If a person lacks good health, the enjoyment of any other abundance in their lives will greatly diminish. This becomes exponentially more truthful when magnified into a community’s collective well being. Health care-related initiatives might not make the same splash as opening a sprawling retail development or upscale high-density housing, but they’re essential to forming the foundation of a thriving community that supports its whole population, in particular its most vulnerable citizens.

Several health care providers who work to protect the physical and mental wellbeing of Middletown’s residents provide insights how their organizations have evolved to leverage innovations in their respective fields to provide support and resources that help patients to cope with challenges and, ideally, thrive.

Premier Health/Atrium Medical Center
Premier Health maintains a network of hospitals and health centers surrounding Dayton and throughout Southwest Ohio. Its Atrium Medical Center, which has served Middletown since 1917 (originally as Middletown Regional Hospital), opened a state-of-the-art facility in 2007, and has grown into an advanced entity that offers a Family Birth Center with a Level II Special Care Nursery and Level III Trauma Center plus numerous amenities that provide life-saving care.

Keith Bricking joined Premier Health as an emergency-room physician in 2005 and grew his skillset by earning his MBA to become the CEO of Atrium Hospital in January 2019 as the first physician in the chief-executive role. In 2023, he moved into the role of chief clinical officer, which entails supervising care delivered by physicians, nurse practitioners and nurses.

Dr. Keith BrickingAs an ER physician, Bricking said that he’s witnessed patients from a far-reaching diversity of backgrounds and challenges.” He said “It’s important that we’re able to optimize our service for their care and their resources. There are limited physicians and nurses available, so telemedicine has become a valuable tool in serving our population.”

Leveraging technology and communication are key takeaways from the COVID-19 pandemic, but he said it’s also been a catalyst that propelled the facility to proactively integrate departments and standardize care that ensured consistency amid crisis situations.

Premier Health has long enjoyed a fruitful relationship with the Wright State University School of Medicine, and over the last three years has integrated the leadership of both institutions to advance academic medicine through a 30-year agreement. Signed this past April, the agreement will cross-pollinate both boards of directors and recruit a School of Medicine dean who forms partnerships with all partners to ensure goal alignment and accountability. The agreement will expand Wright State’s nursing school and will bolster clinical instruction opportunities.

“We believe the partnership will strengthen research efforts and enhance educational development that strengthens our health care workforce,” Bricking said. “We’re looking to expand our footprint to develop the next generation of professionals.”

Bricking said a Premier priority is increasing Atrium’s medical residency and fellowship programs, as well as clinical trial opportunities for Middletown patients that will enable access to emerging medicinal and therapeutic solutions. Currently, Atrium offers 120 clinical trials, primarily in its cancer-treatment facility, and Bricking aspires to similarly enhance the facility’s trials for neuroscience and cardiovascular care.

“To meet this goal, we first need to recruit the right physicians to lead these programs,” he said. “From there, it’s a matter of allocating resources and building relationships with drug manufacturers to provide opportunities and access. Also, effective oversight and effective implementation of technology with more teamwork and collaboration.”

Through the relationship, Bricking is hopeful that the partnership will further enable the region’s political representatives to obtain more funding to serve Medicaid patients.

Michelle Fraley, Atrium’s director of nursing for critical care and maternal services, has been a critical-care medical professional for 26 years. She noted that the community’s expectant parents are increasingly seeking “natural” childbirth, which is managed through Atrium’s Natural Beginnings program, without medication, incorporating midwifes and doulas, and using traditional relaxation techniques such as water therapy and aromatherapy. She said that of the approximately 850 births that take place annually at Atrium, approximately 200 occur via natural childbirth.

Michelle FraleyShe’s looking forward to the Natural Beginnings program earning medical-board accreditation that signifies official compliance with national standards. Fraley said, “Natural Beginnings has received many positive reviews and awards, and we’re looking forward to raising awareness that this is an option for mothers in our region.”

“Some mothers have had negative experiences with postpartum headaches or elevated blood pressure, so it’s important they make the decision for their preferred birth process as early as possible,” she said. “Whatever your choice, prenatal group care and education are so important. We’ve made it a priority to increase the face time during maternity care so that expectant parents can be better informed and discuss their concerns in an early, proactive way.”

Fraley noted one potential that new parents often overlook is safe sleeping techniques, particularly sleeping in the same room as their baby but in a crib: “Parents might think they bond more sleeping in the same bed, or that it looks cute in pictures, but parents might not be accounting for how tired they are, and an accident could happen.”

Breastfeeding education was another instructional priority for Atrium patients, Farley said, because many new mothers are hesitant about breastfeeding or handling feeding challenges properly without instruction. “It’s important that we have the opportunity to teach new mothers evidence-based practices that the Ohio Department of Health endorses.”

Atrium is a Level 2 maternity care provider, which signifies specialty care resources that support mothers with high-risk pregnancies delivering as early as 32 weeks. However, it offers several amenities more commonly associated with Level 3 subspeciality-care facilities, including around-the-clock neonatology services, as well as readily available ultrasound and EKG equipment, and on-staff occupational and physical therapists. Other essential services Atrium provides include a “cuddler” program, where trained volunteers provide soothing contact for newborns with drug dependencies.

Atrium Medical Center operates an emergency department dedicated solely to patients over 60. With a nursing background and a 17-year Atrium employee, Wendy Mitchell, is the facility’s director of nursing for emergency and behavioral-health departments. Mitchell said the admission process entails tests to verify physical and cognitive risks and challenges. Once patients are triaged, their medical providers have access to Atrium’s Level III amenities, which include on-premises medical imaging, blood banks, plus a surgeon always on duty and another on call.

The senior emergency space provides many features that make ER visits more comfortable, such as providing hospital beds instead of standard ER gurneys, dimmable lighting, non-skid, no-glare floors, handrails around the entire room’s perimeter, hearing-assistance devices and in-room toilets. And, because elderly patients are increasingly susceptible to mental-health episodes, Atrium employs on-site social workers around the clock, with on-call psychiatrists available.

The most common culprit for seniors’ ER visits is falls, which trigger fractures and sprains. Prevention is a key step of Atrium’s outreach to seniors, which includes orienting patients’ homes to minimize potential hazards caused by rugs, furniture or appliances. Atrium’s social workers and speech and occupational therapists help prepare home-healthcare plans and provide essential equipment.

Another outreach priority is its “stop the bleed” program, which involves emergency wound-care to minimize bleeding, which is acute need for senior care given their often delicate skin.

A key priority is providing additional resources to provide further prevention outreach, such as engaging primary-care physicians to help disseminate the information.

Jackie Phillips Carter
Every Ohio county maintains its own health department, and cities with more than 50,000, including Middletown, typically operate their own health department. Jackie Phillips Carter, the city’s public health commissioner, began her medical career as a dental hygienist. After advancing her education – Carter earned her associate’s degree in nursing the Kettering College of Medical Arts, her nursing bachelor’s from Miami University and master’s in public health from Wright State University  -- she was hired at the city’s public-health department in 1998 and worked her way into the commissioner’s role in 2010.

She was born in North Dakota and moved to Middletown with her family at age nine, remaining in the area since. Appreciating her deep ties with the community, Carter recognizes that her role in the health department allows her to approach community wellness holistically.

“There are so many health-related issues that we can address through this office,” she said. “There are many issues that profoundly impact our community: infant mortality, obesity, dementia, drug addiction and more.”

Middletown’s health department had previously been entirely dependent on city funding. Early in her tenure, her department’s budget dwindled, the staff was reduced to three and a tax levy to bolster the department failed. Carter was faced with a crisis and found an opportunity.

“Facing a challenge with our budget was the best thing that could’ve happened to us,” Carter said. “It motivated our office to build relationships with nonprofit organizations and businesses, who have been generous in their support and helped us work to protect our community’s health.”

When public health is stable, health departments’ role in protecting communities’ quality of life is overlooked or perhaps even downplayed. When crises emerge, they’re front and center in the public eye and relied upon to allay concerns and solve problems.

“Immediately after 9/11, there was a huge push to ensure Middletown’s emergency preparedness, when germ and chemical warfare were worries,” she said. “The H1N1 swine flu panic in the 2009 made vaccine preparedness a priority. That experience helped us be prepared for the COVID-19 pandemic.”

She continued, “There was a lot of anxiety and uncertainly about COVID-19 vaccines, so we tried to begin with more receptive communities,” she said. “Governor DeWine prioritized getting students back in school, so we emphasized vaccinating teachers and staff. People knew that senior citizens were particularly vulnerable to the virus, so worked with churches and organizations such Kiwanis and the Rotary Club that helped us educate and promote vaccination with their membership. We’ve worked hard to build up credibility and trust with our community, and we had residents of other counties coming her for vaccination because we had earned their trust.”

Through her department’s relationship building, her staff has grown back to eight team members, with procurement of emergency-preparedness funds and a $500,000 Centers for Disease Control (CDC) workforce-development grant in place until 2027. Carter said that it’s unfortunate that public health has been politicized in some quarters and her office leans into evidence-based data in helping the community address health issues.

“We simply rely on data provided by CDC, [National Institutes of Health], and [Ohio Department of Health] and present information supported by experts,” she said.
Carter noted that every health department is required to conduct a community health assessment every five years. The periodic analyses point to several chronic challenges that impact Middletown higher than the national average: infant and maternal mortality, diabetes, heart disease, mental illness and substance abuse. She acknowledged there are no simple answers to these complex problems.

“Access to health care and the expense of many treatments are significant barriers,” she said. “For example, for a diabetic, affordable access to testing strips and insulin is a challenge. People with chronic pain often suffer because they can’t access an MRI. Our office works to advocate for our community and provide resources, but people often don’t realize how much they can do for themselves. Eighty percent of our health comes from nonmedical factors. A lot of health problems stem from feeling isolated, disconnected and helpless, which often leads to poor diet, inactivity, and depression. These are triggers for many health problems.”
 

The next Walk With a Doc will meet on January 18 at 9 a.m. at the Middletown YMCA at 1020 Manchester Ave.

One initiative Carter’s department has undertaken, in partnership with Middletown Connect, for addressing these challenges is its Walk With A Doc program. On the third Saturday of every month, the department sponsors a group walk with a local medical professional, which includes a talk about an important medical topic. 

Joe SimonMiddletown’s Access Counseling Services treats approximately 7,000 patients from four counties. Anxiety, depression, and post-traumatic stress disorder are among the most common conditions it treats.

Access Counseling Services
Mental health has been a component of wellness that has been ignored for far too long. Complaints about problems that weren’t clearly  visible were dismissed as an individual’s weakness or imagination of a nonexistent problem. Thankfully, that stigma is diminishing, though it’s far from extinguished.

Therapy, medication, and other modalities of mental-health treatment are all key components of fighting the epidemic of mental-health struggles. It’s a complex problem with no simple solutions, and Access Counseling Services is the only Middletown-based provider of mental-health counseling. According to Christina Kirkman-Cooke, Access’ senior executive clinical director of supervision and productivity, facility serves approximately 7,000 outpatient clients of all ages, including patients from Butler, Warren, Preble, and Montgomery Counties, and employs 53 therapists and six prescribing physicians.

Access Counseling Services was founded in 2012, and Kirkman-Cooke, who’s worked in the field since 2006, said the acceptance of mental illnesses as legitimate health problems has improved, as have the antidepressant and antipsychotic medications available to counteract these challenges. Generalized anxiety disorder, post-traumatic stress disorder, and major depressive disorder are among the most common diagnoses their patients receive, though bipolar disorder and schizophrenia are becoming more common.

“During the late 2010s, more insurance companies started covering therapy sessions under their policies, which was an important step in encouraging people to seek therapy,” Kirkman-Cooke said. “As people have become more open to the idea of therapy, it’s been easier to develop customized treatment. Some people want therapy only, some medication only, some want a mix, but it’s important to engage and listen with patients to create an effective treatment plan. The overarching goal is to leave our patients better than we’ve found them, and nine times out of 10 patients appear happier when they leave. We’re up front that treatment might initially get worse before it gets better, and together we trust the process.”

She acknowledged that many encounter challenges in finding therapists who are accepting new patients, which she said is driven by the demand for psychological and psychiatric services is far outpacing the supply of new therapists and counselors entering the field.

“Becoming a therapist requires a lot of years of education, insurance and licensing, the pay often isn’t great, and it’s a high-stress field dealing with people who are very depressed or suicidal, and addressing that level of trauma creates a lot of departures from the field. I often encourage my clients to heavily cut down on their news and social-media consumption and any other frequent source of negativity. It’s important to set boundaries and make yourself the priority.”

Kirkman-Cooke said that one positive outgrowth of COVID-19 was increasing the frequency, trust, and access to telehealth visits, which has simplified the process of finding mental-health support. Although the proliferation of available medications and treatments has been generally positive, the torrent of information around has at times been problematic as patients come in asking for treatment based on ads rather than research.

“We discuss evidence-based practices with patients, and there are a lot of options,” she said. “For example, EMDR therapy (eye movement desensitization and reprocessing) is a therapy structured around specified eye movements while addressing traumatic events and memories that has become popular and can be effective, but a patient has to be in a good place emotionally to do this difficult kind of work. Sometimes people who ask for a particular type of treatment aren’t ready.”

Another positive Access Counseling has made is establishing office hours at Middletown City Schools at all grade levels, as well as Waynesville, Monroe, and Butler and Warren County Schools. For many young people, this might present the only opportunity for mental health treatment, and it provides a safe space away from the peer pressure and bullying kids so commonly face.

“Hopefully, exposing kids to therapy and open communication at a young age while helping them develop trust in therapy will help them develop the ability to deal proactively with their mental health as adults,” Kirkman-Cooke said.

You can read earlier articles in the Soapbox Partner City Middletown series here.

The Soapbox Partner City Middletown series is made possible with support from Cincinnati Commercial Contracting (CCC) and the Middletown Chamber of Commerce serving Middletown, Monroe and Trenton.