. Absolutely. There's nothing like the power of a mother and certainly a pregnant woman as it relates to their baby and just watching. I think what it has, I think a critical thing that I've watched is that bond that they have, but also just their shared experience. And I think it also has made me realize how difficult the healthcare system is for people who may come from a different part of the world that have not experienced organized healthcare or non-native English speakers. I think much of what I had assumed is that with interpreters and community health workers that that was enough, and that is not enough. We really need to create space where their shared decision making, where we understand more deeply what their birthing experience should be, needs to be. It's really provoked a heightened level of curiosity for me to really, and the beauty is a partner in this organization is a nonprofit ethic based community organization in her presence and in her presence has just been incredibly valuable in really helping me understand and mercy understand how best to serve, but also how to give space so that there is truly shared decision making, especially for women who may have experienced racism in their country of origin, may not be used to really feeling empowered in our spaces. And they have been just foundational in building up these women to really be powerful mothers and powerful women during their pregnancy and helping us understand as a health system how to really ensure that we're all curious and that we're all committed to really continue to adapt. I'm wondering what it has been like for you to be right in a front row seat with the Sisters of Mercy as they've continued to evolve. Because I know that the sisters that were the educators of my mother when she went to parochial school, I think are not the same sisters that we probably see today. And as an organization, I'm sure it's not the same organization. I'm wondering what you've seen, what has your witnessing been on this whole process? Yeah, absolutely. So the Sisters of Mercy, when I first came to Mercy, we had sisters in habit roaming the halls. I mean, you had sisters in vice president roles, you had chemists and accountants and pharmacists. I mean, you had a variety of really just remarkable women leading the organization. Fast forward to today, we don't have any employed Sisters of Mercy. We do have sisters serve on the governance level. So on our board of directors, and there are probably 60, 70 sisters in the state of Maine. Many of them were leaders or teachers at Macaulay High School, and they are certainly aging. I think what hasn't changed is their deep commitment to service. And so their foundation is certainly there globally. The Sisters of Mercy have kind of come under one umbrella. So what used to be like a Northeast Sisters of Mercy Group and then a Mid-Atlantic, and they now have an institute that they have formed that oversees all healthcare education and their different ministries. So they're certainly not as physically present. Part of my role as vice president of Mission at Mercy is to ensure that we enliven their charism, which is really their mission and values in everything that we do. So I work very closely with the Sisters of Mercy, both at the institute level but also locally in It's really impressive to me that in a day and age of sort of deins institutionalizing pretty much everything where we've said, well, we don't believe in the importance of religion, let's just say, or corporate structures or whatever it is. I think the fact that the Sisters of Mercy has been able to just read, they've just figured out their identity in a new way. They're still there. They're just doing it differently. And I think this idea of mission is truly important because at the end of the day, really it's how do you achieve the goal? How do you achieve the goal of being of service? So instead of holding onto this is what we were before, they have embraced what they need to be now and into the future. And that I think is pretty astounding when we think about how other institutions have just folded. I mean, this is a strong group if they're still out there and they're just doing things in different ways. Yeah, very strong. A great example is Francis Ward Convent that has now been repurposed to house homeless, pregnant immigrant women. When the Sisters of Mercy, it truly was like a assisted living, really was a place where they had their elders. It was purchased when they closed the mother house on Stevens Avenue. So a lot of transitions, a lot of loss for the sisters. They move into Francis Ward and then determine that that isn't the best way to care for elders, and they determine they're going to move on from that facility as well. So it was listed for sale and watching the coming together around developing this space for women of color who are pregnant and homeless, to really come and receive just holistic, highly coordinated care. It really was secondary to us consistently seeing Maine, consistently seeing poor health outcomes. So we came together after just a variety of really chilling data, and the Sisters of Mercy offered up this space at a reduced rate to allow for the good works to continue. So what was a vacant convent now is filled with 15 moms, 15 infants and often 10 children. So to go there to see what used to be vacant and now see soccer balls bouncing off the walls, and these children who otherwise would've been homeless or highly housing insecure, have seamless access to all the care they need. We also deliver workforce development on site. So we have English. You see that education, I always have to get back in to have language acquisition, digital literacy, and we offer behavioral health services for the children. I mean, it is that comprehensive approach, but it would not have happened without the sisters really offering up this space that is remarkable to look at. So it still has that mercy feel, and we've welcomed women who their story is just so horrific walking for months and just their lived experience. So to be able to create that space wouldn't happen without the sisters, and they take great pride. So several of them volunteer there, and there is nothing like walking in to Francis Ward and seeing a sister of Mercy with two babies on her lap because she's in her glory serving the women. I love that. This is what ultimately you're using both sort of evidence, the evidence base and the numbers, but you're also using love and ultimately it does take all of the above to deal with the complex issues that you've been describing. Whether it's not currently having a home or whether it's substance use disorder or whether it's complex medical needs, it's going to always take both. Yeah, oh, absolutely. Absolutely. I have opportunity to work a lot with our employees. What we talk about extensively is ensuring that we pay deep attention to each encounter, each encounter with our patient, and that we demonstrate love and compassion, but also with each other. Healthcare is hard. And so making sure that all of our staff and patients really have a certain type of experiences, our culture is incredibly precious to us all, and we paid deep attention to it. When we asked you before you came in to reflect on your experiences and what was important to you, one of the things that you talked about was navigating through the loss of a colleague. So I just wanted to ask you kind of in your final thoughts, what was it about that? Because if you're bringing forward this idea of the importance of not only caring for the community but caring for one another, I suspect that that plays into it somehow. No, for sure. So you're bringing up an experience that was very traumatic for Mercy. We had a security officer years ago who was shot and killed on site. I think what, as you can imagine, we came together in a significant way as a mercy community, but it was my first time directly engaging, which it was the young man was from the Sudanese community. So I had the opportunity to truly experience how that community grieves, how they come together in this just incredibly remarkable way. And I also had the opportunity to understand what they needed to have happen. Great example is in Sudanese culture, they carry the body in a procession towards the church. And as you can imagine, at that time, we had a violent act in the city, perpetrator hadn't been caught, and you were talking about 600 people that wanted to march, carrying the body very out of the box for a western way of grieving. And yet we were able, I had the privilege of really working closely with the family as well as the Sudanese community, as well as law enforcement to come up with a solution so that they could march from the West end all the way to the east end. And so I think it probably was one of my first experience really understanding how to ensure that you're always present and that you're always really listening and learning and being willing to be fierce. Because as you can imagine, there was a lot of concern around us marching because at that point, I don't know that people knew if it was racially motivated or what had occurred. So I think it was transformative for me because I think it was certainly the first experience where I had worked so closely with people from the Sudan and also planned a march for 600 people. Well, Melissa, I really appreciate your taking time out of your busy schedule to come and talk with me today. Clearly the work that you do as the vice president of Mission for Mercy Hospital is both far reaching and very important. So I know that people are going to be really fascinated to hear about what you do on a regular basis and where Mercy's going in the future. So thank you for coming in and having the conversation with me today. Oh, absolutely. Thank you for inviting me, and I look forward to seeing the podcast. Thank you. Today I've been speaking with Melissa Skahan, who is the vice president of Mission with Mercy Hospital, right in the, well, I was going to say in Portland, but now statewide, really with the connections, and I encourage you to learn more about the work that they're doing. It's obviously multifaceted, but Melissa, what's the best way for people to learn more about mission? Yeah, absolutely. Always feel free to reach out to me at Mercy Hospital. Certainly any number that you call people would easily connect you to me. My direct line is 879-3185. Happy to chat. Well, I think the first time anybody's ever given their direct line on our podcast, so I'm hoping you're inundated with people who would like to support the work that you do. Melissa, it's really wonderful that you're willing to do that and make that connection with people. Absolutely. Alright, well, thank you for joining us here today on Radio Maine. And thank you, Melissa. Absolutely. Thank you.