Marc Harrison: Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Dinah Weldon, director of the Center for Safe and Healthy Families at Primary Children's Hospital. Dinah, would you mind telling us a little bit about yourself and the really important work that you do?

Dinah Weldon: We’re the child abuse assessment and treatment team, we have 16 satellite locations around the state, and we have the most amazing employees that are committed to looking after children after a really bad day. I've been with Safe and Healthy Families now for three years. Prior to that I was with the State of Utah's the Children's Mental Health administrator and then prior to that I had 16 years working with children in the inner City of Los Angeles.

Marc Harrison: You've probably seen a lot of stuff.

Dinah Weldon: I have.

Marc Harrison: Without being graphic, when you say you see kids after a really bad day, I'm a pediatrician, I know what you mean, but I'm not sure that everybody who is listening necessarily knows what you mean. Could you talk a little bit about the things you see?

Dinah Weldon: Children unfortunately sometimes experience physical abuse, sometimes sexual abuse, sometimes they'll have an acute sexual assault, just a stranger one time type thing, and those can be very high risk. Sometimes children are neglected and they fail to grow. All those are the type of things we deal with and help children receive the treatment they need both physically and emotionally to be able to move on with their life and see that they are in safe situations. That's part of a lot of our involvement is trying to work with law enforcement, child welfare and just making sure that kids can be safe and well cared for. One of the new things I saw in coming to Primary Children's Hospital was children with head injuries, abusive head trauma, smaller children. That was something I hadn't seen working in the mental health world.

Marc Harrison: Yeah. As a pediatric ICU doctor, unfortunately, I saw a lot of that and it is particularly heartbreaking when you see a child go from being completely well physically to damaged, sometimes irreparably, or even killed. It's tough. I have a lot of respect for the work that you and your team do. I can imagine that having a mutually supportive team is necessary so that you all maintain your mental health as you work with these kids and families who are under unbelievable stress.

Dinah Weldon: That teamwork, that support of one another is one of the critical things that helps us do it. Also a lot of us have dogs, so when we get home there's somebody just shaking and excited to see us. And we engage in some of the opportunities through Intermountain with mindfulness training and the support. Amazingly of just, for example, a clinical engineer who travels the state, looks after our team in our satellite locations. And having someone just come and solve a thermometer recall issue for you. You're like, “thank you.”

Marc Harrison: Right.

Dinah Weldon: Helping have the support we need to do this important work.

Marc Harrison: Well, I heard about a really extraordinary story that I think you'd like to share with our listeners, that in my mind speaks to our mission of helping people live the healthiest lives possible and keeping people as close to home as possible to receive excellent care and also playing as a team across the enterprise so that regardless of where people live, they can get the right care at the right place at the right time. Could you tell us that story please?

Dinah Weldon: When children have experienced an acute sexual assault, we have a window of opportunity to prevent things such as HIV transmission, but time matters. We also are involved and the forensic aspect of it in terms of the medical care. We also, while we're there providing medical care, we'll collect evidence. In terms of forensic, you have about five day window and the closer to the event the better.

In terms of HIV prophylaxis, the first 24 hours are the most critical and we can still give the medication up to 72 hours, but after 72 hours the disease would have replicated so much we can't. There was a young person that was had an acute sexual assault, high risk rape, that we definitely wanted to provide the HIV prophylaxis, but this child did not come forward. As you can imagine, it's traumatic. You're trying to process what happens. They didn't disclose to their parents until we were in the 60 hour range. By the time we did the exam figured out the high risk element of it, we tried to obtain the medication and it wasn't to be found in that particular rural county. So we raised the concern up through our huddle system. It came up to me, we took it up to Katie Welkie at the director's huddle at Primary Children's Hospital, and she escalated it. And the response and the support was immediate of being able to go, “this is the right thing, we need to get these medications to the kids in a much more time sensitive manner.”

We've got the people working in these areas, but the challenge was we aren't located in Intermountain facilities. We're in areas that don't even have Intermountain facilities. We're a part of the Children's Justice Center program. It was over 40 caregivers over a course of a year that helped us work through all the regulatory, statutory, and functional barriers we faced. We now have medications in the Children's Justice Center and we're directly able to help kids in the moment after a really bad experience.

Marc Harrison: Worst day probably of their life.

Dinah Weldon: Right.

Marc Harrison: That is an amazing story and makes me feel really good that the huddle system works and I guess I'd really encourage everybody who's listening to please make sure they fully are present emotionally and intellectually in their huddles and actually participate because hundreds of times a year we solve really complicated problems across an entire system. Imagine if we had tried to do this... How many sites do you guys have?

Dinah Weldon: 16.

Marc Harrison: 16 one-offs. It’d be impossible. Well I guess it was historically impossible.

Dinah Weldon: It was. We’d never had this option. The team of people that came together were from multiple different areas. It was just this wide range of people that I had never encountered in Intermountain. You've got compliance, you've got IT, you've got R1, regulatory, legal, and then every form of pharmacy person in the world. Supply chain, Rob was able to get us the medications and his team, I know they put them together that night after we got the approval. We had them the next day. Amazing people doing amazing work because they care about children.

Marc Harrison: If I could just point out, Dinah, that this is the beauty of working at a not-for-profit system as well. We've got lots of colleagues in the for-profit world who are honorable, good people, but they have an imperative to make money for their shareholders. I love the fact that at Intermountain, we get the opportunity to work very hard and be really careful with our resources so that we can do the work that you do, and do so beautifully, and that we can have 40 people who have spent tons of time and effort on something that is so valuable in every way except probably economically.

Dinah Weldon: Right.

Marc Harrison: Aren't we lucky?

Dinah Weldon: We are so fortunate. Intermountain is an amazing partner in this work. Part of the funding from this comes through a government contract, but the University of Utah also plays in this important work in an important way, and all the people that were on these calls that we would have, they all very quickly had a vision of this work and gave their hearts to it, not just their time. Everyone was so committed to solving this very complex problem.

Marc Harrison: Let's just talk for a second about partnerships. One of the things that increasingly we at Intermountain believe is there are lots of things that are not in our wheelhouse and that we need to find the very best people in the world to partner with for the things that aren't in our wheelhouse. It strikes me that work, particularly around social determinants of health — including personal safety — is a great example of where partnership really works. Can you talk a little bit about how partnership figures into your world?

Dinah Weldon: You bet. We have many different partners all around the state. A lot of the Children's Justice Centers... Can I just briefly explain those? What they are?

Marc Harrison: Sure. Yes please.

Dinah Weldon: Instead of having a child when something bad has happened have to walk into a police station or a child welfare building or medical or a mental health treatment, go to all these different things, we all come to the child in what's known as a Children's Justice Center. Some of them are nonprofits and they're county run. Some of them are government run and however people do it, the idea is, we all come together, we bring what's in our wheelhouse, we work together on behalf of the child. Then there are just people all the time that are like, what can we do to help? They help us overcome a barrier. They help us have a specific medical tool we need or funding for something else. The Utah State Legislature has helped supported it. The office of the attorney general is a big important contact with us that helps us overcome some barriers. Again, the University of Utah, the department of pediatrics, child protection...

Marc Harrison: We really value that relationship. Phenomenal partners. Well thank you. Thank you for doing the work you do. Thank you for your positivity. I'm sure it rubs off on the kids in the families because they probably need some hope after some of these really bad experiences. Any questions for me? Anything I can share with you?

Dinah Weldon: I know you did a rotation through a child abuse team. Why did you, as a pediatrician, choose to do that?

Marc Harrison: That was a long time ago.

Dinah Weldon: I know.

Marc Harrison: I became a pediatrician for a couple of important reasons to me. One, is I really liked the other people in pediatric medicine. It was important to me to want to work around people who I admired and I enjoyed. Second thing is I wanted to become a pediatrician because I thought that kids were disproportionately vulnerable. You've described that beautifully. Both at risk for violence and exploitation, but also the problems associated with poverty in particular. I was really lucky, there was a guy named Marty Palmer who was the first child protection pediatrician in the Intermountain West and he was my mentor in clinic. And Marty just shaped my life in all ways, including our middle child is Martin Palmer Harrison. After Marty died, Mary Carole and I were just about to have our second kid and we named Martin after Marty.

Marty inspired me and that was a very, very useful rotation, mostly to understand how complicated the lives are of the people who interacted with healthcare on that front. Very rare to find a bad person, very common to find people with the deck stacked against them. Maybe that's where my interest in social determinants of health started way back when, almost 30 years ago. Sorry for the long answer.

Dinah Weldon: No, I love that. Those things you mentioned, the social determinants of health and other people learning about this work, we all, together, can do better in our help and assistance for children.

Marc Harrison: Here. Here. Well, thank you and I'm glad you got a dog who's always glad to see you at home. We do too. A scrawny mutt that we picked up when we lived overseas and she is not the brightest ball, but she's very sweet. She does provide a nice end to every day. I hope all is well with you too.

Dinah Weldon: Yes.

Marc Harrison: Thank you.

Dinah Weldon: Thank you.