PsychEd4Peds: child mental health podcast for pediatric clinicians

42. Implementing Change in Pedatric Practices with Dr. Lia Gaggino

• Elise Fallucco • Season 2 • Episode 42

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In this episode, meet Dr. Lia Gaggino, pediatrician and host of the child mental health and clinician well-being podcast, Pediatric Meltdown.  She shares resources and tips to help practicing pediatricians including her now podcast, Pediatric Mental Health: Building Better Workflows.  This new podcast is about how to implement change in pediatric practices from how to get buy-in for change, set goals, and engage your team in implementing  change, plus tips on billing and coding and more.

Dr. Lia Gaggino's Podcast: Pediatric Meltdown
Website: Pediatricmeltdown.com



Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

Dr. Elise Fallucco:

Welcome back to psyched for Peds, the child mental health podcast for pediatric clinicians. And for all of you helping take care of kids, we're helping you help kids. I am really excited today to introduce my friend and colleague, Dr. Lia Gaggino. She is a pediatrician. A podcaster and host of the fantastic child mental health podcast, Pediatric Meltdown. So welcome to the show, Dr. Leah Gaggino.

Dr. Lia Gaggino:

Oh, thank you so much, Elise. I am so glad that our paths crossed. You've been a guest a couple of times on some very popular episodes. So I am delighted to be here.

Dr. Elise Fallucco:

Yes, this is and to our friends and colleagues, Dr. Leah Gaggino she is one of the people who inspired me to start my own child mental health podcast because I was a guest on her podcast a couple of times, pediatric meltdown, and just thought about what an amazing way to be able to get helpful information out to such a large audience of pediatric clinicians. And so when I was starting up Psyched for Peds, I really reached out to Leah to learn the tricks of the trade and to get ideas and helpful hints and you're like my fairy god sister.

Dr. Lia Gaggino:

Thanks. I'm just so impressed you're really good at it. And I wish you many downloads.

Dr. Elise Fallucco:

Thank you. Okay. So tell our listeners about your podcast, Pediatric Meltdown and particularly why you think they would be really interested in it.

Dr. Lia Gaggino:

I like to think of pediatric meltdown is all the things I wish I'd know over the years about it. All kinds of things. They're, focused around pediatric mental health, emotional health. And then I do quite a few on clinician wellbeing because that is so important.

Dr. Elise Fallucco:

The podcast, the main topics are pediatric mental and emotional health, which is something of huge interest to those people who are listening to psyched for peds right now. And also talk topics about clinician wellbeing, which obviously goes hand in hand. We got to take care of ourselves before we can take great care of the kids and the families and our practices. One of the things that I really enjoy about pediatric meltdown is that you've had fantastic guests on your shows and you really get to know a little bit about them themselves in addition to their work. And you get to hear the backstory and behind the scenes. For example, Lisa Horowitz who helped develop the Ask Suicide Screening questionnaire that, is an amazing tool for looking at suicide risk and suicide screening. It can be used in pediatrics and you had her on her, your podcast and she gets to talk about how did she come up with this and how, what is the process of going through and piloting it in different groups and what did she learn and why is it the way it is now? And You have very exciting news to share with us today. So can you tell us a little bit about your new project?

Dr. Lia Gaggino:

Yeah.. So I've created a new podcast. It's a limited series. so it's called Pediatric Mental Health Building Better Workflows. 12 to 15 episodes, and they're short, so they're anywhere from 10 to 20 minutes, and they're just little step by step, how would I do this? During the last part of my career at my hospital system, I was the medical director for behavioral health and we implemented zero suicide practices and also integrated behavioral health. And so we had to build that from the ground up. I tried all kinds of things. I found out some things that don't work, like doctors won't like to be told that they need to do something differently. People need to know what's in it for me. People want to do the best because it's good for their patients, but without it being too difficult for themselves. It's just human nature.

Dr. Elise Fallucco:

No, nobody likes to be told what to do and we're all trying to do so many things in a short period of time and so if you have to add another thing to your plate, it's really important to figure out a way first of all, why is it important to do it? And second of all, how can we do it in a way that's efficient?

Dr. Lia Gaggino:

Absolutely. And, I had big ideas and I thought I could implement zero suicide in a year. And it took five. And just thinking about how do you implement change? So the first module is on commit to change. Because honestly, if the physicians don't have buy in, nobody's going to do it. And, finding who are your early adopters. Because there's some people who are willing to try stuff. And, Rather than trying to roll it out to the entire practice all at once, you can do little pilots. I, like I said, I learned by trial and error and also other people like my social workers saying yeah, we can't do that. So it was like, okay, let's roll it back. Building Better Workflows is a way to start with that commit to change and then set some goals. And then there's some real nuts and bolts about. screening tools and training because training is super important. And I harp on, you have to have a policy and procedure for suicide prevention. It is the most emergency based, thing. And I, so I really suggest that people focus on assessing what they're already doing, if anything. And does their staff know? What does a staff member do if somebody calls and says, I'm worried about my child? I found something that said that they're thinking about killing themselves and I'm scared. What do you do with that phone call? So I have a step by step there's even a, an educational PowerPoint that you can use. And there's templates and checklists, and there's also a wellbeing guide. And, there's even some stuff on billing and coding. There's a section on how to partner with other folks in your community, mental health providers, psychiatric hospitals. So I hope people will tune in to Pediatric Mental Health Building Better Workflows. So they'll be, again, different than my Pediatric Meltdown podcast in that they're shorter chunk sized bits. And then I have a workbook that is a companion to the episode so that they have those templates, they have those the PowerPoint, they have access to those tools.

Dr. Elise Fallucco:

That's excellent. Pediatric mental health, building better workflows, this capsule series of podcasts that people can access. It's like pro tips for implementing change in a pediatric practice, specifically around, implementing screening for things like depression, thinking about suicide prevention, and you're offering really practical tools and tips for how do you do this? How do you get people on board? What should you not do? Because we've all learned from our own mistakes. Oh yeah.

Dr. Lia Gaggino:

Plenty of those. Trust me.

Dr. Elise Fallucco:

I certainly have. And just to help people along the way, cause I think everybody, nationally and internationally, we're all trying to do a better job. of taking care of kids with mental health problems, of identifying them early, of knowing what to do when you have positive screens. And so you've been through this and you can share your experience and your wisdom with everybody who's trying to do this. So tell us where can our friends and colleagues find pediatric mental health, building better workflows? So

Dr. Lia Gaggino:

you can go to PediatricMeltdown. com and there on the page will be a link to the new podcast. And on PediatricMeltdown. com, website. You'll be able to find access to the workbook. And if you want to set up a discovery call, if you want to call and chat with me about your practice and kind of your pain points, there'll be a link to do that, too.

Dr. Elise Fallucco:

Yeah. So you mentioned the discovery call. I know at psyched4peds. Part of what our mission is about supporting pediatric clinicians in their practices. So any ideas or ways that you can support pediatric clinicians in their practice and tell us a little bit more about the discovery call.

Dr. Lia Gaggino:

Sure. So the discovery call is a quick conversation, but it's really an opportunity for somebody to say, we know the AAP is now recommending that we do suicide specific screen like the ask or the Columbia, and we're just not sure how to do that. That's a pain point. So I could give some suggestions about ways that they might want to begin that process. So just, an opportunity to brainstorm a little bit about how they might implement change.

Dr. Elise Fallucco:

Excellent. Thank you. Any other ideas or anything else you want to share with Psyched for Peace?

Dr. Lia Gaggino:

Sure. If after a discovery call somebody says, gosh, we'd really like you to walk us through this a little bit more, then we can do a deeper dive one on one consulting and that will be something we can set up through the podcast and after a discovery call. Does this make sense? So that we can really dig in on to. Or dig into how to really make change specific to your needs. So I'm hoping that with the podcast and the workbook and some consulting opportunities that I can help folks feel more comfortable and confident about the work they're doing and meet the needs of our kids.

Dr. Elise Fallucco:

It's so helpful to have access to the podcast, to pediatric meltdown, and then to the specific pediatric mental health, building better workflows. And then I love that there's the opportunity for discovery calls to chat with you one on one. And then, if you want to take a deeper dive to consult with you, To, so that pediatric clinicians and their practices can make change specific to their needs based upon whatever, wherever they are in the process of taking care of kids with mental health problems. And, you are the best source for this information because you are a pediatrician. You were the medical director for behavioral health at your practice. This is what you lived and have done. And so you're speaking from you. This, you know what it is like on the inside and so can offer really helpful advice.

Dr. Lia Gaggino:

Yeah. And I think, walking the walk and know what it's like in the trenches and how hard it can be and, being realistic about, you can't do everything at once and you might just need to tweak what you can to start. And I love talking about this and brainstorming. I think that's what I enjoy the most about the behavioral health appointments with patients is problem solving. And I love to do that.

Dr. Elise Fallucco:

Excellent.

Dr. Lia Gaggino:

And I like Psyched for Peds. I think it's really clever. I love the perspective from a child psychiatrist because You bring to it this really rich perspective that makes me go, Huh, I hadn't thought about that. So I love that Psyched for Peds is that, that voice from the child psychiatrist to say, this is how we might think about it so that you can reframe and Basically do a better job.

Dr. Elise Fallucco:

Pediatricians often underestimate how good they are at this speaking with kids and families and having difficult conversations comes naturally because that's a part of what you do day to day. And so it's just a matter of supporting pediatric clinicians with tips, with tools, with little tricks.

Dr. Lia Gaggino:

I think that is so true. I think oftentimes we get tripped up because we think it's about meds and when we think it's about Medications and we get overwhelmed because that feels scary that we don't know what we're doing but the further I got along in my career the more I was like It's not about medication. Yeah, that, that's an important thing. You got to know some of it, but that's not the crux of it.

Dr. Elise Fallucco:

Understanding that it's about having the tough conversations and not getting too overwhelmed with the things that you may not know. And there's so much you can do.

Dr. Lia Gaggino:

Just the fact that you asked, lets people know Oh, I could talk about things that I'm worrying about and, maybe there's something I can do about that or, maybe it's just, I just needed to say it and you're the trusted person that can listen.

Dr. Elise Fallucco:

So many times as clinicians were thinking, I need to be able to fix it and I need to be able to solve it and it makes us feel uncomfortable if we don't have the seven step plan for treatment. And the reality is, especially in mental health, so often just having the conversation, opening the door to have the parent talk about, here's what I'm concerned about, or here's what's going on, even if we can't fix it, just being able to recognize, validate, tell them whether that's normal or not. That's incredibly helpful for families. Yeah.

Dr. Lia Gaggino:

Yeah. And having access to folks like you through child psychiatry access programs is just invaluable. I can't tell you what a relief it is to call and say, Hey, this is what I'm thinking about. And having someone else say, yeah, that's what I would do. And I might try this and it's just so helpful. And honestly, when I used our child psychiatry program, I changed how I prescribe medications completely. I just felt like I could do a better job.

Dr. Elise Fallucco:

That's awesome. And these child psychiatry access programs are now available in pretty much all 50 states. And they're really great.

Dr. Lia Gaggino:

You know, if you're out there listening and you're wondering do I have one? You can go to the National Network map, NNCPAP. org, and find your state. And there's a number, and you can get started. Just that easy.

Dr. Elise Fallucco:

Thank you so much for coming on. Thank you for being a fantastic pediatrician, fantastic podcaster. And I'm excited because I think our friends and colleagues at Psyched4Peds can learn a lot too.

Dr. Lia Gaggino:

Thank you so much and I love that listeners from Pediatric Meltdown can hop on over to Psyched for Peds and vice versa because I think between the two of us, we have a really rich library of resources and conversations that are helpful.

Dr. Elise Fallucco:

Excellent. I think so too. So I would encourage our listeners to check you out at pediatricmeltdown. com. And of course, you're available on all of the podcast players for free. And to our friends and colleagues of psyched for paeds. Thank you so much for listening and we'll see you next week..