Podcasts about so amy

Santina Muha is a comedian, actress, writer, producer and disability activist. Her many roles in film and television include appearances opposite Joaquin Phoenix in the Gus Van Zant film “Don't Worry, He Won't Get Far on Foot” and the role of Beth on “One Day at a Time.” She recently wrote, recorded and shot a music video called “Ass Level.” Learn more about Santina on her Instagram feed. Learn more about The Passionistas Project. Full Transcript: Passionistas: Hi, and welcome to the Passionistas Project podcast, where we talk with women who are following their passions to inspire you to do the same. We're Amy and Nancy Harrington and today we're talking with Santina Muha, a comedian actress, writer, producer, and disability activist. Santina's many roles in film and television include appearances opposite Joaquin Phoenix in the Gus Van Sant film "Don't Worry, He Won't Get Far on Foot" and the role of Beth on "One Day at a Time." She recently wrote, recorded and shot a music video called "Ass Level." So please welcome to the show. Santina Muha. Santina Muha: Hello, how are you? Passionistas: We're good. We're so glad to have you here. What are you most passionate about? Santina: I'm very passionate about TV and pop culture and all of that. I'm also very passionate about food, particularly Italian food and Italian culture. And I'm very passionate about dogs and animals and tea. I drink tea every day. I drink black tea in the morning. I drink green tea in the afternoon. I drink herbal tea at night, so I do drink more tea than anyone I know. Passionistas: So let's go back to your childhood and when did you first become interested in pop culture and what was your childhood like and what role did pop culture play in that? Santina: I was in a car accident when I was almost six years old. Any memories I have walking, I know I was at least five or younger. Right. And I can remember walking every time, like certain commercials would come on, I would jump up and position myself. Like where would I be in this commercial? Okay. It's Zach, the legal maniac. I'm his little backup girlfriend and dancer, you know, like. And I was in dance when I was little and Oh, and then MTV. So I lived with, I lived in what I like to call an Italian full house because my mom and I moved back in with her parents after my parents got divorced and my two uncles lived in the house and they were young, my mom was 20 and they were her two younger brothers. So they were still in high school. And I had so much fun living with these cool young uncles. We would watch MTV. I would dress up like Bon Jovi. I mean, cause I'm a Jersey girl. So of course Bon Jovi. It just was always in the background. And then when I got in the accident, I watched beetle juice every day. They only had two movies on my floor, "Beetlejuice", and "Ernest Goes to Camp", which, so I watched the "Beetlejuice" every day and I played Super Mario Brothers. You could rent the Nintendo for like blocks of time and I would play that. So, I mean, it also kind of got me through some of those hard times where I couldn't leave my hospital room for essentially a year. And so it got me through those tough times, too. I remember watching PeeWee Herman during my sponge bath every Saturday, it was like PeeWee's Playhouse during the sponge bath, you know? So it, it, it really got me through would watch golden girls with my non that that was my mom's mom and they were Italian off the boat. So I spoke Italian as much as I spoke, if not more than English growing up. And my Nona who didn't really speak a lot of English and me who was four years old, we would watch golden girls together. So we, we didn't really understand the jokes. But we did know that when Dorothy made a face, the audience laughed right. I learned some of my comedic timing from Dorothy Zbornak and Sophia on "The Golden Girls", you know, and all of that sort of translated to when I got out of the hospital. And now here I was this little girl in a wheelchair, the saddest thing anyone ever saw, you know, in our society. And they would look at me like, How you doing? And I'm like, Oh God, I am depressing. So I would have to cut the tension. And I learned from golden girls and one day at a time, which I later got to be on the reboot. All of these shows, I learned like, Hey, make a joke, make a face, do it thing. And then it will ease the tension. It really has helped me just make it through, you know, life. Passionistas: That seems like a common thread with the women that we've interviewed, who were in the comedy show, that we did that feeling of it's your responsibility to make everybody else feel comfortable. Santina: Yeah. At six years old, I'm like telling adults. No, it's okay. We're I'm fine. I'm happy. I I'm in school. I have a boyfriend, whatever a boyfriend was at seven years, I held hands with a boy, whatever. I mean, I had to convince everybody that I lose. Okay. All the time. I'm still doing it. Passionistas: Did you consciously feel that at six years old where you were aware you were doing it? I was adjusting, no, but it's an automatic thing. Santina: Automatic. I didn't realize it until I was older. That that's what I had been doing. When you're younger, it's really the adults that you have to make feel better because the kids are like, cool. What is that? Can I try? Can I push, can I sit by you? Can I go on your special bus? And then once, once those kids start turning into adults, middle school, high school, that's when you're like, Oh no. Now they're sad about me or think it's weird or think it's different. And now I had to start dealing with my peers in the same way that I was dealing with the adults, you know, cause kids don't care. First I was crawling, then I was walking. Nobody told me that change. Wasn't tragic. So then all of a sudden I was walking now I'm willing. So I was like, Oh, that's wrong? Okay. Sorry. I didn't know. You know, as far as I knew, I was just on the trajectory. I didn't know. It was quote, wrong thing until everybody was like, that's not what we all do. And I'm like, Oh, sorry. I don't know. I'm just trying to get from point a to point B. Like you. Passionistas: You had this love of pop culture, you kind of integrated comedy into your daily life to get through the reactions you were having from other people. When did that love of comedy and acting become like a real thing for you? Like, I want to do this when I grow up. Santina: The whole time. I mean, like I said, I would jump up and be in the commercials or, you know, I would watch "The Mickey Mouse Club" after school and put myself off of basically an order and say, Santa Ana, you know, wherever I thought I would fit, I wanted to be on saved by the bell. I wanted it to be on nine Oh one. Oh. When I was little, I did my mom. I lived in New Jersey, so my mom would take me to audition. Sometimes I had an agent like commercial auditions and stuff like that. But in the end, a lot of times they would say, it's just too sad. You know, we can't sell fabric softener if the girl's in a wheelchair. And it's like, why do you think. That the fab. Do you think people are so stupid? They're going to think this fabric softener, it's going to paralyze their children. Like what? We don't give people any credit. And then I'm like my poor mother who they have to hit to hand me backdoor and say, sorry, it's too sad to have a daughter in a wheelchair. My mom's like, okay, well, great. Cause that's what I have. You know, it's like that right. It's up right when I was little, I just thought, Oh, that person stupid. I didn't realize wow. Society is kind of stupid. Sorry to say. No, it's getting better, but I'm talking about, it's just slowly starting to get better now. And that fabric softener commercial. I was seven. So I mean, w come on six glacial pace here. I was a dancer before the accident and that I still dance like here and there, but I don't know, like comedy was always. Acting, it just always, I went right into the school plays in summer summer theater programs. And I didn't think there was any reason why I couldn't do it. I just felt like, all right, I got to keep convincing people. I could do this. Just look I convinced them that I could be in the regular class in school and not in the special ed class. So God, there's something wrong with being a special ed, but if you need it, I didn't need it. I just had to prove to everybody I could be among my peers. At all times, and not now, I'm still doing that in the acting world, but it was just always something I wanted to do. I just felt drawn to the entertainment industry. And in college, I didn't major in theater or anything, but I did major in communication. So I did a lot of interviewing. And then my first job out of college was I had two jobs. I worked for the national spinal cord injury association and I worked for tiger beat magazine. It's like, I can't escape either one of these, because it's funny in the intro, you called me a disability activist and I'm like, God, am I? I mean, it's like, I didn't mean to be, but you kind of can't help it because if you're doing anything normal, like in high school, I was a cheerleader and I thought, great, I'm gonna just going to be a cheerleader because everybody wants to, to do wheelchair basketball and wheelchair this and wheelchair that. And I don't want to, I just want to be a cheerleader and I'm going to buck the system and I'm not going to be an advocate for anything. I'm just going to be asleep there. Meanwhile, I was the only cheerleader in a wheelchair. You can't help, but be an advocate because just because of the fact that people are looking at me. Passionistas: Tell us a little bit about your work with them National Spinal Cord Injury Association. What did you do for them? Santina: I was there communication director and also media point person I wrote for their publication, sci life spinal cord injury life. I interviewed a lot of bull, like different athletes, Paralympians. I worked with the spinal cord injury hall of fame. I worked with putting that together. And things like that, but it was just all disabilities talk all the time. For me, it was just a little bit of an overload. I wanted to do comedy and it'd be more of a creative. And so eventually I had to leave there and move to Los Angeles and start working in comedy, but taking everything that I learned in all of those connections. And now I have a show called "Rollin' with My Homies", where I interview other people with disabilities. And when we, when it was on the stage, we did improv off of those interviews, which was really fun, but I'm able to still keep in touch with all of the coaches, the texts that I made at the national spinal cord injury association. And I know who these people are and what they're done, and I can sort of help bring them into the mainstream, which is my overarching goal is to help normalize the disability and. Where, you know, where if you see someone with a disability on stage, you're not like waiting to see like, Ooh, where's the joke. I can't wait to see why she's in a wheelchair. You know? It's like, that's not funny. It's not, that's not the joke. Sometimes it's part of the joke, but it is the joke. Passionistas:  Before we go to LA. So what did you do at Teen Beat? Santina: We all had those posters on our walls growing up. Right? I mean, if you're pop culture, people, you I'm sure you did. I did too. You know, Jonathan Taylor, Thomas, right. And Luke Perry is my number one love of my life forever. Everybody knows that. I had a friend who was working there and she got promoted to the LA offices and they moved her out to LA and she, they needed someone to replace her as their East coast correspondent. And she was like, I have a friend who is very jealous of my job. She would love to do this. I had an interview. And then the very next day from that interview, I was in Manhattan at the opening of Dylan's Candy Shop interviewing Jesse McCartney. Oh. Was so fun. That's good at MTV music awards and movie awards, all these red carpet events, and I was freaking out. It was so fun. So cool. I got to interview the Backstreet boys and the Jonas brothers and just whoever was hot at the time. Kelly Clarkson, LMF, FAO. You know, he was just really fun. I really loved being able to do that. And sometimes it was hard. Like one time I showed up somewhere and I had to interview someone who was doing Broadway show while they were getting their hair and makeup done. And it was up a flight of stairs and there was no elevator in that building. And luckily I had my boyfriend at the time had driven me to Manhattan and he was going to go like, have a drink or something while I did my interview. And instead he ends up having to carry me up and down. So there were times where I had to navigate around being in a wheelchair, but I ultimately, I love that that was a job that I was doing that had absolutely nothing to do with the fact that I was in a wheelchair. And then once I moved to LA, I started working with hello giggles, which I also really loved because I was writing more pop culture stuff. And again, when I applied for that, when I sent in my samples and I got the job, it was not based nothing to do with being in a wheelchair. Again, it was just based on my love of pop culture. And that was another like nice win for me because sometimes you never know, like, Are they giving me an extra edge because sometimes it works in my favor. And then also it's like, wait, did I not get the job? Because I'm in a wilderness. Sometimes it works against me. So you just, it's nice when I don't have to think either way about it. Have you always been a writer? Yes, I remember in third grade they sent me as the ambassador to represent our school to the young author's club meeting. Every Friday was creative writing day. And then on Monday they would read the best ones. And it was like weird. If, if mine didn't get read on that day, it was like, Whoa, I wonder what happened to Santina on Friday. And I was, I was a big reader growing up. I went through a hiatus of reading, like once I discovered. Hot to be honest in middle school and high school, not middle school, high school. I started smoking a little, like having partying and then I was like, really? It's not cool. And then when I got older, I was like, Oh yeah, that's right. I like reading. And now I'm back to reading again and now I can do both. Now I can read what I'm gonna look, you know, smoke a joint and read on a Sunday. Hey, why not? Passionistas: You created the Ask a Woman in a Wheelchair series for Buzzfeed, and it was hugely popular, got 10 million hits and counting. So how'd that come about and why do you think it was so popular? Santina: They had a few, right. I think they had like an ask a lesbian one or something. And then someone there was like, I want to do a wheelchair one and co contacted me. And, um, and I was like, yes, let's, let's put this together. It's more about addressing the fact that people are asking these questions than it is about answering these questions, because there's a time and a place to answer those questions. But I think that's why they do well, because I think people see themselves in it. You can't help, but be like, Oh God, I've definitely used the handicap stall before. Or I've for sure. Stared at someone or even gone up and asked somebody what happened. I can't blame people for their curiosity, but think about it. If you've asked one person what happened. Think about how many times that person has had to answer that question, you know, it's like harmless to ask. That means I've had to answer it. Literally thousands of times I'm writing a book right now where I talk a lot about different things. And it's like, I just want to answer these questions from people because I understand the curiosity. And by the way, if a child ever asks me, it's like, okay, great. Let's talk about it. But when it's an adult, I'm like, Do you really want to know how I Santina have sex? You want to know what I enjoy personally me? Or are you asking how people in wheelchairs that's like, what are you asking me right now in the middle of the supermarket? What are we talking? I don't even know you. I get it. But also I'm like, come on. I try to think, like, if I see somebody with an impairment or something, do I want to just go up to them? What up? And it's like, no, I don't. So I don't know. It's a weird, weird line. It's like, we're just not doing a good enough job in. The representation of people with disabilities in pop culture and in media. And it's always like so dramatic and they want to kill themselves at the end. And then the actor that portrayed them gets an Oscar. Meanwhile, I can't even book a commercial for a fabric softener knowing you're giving him an Oscar it's like, come on. Passionistas: Absolutely. And, and I think what you said earlier is really important. Like we have to normalize the concept so that people will stop approaching you and asking that question. Santina: For example, I'm dating, right? I mean, I'm single and dating, right. So sure. Of course, if I'm dating a guy, who's going to want to know like, what's going on, what happened at some point. Right. But if that's like out the gate, I'm like, I don't know. Do you really want to get to know me? Or like what's, if your profile said you're divorced, it's not like I come at you, like what happened? Who blew it? Who, you know, who was the cause of that divorce? It's like, we'll get to those conversations. We'll get to them. It's important to know. Everything about the person that you're with, but it is not important to know everything about the person who's sitting next to you at a show or whatever. And then also it's like weird puts like a weird pressure on me where I'm like, okay, I'll answer. I can answer. But I'm only answering on my behalf because I don't know what XYZ other people do. You know how they drive, how they swim, how they, whatever. I don't know. I can only tell you what I do. So I don't want to answer this question. And then you go off in the world thinking now, you know everything about spinal cord injury, you know, you know what I mean? I don't even know. I mean, that's part of my, what I love about my. "Rollin' with My Homies" is when I interviewed these other people in wheelchairs, I learned so much and I'm like, Oh, what a great idea I could do that? Or I should be doing that. Or, or like, Oh God, I would never do that. You know, it's, it's interesting to me to see the differences among the community, as well as the similarities. Passionistas: How did you start that show? Santina: I went to Italy and I, and I hadn't gone to Italy for. The whole beginning of my life, even though I really wanted to, like I said, I grew up speaking Italian. It is my motherland Sicily in particular, I'm Sicilian. And I just want it to go so badly, but everybody always said, Oh, it's going to be hard. It's not really accessible. So old. And kind of, I let that get in my head for too long. And ultimately, you know, in my early thirties, I think was when I went and I said to my, my best friend, I was like, Please can we go? And she was going through some marital stuff at the time. So she was like, yeah, let's just go. So we went, I trust her. I've known her since seventh grade and she's just like a great friend who has always had my best interest in mind. Like when she got her first car, she made sure it was a hatchback cause she could fit my wheelchair in the trunk, you know, and she doesn't even need that. So it was just, I knew she was the right person to go with. We went to this town in Sicily where my Nona grew up, my grandmother grew up and I was like, pleasantly surprised by how accessible it was. And I said to my cousin, there are so many ramps here. What is going on? It's just an old fishing town in, in Sicily. And she said, Oh yeah, well, you know, if you, years ago we had a mayor or whatever, they call their person there. And Sicily who decided to spend a day in a wheelchair. And roll around the city in a wheelchair and see what needs to be done. Um, and then he did it and then he put ramps here and there. And I was like, Oh my God. Yes. And it's like, not the exact same thing, but a day in the life can be helpful. We live in a world where people are obsessed with celebrity, right? So let me, I have some access to some celebrities, some comedians through UCB, let me put them in wheelchairs and see what they learn and then how they can take what they learn now and bring it to the. Grips that they're writing and the shows that are show running and the shows they're directing, that's how it started. And I did the first one was a fundraiser called don't, just stand there and then it's spun off their slot of wheelchair puns. People it's been off into Berlin with my homies. So I had a show at UCB called that girl in the wheelchair. It was a solo show. And I learned that when people came to see the show, they knew what they were in for. They knew they were coming to see some disability humor and they could laugh. But when I did, uh, Piece of the show in like a variety or best of show at UCB and people didn't know what to expect or didn't know a girl was going to come out and start making fun of disability life in any way. The audience was like, Oh my God, are we, can we laugh at this? I don't. What's she doing? She making fun of disability. Wait, is she really in a wheelchair? Like they didn't. Right. And so I learned that. I had to again, make my audience comfortable with disability before I could even start making these jokes. And so I found that if we first made fun of the episode of saved by the bell redacted thrill on the wheelchair, right? The episode of "90210", their cousin Bobby comes to town and he's in a wheelchair. If we first made fun of that, then I could get my improvisors on board. Cause even the improvisers didn't want to touch. The wheelchair humor. I had been the monologist for as cat, you know, UCBs like flagship show four times. And I would tell great stories about being in a wheelchair. And they would even the most seasoned improvisers would often take the wheelchair element out of the story. And I'm like, Nope, that's why it was funny. But they were like, I know, but we can't do that. So I said, okay, here's what we're gonna do. We're gonna spend the first half of the show making fun of Zack Morris and NBC and the eighties. Then I'm going to bring up a person in a wheelchair. The second half of the show, I'm going to interview them. And by then, you're going to feel comfortable doing the wheelchair humor. And it worked, it really worked, but it took me a long time to sort of like figure out how to disarm people and get there. And it works for the audience as well. So I think that's some of the things I've like honed over the years is how to incorporate disability and with comedy and make it okay. Cause you can't just come at people with a joke and they're like, are we allowed to laugh at that? You have to make, unfortunately. Make them comfortable first it's annoying, but it is what it is. Passionistas: I imagine nowadays people are even more overly sensitive towards not laughing at things because they're trying to do the correct thing. And so even though it's becoming more of an awareness for people, is it, is it in somehow in some ways, a little bit harder now or is it getting easier? Santina: It's both, it's harder, but in a way that it just makes you work a little smarter work a little harder. You didn't have to figure it out. Yeah. It's hard, right? Because you don't want to insult anybody. And that's really hard because there are people out there who are looking and to be insulted. There's a quote. I love that. I try to remind myself constantly, which is you could be the juiciest, ripest peach, and there will still be people who don't like peaches. If I make my jokes, like if I try to make them too inclusive, I'm, I'm always going to be leaving somebody behind and then I don't want to hurt anybody's feelings. You can't please everybody with every single joke with every single thing with her. And I'm writing this book of essays right now, and there are times where I'm like, Oh God, this is going to piss somebody off. I know it. No pun intended paralyzes me as a writer of like, then maybe I just won't. But it's like, no, you've got to put the book out because you're going to help more people than you're going to hurt. But I don't want to hurt anybody, but, uh, it's a lot. We're all, you know, we're all as content creators, we're all dealing with this. Right. But it is scary because we are at a time right now where you don't know even something that's okay to say today might not be okay to say next year. And you're like, Oh shit. Now it's in print. Once it's published, it's that it's done. You know? And even if I changed my mind or my point of view, which is. Something that has already happened to me, even from drafts that I've written, you know, before COVID times. And I'm like, Oh wait, this is, I gotta change this. You know? So it happens once it's out there, you know, good luck to us all. Yeah. You have these open conversations with people and it's like, okay, you know what? That's true. That's sorry. I didn't realize that's messed up. So as well, I just, I want to be aware and. I try to give people the same courtesy. Like if someone says something that I feel like is sort of abelist, which is a term that even, I only learned in the past few years, I mean, people were being able as to me all my life, but I didn't know that's what it was called or what it was, but I try to educate before I cut people down or out, it depends on my mood. I said early in the beginning, you know, if you get me on a compassionate day, great. But if you get me like on a day where I'm just like, I've had it, I don't know. Passionistas: We're Amy and Nancy Harrington. And you're listening to the Passionistas Project Podcast and our interview with Santina Muha. To keep up with her projects, follow her on Instagram @SantinaMuha. If you are enjoying this interview and would like to help us continue creating inspiring content, please consider becoming a patron by visiting the Passionistas Project.com/Podcast and clicking on the patron button. Even $1 a month can help us continue our mission of inspiring women to follow their passions. Now here's more of our interview with Santina. Passionistas: Was it through UCB that you hooked up with Amy Poehler to do the conversation on disability and comedy? Can you tell us about that? Santina: I love her so much. Yes. I met Amy Poehler at UCB in the hallway one time and I was just like, woo. Oh my gosh. It was like, because she's, you know, she found it she's one of the four founders of UCB. Uh, and so she's like the queen and it would be like running into Dave Thomas, right. His daughter at Wendy's. Right. So it's like, and, and I, I introduced myself to her. I was just a student at the time. And then I kind of came up through the ranks of UCB and became a performer. And then, you know, when they opened up. The sunset location, which we were also excited about was just recently as closed now, which we're also sad about. We had a big opening party, you know, and I was on a house team at the time. So we got to like decorate and Amy was there. All the, everyone was there. Everybody was at that party and dance and just together, all of us dancing. And it wasn't like we were there to watch Amy perform. We were all, all performance together. It was like, amazing. Oh my God dreams just coming true left and right for me, And then we kept in touch and then, you know, she did that. She directed that film wine country on Netflix. And she sent me an email that was like, I need a voice of a receptionist and she's from the East coast, too. And she's like, and I feel like receptionists are always, they always sound like a little sweet, but a little bitchy. And I feel like that's how you sound. So could you come be the boy? I'm like, yup. I just like, felt so seen I'm like, that is what I am that's me. She nailed it. So I'm like, she got me. And then after COVID and there was a lot of issues with, you know, UCB in the way they handled diversity and inclusion and stuff like that. And they made a lot of mistakes and they, you know, they're working on those mistakes. So a few of us started this group called Project rethink, where we addressed a lot of those issues. And Amy and Matt Bester, I met Walsh, Indian Roberts or the other founders, and they were all involved. We had a bunch of zoom meetings with them to tell them here's what we as marginalized. Comedians feel, you know, we have all different types of marginalized comedians in Project rethink. So Amy and I got to talk over zoom that way over quarantine. And then through emails, we were like, Hey, why don't we do something like take this time that we have, that you see these not running right now that we have this sort of extra accessible platform accessible, meaning we can reach more people than just the people that can come to the LA location and do this thing we did. And Amy is very passionate about giving a voice to comedians. That wouldn't otherwise, you know, or, or trying to do that, whether it's women, she has her smart girls thing and just UCB in general was created for that purpose to give comedians a platform. Passionistas: Tell us about your experience working on the film “Don't Worry, He Won't Get Far on Foot.” Santina: That was amazing. That was also through. UCB because they came, you know, Gus Van Sant, who directed that film. It's a very serious film, but he wanted it to have some levity. So he thought, well, I know what I'll do. I'll hire comedians to play the doctor, to play the journalist, to play them. So that even though the topic is serious, there'll be some level of levity within. I think that, you know, there was like a smart move by Gus. So he came to UCB. It's based on a book written by a humorous too is quadriplegic. And he had a friend. In rehab, who was a spunky brown haired girl in a wheelchair. So they came in, they're like, Hey, do you have this? And they were like, actually we do have one of those. They called me in for this audition. And then I got the call back and the callback was with gusta and sad and Francine Maisler, who's cast it, all these great things that, you know, when you're an actress, like the casting people are celebrities stress, right? So I'm like, Oh my God, I'm going to be friends. I went in and did the call back. And I knew like, you know, sometimes you just know like, Oh my God, you know, you just can tell. A lot of people who have spinal cord injuries, what we do is we celebrate the day of our injury. It's like, because you could either mourn the loss of your legs or whatever, or you can celebrate the fact that you survived on this day. When I was in high school, I locked myself in my room and I was very email about it. And then somewhere in college, on it's my anniversary is March ninth. I decided I it's. So when I had my accident, I was. At Robert Wood Johnson hospital in new Brunswick, New Jersey. So I always have like a bad connotation attached to new Brunswick. Then when I went to college, I went to Rutgers, which was also in new Brunswick, New Jersey, and also the four most fun years of my life. So it kind of switched, you know, the way I thought about new Brunswick and being so close to Robert Wood Johnson. I said, one March night, I said, you know what, let's go bring flowers to the adolescent ward where I stayed. There were two nurses sitting at the desk. One was sitting a little further off and one was sitting up front and I went up to the one sitting up front. I said, hi, I just want to give you flowers and thank you for everything you've done and everything you do as a nurse, you know, I was here many, many years ago. I had a car accident and I was here and the nurse at the far end of the station goes Santina. And I was like, Oh my God. And she came over and she goes, Oh my God, you look the same, whatever she's telling the other nurse, this is Santina and this is San Antonio. And they're just like, Oh my God, you're saying, so it was like such, you know, I had made already an impact here and I thought, okay, this is what I need. This is the universe telling me, this is the way to go. Now you do something like this every year on this day, because you've made an impact and you've got to keep doing that. So then every year on my anniversary, I would do something nice. And this one. Other things I've done is one year I had a roller skating party and I rented out the roller skating rink. And I put all, because I said, we're all my friends were all on wheels today. Right. We're all going to be on wheels. And that was nice. So anyway, it just so happened that my first shooting day of don't worry, it was on March 9th. So I got to spend that day, that year in a park, right with Joaquin Phoenix and Gus Van Sant, directing us, just dancing in the park with walking Phoenix, both of us in wheelchairs. I mean, it was amazing. That's when you know, those are the times the universe is telling you you're on the right track. Passionistas: So in 2018 you were cast as Beth on the TV series, the reboot of "One Day at a Time." So how did that come about and tell us a little bit about your experience on that show. Santina: That was another thing where a friend of mine who I'd met through UCB was good friends with Gloria Calderon Kellett was the showrunner was the showrunner of "One Day at a Time." And she said, you gotta meet my friend Santina. I think she'd be a great addition to the show because one day at a time was great about inclusion and diversity and not making a big deal about things and just kind of normalizing them. And I think that she would be a great addition to the show and Gloria was like, Oh my God, I know Santina. And I've seen her perform at UCB. She would be great. And then they offered me this part. I do not do audition. So like we have the main character. Penelope is a veteran she's in the support group and the support group is run by Mackenzie Phillips, who was the original daughter on the show who, like I said, I used to watch with my nonna. So another full circle moment for me to be sitting there in this support group now with Mackenzie Phillips and my nonna used to wear this ring. And I remember like I would play with the ring while we watched TV together. And I would wear that ring on the show every, every time. Just to kind of like, I'm really big on all that stuff. I'm big on full circle moments and I'm big on like that happened then to get me to where I am now, you know, I pay attention to all this stuff. And what I loved about doing one day at a time is that it was like the best of, of all of my worlds here, because it was a multi-camera. And so for people who don't know multicam is like, when you're watching a show like full house or family matters or whatever, where the audience is laughing. Right. And it it's. So you get to shoot the show. In front of a live audience. So that's like the improv, but then also you get hair and makeup and craft services and you get to tell your family and friends what channel it's on. Right. Which is something you don't get from improv. So I got to do both things at the same time that I loved and feed off of the audience, but then also tell my family, you know, what time they could watch it and where, and when. And then I got to work with all of the, I mean like Rita Moreno. Are you kidding? Me and Jesse Machado, who I loved on "Six Feet Under". And I was just like in awe of everybody around me, Judy. Right. It just, I feel like now I have to, I'm not going to mention everybody because all of them, Oh, it was the best. It was the best. And I've been on like other sets. They're not all the best. That was great. Passionistas: You're not just a comedian. You're not just an actress. You're a creator. And I think that's really important to give you a chance to talk about that. Santina: I have two films that are actually at slam dance right now. And one is "Ass Level", which is a comedic, you know, parody, rap song type thing, where I talk about all the perks of being in a wheelchair, because I thought, God, everybody's always talking about how much it sucked all the time, but sometimes like it's a cut the line sometimes, you know, I get free parking. So I thought, Oh, you know, rack is like a fun way to like brag, you know? And it's like, I, I grew up loving. Uh, Salt-N-Pepa and Missy Elliott and all this like will kill all was like really fun. Nineties raps. I wanted to paint, pay homage to that. I also did for the Easter Seals disability film challenge this year, the, the street last year, the theme was the genre they gave us was documentary. And so the, my team that we decided we were going to do the spilled challenge, we were like, Oh, okay. Now we've got to make a documentary. All right. We're all coming to, you know, comedic creators. So we're like, well, What are we going to do? And I said, here's something cool. In COVID times I've been meeting all these people over zoom and they don't know I'm in a wheelchair until I tell them, which is very different because usually people see me, they see the wheelchair and right away that that's everything. Now that I tell them it's filtered or wow, she's in a wheelchair. And she did that. She was in a wheelchair and she did that. Right. So it was really like, this is interesting. I get to meet people. They get to know me first and then I can fold the wheelchair into the conversation. So we did a documentary and that's called full picture. It's doing really, really well getting great reviews. It's a short doc and I hope people check it out because I learned some stuff about myself too, in my own, like sort of implicit bias that I had internalized ableism that I have, you know, from whatever media and pop culture has put into my head. Right. And I'm really proud of that and proud of this book. And I'm also writing two movies right now, one by myself and one with two writing partners. And I'm just trying to create content, especially now that. In this time where I can't really, you know, go anywhere, do anything because the world is on pause. There's a great opportunity to, to write. And that's what I've been doing, just so I don't feel like lazy. Passionistas: What advice would you give to a young woman who is living with a disability? Santina: If you think you can't do something, then. And you probably aren't thinking of all of the ways that you could do it. You might not be able to do it like this, but I I'm sure that there's a version of the thing that you want to do that you can do. Or maybe that thing that you want to do is leading you to the next thing of whatever it is. Right. So just know that even if it doesn't look like. What you're imagining sometimes it's not about the experience of the circumstance, but the feeling that you, that you have. Right. And you can achieve that, feeling, doing something, doing something you'll get there. Right. You'll get to that feeling. Even if it doesn't look externally, like what you thought it would. Passionistas: Thanks for listening to our interview with Santina Muha. To keep up with her projects, follow her on Instagram @SantinaMuha. Please visit ThePassionistasProject.Com to learn more about our podcast and subscription box filled with products made by women-owned businesses and female artisans to inspire you to follow your passions. Sign up for our mailing list to get 10% off your first purchase. And be sure to subscribe to The Passionistas Project Podcast. So you don't miss any of our upcoming inspiring guests until next time. Stay well and stay passionate

Episode Summary In this episode physical therapist, biomechanist, and researcher,Dr. Amy Arundale talks about how to decrease the risk of ACL injury.  Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher.  Amy is transitioning to a new role as a physical therapist at Red Bull’s Athlete Performance Center in Thalgua, Austria. Today, Amy tells us about injury-prevention programs, communicating with different stakeholders, and helping empower athletes through education. We also get to hear about her recent publication on Basketball, Sports medicine, and rehabilitation. How does motor-learning, creative thinking, and problem-solving relate to ACL injuries? Amy tells us about implementation and compliance with injury-prevention programs, internal versus external cues as they relate to injury prevention, and the gaps in the research, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “We’ve got great information. We know these programs can work, but for them to work, you have to do them.” “You may be a physio, and you may have this injury-prevention knowledge, but you don’t have to be there for this to happen. It’s just as effective for you to run this program as it is for a coach or a parent to run it.” “It’s exciting to see where this next generation is going to be because I think we’re going to have some athletes that are more empowered to know more about their body.” “We need to be better at reporting our biases, looking at our subject populations, and funding and encouraging studies outside of ‘the global North.’” Giving yourself the space and kindness to recognise that you don’t know everything and make it a point to learn more is good therapy.   More about Amy:  Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience throughout college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University and throughout gained experience working at multiple soccer clubs in the US and Norway. Amy applied this experience working at Balance Physical Therapy providing physical therapy for the Capitol Area Soccer Club (now North Carolina F.C. Youth) and the U23 Carolina Railhawks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to performance in soccer players. After a short post-doc in Linköping, Sweden in 2017, Amy joined the Brooklyn Nets as a physical therapist and biomechanist as well as The Icahn School of Medicine at Mount Sinai Health System as a visiting scientist. Currently, Amy is transitioning to a new role as a physical therapist at Red Bull’s Athlete Performance Center in Thalgua, Austria. Outside of work, Amy plays Australian Rules Football for both the New York Magpies and US National Team.  Amy has also been involved in the APTA and AASPT, including serving as Director of the APTA’s Student Assembly, a member of the APTA’s Leadership Development Committee, chair of the AASPT’s Membership Committee, and currently as a member of the AASPT Diversity and Inclusion Committee.   Suggested Keywords ACL, Injuries, Recovery, Injury-Prevention, Learning, Sports, Physiotherapy, Research, PT, Rehabilitation, Health, Therapy,   Recommended reading https://bjsm.bmj.com/content/54/21/1245     To learn more, follow Amy at: Instagram:       @squeakyedgar LinkedIn:         Amelia (Amy) Arudale Twitter:            @soccerPT11   Subscribe to Healthy, Wealthy & Smart: Website:  https://podcast.healthywealthysmart.com Apple Podcasts:      https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:    Speaker 1 (00:07): Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Speaker 2 (00:38): Hey everybody. Welcome back to the podcast. I am your host. Karen Lindsay, and today's episode is brought to you by net health net health therapy for private practices, a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus a lot more in one super easy to use package. Right now, Neta health is offering a special deal for healthy, wealthy, and smart listeners. Complete a demo with the net health team and get $100 towards lunch for your staff. Visit net health.com/ [inaudible] to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y my last name very, very easy now onto today's episode. So what we're doing with the podcast this month, and really every month going forward is we're going to have several guests that are all going to talk about one topic in various forums. Speaker 2 (01:40): This month, our topic is ACL injury and rehabilitation. And my first guest is not only an incredible physical therapist, a great researcher, but also a great friend of mine. That is Dr. Amelia, Aaron Dale, or Amy Arundale. So Amy is a physical therapist and researcher originally from Fairbanks, Alaska. She received her bachelor's degree with honors, from Haverford college, gaining both soccer, playing and coaching experience throughout college. She spent a year as the William Penn fellow and head of women's football at the Chigwell school in London. Amy completed her DPT at Duke university and throughout gained experience working at multiple soccer clubs in the U S and Norway. Amy applied this experience working at balanced physical therapy, providing physical therapy for the capital area soccer club. Now North Carolina FC youth, and the U 23 Carolina rail Hawks. In 2013, Amy moved to Newark Delaware to pursue a PhD under Dr. Speaker 2 (02:40): Lynn Snyder, Mackler Amy's dissertation examined primary and secondary ACL injury prevention, as well as career link and returned to performance in soccer players. After a short postdoc in Linkoping Sweden in 2017, Amy joined the Brooklyn nets as a physical therapist, the biomechanics as, as the Icahn school of medicine at Mount Sinai health system, as a visiting scientist, currently, Amy is transitioning to a new role as a physical therapist at red bull's athletic performance center in Austria, outside of work, Amy plays Australian rules football for both the New York magpies and us national team. She has also been involved in the AP TA in the AA S P T, which is the American Academy of sports physical therapy, including serving as director of AP TA student assembly, a member of the AP TA's leadership development committee, chair of the AASP membership committee, and currently as a member of the AASP T diversity and inclusion committee. Speaker 2 (03:37): So what do we talk about today? All about ACL's right. So we talk about injury prevention and risk mitigation programs, how they work, what the pros and cons are how collaboration is so necessary amongst all stakeholders and why exciting new research that includes motor learning principles, creative thinking, and problem solving, and are there gaps in the literature and what can we, as clinicians and as researchers do about those gaps in the research. Now, the other thing Amy has so generously done for our listeners is she is going to give away one copy of basketball, sports medicine in science. This is a book that she was involved in as an editor, and it is over 1000 pages. The book is massive, it's huge. And she's going to give a copy away to one lucky listener. So how do you win that copy? All you have to do is go to my Instagram page. My handle is at Karen Lindsey, and you will find out how to win a copy of basketball, sports, medicine, and science. Again, that's go to my Instagram page at Karen Lindsey, and we will give this book away to one lucky listener at the end of the month of February. So you have the whole month to sign up for this. So a huge thanks to Amy and everyone enjoyed today's episode. Speaker 3 (05:04): Hey, everybody, welcome back to the podcast. So this month we're going to be examining ACL injuries and ACL rehab. And my first guest this month to help take us through the ACL Mays is Dr. Amy Arundale. So Amy, welcome to the podcast. Thank you so much. We're starting up at the beginning of the year with the A's with it. I didn't even think about that. Yes. But then next month we go right to running and just skip everything else in between. That's fine. Excellent. So Amy, before we get into sort of the meat of the episode, what I would love for you to do is tell the listeners a little bit more about some of your more current research projects, things like that. So I will hand it over to you. Sure. So I'm just finishing Speaker 4 (05:58): Up as a physical therapist and biomechanics at the Brooklyn nets. So I've been working clinically with them and then doing a little bit of kind of in-house research as well. And then on the side have been working on a few different projects. The biggest one right now is starting the revisions for the knee and ACL injury prevention me Andrew prevention, clinical practice guidelines. So those were originally published in [inaudible] in 2018 and clinical practice guidelines get revised every three years. So 2021 we're due for we're due for a revision. So that's my, the biggest project I've got going right now. And a few other things working with the United States Australian rules, football league on some injury surveillance and injury prevention, particularly on the women's side. And I'm getting ready to move to Austria to begin working for red bull and I, which I'm really excited about that. Speaker 3 (07:04): Amazing, amazing. They all sound really like really great projects. And since you brought up injury prevention, let's dive into that first. So there are a lot of injury prevention programs. So can you talk a little bit about those programs in general, and then talk about really, what is what's really key for injury prevention in our athletes when it comes to those programs? Speaker 4 (07:34): Absolutely. So there's a range of different programs that have all been published on and some of them are probably a little better known than others. The FIFA 11 plus, or what's now known as just the 11 plus maybe the, one of the most notable it actually came out of a program that was called the pep program. So the 11 plus was kind of aimed at soccer players, although it has been tested in other athletes and it's considered, it's kind of a dynamic warmup. So it has some dynamic stretching and some running, some strengthening, neuromuscular control, some balance exercises within it. And most of the programs that we see that have been researched are similar kind of dynamic warmups and include a variety of different things that help athletes kind of get warmed up. So some of the other ones that have been published on include the control or knee control program coming out of Sweden at the microburst and the ACL prevention in Norwegian handball has had some great success and great literature. Speaker 4 (08:47): There's the harmony program and then the sports metrics programs a little bit different. It's actually a program that was designed to be kind of a in and of itself. So it's a three times a week, 90 minute per program, primarily plyometric based. So it's a little bit different from the other programs, but has also been successful. So we've got a number of these programs that we've seen to reduce knee and ACL injuries in particular. And most of them actually have been quite successful at reducing just injuries as a whole. But the key components that we see in particular being important for ACL and knee injuries are that these programs have a strength component. So they're building strength, particularly in the hips, the quads, the hamstrings, but also in the core. So it kind of proximal in like terms of like hip and core strengthening, being important plyometric component seems to be important. To some extent a balance component may be important, although that's kind of questionable as to like how important that is. And that's one of the things that we still need more literature on is how do these components interact and influence each other? Because we seem to know what we think is important, but how much and how those different components interact. We still don't know as much about. Speaker 3 (10:25): And when we're talking about these programs, I would imagine some of the most difficult aspects of them, especially if we're looking at a younger population. So your high school, even collegiate athletes is doing them. Yup. So can you talk a little bit about implementation and compliance with these programs and how to instill that into these players and teams? Speaker 4 (10:57): Yeah, I think, you know, we've got, like you said, we've got great information. We know these programs can work, but for them to work, you have to do them. And that implementation piece, you know, whether that be in clinical research you know, we talk about that gap between research and clinical practice. We really see that here in ACL injury prevention. And part of that also is it's not just physios in implementing where we've got a whole range of stakeholders, whether those be the athletes themselves, to coaches who are often running training sessions to parents who really have to kind of be bought in to teams and clubs as a whole. Because if you have a culture that kind of instills the importance of doing a prevention program, then it's going to kind of, it may benefit in kind of trickling down. And that's also a wider culture as well. Speaker 4 (11:58): Social media scene pro teams do it. There's all sorts of layers to this. But what I think implementation really takes is identifying with that athlete or that team what's what are barriers what's important? What do we feel is, is most important? What's not as an important, and then coming up together kind of, kind of with a collaborative strategy to overcome what are those barriers? So we know information and knowledge kind of that buy-in is important. Why the why, why are we doing this in the first place? But then there's also some of the actual practical pieces of your athlete might not want to do an exercise lying down in the grass because that grass might be wet. They're going to be wet for the rest of their training session, wet and cold for the rest of their training session. So I think it has to be a really collaborative effort. Speaker 4 (12:59): And each in each situation that solution may look a little bit different. We've got some really kind of interesting information coming out. For example, the 11 plus has now a couple of studies on breaking it apart. So taking some of the pieces, for example, taking the strengthening pieces and putting them at the end of training sessions. So coaches often complained that, you know, these injury prevention programs take too long and when you've only got the field for an hour, they don't want to give up 20 minutes of their training session to do this program. So now let's take, maybe we can take this strength piece out. I means, all right. So maybe it's 10 minutes warming up at the beginning. That's probably a little easier for a coach to swallow. Then as we're cooling down, maybe we're off the pitch where we get everybody together, we finished those strengthening components. So we're still getting the entire prevention program done with that training session, but it's split up. And so thinking creatively like that are some of the ways that I think we can do a lot better in our implementation, rather than just saying, do this, here you go. Why aren't and then coming back and saying, well, why aren't you doing it? Speaker 3 (14:18): Right, right. Oh, that's, that is really interesting that and what is, does the research show that splitting it up is still as effective? Speaker 4 (14:28): Yeah. From what we know thus far, it does seem to be as effective. I think there's some other projects that are starting to look at, can you actually do that strengthening piece at home now there's other pieces that, you know, compliance at home, remembering doing those exercises the right way that could come into play there. But as of right now, what it seems like splitting it up does seem, seem to be splitting it up. At least within a training session does seem to be as effective. Speaker 3 (14:58): Excellent. And so aside from time and constraints on like you said, wet grass, things like that, what are some other common barriers that you have seen or that the research has shown to be a barrier to doing any of these? The above mentioned prevention programs. Speaker 4 (15:21): Yeah. I think coaching education is a really big one. So whether there's a few studies in Germany that we're just looking at a coach's awareness of the 11 plus and for a program that's kind of sponsored by FIFA, you know, it's promoted as kind of this soccer warmup, you would think that coaches would be kind of aware of it. And it's, it's very quite, it's actually quite surprising how few coaches are, are aware of it. Part of that is it's not in their coaching education. So at least in soccer, as coaches move up, what kind of within the ranks and, and in higher level teams, they've got a complete licenses, just like you have to complete a license to be a physio and complete continuing education in soccer coaches do to getting that program into that coaching education, I think is a really important piece. Speaker 4 (16:18): But then there's also the piece of helping them understand, again, coming back to that, why, you know, yeah, you want your players to be available. You don't want your players injured. And that's not just a, an immediate fact, but helping them understand the long-term implications, especially of something like an ACL injury, this is not an injury. That's just going to mean you don't have this athlete for a year. This is something that's going to affect how they play long-term it's gonna affect their knee long-term it could affect their career. So this has long-term implications. Buy-In also can come from kind of some of the performance effects, the stronger, faster, more talented athlete that's that there are some of those performance effects coming potentially from performing some of these injury prevention programs or injury prevention or injury risk medic mitigation programs that can help buy in. Speaker 4 (17:22): And then if we just look at Google would cut straight to the chase, is coaches want to win oftentimes and money. If you've got more players available, we know more players available equals a more successful team. And even Holly silver is actually in some of her dissertation work looked straight at the more you do the 11 plus the more successful the NCAA division one men's team was. So there's, there's she, she actually was able to draw a connection between doing the FIFA 11 plus and winning that those are the types of things that oftentimes coaches will latch onto and say, yeah, I want to win. Or clubs will say, yeah, we want to win. We want to do that thing that makes us that, that next level that makes us better at the higher levels that keeps us earning money. Speaker 3 (18:18): Okay. Exactly. So from, from what it sounds like is to get these programs implemented is you need a lot of collaboration from everyone, from all the stakeholders, whether it be the coaches, the trainers, the physios, the players, the owners, when we're talking about big league teams and, and with our younger, our younger subset of athletes, parents, coaches, and the kids themselves. And, and I guess communicating the value of these programs depends on who you're talking to, which is why, if you're the physio communicating the program, you really have to have a different set of communication bullet points, if you will, if you will, for each person on the, within that team, because you're going to talk differently to a parent than you are to an owner of a team, or you're going to talk differently to a coach than the player or the parents. So really knowing how to, how to talk to those stakeholders is key. And I think everything you just said will kind of help people understand how to have those different conversations with different people. Speaker 4 (19:26): Yeah. And I think there's all the other piece that some of those conversations is really empowering them. So there's the education piece and helping them understand, but there's also the empowerment piece that you may be a physio and you may have this injury prevention knowledge, but you don't have to be there for this to happen. It's just as effective for you to run this program as it is for a coach or a parent to run it. And we have, there's some good data on that that coaches can run really effective injury prevention programs. And so helping them kind of take on that role and say, yeah, no, I, I feel confident in taking my players through this. I feel confident in knowing why we're doing this there. I think that's the second piece too, is that it kind of empowerment piece, and maybe it's a player, maybe it's a captain that, that needs that education or that kind of empowerment as well. Speaker 4 (20:31): I think the generation of players that's growing up now is going to be very different from the generation of players say that you and I played played with we didn't understand or really have much of this. Whereas I think there's some really, there's some kids growing up now who are growing up with some amazing knowledge. And I think also coming with it, hopefully some better strength, some more and more neuromuscular control than maybe we had coming through puberty as well. So I think it's exciting to kind of see where this next generation is going to be, because I think we're going to have some athletes that are just like that more empowered to know more about their body. Maybe have a little bit more control maybe even coming with also potentially better talent who knows, who knows? Yeah. TBD to be determined. So you mentioned a little bit about motor learning. So let's dive into that a little bit because there is new research that includes motor learning, problem solving creative thinking. So what exactly does that mean in relationship to ACL injury? Speaker 2 (21:51): No, we're going to take a quick break to hear from our sponsor and we will be right back net health therapy for private practice as a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more and one super easy to use package right now, net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff visit net health.com/lindsey to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y. Speaker 4 (22:38): Yeah. So I think it's a really exciting area. And I think we're really just kind of tipping a little bit of the iceberg. People are starting to pay attention to some of the work that's coming out. And I think it's, it is really exciting and in the kind of prevention realm what we're seeing is people kind of pointing out that the programs that we have, we know we kind of have some principles of motor learning, but the programs in injury prevention that we have haven't really paid much attention to them. So at a very basic level one of the things that has been talked about from a motor learning perspective for a while now is internal versus external cues. So we know that giving an external cube, giving an output outcome focused, Q2 and athlete is going to help them keep that motion kind of more automatic. They're not going to be thinking about like, I need my hip in line with my knee in line with my toe and foot, my knee. Can't go too far over my shoe laces. I need to sit down. Speaker 3 (23:50): That's a lot to think about. Yeah. You can't Speaker 4 (23:52): Play a sport while you're thinking about all those things. Yeah, Speaker 3 (23:55): Yeah, no, no. Speaker 4 (23:58): So when that, if that cue is external or is outcome-based suddenly that athlete's much, much more, much better able to pay attention to the soccer ball that's flying past them or getting ready to, to bat. Speaker 3 (24:13): And can you let's if you wouldn't mind, just so people have a better idea of what an internal versus an external cue is. Can you give an example of, let's say a situation we'll use soccer as the example and give an internal cue and then give an external cue so that people can differentiate. Speaker 4 (24:34): Yeah. Yeah. So maybe, maybe we'll do say we're doing like a single leg squat, similar to what I, what I just said. So an internal cue might be, I want you to keep your hip, your knee and your foot all in one straight line that external cue might be giving them a we'll say a pole that's lined up in front of them and you might not even tell them what they're, what what's going on. Maybe you've got a pole in front of a mirror, so that's poles running vertically and they're, they're they're we, we just set them up so that their foot's in front of that pole and they're doing that single leg squat. So now you've got a visual line in front of them. You're paying their, their attention is going to be on that visual line. As they're doing that single leg squat, suddenly you see that they see that like, if their hips pretty far adducted or their knees collapsing in, you've got a line you can say, focus on that line. I'm going to focus on that line. Got it. That one, it isn't their body. Other cues, maybe like giving analogies I want you to think of your body as a column or that's, that's not a brilliant one. But you know, things like that. So analogies are helpful for external cues. They're also we'll get in, I'll get into that in a, in a sec, cause they're actually another, Speaker 3 (26:10): Go get into it, get into it. Speaker 4 (26:12): So analogies also bring in another piece of motor learning, which is called implicit learning. Again, kind of having that internal picture of what emotion should like should look or what that motion should feel like is implicit learning. So you've got external and internal, external internal cues, but you've also then got kind of implicit learning. So a great example of implicit learning is when you ask, you know, a really athlete to explain what they do on the court or on the pitch. And a lot of times they can't put words to what they do. And that's, that's kind of a good example of maybe implicit learning is they've got, there's no rules set to that learning. There is no order. It's just, I've got this internal knowledge, internal picture internal kind of motor memory of what, what that is. And I just execute that. Speaker 4 (27:11): I don't think about it. And so with those, all of my attention can stay to the game. I'm not thinking about how I'm moving. I'm just, just, just kind of to the game. So pulling those back to prevention are kind of injury prevention programs have said, here's a video or here's a picture. This is good. This is bad. Or they've given kind of implicit our internal cues. So those internal cues are those, keep your knee, your hip and your foot all in one straight line where we may benefit and where we might be able to bolster. Some of those programs is by adding some of these, these motor learning pieces at the very basic level, adding external cues, maybe adding some analogies or some implicit learning. Another, another way you can facilitate implicit learning is through dual tasking. One of my favorite things reading through some of the literature is in studying implicit learning. A few authors have taken novice novice golfers, and these novice golfers have, have to go and put, and while they're putting they basically yellow letters. Speaker 4 (28:35): So you literally just be out there like trying to learn to put you, you don't. I know how to put, you may not even get any directions, but you're just out there kind of yelling some letters, because if you have to generate letters, you can't be entirely focused on that pudding. So there's that aspect actually, of having two tasks going on at once. That means not all your attention can be on one of those tasks. How does that help? How does that help the movement? Yeah, so, so that's a very good question. What it means is, as you're learning, it it's like harder, but yeah, once you get to that kind of point where you're comfortable, you're able to execute that movement. It's an automatic movement, it's unconscious, it's automatic. And when we put that in the context of sport, that means that movement is happening without the athlete thinking about it and their attention remains, remains elsewhere. Their attention can remain on the game, that's going on the ball, that's flying at them. You know, that random thing that just flew by them that wasn't the ball and wasn't part of the game, but could be that perturbation, that in another situation could be distracting enough and could lead to an injury situation. Potentially. Speaker 3 (29:58): Got it, got it. Yeah. Like I, and you and I have had this conversation before, because I have a young athlete and we're doing, trying to do incorporate some of this stuff. So one of the things we're doing is I'm having her do some unpredictability drills with clock yourself, but we're trying to do them in Spanish. So she has to say things in Spanish as she's doing them. So that she's a little do. So she's accomplishing this kind of dual tasking. And, and I will also say it's fun. It's fun for the patients, fun for the therapist. And they kind of understand while they're why they're doing those things. And then every once in a while, just like throw a ball at her and see what happens. Speaker 4 (30:42): And you put this in the context then of some of those injury prevention programs and coach buy-in. So let's put Bali's in with single leg squats, but, but you know, squats and you jump into a header. There's already a little bit of some of that in some of the programs, but the more we can get that ball, some of those technical skills involved mix them potentially in with some of the movements that we're working on, maybe that might help with some of these, this kind of adding in some of this motor learning piece. Now I say all of this, none of this has been tested yet to change any of these programs we're really doing or to kind of, we need to go back and test them. And so, you know, this is where I say this, but it is kind of hypothetical, but in thinking about it, as well as we're kind of trying to overcome some of those barriers, that 10 minutes, that we're not, maybe we're at 10 to 15 minutes where we're trying to convince a coach to do something. Speaker 4 (31:49): Coaches are going to buy in a lot more. If there's a, if they can build some skills into that or they can see the sport reflected in it, rather than it just being kind of this abstract quote unquote injury prevention program. So can we get some of this dual tasking, can we get some of this kind of real world kind of environment type demands and challenges integrated in with some of those pieces that we're trying to build from a neuromuscular standpoint, can we mix them all together and end up with a maybe potentially more beneficial outcome? Speaker 3 (32:26): Yeah. And, you know, as you're saying all of this, it's kind of opening my mind up into these programs as being these living, breathing programs that aren't set in stone and that have the ability to change and morph over time as research continues to evolve. And I think that's really exciting for these programs as well, because you don't want to have these programs be thought of as stale because then that's going to not help with your buy-in. Speaker 4 (32:55): Yep. Yeah. And that's one of the complaints that you sometimes see about some of these programs is all right, so my team's done him for a season. They've all mastered, you know, all my players have mastered this program. They're bored of it now. And the likelihood that every single one of your players has mastered every single one of those exercises is that we'll put that into question, but we'll put that one on the side, but yeah, if you're doing the exact same program, the exact same exercise, every single training session for multiple years, yeah. Your players are going to get bored of it. And so are these, some of the opportunities where we kind of help with that buy in where we make it a little bit more creative, where we help kind of with some of those implementation pieces to make it more interesting to make it more long-term and to, to really help with people wanting to do them. Speaker 3 (33:50): I think it's great. And now we're, we've spoken a little bit about research here and there. So let's talk about any gaps in the research. So, I mean, are there gaps in the research? I feel like, of course, but are these gaps something that can't be overcome? Speaker 4 (34:09): No. All of the gaps that at least dive I'm aware of, and I'm sure there are more I just finished writing a paper alongside Holly and grant the Mark. So Holly silvers and, and Gretta microburst for the journal of orthopedic research. And, and one of the things that we did was kind of go through the literature and identify some of the gaps. Speaker 3 (34:35): What were, what were they, you don't have to say all of them, just give a couple of a couple of the big ones, Speaker 4 (34:42): But one of the big ones is a lot of our literature is focused on women, which is important, but in total numbers, we still have more ACL's happening in men. So we need more research in men. A lot of our research is in soccer and handball. There's a lot of other high-risk sports at there. So there were focused kind of on team sports but there is some pretty high risk team sports, something like net ball play ball volleyball have very high ACL injury numbers, individual sports things like gymnastics and wrestling. And those are also Tufts sports to come back to they're very high impact or they're very MBA. They've got some crazy positions that you don't see. So individual sports, I think have quite lacked outside of skiing. Skiing's got a lot of attention. One of the biggest ones that I think for me is really important is we don't have good reporting of the subjects and the diversity within the research that we've done. Speaker 4 (35:51): So most of the, the research that's been done has been done in the U S some in Canada and in Scandinavia, or at least in Europe as a whole, there's been a few studies that have been in in Africa. But we even within the studies that we have in the us and Europe and Australia, we don't, none of them have reported any of the, like really the, the, the race or ethnicity of the athletes who were part of them. So those may have implications and Tracy Blake did a amazing BJSM blog that was kind of a call to action for researchers. And it's one that I'd love to echo here that we need to be better at reporting our biases looking at our, our subject populations and funding and encouraging studies outside of kind of we'll call it quote, unquote, the global North. I think that's, that's a big gap that we need to fill and we need to be more aware of. Speaker 3 (37:01): Excellent. And on that note, we are going to wrap things up, but what I would like you to do is number one, is there anything that we didn't cover or anything more that you want to add to any of the subjects we covered? Speaker 4 (37:16): Ooh, I know you always ask this question and I always have never prepared for it. Speaker 3 (37:23): Well, you know, cause I don't want to like skirt over something and then the guests at the end is like, I really wanted to say this. And she just ended the interview. Speaker 4 (37:32): Think of it probably right before I go to bed. Probably. Speaker 3 (37:36): I can't think of anything right now. Okay. Speaker 4 (37:39): Excellent. Excellent. For any readers who haven't read Dr. Tracy Blake's BJSM post definitely go check it out. We'll put the link in. Speaker 3 (37:47): Yeah. Yeah. We'll put the link into the show notes here. So you can read her blog app over at BJSM and I agree. It was it was very well written and it was a really nice call to action and or call to awareness. Yes. Yeah, yeah. Right. Maybe not call to action, but certainly a call to awareness, which is step one in the sequence of actionable moves. Definitely. So yes, she's a gym. So now before we wrap things up I'll ask the same question to you that I asked to everyone and knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad? Let's say like not new grad PhD grad, but new Speaker 4 (38:36): Duke grad, new, new grad coming out of Duke PT school. I'm trying to think of what I said the last time I was on. Speaker 3 (38:46): Well, don't say it again. No, I'm just kidding. Speaker 4 (38:48): Well, yeah, that's what I'm worried about saying the same thing again. I think what I said last time, but what is my like big thing is being more gentle on myself. When I came out of PT school, I started work. I was the first new hire new grad that they'd hired. And so I was working alongside some just phenomenal clinicians, but they had the least experience, one head, like 15 years of experience. And I came out of school, unexpected myself to kind of treat and operate on the, kind of the same experience level that they did. And I it's just not possible. So I've spent a lot of time kind of beating myself up. And so it takes a lot of reminding even now that like, I still have, you know, I've graduated in 2011. So I'm coming up on 11 years of experience and it's still not a lot in a lot of ways. So being gentle on myself that I don't have to come up with, you know, everything on the spot that I don't don't necessarily have the experience to know or have seen everything or every course or development. And so being okay with that and being gentle and allowing myself to be, to, to just be where I'm at is, is I think Speaker 3 (40:08): It's wonderful advice. And just think if you thought you did know everything, I mean, how boring number one and number two, you'd never move on for sure. Speaker 4 (40:18): Yeah. Yeah. Right. So Speaker 3 (40:20): You're stuck. You'd be pretty stuck. So giving yourself the space and the kindness to say, Hey, I don't know everything. So I'm going to make it a point to learn more is just good therapy. It's just being a good PT, being a good physio, you know, otherwise you're just stuck in 2011. I mean Speaker 4 (40:41): Gotcha. Yeah. 11 wasn't bad, but I'm glad I'm not stuck there. Speaker 3 (40:45): Yeah. I mean, what a bore, right. You'd be like so boring as a PT cause you would never advance. Speaker 4 (40:51): Yeah. So your ex Speaker 3 (40:54): Excellent advice. And now where can people find you on social media and elsewhere? Speaker 4 (40:59): So I am on Twitter at, at soccer, PT 11 I'm on Instagram at squeaky Edgar. I will note that's actually more personal but follow me anywhere cause you'll get some great, great adventures. And those are my primaries social media. Speaker 3 (41:20): Excellent. And before we hop off, can you talk quickly about basketball, sports, medicine Speaker 4 (41:26): Science? Oh yeah. I forgot to talk about that in my projects. Speaker 3 (41:30): Yeah. Let's talk about this quickly. Yes. So Speaker 4 (41:34): Was honored to be a part of an editorial group that just completed. I just got a book out. It's an ASCA public, a publication on basketball, sports medicine and rehabilitation. So it's a quite the book. But I say that because it is over over 1100 pages if I remember correctly. So it's, it's a, it's a, it's a chunk of a book. But we are, I've got an extra copy of it. So one of our allowed visitors really be getting a copy. Okay. Speaker 3 (42:15): Well Amy, thank you so much for coming on. I really appreciate your time. Speaker 4 (42:19): Thank you so much for having me. It's always fun. Speaker 3 (42:21): Everyone else. Thank you for listening. Have a great couple, have a great week and stay healthy, wealthy and smart. Speaker 2 (42:28): A big thank you to Dr. Amy Erindale for coming on the podcast today. And of course a big thank you to net health. Again, they have created net health for private, for net health therapy for private practice, which is a cloud-based all in one EMR solution for managing your practice. One piece of software that handles scheduling documentation, billing reporting needs. Plus a lot more. If you want to check it out, there's a special deal for healthy, wealthy and smart listeners. Complete a demo with the net health team and get a hundred dollars toward lunch for your staff. Visit net health.com/glitzy to get started again. That's net health.com/l I T Z. Speaker 3 (43:09): Why thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.  

This week we talk legal marijuana while social distancing from their respective homes with the help of Ming Chen from A Shared Universe PodcaStudio, or so we had planned. In November, New Jersey residents, with a significant majority, voted “yes” to Public Question No. One to legalize and regulate cannabis. So Amy & Joe were […]

So Amy and Greg hung out last night, ugh........

Black Lives Matter. The NBA/WNBA/MLS/MLB all create history while the NHL has a moment of reflection. So Amy decided to do the same, and a little bit more. Read more about the Hockey Diversty Alliance and their mission (and make a donation) here: https://hockeydiversityalliance.org/ Read more about Black Girl Hockey Club and their mission (and make a donation) here:: https://blackgirlhockeyclub.org/ Follow the podcast on Twitter @LockedOnCaps Follow Amy on Twitter @AmyRothenberger Like and follow the podcast on Facebook @locapitals Send an email: lockedoncaps@gmail.com Amy also has another hockey podcast where she swears and yells a lot with her friend Julie, but it doesn't happen daily, or even weekly. You can find it @puckeruppodcast Support Us By Supporting Our Sponsors!  Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. Door Dash Right now, our listeners can get $5 off and zero delivery fees on their first order of $15 or more, when you download the DoorDash app and enter code LOCKEDONNHL. Roman Go to getroman.com/lockedonnhl TODAY. If approved, you’ll get fifteen dollars off your first order of ED treatment. Manscaped Go to Manscaped.com and use code LOCKED to get 20% Off and Free Shipping. Manscaped is #1 in men’s below the belt grooming and offers precision-engineered tools for your family jewels. Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKEDON,” and you’ll get $10 off your first order. Learn more about your ad choices. Visit megaphone.fm/adchoices

Back when we first started making Out to Lunch in New Orleans, one of our earliest guests was a young woman by the name of Amy Chenevert. Amy had gone to a football game and realized that all the guys were wearing fan fashion, but there was nothing fashionable for women to wear on game day. So Amy started up a company that made gameday apparel for women sports fans. That was back in 2007. During the 2019 football season, a new piece of women's sports apparel started popping up. If you don't have one yourself, you've probably seen someone wearing it. It's a sparkly, sequined sports jacket, in appropriate Saints, Tigers, and other team colors. That sparkly jacket marked Amy Chenevert's return to sports fashion. After taking some time away from her business, Amy is back at the head of her company, Tru Colors Gameday. The company makes fashion items specifically for women to wear and take to the game on game day, centered on a very specific NFL women's fashion accessory, the clear bag.  Game Day Every Day the New Orleans Saints, the LSU Tigers, and every other successful sports team know how to go out on the field and win. Everybody knows their position. Everybody knows the rules. Everybody on the team knows exactly what to do. But they still have a coach. You can't even imagine a football team without a coach. When an organization with a lot of moving parts is dependent on communication and on-the-fly decision making, it makes sense to have someone who can stand back and see the big picture. Which is why businesses have coaches too. Like Julie Couret. The companies Julie coaches are an impressive list that include GE, the Marriot, Sheraton, Entergy, Ochsner Health System, and many others. Recently the question for a lot of businesses has gone from, “When will things get back to normal?” to “How do we survive if things never go back to normal?” Julie imparts a great deal of wisdom for businesses coping with Covid in this conversation. Photos from this show by Jill Lafleur are at our website. More conversation about the future of the NFL season with Saints CFO Ed Lang is here. See omnystudio.com/listener for privacy information.

Back when we first started making Out to Lunch in New Orleans, one of our earliest guests was a young woman by the name of Amy Chenevert. Amy had gone to a football game and realized that all the guys were wearing fan fashion, but there was nothing fashionable for women to wear on game day. So Amy started up a company that made gameday apparel for women sports fans. That was back in 2007. During the 2019 football season, a new piece of women's sports apparel started popping up. If you don't have one yourself, you've probably seen someone wearing it. It's a sparkly, sequined sports jacket, in appropriate Saints, Tigers, and other team colors. That sparkly jacket marked Amy Chenevert's return to sports fashion. After taking some time away from her business, Amy is back at the head of her company, Tru Colors Gameday. The company makes fashion items specifically for women to wear and take to the game on game day, centered on a very specific NFL women's fashion accessory, the clear bag.  Game Day Every Day the New Orleans Saints, the LSU Tigers, and every other successful sports team know how to go out on the field and win. Everybody knows their position. Everybody knows the rules. Everybody on the team knows exactly what to do. But they still have a coach. You can't even imagine a football team without a coach. When an organization with a lot of moving parts is dependent on communication and on-the-fly decision making, it makes sense to have someone who can stand back and see the big picture. Which is why businesses have coaches too. Like Julie Couret. The companies Julie coaches are an impressive list that include GE, the Marriot, Sheraton, Entergy, Ochsner Health System, and many others. Recently the question for a lot of businesses has gone from, “When will things get back to normal?” to “How do we survive if things never go back to normal?” Julie imparts a great deal of wisdom for businesses coping with Covid in this conversation. Photos from this show by Jill Lafleur are at our website. More conversation about the future of the NFL season with Saints CFO Ed Lang is here. See omnystudio.com/listener for privacy information.

Back when we first started making Out to Lunch in New Orleans, one of our earliest guests was a young woman by the name of Amy Chenevert. Amy had gone to a football game and realized that all the guys were wearing fan fashion, but there was nothing fashionable for women to wear on game day. So Amy started up a company that made gameday apparel for women sports fans. That was back in 2007. During the 2019 football season, a new piece of women's sports apparel started popping up. If you don't have one yourself, you've probably seen someone wearing it. It's a sparkly, sequined sports jacket, in appropriate Saints, Tigers, and other team colors. That sparkly jacket marked Amy Chenevert's return to sports fashion. After taking some time away from her business, Amy is back at the head of her company, Tru Colors Gameday. The company makes fashion items specifically for women to wear and take to the game on game day, centered on a very specific NFL women's fashion accessory, the clear bag.  Game Day Every Day the New Orleans Saints, the LSU Tigers, and every other successful sports team know how to go out on the field and win. Everybody knows their position. Everybody knows the rules. Everybody on the team knows exactly what to do. But they still have a coach. You can't even imagine a football team without a coach. When an organization with a lot of moving parts is dependent on communication and on-the-fly decision making, it makes sense to have someone who can stand back and see the big picture. Which is why businesses have coaches too. Like Julie Couret. The companies Julie coaches are an impressive list that include GE, the Marriot, Sheraton, Entergy, Ochsner Health System, and many others. Recently the question for a lot of businesses has gone from, “When will things get back to normal?” to “How do we survive if things never go back to normal?” Julie imparts a great deal of wisdom for businesses coping with Covid in this conversation. Photos from this show by Jill Lafleur are at our website. More conversation about the future of the NFL season with Saints CFO Ed Lang is here.   See omnystudio.com/listener for privacy information.

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Daniel Chelette, Amy Arundale and Justin Zych on the show to discuss some questions from our presentation at the Combined Sections Meeting in Denver, Colorado entitled, Turning the Road to Success Into a Highway: Strategies to Facilitate Success for Young Professionals. In this episode, we discuss: -How work-life balance evolves in your career -The physical therapy awareness crisis -How to tackle the female leadership disparity in physical therapy -Burnout and when to pivot in your career -And so much more! Resources: Amy Arundale Twitter Daniel Chelette Twitter Justin Zych Twitter   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Daniel: Daniel Chelette is a staff physical therapist at Orthopedic One, Inc., a private practice in Columbus, OH. He graduated from Duke University with his Doctorate of Physical Therapy in 2015. He is also a graduate of the Ohio State University Orthopedic Residency Program and Orthopedic Manual Therapy Fellowship Programs. He became a Fellow of the Academy of Orthopedic Manual Physical Therapists in April. Since June of 2018, he has served as the Chair of the Central District of the Ohio Physical Therapy Association. Daniel’s interests include evaluating and treating the complex orthopedic patient, peer to peer mentorship, marketing and marketing strategy and advancing the physical therapy profession through excellence, expert practice, and collaborative care.   For more information on Justin: Dr. Zych currently practices physical therapy in Atlanta, GA as an ABPTS certified orthopaedic specialist (OCS) and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) with Emory Healthcare. Additionally, Justin is an adjunct faculty member with Emory University’s Doctor of Physical Therapy program and a faculty member of Emory’s Orthopaedic Physical Therapy Residency. Justin earned his Bachelor of Science from Baylor University, then graduated from Duke University with his Doctorate in Physical Therapy. He has completed advanced training in orthopaedics through the Brooks/UNF Orthopaedic Residency and OMPT Fellowship programs, while concurrently practicing as a physical therapist and clinic manager in Jacksonville, FL. Justin is actively involved with the Academy of Orthopaedic Physical Therapy and Academy of Physical Therapy Education. He has identified his passions lie in clinical mentorship and classroom teaching, specifically to develop clinical reasoning and practice management for the early clinician.   For more information on Amy: Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience through college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University, and throughout as well as after, she gained experience working at multiple soccer clubs including the Carolina Railhawks F.C. (now North Carolina F.C.), the Capitol Area Soccer League, S.K. Brann (Norway), and the Atlanta Silverbacks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Working closely with her colleague Holly Silvers, Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to sport, primarily in soccer players. After a short post-doc in Linkoping, Sweden in 2017, Amy took a role as a post-doc under David Putrino at Mount Sinai Health System and working as a physical therapist and biomechanist at the Brooklyn Nets. Outside of work, Amy continues to play some soccer, however primarily plays Australian Rules Football for both the New York club and US National Team. Amy has also been involved a great deal in the APTA and AASPT, including serving as chair of the AASPT’s membership committee, Director of the APTA’s Student Assembly, and as a member of the APTA’s Leadership Development Committee.   Read the full transcript below: Karen Litzy (00:00): Hey everybody, welcome to the podcast. I'm happy to have each of you on and I'm going to have you introduce yourself in a second. But just for the listeners, the four of us were part of a presentation at CSM, the combined sections meeting through the American physical therapy association in Denver a couple of weeks ago. And our talk was creating a roadmap for your physical therapy career. And afterwards we had a Q and a and we just had so many questions that we just physically couldn't get to them due to time constraints and the such at CSM. So we thought we would record this podcast for the people who were there and the people who weren't there to answer the rest of the questions that were in our Slido queue. Cause I think we had quite a bit of questions. So, but before we do that, guys, I'm just gonna shoot to you and have all of you give a quick bio, tell us who you are, what you do, what you're up to, and then we'll get to all of those questions. So Justin, I'll have you start. Justin Zych (01:00): Sure, so I'm Justin Zych. I'm currently with Emory university. I am teaching in an adjunct role with the DPT program and then also the orthopedic residency. I went through and did an orthopedic residency and manual therapy fellowship through Brooks rehab in Jacksonville and did my PT education with Duke university. Daniel Chelette (01:28): Hey everybody. My name's Daniel Chelette. I also graduated alongside Justin from Duke in 2015. And also completed an orthopedic residency at the Ohio state university and then stayed on and completed a fellowship and with manual therapy at Ohio state as well. And then worked in an outpatient orthopedic clinic for a couple of years and then was fortunate enough to have the opportunity to join on and work as a physical there, the player performance center with the PGA tour. So actually up to two months into that and it's been a pretty cool experience. So that's where we're at right now. Amy Arundale (02:15): Hi, I'm Amy Arundale. I'm a physical therapist and biomechanistic with the Brooklyn nets. I also went to Duke although a few years before Dan and Justin and then worked in North Carolina for a little while as a sports physical therapist as well as working with a large soccer club before going and doing a PhD at the university of Delaware under Ireland Snyder Mackler. So did research on primary and secondary ACL injury prevention did a postdoc in Sweden with Juan activist and Martin Haglins before moving here to do Brooklyn. Karen Litzy (02:56): Well, thank you all for joining me and allowing the listeners to get a little bit of a glimpse into our CSM talk for those who weren't there and for those who were, and maybe we didn't answer their questions while we were there. We can answer it right now. So Daniel, I'm going to throw it to you. I'm going to have you take the lead for the remainder here. So take it away. Daniel Chelette (03:20): Let's do it. All right, so just a quick little background of the foundation or basis for this talk. It really focuses on some lessons and things that we have learned through the four VAR unique experiences up until this point about professional growth and professional development and things we've learned, the easy way and things we've learned the not so easy way. And just tidbits of wisdom we've picked up along the way and we thought it'd be valuable to put it together and have a talk for CSM. And that's kind of what well what the basis of all this was. So towards the last portion of the talk we just opened up wide open Q and A. and we got through a few questions but we've got a handful more that we're going to go with. So we're going to start out with let's see. What do you recommend for the future PT that wants to get involved in a specific section of PT but wants to remain local to their community? Amy Arundale (04:26): I can start with that one. I think one of the nice things about being involved in the like sections is a lot of times they actually are based where you're at. So they don't necessarily, they may require going to conferences but they sometimes don't even require that. So it's really easy actually to stay local and still contribute and get involved in the sections. Really. The big piece there and is just reaching out and saying, Hey, I'm really interested in getting involved. How can I volunteer? And that might be, you know, helping with a membership that, which might be making phone calls or emails or following up with people who have maybe accidentally dropped their section or their APTA membership. It might be helping with various other projects, but a lot of times those are actually you know, maybe they're internet based or they're going to be through conference calls. So it's pretty easy to stay local. Karen Litzy (05:27): Yeah, I think that's a great answer. I'm pretty involved in the private practice section of the APTA and I would echo what Amy said. A lot of you can get involved in committees. So a lot of the sections have individual committees and most of that work is done online with, maybe you have to go to the annual meeting of that section, but that's just once a year. And the good news is if you're doing a lot of things online, you're meeting people. When you go to, let's say the section meetings each year, you'll get to know people in your immediate local area. And it's a great way to start making and nurturing those connections in those relationships. So then you'll have people in your immediate area that you can go to for guidance and just to hang out and have fun as well. But I think starting, like Amy said, just have to ask. Daniel Chelette (06:27): Yeah. That’s beauty of the age that we live in is that it's really easy to connect be a long distance. So technology allows us to do that. And I'm a part of a committee through the American Academy of orthopedic manual physical therapists. It's the membership committee. And everybody's all over the place where all across the country. And that was just something I got plugged into and I've met a lot of cool people through it and have made some connections within that realm. Be that, so there's a lot of different like online and long distance ways that you can get connected without being connected, which would be, is it helpful if there's a particular area you want to stay in, but you still want to get connected? Two people within your community but also outside. Karen Litzy (07:17): All right, Daniel, go ahead. Take it away. Daniel Chelette (07:21): All right. We're stepping it up here. This next, and this is a good metaphysical question. Do you compartmentalize your life? How do you approach the interaction between family and professional domains? Justin Zych (07:36): So yeah, that is a really deep question. I'll try to go through and answer to the best of my ability. I think that that intersects a little bit with my section of the talk, which really focused on trying to make sure that you could handle all of the new responsibilities that come with being a new physical therapist. I'm getting used to the responsibilities and productivity expectations, but while also at the same time understanding that it's important to have a balance outside of the clinic and a really good work life balance. So as far as compartmentalizing it, I don't know if I've specifically sat down and tried to put things into boxes. I do have a little bit of a blend. I mean, even my wife works for a different physical therapy company, so we share a little bit of a shared language with that. Justin Zych (08:24): But it's important that whether it's documentation or other things. When I leave the clinic, I try to leave and make sure that I have a little bit of time for me and time to focus on whether that's my own professional development going and taking advantage of opportunities like this to meet and talk with other people or just relax and kind of step away from the responsibilities that you go through throughout the day. So that's a great question, but a very, I think you're going to find a bunch of individual answers from it. Daniel Chelette (08:56): Yeah, I think it really, it's an individual question kind of like Justin mentioned in, I think for me. What I've found is, you know, maybe well work life, work life balance, particularly going through residency and a fellowship you know, work life balance, a 50, 50 split, maybe not completely realistic, it's a work life division. So where you just have, you have things within your life, be it relationships or activities or whatever. We are able to unplug a little bit from work. And those might be bigger parts of your life at different points in your life. But it's being able to, you know nurture and engage in all aspects of who you are as a person. And not just work, work, work, work, work but kind of be guided by what you're passionate about, what's important in your life. And those will take up bigger sections of your life pie at different points in your life. So it's just important to try to have a division but not necessarily think that you have to keep that division at a certain level at all times throughout your life because life changes. Amy Arundale (10:11): So my old advisor LENSTAR Mackler and I've also heard Sharon Dunn use the metaphor of juggling. And they talk about juggling rubber balls and crystal balls. So your crystal balls being the things that are like really, really important. The things that you have to keep in the air because if you drop they shatter, so those might be like family, they might be important relationships. They might be work. And then you also then also have rubber balls. So rubber balls would be then things that if you drop they'll bounce back. They're not quite as crucial to keep in the air all times. And, that balance between some of those rubber balls and crystal balls is always going to change. But that there are some things that you have to keep in the air and some things that you can let drop or you might have, they might have a different kind of juggling cycle than others. Amy Arundale (11:07): So yeah, I think it changes from time to time. You know, I've had periods of time where I've basically just worked full time. My postdoc was a great example. I was basically, you know, going to work during the day working on postdoc stuff and then coming home and trying to finish off revisions on my PhD papers. And I was in a long distance relationship at the time, so it kind of just worked that I was literally working, you know, 14 sometimes 14, 16 hours a day. That's not sustainable for a long period of time though. And I'm guilty of sometimes not being good at that balance. I would like to think as I've gotten older, I'm better at creating time where I'm not working or you know, actually taking vacations where I'm putting an email like vacation, email reminder on and not looking at emails. Amy Arundale (12:04): But it's going to change from time to time. Those priorities will change as your life changes. So I don't know if it's necessarily compartmentalizing, but prioritizing what needs to be, what's that crystal ball? Are those crystal balls and what are those rubber balls?   Karen Litzy: Okay. You guys, they were all three great answers and I really don't think I have much to add. What I will say is that as you get older, since I'm definitely the oldest one of this bunch, as you get older, it does get easier because you start to realize the things that drive your happiness and the things that don't. And as you get older, you really want to make, like one of my crystal balls, which I love by the way, it's Sharon Dunn is genius obviously. But for me, one of my crystal balls I'm going to use that is happiness. Karen Litzy (12:58): And so within that crystal ball, what really makes me happy. And that's something that I keep up in there at all times. And at times maybe it is work. Maybe it's not. Maybe it's my relationship, maybe it's my family or my friends or it's just me sitting around and bingeing on Netflix. But what happens when you get older is I think, yeah, I agree. I don't know. And I think we've all echoed this, that I don't think you compartmentalize. You just really start to realize what's the most meaningful things for you. Right now. And it's fluid and changes sometimes day to day, week to week, month to month, year to year. Daniel Chelette (13:55): All right. And one, one quick thing on that last question. Kind of a hot topic, particularly in the medical doctor community is burnout and resiliency and you'll see those terms thrown around a lot. And I think a big thing is to realize that those types of things as far as burnout and kind of getting to a point, we're just sort of worn out with what with the PT professional, which do on a daily basis everybody's susceptible to it. You know, we can all get caught in this idea that maybe we're indestructable or you know, Oh, I can take on as much as I wanted to or need to like machine X, Y and Z. At a certain point it's a marathon, not a sprint. And you have to sort of like Karen and Amy alluded to that prioritization is huge. And definitely gets a little bit easier as you gain more life experience and kind of see what matters and maybe what doesn't so much. Daniel Chelette (14:51): Okay, now they're kind of good solid question here. So I'm going to paraphrase a little bit in, So companies, businesses usually do something really specific now for a specific product or a service or something like that. They focus on one thing. Daniel Chelette (15:02): In PT, we do many things. Is there an identity crisis within the profession of physical therapy? And how do we address it? So I’ll kind of get the ball rolling? That's a heavy question. I think to a certain degree, I don't know if I would say crisis, but I do think at times like I use the situation of if somebody asked me what physical therapy is. Initially I have a little bit of a hard time describing it. I think, I guess the mission statement of the vision 2020 is sort of what I fall back to. It's a really good snapshot of how we can describe what we do. It's basically helping to optimize and maximize the human experience through movement and overall health and, you know, but that in itself is a little bit vague and a big picture and sort of hard to really put a specific meat too. So, yeah, I think, I think to a certain degree it's a little bit hard to say what is physical therapy’s identity? What do you guys think? Amy Arundale (16:21): I would say, I don't know if we have an identity crisis, but I think we have an awareness crisis. I think the general public's knowledge and awareness of physical therapy and then also within the medical profession, the awareness and knowledge of what physical therapy is I think is a massive problem because that knowledge and awareness isn't there. And probably part of it then comes from us. I think, you know, Dan, what you're saying, I think that is that kind of, if we can't describe ourselves then no wonder other people can't figure out what we do or how we do it. So I'll give a shout out actually to Tracy Blake who's a physical therapist and a researcher in Canada. And one of the things that the last time when we sat down and had a chat was, she kinda gave me this challenge was if someone were to walk up to you and ask you what you do, come up with a way to describe what you do without using any medical terminology. Amy Arundale (17:28): So without using movement, without using sports, without using some of our fallback terminology, like come up with that elevator pitch of this is what I do. So I'm happy if you've got that at the ready. If you understand that, if you can kind of, yeah, the drop of a dime, give that, you know, five seconds spiel about what physical therapy is, then suddenly, you know, that person knows. But we've all got to have that at the ready and we've all that. I'd be able to do that so that we can put it in a common language that, you know, your next door neighbor can understand, that your grandmother can understand. So when they come to you and say, you know, you know, my hip's been bothering me for six weeks and I've been going to a chiropractor you've got that language to be able to say, well, have you thought about physical therapy? Amy Arundale (18:29): When you're talking to a doctor in a hospital or even just in a, you know, normal conversation you know, you've got that ability to say, well, Hey, you know, what about PT? Yeah, let's not put them on an opioid. Let's get them into physical therapy. So I think it's really a Big awareness crisis.   Karen Litzy: Okay. So Amy then my challenge to you is to Tracy's point, how do you answer that question? And then I haven't even bigger challenge though I'll say to everyone, but how do you answer that question?   Amy Arundale: So I've written it down. Let's see if I can get it right. The short version of mine is that my goal is to help athletes at all levels develop into their optimal athletic being as well as develop their optimal performance. What if someone says, well, what do you mean by optimal? That's a good question. What does that mean exactly? How do I help you become the best you can be? Karen Litzy (19:27): Okay. Not bad. Not bad. Excellent. Very nice. Very nice. So now I have a challenge for the three of you and let's see. Daniel, well, no, we'll start with Justin. Let's put him on the spot first. Great. All right. So I was at an entrepreneurial meetup a couple of years ago, and the person who was running this, Mmm gosh, I can't remember his name now. Isn't that terrible? But he said, I want everyone to stand up. In five words. So you have five fingers, right? Most of us. So in five words, explain to me what you do. So talk about stripping it down to its barest essentials. Simplifying to the point of maybe absurdity. It's hard to say what you do in five words, but Daniel, I'll start with you. So someone comes up to you and you say, I'm a physical therapist. Five words. This is what I do. Help people live life freely. Karen Litzy (20:48): Okay. That's not bad. Not bad. Justin. Justin Zych (20:51): I'm not going to use a sentence, but facilitate. Educate. Yeah. Facilitate. Educate. Empower. Does that count that I repeated like six. Now, restore, empathize. Throw the thighs in there. Karen Litzy (21:09): Nice. Yeah. When I did this for this little meetup, I said, I help people move better. That's what I said. Those were the five words. I help people move better. But I do like where I think maybe if we put our heads together and we mashed up all four of ours, I think we'd come up with a really, really nice identity statement that is maybe 10 words. So maybe we can put our heads together after this and come up with a nice identity statement made up of 10 words. And if we were at CSM, we would have the audience do this. This would have been one of their action items. So what I'd be curious is for the people listening to this, you know, put an action item put, what are your five words, what would you do to describe what physical therapy is? And then if you're on Twitter, just tag one of us. You can find all of our Twitter handles at the podcast, at podcast.healthywealthysmart.com in the show notes here. So tag one of us and let us know what your five words are because I'd be really curious to know that. Excellent. All right, Daniel, where are we at? Justin Zych (22:42): So actually I want to, I still want to go back to the last question cause I think there's a really good point in there. So Amy hit it really well with the awareness issue versus the identity crisis within our profession. I, I think one of the things that sets us apart is how dynamic we're able to be. And the skill set that we're given in, you know, when we have our DPT education and when we graduate, you know, granted, you know, we're using the term as a generalist where you can go and specialize further. But I think that that's a, that's a rare but very very powerful trait of our profession is that we're able to help across a spectrum of a lot of patients. The challenge that I would say if that question was worded a little differently is if we focus specifically just on one section, so is there an identity crisis within the orthopedic section? Justin Zych (23:36): If somebody comes in and they have hip pain, are they going to be treated differently by all four of us and then therefore does that make it really tough for us to come up with this five words, 10 words statement? Because we're, we're very heterogeneous in how we, how we address patients still kind of within specific subsets. So I think that's probably the bigger crisis if you will. We still have a, you know, even within specific sections, a 10 lane highway instead of, you know, two or three based off of specific patient needs. Karen Litzy (24:10): And do you think that publication of CPGs helps that it for people who, and this is going off on a totally other question, I realize that, but following up with that, do you think CPGs published CPGs help with that and staying, I guess up and current on the literature can help with that? Do you feel like that is something that might close that gap of huge variability? Justin Zych (24:39): Yeah, I think the way that they're designed, that's exactly what they're trying to do is they're trying to take all of this, this you know, research literature review that we should all be doing and put it in a really nice, you know, consensus statement for us and then give us, you know, specific things to look deeper into the CPG. So I think that it's there, it's just again, how do you, is everybody finding that? And if they are finding it, are they applying it properly, you know, towards their practice. So I like that the information is coming out there. At this point, I'm not completely confident that it's reaching throughout, you know, the spectrum of everybody that it should be. But hopefully, you know, it continues, especially with, as we have new people graduating, we really start to develop that as more of the norm. And then it's a lot easier to not necessarily standardize but get everyone in in a couple of lanes instead of 10 lanes. Daniel Chelette (25:36): So Justin, just to play devil's advocate what about the good things that come with having 10 lanes versus two? And there's some people that I completely am on board with what you're saying, but I think there are plenty of folks that would say, well that's the beauty of physical therapy is that it can, you know, you can really make it make it individualized and what it is to you and you can treat. Obviously there's principles that you abide by, but you can be different then the PT next to you and different to the PT next to them and I can still offer high value. What would you say to somebody who would say that? Justin Zych (26:26): I think that your statement you just said is completely fine. But, the issue that comes about that is that therapist who wants to provide the individual approach, have they, you know, exposed themselves to enough different approaches or different ways that they would look at it, that they can be truly individual to the patient instead of saying, okay, I'm going to focus on I’m a, you know, to throw anyone or anything under the bus here, but I am specifically a Maitland therapist. I'm specifically a McKenzie therapist. And then that approach fits that patient all of a sudden, as opposed to being able to expose yourself enough to be able to flow in and out. Again, based off of what you said, which is I completely agree with that individual approach. So making sure that you have that dynamic flexibility to cater your skills. Sorry, a little bit of a tangent there, but can't help myself. Amy Arundale (27:37): I'll piggy back and put a shout out to people who want to get involved. But one of the things that the orthopedic and the sports section, I'm going to go back to their old names, the orthopedic section and the sports section. In the newer clinical practice guidelines. One of the things that I think Jay has done a great job of is kind of forming committees around each guideline on implementation. So when we did the knee and ACL injury prevention clinical practice guideline, we actually had a whole separate committee that we pulled together that was in charge of how do we help disseminate this information and help clinicians implement it. So that was putting together a really short synopsis for clinicians, a pamphlet or just like one pager that can be like just printed off and given to a clinicians. It was two videos. So videos of actual injury prevention programs, one for field based athletes on one for court based athletes. But getting those out, just like you talked about Justin, you know, that that's sometimes where that or that is where that gap between research and clinical practice comes. And that implementation is so important, but it means that yeah, there's a chance to get involved for people who are interested in helping those guidelines really kind of truly get disseminated in the way that they need to be. Karen Litzy (29:04): Great. And I think that's also really good for the treating clinician because oftentimes as a treating clinician, we feel like we're so far removed from the researchers and even from the journals that you think, well, what is my contribution going to do? Like how can I get involved? I'm the J word, just a clinician. And so knowing that these committees exist and that as a treating clinician, you can kind of be part of that if you reach out to get involved I think is really important because oftentimes I think clinicians sometimes feel like a little Karen Litzy (29:42): Left out, sort of and left behind as part of the club, you know. So I think, Amy, thank you so much for bringing that up. And does anyone else have any more comments on this specific question or should we move on to the next one? Daniel Chelette (29:59): Alright. So Amy and Karen, this question is geared towards you guys. So the question reads while PT is a female dominated field, there is still a disparity in female leadership. Do you have advice for female student physical therapists who may desire those leadership roles? Karen Litzy (30:24): I would say number one, look to the APTA. Look to your state organization, look to your, even where you're working and try to find a female physical therapist or even look to social media, right? Look to the wider world that you feel you can model. So I think modeling, especially for women, for people LGBTQ for people, minorities is so important. So you want to look for those models. Look for the people who are like, Hey, this person is kind of like me. So I really feel like I can follow a model, this person, I would say, look to that first and then follow that person, see what they're doing, try and emulate some of, not so much of what they're doing in PT, but how they're conducting themselves as a professional. And then like I said, during our talk, reach out, you know, try and find that positive mentor of try and find that the mentorship that that you are seeking and that you need and that you feel can bring you to the next level, not only as a therapist but you know, as a person and as a leader within the physical therapy world. Karen Litzy (31:46): And I think it's very difficult. I'll do a shameless plug for myself here really quick. We created the women in PT summit specifically to help women within the profession, a network, meet some amazing female and male leaders within the profession and have difficult discussions that need to be had to advance females within the profession. And I will also say to not block out our male counterparts because they need to be part of the broader conversation. Because without that, how can we really expect to move forward if we don't have all the stakeholders at the table. So I would say speak up, speak out, look at people who are at the top of their game. Karen Litzy (32:40): And then in a high level positions, Sharon Dunn, Claire, the editor of JOSPT, Emma Stokes, the head of WCPT. All of these people, if you reach out to them or you hit them up on social media, they will most likely get back to you. It may not be really fast, but they will probably do that. So I would say look to the broader physical therapy community. Look to the world of physical therapy right down to your individual clinics because I think that you'll find there are a lot of people to model. Amy Arundale (33:41): Mmm, yeah. Yeah. I 100% agree. I think modeling and mentorship are huge. Finding people that you connect with and who can give you honest, upfront feedback but also support. So I feel like I'm pretty lucky in both having really strong women who I consider as mentors, cause I think that is important. When I was part of the student assembly, Amy Klein kind of oversaw the student assembly and she became someone who I really look up to and admire and will go to for, I know she'll give me it straight whether it's you know, good or bad, I know she'll give it to me straight and I need that. But then also Joe Black is somebody who's also been a longtime mentor of mine recently. And the Stokes I've connected with and that was just meeting her at a conference. And we connected at a conference and had an amazing conversation and that's developed further too. So I think mentorship and then getting involved seeking the opportunities. Mmm. And seeking and creating, cause sometimes they're not already there. Sometimes, you have to create them yourself. Some of those opportunities that you want going out and saying, Hey, can I volunteer here? Where they may not have had volunteers before. So finding those opportunities that you want and that you think will help you develop towards your end goal. Justin Zych (34:53): I was just going to say really quick of course you two have been, you know, great examples of how females can Excel and create their own path. Justin Zych (35:08): The thing about mentors is with mentors, it's so important to have a variety of mentors because you're going to pick out different things that the mentors are going to help you with. One of my most influential mentors was a female. She was, you know, I was involved with her in the fellowship program that I was in. And she really helped give me some really blunt but helpful feedback that helped a lot with some of my soft skills. So I'm kind of exposing myself a little bit, but she told me that after my lecture, it was on the cervical spine. She was like, yeah, like the content was great. You just weren't likable and just kind of threw that right at me, let me chew on it a little bit. But that actually really changed how I approached a lot of different things and helped me develop those soft skills. Justin Zych (35:55): So at the same time, she helped me through some managerial struggles that I was having. So that variety is incredibly important. And I've been a mentor too. You know, some of my mentees were females and they're doing amazing things right now and I hope that whatever feedback I gave them, they took the right things from and continue to move forward. So it's an issue that goes across, you know, the gender lines. And as males, I want us to be aware that it's going on as well. And not to lead into that discrepancy that Karen described, but still provide that same level of mentorship, same level of opportunity and consideration. So it's a great question and hopefully the gap narrows as we go forward. Daniel Chelette (36:59): Oh, here's another good one. Any recommendations for a PT that is two years out and feels completely lost and, or in the wrong setting? Justin Zych (37:10): Yeah, so I'll start with that one. You know, of course understanding that I probably don't have the exact answer here. This really tied into my portion of the talk, which was the importance of the clinical environment within your first couple of years of development. And then also making sure that you understood that we clarified the difference between being engaged in your environment, in your system, and even in your organization versus being burnt out. And how those two aren't necessarily exactly the same thing. Burnout is something that we describe as more of like a longterm reaction with like physical manifestations where engagement is more of deciding how you want to use your remaining effort in the day, the effort that you can discern as I can do this to go home and watch Netflix or I can do this to really give back into my system. Justin Zych (38:06): So I actually had somebody right after the talk come up to me and just say that she really appreciated just hearing it and understanding that there are a lot of people that have that same sense where your question's coming from. So I just want to put that out there first of all. So I would say first reflect on what first off what you want out of your clinic and see what they are and are not matching. And if you've been in that for two years, that's a pretty good trial run to figure out if there's a different environment that maybe you would want to consider that's going to work more on engagement. What maybe that you want to be more involved in a clinical instruction and be a CI. Maybe you want to do some project management, have some more specific mentorship or it's just the way that they're setting up their productivity. So is it a question that I'm glad you're steering into right now? But it's gonna take a little bit of reflection not only on what your expectations are of the clinic and how you see yourself as a therapist but going even further, you know, keeping your system, your clinic accountable for are they meeting or at least trying to meet and keep me engaged in those environments. So we should, I wish you luck with that reflection. Amy Arundale (39:27): Nailed it. Daniel Chelette (39:29): Crushed it, man. I just got, I mean, that was a sick answer, man. That was right, right on the money. And the one thing that I would highlight is what I spoke on in my portion of the talk is try to strip it back and think, okay, like what am I about as far as life goes? Like, what am I passionate about? What am I into? What gives me energy? And then kind of builds yourself back up, okay, what as far as work goes, what aligns with that? And then why do I feel a disconnect with where I'm at? And are there ways that I can change my current situation kind of within it? Or do I need to you know, do I need to move on or do something different? Daniel Chelette (40:22): So I would try to use your personal passions and sort of your foundation of who you are as a person to help you kind of reset and try to figure it out. But you know, I think that's a great question cause we all go through it at some point in time. And you know, the concepts of burnout. Mm. Oh, reduced engagement and things. That's all part of the game. And those are completely, but I think burnout obviously isn't a good thing, but don't feel bad or guilty if and when you run into those things. Cause we're all humans. And, they can happen but know that there are ways that you can move out of that and move past that. And that's one of the cool things about PTs. There's so much to so many different things to do and get involved in. But yeah, great question. Amy Arundale (41:15): That passion was just like the one word that I felt like we needed in that answer. So I think those two are perfect.   Karen Litzy: So we're good. We hit all the questions. So I'm going to ask one last question. It's a question that I ask everyone and Justin, I'll start with you. Not to put you on the spot again, but given what you know now in your life and in your career, what advice would you give yourself as a new grad fresh out of Duke. Justin Zych (41:47): Okay. Yeah, no, that's an awesome question. I think the biggest advice that I would give myself is to not have expectations of quick motion, quick development. I'm going through. And in my talk I talked a little bit about, we were in Denver for CSM. So I talked about using the French fry approach with skis where you go down quickly or the pizza approach where you go slowly. So making sure that at times, I was looking at the, you know, what I would tell myself now is make sure that you're looking at just that next step and not focusing on the step that's three or four away. So that you're really present in those moments cause there's a lot of development things that you can potentially miss over as you're trying to really quickly make it to that next step. So take a little bit more of that ski pizza approach. Amy Arundale (42:40): Fabulous. Daniel, go ahead. Daniel Chelette (42:42): I think what I would say is it's a marathon, not a sprint. You know, it's as far as, you know, career goes in, life goes, it's not just, you know, going 110% each and every day. It's being able to look at the long game. So with the short game, kind of along the lines of with what Justin said, just keeping in mind that Mmm,  it's a marathon, not a sprint. You have to keep the big picture in mind. Amy Arundale (43:47): For me, it would be like give yourself permission and that I think that extends to a number of different things. But you know, one of the big ones is kind of self care, you know, kind of giving your self permission to take that time off or to let something else be a little bit higher priority. Whether that's working out or spending time with people, kind of give yourself permission to you know, take that step back and look at things from that 30,000 foot view. So you can really see that big picture. So I think that would probably be mine. Karen Litzy (44:32): Excellent. And then I feel like I've answered this question in various iterations over the years, but I've really think what I would tell myself. Yeah, right. Knowing what I know now and when I first graduated, which was quite a long time ago, would be from a career standpoint to get more involved. Whether that be in the APTA or sections or things like that. Because I really wasn't involved and from a personal standpoint is like I needed to calm down. Yeah. Like the Taylor Swift song, like I needed to calm down and that's what I would tell myself. Like I was always kind of go, go, go, go, go and I have to do this and I have to do that. And so I would tell myself like, calm down. Karen Litzy (45:27): Things will happen. Kind of echoing Justin and Dan, like I really that's advice I would give to myself is like, calm, calm down, you'll be fine. So that's what I would give to myself. So you guys, thank you so much. All of you for taking the time out and answering all the rest of these questions I think will be really helpful for people who are there and people who weren't to get a little taste of what we spoke about at CSM. And like I said, everybody's social media handles and info will be on the podcast website at podcast.healthywealthysmart.com in the show notes under this episode. So you guys, thank you so, so much. I really appreciate it. And everyone, thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.     Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

The world is real weird right now. But for many of us, that means some extra time to binge shows and attack our to-be-read piles. So Amy and Erin got on a Zoom call and recorded this special Quarantine edition of Broads and Books, where we're recommending binge packages to help you get through. Stay safe, stay weird, and don't hoard the toilet paper. _____Our picks this combine previously-recommended books and pop culture picks into special packages. Follow the links below to listen to the original Broads and Books episodes, where we dig deep into each pick!Package 1 Amy: Kill Bill (Movie); Bitch Planet, Kelly Sue DeConnick (Graphic Novel)Erin: Feud: Joan Crawford and Bette Davis (TV); I Like to Watch, Emily Nussbaum (Essays)Package 2 Amy: Bridesmaids (Movie); Yes, Please, Amy Poehler (Memoir)Erin: Robot Chicken (TV); Spoiled Brats, Simon Rich (Stories)Package 3 Amy: Fargo (TV); Chaos, Tom O'Neill (Nonfiction / True Crime)Erin: Queen of Versailles (Documentary); The Seven Husbands of Evelyn Hugo, Taylor Jenkins Reid (Novel)Package 4 Amy: Gay Future (Podcast); Y: The Last Man, Bryan K Vaughn (Graphic Novel)Erin: Cheer (TV); The Lost Girls, Robert Kolker (Nonfiction / True Crime)Package 5 Amy: Veronica Mars (TV and Movie); The Gone Dead, Chanelle Benz (Novel)Erin: The Good Place (TV); Good Talk, Mira Jacobs (Graphic Memoir)

Live from my personal Facebook page, I welcome Dr. Mark Milligan, PT, DPT from Anytime.Healthcare as he discussing how we can implement telehealth services into our physical therapy practice.  In this episode we discuss:  * How to set up a telehealth platform * How to perform an initial eval and follow sessions * How to bill (at least what we know right now) * The paperwork you need to start seeing patients today * And so much more!  Resources:  Anytime.healthcare Doxy.me Connected Health Policy/Telehealth Coverage Policies State Survey of telehealth Commercial Payers Telehealth Paperwork   For more information on Mark:  Dr. Mark Milligan, PT, DPT, is a board certified, fellowship-trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions. He is a full-time clinician with multiple patient populations and is the Founder of Revolution Human Health, a non-profit physical therapy network. Helping others create the best patient experience and outcomes through his continuing education company specializing in micro-education is also a passion. His latest venture is creating the easiest pathway to access healthcare for providers and patients with Anywhere Healthcare, a tele-health platform. He is an active member of the TPTA, APTA, and AAOMPT and has a great interest in the pain epidemic, public health, population health, and governmental affairs. Read the full transcript below:  Karen: (00:07): Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, dr Karen. Let's see. Hey everybody. Welcome back to the podcast. I am your host, Karen Litzy and in Karen  (00:40): Day's episode. I am sort of re airing a Facebook and Instagram live that I did last Wednesday with dr Mark Milligan all about telehealth. So a little bit more about Mark. He is a board certified fellowship trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions. He's fulltime clinician with multiple patient populations and is the founder of revolution human health, a nonprofit physical therapy network, helping others create the best patient experience and outcomes through his continuing education company specializes specializing in micro education is also a passion. His latest venture is creating an easy pathway to access healthcare for providers and patients with anywhere. Dot. Healthcare. This is a telehealth platform. He is an active member of the Texas PTA, P T a and a amped and has great interest in pain epidemic, public health, population health and government, governmental affairs. Karen  (01:41): I should also mention that he is also on the PPS coven task force. So if you want to get the most up to date information on how the coven pandemic is affecting physical therapists in private practice, you can find that at the private practice sections website. It's all free even for non-members. All right, now onto today's podcast. Like I said, this is a recording from the Facebook live that we did last week. And in it we talk about what is telehealth. We talk about how to set up telehealth, how to implement telehealth, how to conduct a telehealth session for an initial eval or for a followup. We talk about how to get paid for telehealth and this is the information that we knew at the time. That was last Wednesday. Like I said, things are moving really, really quickly here. So the best thing to do in Mark says this is to check with your individual insurance providers, check with your state things are moving really, really fast. Karen  (02:45): And of course finally we talk about answer a lot of viewer questions. So a big thanks to Mark and I think this is really timely and I hope that all physical therapists that if you're listening to this, that you can set up an implement your telehealth practice ASAP. Thanks for listening. So today we're talking about how to implement telehealth into your physical therapy practice. As we all know, the COBIT 19 virus is causing a lot of disruption in healthcare and we're hoping that telehealth can help at least mitigate some of that interruption for the sake of our patients, for the sake of our own practices and for our businesses and for our profession. So Mark, what I would love for you to do is can you just talk a little bit more about yourself, where you're coming from and why we're doing this interview. Mark  (03:34): So Mark Milligan, Austin, Texas physical therapists board certified fellowship trained, but also for the last few years have stepped into a telehealth space and have anywhere healthcare, which is a digital platform for delivering healthcare. It's agnostic to provide her, so PTs, mental health providers, anybody that needs a HIPAA compliant platform to connect with patients. So the current situation is it's pretty mind blowing, right? We're seeing a, a world changing epidemic that will change the landscape of healthcare as we know it today. For several reasons. One is that people will be now exposed to a delivery of care method that they weren't otherwise are supposed to before. So telehealth and tele PT and tele medicine had been out there for a long time. Teladoc started in, in 1987, somewhere in there. So it's been around for a long time, but a rapid adoption of telehealth has really occurring right now for physical therapists. Mark  (04:30): What we need to know and what are the most important things right now are how it applies to us in this landscape. How can we be the best providers to meet our patients? Demand to help quell fear, doubt and an anxiety for our patients as well as, as providers and our businesses. And so stepping into this space is, it's been a little bit overwhelming. It's been a nonstop 70, 96 hours really. And so everything that I say today may or may not be true and four hours or smart [inaudible] because of how fast things are changing. So yeah, I think that tees it up. You want to kick it off? Yeah, Karen  (05:10): No, I think that's, that's great. That's perfect. So let's start out with, we got a number of questions from people from different therapists from around the country. And I think let's start with the number one question is how do you actually set it up? Totally basic one Oh one. So let's start with that, Mark  (05:33): Right? So the first thing you have to make sure is that you have patients that want this. And right now everybody wants that, right? So patient adoption of technology can be challenging, especially especially generational. So the issue with in, yeah. Pre COBIT has been adoption by, by therapists and by patients just because of ease of use. Now it's a, it's a forced adoption. So now we're in a set up where we, where are going to want this regardless of whether or not they want it. So first thing is patient population. Second thing is you need to look at your business, right? You need to look at your patient workflow and your business flow. So you need to have the appropriate from a business standpoint, you need to have a liability to make sure that you're covered in the telehealth space. So in my experience over the past few years, almost every liability insurance cover, it doesn't see telehealth as a, is a different delivery mode for physical therapy. Mark  (06:26): But with everything changing rapidly, it would be real. It would be highly advised that you contact your liability insurance provider and make sure that tele-health is approved as, as in your cupboard. All right? So that's logistics. Secondly, you need paperwork, you need onboarding paperwork for digital visits. You'll need a telehealth consent form and you'll need the digital release form. And if you're recording visits, you need to have a very specific form that that allows you to record patient visits. Some States don't allow recording some. And so you have to be very mindful of that. So onboarding paperwork, it's, it's good to have in fillable PDFs so that a patient can fill it out and then send it back to you digitally. Making sure that that transmission is is secure. You can also have E faxes, right? So they can electronically fax to you over a secure portal as well. So just basic things that we haven't really thought about as providers we need to adopt as mobile providers. Right. So, Oh, go ahead. Karen  (07:24): I know, I was going to say, so when we're talking about who is the best, what is the easiest way for us as a clinician to get that paperwork Mark  (07:32): Right? So they can email me. I've gotten a tele-health consent. I've got I've got that. So they can just email me at market anywhere. Dot. Healthcare. And I can send 'em I'm been sending that out over Facebook. I'm happy to share that with people. And of course you need to make sure and adapt it for your state in your practice. It's a word doc so you can switch out the logos and everything, but I'm happy to provide that for people. They can pass that that step. Karen  (07:57): And then one more question on paperwork and things like that. So when we are calling our insurance, our liability insurance carriers, aren't there specific questions we need to ask them or like what is the best way to have that conversation with our liability insurance providers? Mark (08:16): Right. Just say in this facing time that we're starting to provide care digitally. Am I covered for providing telehealth as a physical therapist? Simple. Straightforward. Karen (08:25): Okay. And so you may already be covered in your current policy, it might be part of your current policy, you just don't know it and then you're not, is that then added as a rider to your yes. Mark (08:38): Typically it's a very inexpensive writer. Okay.  Karen (08:41): All right. So before we set everything up, we get our liability coverage covered and we get consent forms, which can email to you or you can share them on under this post. It's whatever you feel more, most comfortable with or what might be easiest. And then we do what we got the paperwork covered. Now what? Mark (09:06): So you're sending that out to the patient. So they need to agree to be treated digitally. Right now it's really an interesting space. The CMS has waived temporarily a HIPAA privacy with when it comes to digital communication. I'm can't stress this enough that this is a temporary wave in, in the absence of mass abilities to communicate or HIPAA compliant platforms that patient that people are able to communicate via other means of non HIPPA compliant video software. So right now Skype and FaceTime are considered and what's the other one? Zoom and zoom and those well-known platforms are, are open, enable all those zooms just increased their prices yesterday. Yeah, so I would argue that you could use the, what's free and what's available right now in preparation as you prepare after this is over, you'll need to go back to HIPAA compliance. So in the immediacy video platforms are readily available across all. You cannot use public facing video platforms like tick talk or other things that mass put out your video. Okay. Karen (10:22): Instagram live or Facebook live. You can have your patient video, you can have your patient treatment sessions over live video, Mark (10:30): Right. That it means sounds, it sounds obvious, but you never know where people will do right by a group session. You can just do a giant group session. I'm going to train everybody on the East coast of America on a Facebook live. Karen (10:42): Yeah. Okay. All right, so good to know. So no one social media lives like we're doing right now, but for the time being during this outbreak, we can use face time, we can use zoom, we can use Facebook, zoom, Skype, Mark (10:59): Right. Totally. And you need to make sure that in your notes and documentation for your intake software or your intake paperwork, that you are waiting, that the patient is waiving their HIPAA rights during this time due to the COBIT outbreak and you are using this unsecured software and you will return to it as soon as possible. Right. Okay. This is a window. This isn't something that will last. And you need to note for your own CYA that you are, you acknowledged the existing coven scenario and that you will prepare for post that with, with my platform. Yeah. Yep. So technology on the technology side, it's really easy because you can plug and play as long as you get someone's if they have an iPhone or if they have Skype, easy set up, you can connect technology there. So once you get the form signed, you have the informed consent, the HIPAA, the HIPAA included waiver as well to sure that they understand that they are on an, they have to understand and agree to an unsecured network. Mark (11:58): Even though you can provide it, some people may not want it because FaceTime, that's all easily hackable. Right? So so they may not, or may, they may, they may not want to agree to that. So just have to be transparent with them in the, in your services. Right. So once you get that, I mean, it's really a matter of getting the patients, depending on your system, everybody's so different. So if you're, if you are a concierge PT and you're practicing out there for a fee for service cash base, you handle all your own scheduling when it comes for their time, you just flip them and you just call them on FaceTime, right? You collect their face, their number and you connect that way and you do your treatment, which we'll talk about in a bit, some other scheduling systems. You may have to, you know, type in a telehealth visit and your scheduling system or have some type of a demarkation for a telehealth visit versus an in person visit. Mark (12:47): And so work with your scheduling software, work with who you work with in order to make sure that that's appropriate so you can have the right amount of, or the right type of scheduling so you know where to go and what to do and how to bounce it. A billing, again, for the concierge practices out there, this is fee for service. Tele-Health doesn't take as long as normal to as normal PT. So I have my hourly rate broken down into 15 minute increments because it's roughly about 15 to 30 minutes. Is it an average tele-health followup evaluations in the last 40 to 50 minutes? But it just completely depends. So fee for service, it's really straight forward. You just charge per time, per minute, dollar, dollar, dollar, $52 a minute to 15 minute depending on your price point. Karen (13:29): Okay. All right. So now let's get into, so knowing how to actually set it up. So we've got a lot of these different things. What are some other platforms? I know anywhere. Dot. Health care. Doxy.Me. Mark  (13:46): Yup. Doxy.Me co view. So anywhere. Dot. Healthcare is the platform that I created. It's straight forward. Right now I'm offering you a $10 a month, unlimited use for anybody for three months while onboarding everybody. So to, to help people get to see patients doxy dot. Me actually has a free version where that's a, a room where people meet. So you can actually sign up. The patient is sent a link, they click on a link and it drops them right in a meeting room. Super convenient, super easy. There's no bells and whistles and it's free right now. So you can do that. I think a couple of other platforms I've seen throughout the Facebook live of Facebook groups that I'm in a few platforms are pushing out a free entry level software right now. So it's everywhere. So I think Karen  (14:31): We'll use G suite Mark  (14:32): D suite, right? So G suite, if you have a BA with, with Google, you can use Google meet. Right now actually with the, with the HIPAA waiver that's happening right now, you can actually use Google hangout. That would be another appropriate thing to use as long as the other person has the G suite or Google doc, a Google suite downloaded on their computer. So there are lots of, there's literally lots of options now there, there are other companies that offer other features, right? As you get into anywhere that healthcare, not only as a platform, but also as a billing feature and a scheduling feature. Doxy dot. Me if you upgrade to the higher levels, has a scheduling feature, a messaging feature, all types of stuff. So it really looking for different platforms. You need to be, do your due diligence and test them out to see what fits your practice best. I mean, some, some have exercises that are completely a part of the package that you can just have an HTP that sends right out from the program. Some have an actual, a range of motion measuring system so people can move their arm or their body in front of them. The then they can actually measure range of motion live on camera, which is pretty cool. So it just really depends on the need for your, your practice and also the practice size. Karen  (15:44): Got it. Yeah. Okay. So that's a lot of options for people going from free to low priced too. Mark  (15:52): $200 a month for co for HIPAA compliance zoom. Karen  (15:55): Right, right. Yeah. Yeah. Okay. So lots of options there for people. So we know we need some onboarding paperwork and we need to call our liability insurance carriers to see if they cover telehealth. Presently. And if they don't, then we need to ask them to put an addendum on and you can, they can do that immediately. It doesn't take like 30 days for that to happen. Right. Should be immediate. Okay. And so once we have all of the right paperwork and everything we decide what platform we're going to use and you just gave a whole bunch of different platforms that people can use. So all of those platforms are pretty easy to set up. And like you said, you send a link to the patient, they'd drop in and boom, there you go. And at this time we can use Facebook and Skype and, and not Facebook, sorry, Facebook. We can use Skype, regular zoom face time, all that. Okay. All right. Now Mark  (16:58): You may need other equipment though. You may, depending on the situation you may need. So some people, a desktop versus a computer are versus a tablet versus a phone all matter, right? So a desktop computer tends to be really well for you to have good communication and see the patient really well. But it's also very challenging for me to move my desktop to show somebody how to get on the floor and exercise, right? So the part of being a a digital physical therapist is that you have to be able to move and your equipment has to move with you. So some people use, I, you know, some people use a selfie stick to demonstrate exercises, right? Some people have one of those little iPhone holders that can be multiple or wrap around something so they can have different angles or show people at different places. Mark  (17:41): So understand that desktop can be good for this face to face interaction and the, and the immediate subjective interview. But maybe moving towards the objective exam or, or showing the exercise parts you may want to find or have a different device that's more mobile. So just thoughts for that. And you also need to think about your area or your headphones, your microphone and your lighting that can all add or take away from the experience of the digital experience. So making sure that you have those things. I use, I'm old school. I just use the old wired ear buds. They, when you're on the computer a long time, the wireless can die, right? And then all of a sudden you don't have new headphones. So I'm always a fan of just good old fashioned things that won't die on you after a long day of work. Mark  (18:26): So something to think about. You also may want to get a tripod to hold up your computer or you can get a standing desk. So there's lots of options in that space. But also you have to be considered for your backdrop. I love your backdrop that you have there in New York here and with the, with the cherry tree, that's all. It's very Boston's. That's awesome. I just have a plain white wall. Just be mindful of the environment that you're delivering this care in, right? You don't want you to be distracted. You don't want the patient to be distracted. You need to connect with the patient. Some of the key things that you need to think about are the connection that you're going to have with a patient. Something you can do easier face to face. It's challenging to get the connection and to have the emotional connection with the patient by a digital care. So setting up the environment for not only you to feel safe and, and that you feel comfortable that you're, no one's going to bust in, but also your patient needs to feel safe in that space too, so they can communicate to you in a free way that their patient information isn't being broadcasted to other people as well. So backdrops, microphones, computers, tablets, all have to be taken into consideration while you're doing this, while you're doing this intervention. Karen  (19:32): Okay, thank you. Those are great tips. How about cats that could, that could help or hurt you. Right? People love a cat. Great. If not, it can be a problem Mark  (19:44): Or at least they're not allergic to it. They're alerted to it. It doesn't matter. Right? So Karen  (19:47): Right. So pets can help or hinder, just kind of depends. Okay. So we've got, let's say now everyone has a better idea of how to set it up. And then the next question I got was how, Oh, they said this is great. Sound isn't great. I don't know why this sounds not great on, on Instagram, but, well, I mean it's going to be out on it as a podcast as well. So we'll, you'll be able to hear full sound tomorrow. At any rate, I dunno what to do. I could get my earbuds, but as we just said, what if they time out on me? Yeah. Okay. So let's talk about let's talk about how do you, what was it? How did, Oh, how do you actually execute a session? Mark  (20:40): Yeah. So once you've got somebody on the line, once you've got a patient in front of you, right? We know from our PT and our PT exam that about 80 to 90% of your differential diagnosis occurs in the subjective. So you go back to your old way of being, you shut up and you listen to the patient. Right? So, you know, so this is also assuming that you're doing an evaluation via telehealth, right? So most people at this space have patients that they'll flip from brick and mortar or in person into telehealth. So that's a different beast, right? So that's followup. That's exercise progression. Those are obvious things, right? That you're going to show them. You're going to talk them through their progression and talk to them about what they need to do next. Maybe show them a few new exercises when you're, we're, we're going to get, what we're talking about right now is the new patient that you'd never met before and what, how do you gain information to get them treated? Mark  (21:33): So subjective is key, right? You need to have your differential diagnosis hat on. You need to ask the next best questions, their intake form. You should have looked over, created your hypothesis list and make sure that you have a good idea of what you're trying to discover. It's your responsibility as a provider. I know it's written in the Texas legislation that if you, if the patient is not appropriate for digital care, you have to get them to an in-person provider, right? So doing your, you still have to do your red flag screens, you still have to do your due diligence and your differential diagnosis and make sure the patient's appropriate. Right? This is, you have to consider a digital visit to be no different than an in person visit. You have to take every precaution that you would take. I'm minus taking vitals unless the patient has their own, you know, portable, vital kit. You're gonna have them do that. But you have to take every precaution you would from an initial evaluation perspective as you would in a digital space. So going back to forms, you also have to have your intake form and consent to treat in there as well. That needs to be signed off as well. Karen  (22:31): So the, the same sort of forms that someone would have if they were coming to you or if you're like a mobile practice like me, you have them sign that initial paperwork regardless of whether you're seeing them in their home, in your clinic or, or via telehealth completely. Mark  (22:48): This is, you cannot be this any differently. Right? So take it, having all the consent to treat forms, signed all your intake paperwork done, differential diagnosis, red flags, you know, your three tiers. Are they appropriate for physical therapy or are they a treat and refer or they refer. You have to have that, you have to have that hat on. And so if they're presenting with sub with symptoms that aren't musculoskeletal and presentation, you need to be mindful of that and get them to the approved provider, right? So you have to be a triage at this point. So once you get through and determine their appropriate for intervention, you have to get your thinking hat on, right? This is where, this is where things change. And as a mobile PTM, I know that you have walked into somebody's house and been like, huh, how are we going to do PT in here today? Mark  (23:32): Or you have to completely be a problem solver. Think about being a problem solver on steroids when it comes to digital health. Right? Because you didn't have, at least in someone's physical environment, you can see what they have available. Right? If you treating me right now, all you would know is I'd have a white wall behind me. You don't know what chairs I have. You don't know what equipment I have. You don't know anything that I have. So asking them about what equipment's available is important. I take all my patients, depending on what they have, if they have, my most common thing I treat is, is back pain. So most commonly about 20 to 40% of patients, that's 20 to 30% of patients will fit into some type of directional preference when it comes to low back pain. So I take them through an active range of motion our digital active range of motion to see what exacerbates or relieves their symptoms. And if, and if repeated extensions and standing it relieves their symptoms, I go why? Clear out other things, but I go right into treatment. Right. So you can use progressive movements, repeated motions right in your treatment from the get go the same way you would do in the clinic. Mark  (24:35): Some of them prior, Karen  (24:36): It's New York. I don't even literally grown even here at anymore. It's just did with something there. Is there the engine going up, I don't even hear it. Anyway. Mark  (24:46): White noise. White noise. Yeah. So you have to go through your objective range of motion in your objective measurements just like you would in home or in the clinic at home. So knowing your physical exam and having a musculoskeletal screen is super important. So if I have somebody with radiating arm pain that I'm treating, where's my arm on my camera? If I have somebody with radiating right arm pain, I'm going to take them through cervical active range of motion. I've actually even had people do over pressure to themselves. Right. To see, I've had somebody to do their own spurlings to see if it's ridic. So you have to get really creative teaching someone how to do a UNL TT a on camera is because you have to back up. Right? That's another thing. You have to have visibility and you have to have the ability to see what the patient's doing and also correct them while they're doing their motion. So I take my patients, do as many physical exams that they can do on their own without, without me being present to do it. Karen  (25:45): Yeah. So I think it's important to note cause my good friend Amy Samala said, can you do this for brand new patients in your practice or is this just to be used for existing patients? So I think Amy, I think we're covering that right now, that yes, Mark is sort of taking us through how he might do an initial evaluation with someone via telehealth. Mark  (26:05): Totally. Totally. Now I think we should probably circle back to billing again and payment. I think we, we've, Karen  (26:12): Yeah, yeah, yeah, yeah. Let's definitely talk about that. And one other thing that I, I want to make people aware of, Mark, is how using you want to have space. So not only you want to make sure that not only your patient has space or depth, but that you do as well as a therapist because you may need to step back to show them something and then come closer. Mark  (26:33): Right. And I've I often, so I have a flat couch in the back, so I have this couch that's right behind me so I actually use that. I pushed my chair of the way and I show repeated extensions and prone. It's a six or seven foot long couch and I show double needs to test and I sh if I mirror exercises for patients. So you cannot do everything verbally, you can't. Could you imagine telling somebody, okay, I'm going to walk you through a double a single knee to chest with words only. It becomes extremely challenging. So you get up and you move. I just hop on the couch. I'm like, all right, so you're going to lay on your back. You'll grab both knees. You see my hands on the outside of my knees. Knees are slightly apart. We're going to pull that all the way up until you feel a big stretch in your back and I show them. Mark  (27:13): I walked through the exercises with them. Same thing with, same thing with nerve glides, right? If I'm doing a U L T T a I'm going to say, I'll bring your a shoulder all the way up. Like you're going to put those little, or you CC that you're going to put the little ion right and then you're gonna lift your elbow up and see if that changes it. Right. And so you have to walk them through. It's easier for them to mirror you than it is to say, okay, you need maximum shoulder flection with external rotation. NOLA deviate. Like you can't do that. Karen  (27:39): Yeah, we know jargon doesn't work. Yes. You can never say that in an NPR. If you are face to face them, you would never just sit there with your arms folded and be like, okay, flex your arm to hear externally. Like if you just want to do that, you wouldn't do it. I think it's important to know that we can still certainly in well versed in strong verbal communication in this space. Oh, that's nice. From work. Yes. Or there was a delay. Oh, okay. So I think we're good. So Amy said, yes, sorry, there's a delay. She's all the way in New Jersey, so forgive the Jersey part. Yeah, New Jersey. Okay. all right. So I think people get an idea that yes, this is how you can set this up. You just want to make sure that each of you have enough physical space to do everything that you want to do. That yes, you can do your initial evaluation. It's all about the subjective, in my opinion, in that initial evaluation anyway. Definitely. and then once you see them for the initial evaluation, as you start progressing them, like you said, it would be like any other exercise progression you're just not putting hands on, but it can be done. Mark  (28:51): Definitely. Definitely. If you think about the interventions that we do in the clinic that you can apply to home. So I work with people that you know, that don't, they may not have good balance. So safety is a, is a concern in that space. Right? So I talk people in a corner, I show them what it looks like to get into a corner with a chair in front of me or in front of my couch or the chair in front of me and teach them how to do single leg stance while having my fingertips on the chair. Right eye. You have to physically show people what to do so they understand that better. And so like you said, it's about being able to show and speak at the same time, right? Because a lot of the field like nerve tension testing, a lot of times it's, you can feel the tension before the symptoms ever get there. Mark (29:34): So you have to educate somebody that has a really angry nerve that's a, it's a hot nerve and say, look, we're just going to take this up until you barely feel it. Right. We're just going to touch it. And then if you feel it there, just bring it back down. Right. You, you can't rely on your hands to feel that tension anymore. Not that we can reliably feel it anyway, but we want to make sure that we prime the patient for success. Right? Communicate expectations. Like we're going to do some discovery today. We're going to walk through a lot of different movements to see what's happening with your body. See if we can figure out ways that we can help you feel better through movement. Cause that's what ideally what we're going to do, right? We need to make sure that we enable patients and make them feel safe and comfortable that we're going to help them. We're going to take them through this. We just need to, we need to communicate to that. This is going to be something that I should be completely comfortable with. Yeah. Karen  (30:24): Perfect. All right. Now let's get to the part that everybody really wants to know about billing. Someone. let's see. Oh, Mark Rubenstein also New Jersey. He had kinda some of the same questions. No, I have nothing against New Jersey, New Jersey. So he kind of had the same question I had before we went live. He said but Medicare will only pay now for existing patients as per info yesterday. So this is the info, I guess on that evisit versus tele-health. So can you kind of give us, cause I know just for background, Mark is a part of a PPS task force and he is really being updated a lot. And I'll let you kind of talk a little bit more about that and, and how you are helping to work the billing aspect of things and the difference between an evisit and tele-health. Mark  (31:20): Right. I'd like to first shout out to the PPS members, Allie shoes and the I and alpha are our lobbyist for the APA. We are meeting for hours daily and we are, so everyday we have scheduled calls on this task who have a task force. We're pushing out content on the APA plus the PPS site. So there are 18 to 20 people that are hard at work to get, to gather information, to interpret it and then to question it and then make sure that it's legal. Right. Because there's information that comes out that it's great information, but it may not be legal for us to do based on practice act. So there's, there's a federal level, then there's the, then there's the PTA level, then there's the state level, then there's your individual insurance levels. So there's a, there's so many different paradigms. It's not just a cut and dry situation. Mark  (32:06): So right now, some of the biggest things that we're working on behind the scenes with this PPS task force are really are defining out what it means from Medicare as it relates to the visit ruling. So E visits technically are not telehealth. Medicare is not calling these eVisits tele-health. They're calling them eVisits because they derive them from the medical, from the MD coding as, as a bra, a brief and abrupt follow up to a situation where the patient is in an engaged patient. So imagine somebody who may not be feeling well after seeing, having a doctor's appointment just to follow up to touch. So the visit codes right now can only be billed based on time, so their cumulative time and there are three levels. The max level is 21 minutes to be billed one time over a week. And so you add all the time for one week and over 21 minutes is the third code. Mark  (32:59): And that can only be a build a once every, well in seven one time in seven days. There is a question right now about whether or not that code can be repeated the next seven days. That information has not been gotten yet. We have not had a clear answer on that. So please be patient while we investigate whether or not that code can be repeated the next week. So right now, currently we are still working on whether or not now that these eVisits have come out, the question is now whether or not CMS sees us as telehealth providers, which upfront does it look like they do. But we still haven't gotten for Bay. We still haven't gotten the, the appropriate word from CMS whether or not we are. We are providing tele-health, which they said we're not. So we can assume we can assume anything. Mark  (33:49): But so they said we're not providing tele-health, but we think they will. They won't include us in the, as a telehealth provider, which is extremely important because if they don't consider us Medicare providers, then we can, well, I'll wait about Medicare billing Medicare patients, we'll, we'll wait to hear what happens. I'll have to have an update on that. And so right now we are not approved providers for telehealth, for Medicare. And we can build he visits with an established patient that has to make contact through a patient portal to the provider to request their evisit. Now it's been clarified that you can notify a patient that they have the option of that type of care. You can tell the patient, Hey, you know, we're not treating people in person, but you do have the option for an evisit. Here's how you do it. If you choose, if you were to choose to have an E visit, you would go to this part of our website to our port, your patient portal and request a visit so you can prime patients to go utilize that service. Whether or not you can only do that for one week or multiple weeks, that's in question. Karen  (34:52): Okay. And a patient portal is not Skype zoom face time or any of the telehealth platforms that is not a patient yet. Mark  (35:04): Well, some platforms have a portal, some, so it has to be a patient portal. So it has to be a place where a patient can log in and request a visit. And so we're still also waiting for a clear definition of a patient portal. But for our understanding the patient, it's a place where the patient goes to get their information or connect or message their provider. Right. So right now that's still being clarified through CMS on the other private payer front and medicate well, so Medicaid is being rapidly adopted by payers all across the country. Right. So we've seen, I know Louisiana is about to release a wording today at some point. I know that I think Minnesota, I think that a few others have already, Medicaid has already blasted that inflammation and that are, that are, that there are approving and paying for telehealth or physical therapists, payers on a national level are all over the place. Mark  (36:00): So if you are a, in the work provider, you need to call your payers and ask very specific questions and we have people working on this across the country. You have to ask them if your patient has tele-health benefits, you need to ask them if those benefits are payable to a physical therapist. So if a therapist is a PT, a paid as a payable provider of telehealth services, if they need any modification codes, right? So like an Oh two location code modifier, right? That needs to be asked and then what CPT codes they reimburse for. Okay. Right. So manual therapy is not going to be one, but neuro, our neuro they're ex their acts home care, self care, all of those codes should be available. And it just depends on the, on the payer and the carrier. Okay. I have a Google doc that we can link that I'm trying to collect that data from across the country. Mark  (36:58): So people can have open access to it that I can send you that link here and it's on a couple of Facebook pages. But we're trying to collect that data so people can see because, and you don't put any reimbursable fees, don't breach your contracts, don't talk about a fee per schedule, but where you're scheduling fees or your fee schedule. But I'm just put whether or not they pay if it's parody, right? Some States out parody. So here's the kicker. Parody States doesn't miss it necessarily mean payment, right? And this is a, this is a very confusing, a very confusing thing. So somebody says, Oh, we have parody in the state so that, and then we are going to get paid equal in person as we do digitally. Just because you have parody doesn't mean to pay your pace for telehealth, right? They may pay for physical therapy, but they may not pay for tele rehab, right? Yes. Check. Karen  (37:47): Why can they just not make this easy? Mark  (37:50): Right? So you can have parody in a state and you could have a parody law and then the payer not even pay for telehealth. Right? So there's nuances upon nuance, on nuance. And in some States, some carriers have contracts with larger telemedicine providers and their members can only have telehealth through that tele provider and they may not have tele, they might not have tele PT. So then they had no tele-health, physical therapy option for that payer. Does that make sense? Karen  (38:28): Okay, so I'm going to just do this. So for example, I'm just going to take a for example, and tell me if I heard you correctly. Oh one more thing. So Rina said, we're talking about the visits, that's all specifically for Medicare patients only the egoist. Yes, yes. Mark  (38:46): As of now we have, we are unaware. I am unaware. I'll say that of any payer that's adopted the evisit policy and that's as of our Medicare Copa. Our coven call ended at noon today. So I don't know. That may change. Karen  (39:02): Okay. So let's talk about your individual. Let's talk. Oh, somebody said, Oh Mark, can you bring your microphone closer to your mouth? But you've got the ear buds in, Mark  (39:13): Right? So I have my phone a lot. Loose ear buds are going to the computer, but now you see if you can bring the microphone closer to your mouth, then they see my giant fivehead here and I'm like, I mean, how about if I go, that's fine. We'll do that. Karen  (39:32): We'll do that. It's fine. It's fine. Okay. Oh, so here, let me just ask some, get some of the questions. So Kim wants to know, she's in New Jersey also. He lives in New Jersey, but her practice is in Brooklyn. How do we find out if our state has parody? Mark  (39:51): So again, I, the, I will link you guys to the center for connected health policy and I also have a link to the parody in the different States. So I have links to both of those that I can give you, that we can add to this. Karen  (40:07): Yeah, we can put that in the comments under this Facebook under the live here. Mark  (40:12): So where, and so the, the commercial parody book is only 150 pages of nice, easy light reading. Where should I go for Facebook live? Karen  (40:23): Just go, if you go to my page, just go to me and then you can put it in. You'll see, you'll see us. You can put it in the comment section or we could put it in the comments section. When we're done with the live, we can add it in as well. Mark  (40:35): Oh, there we are. All right. So I'm dropping it in the, yeah, Karen  (40:37): You can drop it in right now too. Mark  (40:38): There's the parody laws. Here is the fact sheet on the UpToDate. This is a live document on what's happening in the world right now. As far as tele-health policies and procedures across the country. So those two documents should have a lot of information. But here's the kicker. Just because the state has a parody law doesn't mean that, that, that the payers have a policy that reimburses tele PT, Karen  (41:08): Right? So parody and, and just to be very clear parody means because you, you can do tele-health because you see them in person. So it's like Mark  (41:20): No. So parody only means parody only means payment. So parody means if they have a parody law and they both reimburse for inpatient physical therapy and for telehealth benefits, they paid equal. Karen  (41:32): Say again Mark (41:33): If the, if the, if a payer say let's let's say blue cross blue shield, if that, if that patient has a blue cross blue shield policy and they have a physical therapy benefits and they have tele-health benefits that a physical therapist can provide, they pay equal. Right. Okay. So it's the same face to face as the say. So because a lot of insurances will the 75% or 50% of impersonal versus digital. So it's literally a payment equality clause. Karen (42:02): I see. Okay. Okay. But you have to call blue cross blue shield because they may not actually, that patient's policy might not include tele-health. Mark (42:13): Right. And then even if they have a parity law, you're not getting paid for it. Karen (42:17): Got it. Right. I got it right. It's okay. Kim. I hope that my inability to understand help you. Dah, dah, dah, dah, dah. Can hear Mark fine. I'm physic. Oh, Deborah joy Sheldon. She said, is there a particular language that needs to be included in the documentation? So when we document the visit, how, so? Let's say we know how to set it up. We have the visit, how do we document it? Mark (42:47): Right? So you typically documented as a telehealth visit. So there's no you, your billing will coat it with an OTU location modifier, but you need to denote specifically that it was a digital visit. Okay. Yeah, that's the, Karen  (43:02): Because we just got a question on what's the location coding for telehealth and you just answered it. So Abby, I hope that that helps you. And [inaudible] can we skip insurance and just bill cash or has this new E health stuff messed that up? Mark  (43:26): So that's unsure right now. So the visit has, it's not considered telehealth by early information. That's not considered to be telehealth. We are still not telehealth providers by Medicare. So that should not impact that. That's my, that's my personal uninformed or relatively informed opinion. Please don't take that to anybody else. We're still discovering that. And private payers still do not, are not adopting that yet. That we've heard of. And so you should, Mark  (44:01): If you are currently billing or having people pay cash in there and they do not have coverage, then you should be able to continue doing that. Does that make sense? Okay. Right. I mean, you need to check your contract language. Where we get sticky is, is this considered a non-covered service by a policy? Right. So this is where the sticky sticky comes in. Okay. Is tele-health considered physical therapy just delivered in a different manner, not a non-covered service, right? Yeah. Yeah. Well that V that opinion varies. And so if it's a non-covered service for Medicare, you can, they can, you can charge cash for that service. Right? And so, and that also applies to other payers. Correct. So if, if your payer has a policy that considers telehealth to be reimbursable by PTs, you wouldn't be able to pay, have them pay cash. But if Karen  (45:03): Your individual patient's insurance does not cover telehealth right, then can you charge the patient cash? Mark (45:12): I'm not a healthcare attorney. But we're doing that. Karen  (45:16): Where the heck, I know she's on here somewhere here in Jackson. I know she's watching, I saw her log on, Karen  (45:23): Come on or Jackson answer that question for me Karen  (45:25): Or an answer that question please in the comment section if you're still watching if not, maybe we can ask her or care Gaynor through the APA might be able to answer that question. So again, that question is if Aaron's still watching is if your patient's specific policy does not cover telehealth, again we'll use blue cross blue shield. So they have blue cross blue shield, they do not cover telehealth. Can you charge cash to that patient if they don't have it covered on their policy? Mark (46:02): That is a good question. Yeah, that's a great question. And I think, I mean I, I think I know what my answer would be but I cannot speak as Karen (46:12): Brought any information to anyone or misleading information. So maybe that's something we can ask Cara Gaynor on Twitter. Maybe she can answer that or if Aaron is still listening, maybe she can pop that into the comment section at some point. So Mark (46:28): And having amazing people that are listening that can help. Yeah, exactly. Taking, cause this is a, this is a mad house right now when it comes to legislation and information. So it's all over the place and apparently so yeah, it's just all over the place. We can't information that was [inaudible] I did hear that. Some of the bigger things for Rhode Island and for Pennsylvania this morning, that the governor, the governor assigned legislation that would massively require all payers to pay all providers for telehealth. All right. Yeah. Yeah, yeah. Okay. One other big question that comes up is location for these for, for billing. Right. And so the word from CMS is the, the, the POS code is the location of the billing practitioner. So in the case where remote services are rendered it does not matter where the corporate address of the billing provider is either, nor does it matter what the beneficiary's address, it matters where the services was rendered. That is where the biller is located. Okay. All right. So when that happened, Karen (47:43): Put that into like example. Mark  (47:45): So when that happens, let's say yes. So if you are, New York has parody, right? Or you got to know you guys have compact revolution, right? Correct. I thought you did. So let's say you're a large provider and you have multiple States that you are in charge over that or multiple States. You treat patients and you're billing Medicare that the, the, the service in the, in the billing, in the service location code is the place where the provider is located. Karen  (48:18): I see. So like for example, if we use something like Athletico like a big gigantic company or maybe someone like, I think Michelle Kali has some places in Rhode Island. I think she just went to Massachusetts, but the headquarters is in Rhode Island. So if you're a therapist in their Massachusetts office, you're using Massachusetts. Mark  (48:40): No, you're using wherever you are and delivering the code. Deliver. Karen (48:43): Where do you get where you are? Okay. Mark  (48:45): Okay. Yup. Karen  (48:46): Okay. and then Michelle Townshend said, how does this work with EHR? Ours? Mark (48:55): Yeah. So eeh Karen  (48:57): So she is looking at a separate telehealth provider from our EHR who also does our billing. Mark  (49:04): Right. So EHR is, there's only a handful of the HRS in the physical therapy space that offer tele-health as a part of the platform. I think PT everywhere is a platform that has that has it built in. And self doc is another ER EHR that'll be live and in the next couple of weeks they'll have a platform within six weeks. But most of them are stand alone freestanding. So you just have to find the best system that are set up that can work simultaneously with your other systems. There's really no way to unless the company has an integration with your EHR, which the HRS don't like to integrate with people because that's patient data and it's a, it's a whole hot mess. So most of these are just freestanding side by side. So you'll have your EHR on one side and you're in your camera on the other. So you just do, and that's what I did with anywhere healthcare, it's just basic connection so you can document everything ever somewhere else. Okay. Karen  (50:03): All right. And then Debra says, Mark, my state has parody related to my hospital being F, Q, H C I do not know what that means. Any insight on that? So what does FQHC mean? Any thoughts if not, maybe Mark  (50:25): It's a federally qualified health center federally. Okay. So they have parody. I don't think I understand the question. Karen  (50:33): Yeah. In my S my state has parody related to my hospital being FQHC. Any insight on that? Mark  (50:40): Oh good. So she Oh, she said they have parody. Karen  (50:43): Yeah, they have PR has parody. Yeah. Mark  (50:46): I'm unsure on that. That has to parody is I've, I linked that doc into the live on Facebook. I can look up parody by state and by organization. Okay. Yeah. Karen  (50:59): Okay. Let's see. Let me we already touched, so I'm just kind of, what paperwork do we need? We talked about that. Oh, what if you're not a Medicare provider? Gosh, all right. Dah, dah, dah. Oh, we are usingG suite and doxy.me. This is from,uKelly Dougan, I think. Yeah. But haven't started officially yet. We have an ABN and I wanted to have liability form as well. So those liability forms, that's something that we can, that you can maybe share also on this link here and people can make it their own. Is that by liability? Like the patient has to sign off on saying yes, I'm okay with having telehealth. Mark  (51:51): Is that of course for me. Yeah, I would assume that what she's saying. Yeah. So I'll, I'll create a, I'll create a Google drive folder and drop a link in to the chat Karen  (52:05): And then one other, we've got two other questions. So to clarify for service location code, so that you said that, is that like the OTU code? Right. Okay. If I or any of my PTs are in their own home while tele-health with patient, is she using her home address? Mark  (52:28): Oh, that I can't answer that I haven't gotten, yeah, that would be a billing question. That hasn't been brought up, but I, we have a meeting tomorrow morning and I'll ask that question. Karen  (52:39): All right, Kimmy, we will get to that. Mark  (52:43): We're saying the PTs can just stay home and bill from there. But Medicare has specific guidelines on origination sites. And I know if origination sites apply to eVisits versus telehealth. That very question. Do origination, do originations, I'm writing it down so we can ask this to origination sites. Apply to eVisits. Yeah, cause that's, that's a game changer too. Karen  (53:11): Yeah, yeah. Oh, sorry. She said, sorry, I meant to say service location. Did you clarify for service location address? If I or any of my PTs are in their home while doing telehealth, do they use their home address or does she use her address? So Kim, like lives in New Jersey, her practice in Brooklyn. So that's a really good question. So, Kim, maybe we can get back to you with that answer. Mark  (53:33): And is she a Medicare provider? Karen  (53:35): Kim, are you a Medicare provider? I think so. We'll see. We're on like a 22nd delay. Mark  (53:43): Yeah. So I'll ask, I'll ask service location for employees versus brick and mortar versus mobile provider. Karen  (53:52): Perfect. And then Sarah Catman says, if you are licensed in more than one state, but only practice, may single state, can you only do telehealth in the state you practice in or can you do, hello, hello, hello. Telehealth and States you are licensed in. Mark  (54:12): Yeah. So that's where it comes to state rules and regs and yeah. So everywhere that you have a practice reciprocity or you have a licensed in other States, as long as they, you are allowed legally to practice tele-health in that state. Yes, you can practice telehealth in that state. I mean it's, but you have to sit, you have to make sure to abide by the rules and regs when it comes to our the licensure compact of the rules and regs of the state that the patient abides in or they live in. Right. Cause that's just compact language. So like I can do tele-health and Missouri, but they don't have direct access. So I would still have to have direct access or I'd have to have a referral for that patient if I want to open Missouri. Right. So like example. Yeah. so I think, yeah, so we have to make sure that you abide by the laws of the state that the patient resides in. But yes, you can do tele-health across the country. That's the beautiful thing about the compact, right. Compact allows for us to practice across this country with with little, with, without a lot of that a lot of restraint or not restraint, but a lot of challenge. Karen  (55:20): Okay, perfect. All right, so we're at about an hour, which is as long as I think people's attention spans are, and I think we have an apparently as long as Instagram will go live. So if anyone has any other questions, please you can keep adding them into this feed here and we'll try and get to them as, as best we can. Thank you Mark for dropping that stuff into dropping those links in here. And again, we'll get some of the, the onboarding paperwork from you and maybe can drop it in here as well, or you can point us to maybe where it's been put in other Facebook Facebook links. But yeah, everybody, you're welcome. You're welcome. And Mark, thank you so much. This was above and beyond. I think what you had to do but I think we all appreciate you so much because we're in a time where there's a lot of uncertainty and tele-health is at least a way to one, keep our patients healthy and moving and to kind of keep our practices going as best we can in these times because we don't know. Mark (56:38): Yeah. We don't know. Karen  (56:41): Okay. Mark  (56:43): Yeah, I think, I think, I think as a profession we need to remain calm and PT on, right? Like there's a lot of things happening right now. There's to be the, the future is unknown for us as a healthcare profession. All I do know is that it's going to be changed on the other end. This will no longer be an exception to the rule. This will be an expected method of care. People will, will now grow to understand that digital health is a real opportunity in every aspect, not just in, in telemedicine. So I think if I can say one final thing is just be prepared to adopt this and, and, and set up your systems for the long game. Not for this short, immediate, even though the immediate needs to happen. We have things in place like the waiver for using different platforms just to make it happen while it is, but set your practice up, set your systems up for a long game to provide digital care to your patients. Because that's where we're going to go. Part of it is so yeah, but be patient with each other, love each other be kind and wash your hands, Karen  (57:49): Wash your hands and don't touch your face. Yeah. And be mindful of the people if you are still, if your offices are still open, be mindful of the people coming into your office. If you are a home health therapist, be mindful of the people that you're that you're going to be treating because they may be in that vulnerable population. And because we, there's so much that we don't know, just be very mindful of how you're doing that and utilizing telehealth is a great way to have that extension of care for our patients, so. Mark  (58:27): Right. And feel free to reach out to me market anywhere. Dot. Health care. I'm here as a resource. I'm trying to be as available as I can. I have to go to the bathroom occasionally or drink some water, eat some food, but I'm trying to be as available as I can in order to help help us transition and get through this, navigate this time. Karen  (58:45): All right, well Mark, thank you so much. Got it. You've got everything there. Check out. Also, check out Mark's platform anywhere. Dot healthcare. I'll be happy to give a plug for that of course. And thank you so much. I really appreciate it. This is everyone else on this, on this call, so thank you. Mark  (59:01): Beautiful. Thank you. Karen  (59:04): Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

My recent episode with psychotherapist Amy Van Slambrook had me so intrigued I needed to have her back on the show for more. So Amy has returned to The Business Fighter this week to talk about her own story and some of the circumstances that led to her doing the great work she does today. We talk about surviving trauma, Coronavirus, and more!

This week the girls were supposed to interview Liz Lilly, but she had the flu, which has been making the rounds. So Amy and Penny had to improvise and they came up with a list of five questions to ask each other, this hard hitting and insightful will get you right in the GI tract.

Amy's 12-year-old daughter Stachira really loves having responsibility at the house. She also gets really invested at cooking times. So Amy decided to teach her daughter how to cook on their gas stove, but her husband isn’t having it. Lunchbox went Christmas caroling at almost the end of January. He went singing to people’s houses that still have Christmas lights on. New evidence has emerged about Eddie and if he really did see Taylor Swift driving her own car in town. Learn more about your ad-choices at https://news.iheart.com/podcast-advertisers

In our sixth See It to Be It podcast interview, Amy C. Waninger speaks with Robert Cartwright Jr., a division manager of Bridgestone Retail Operations in the Northeast Region, about all things risk management. Robert is highly skilled and knowledgeable in risk management and is a very well-respected mentor and leader in the space. Additionally, he serves as chair of the Diversity and Inclusion Advisory Council of RIMS. They talk a bit about how he got into the field, and Robert explains to us how risk management intersects with just about everything.These discussions highlight professional role models in a variety of industries, and our goal is to draw attention to the vast array of possibilities available to emerging and aspiring professionals, with particular attention paid to support black and brown professionals.Connect with Robert on LinkedIn and Twitter!Find out more about RIMS - they're on Instagram, Twitter, Facebook, and LinkedIn.Visit our website!TRANSCRIPTZach: What's up, y'all? It's Zach with Living Corporate. Now, look, every now and then we try to mix it up for y'all, 'cause--so look, dependency and consistency is really important, but even within those lanes of consistency, you gotta have a little bit of variety, you know what I mean? You don't come home and just eat the same thing every day, or even if you do--you know, you got a meal prep thing--maybe sometimes you put a little red sauce. Maybe sometimes you put a little green sauce. You know, you gotta just, you know, mix it up from time to time. Maybe sometimes you grill it. Maybe sometimes you saute. Maybe sometimes you rotisserie. You gotta just--am I hungry? Yes, I'm hungry, y'all. My bad. Listen, check it out. We have another entry for y'all from our See It to Be It series. Amy C. Waninger, CEO of Lead at Any Level as well as the author of Network Beyond Bias, she's actually been a member of the team for a while now, so shout-out to you, Amy. Yes, thank you very much for all of your work here. And part of her work has been in driving this series called See It to Be It, and the purpose of the series is to actually highlight black and brown professionals in these prestigious roles, like, within industries that maybe we--and when I say we I mean black and brown folks, I see y'all--may not even know exist or envision ourselves in, hence the name of the series, right? So check this out. We're gonna go ahead and transition from here. The next thing you're gonna hear is an interview with Amy C. Waninger and a super dope professional. I know y'all are gonna love it. Catch y'all next time. Peace.Amy: Robert, thank you so much for joining me today. How are you?Robert: I'm doing great, Amy. How are you doing today?Amy: I'm doing quite well. I was hoping that you could tell me a little bit of how you got involved in risk management and what about it appealed to you.Robert: Okay. Wow, so I have to go back a little bit, because risk management was not a field that I had even thought about, because my background is actually HR, and I managed a couple of plants, manufacturing plants, and when I took over one plant--it was in Philadelphia, and they also made me head of plant operations, and the first issue I encountered was an OSHA citation. It was about $160,000, and it kind of threw me into the field of what is this all about and what are we looking at. So I didn't understand the term risk--and this is in the early 90s when this occurred--and I think it was more of a thing of, you know, the exposure or the things that we had to figure out with how we're going to manage that. So one of the things that the owner asked me to do was to look more into what that was all about, and so that was my first exposure to what risk management was. Now, going on another eight years, and then at this point now I'm working for Bridgestone. I was overseeing part of their [work comp?] program, and as I was moving further along with that I got exposed to, from the insurance side and the claims side of things, the exposures and the risks associated with it, and so I wanted to learn more about it, so I looked it up on Yahoo. That was before Google. Yahoo was a big search engine back then, so I'm dating myself, but Yahoo was a search engine, and it talked about risk management organizations, and I wanted to find out more about it. They directed me to Risk and Insurance Management Society, and they had a local chapter in the greater Philadelphia area, and I went to their meetings, and that's when I started to really learn more about all of the elements that involve risk management. It is a vast operation, and a lot of things that are done, especially from the RIMS perspective, is more volunteer-based. So there's a lot of volunteers that were trying to put together risk management programs for their communities and their communities spread across the world. So that was my first exposure to risk management. The other thing I found that was very interesting is that it was so interconnected with business, and a lot of times businesses are siloed. You have operations doing one thing and HR is doing something else, and, you know, finance is doing something else, you know? They're all kind of siloed, where risk management was really trying to be the gatekeeper for all of those and trying to put them all together and say they're all elements of exposure that will harm the company. We need to find ways to do a better job with that. So I think the short answer to that is that I kind of researched and fell into risk management. It wasn't a career that I chose. The career chose me, and so here I am 35, 36 years later, and just really being an advocate for risk management.Amy: That's fantastic. Did you go through any formal training for this or did you really just research this on your own and kind of pull from these different disciplines?Robert: Yeah. So I did get my CRM, my Certified Risk Manager designation. So I went through those five principles of risk management, risk finance, risk factors, risk analysis and things like that. It kind of gave you a basis of what risk management was for, and that really was I think the biggest education that I got, because I didn't know anything about it, and that was really the exposure. So I did that. I got my certification that way and started to bring some of that information back into my company, but at the same time I was getting more and more involved with the risk management organization, the RIMS orgnization, and so with the local chapter I was able to really kind of build a very robust program that was gonna benefit the community that we were serving, and then I found that it was on a global level, so I started to get involved in other committees and other counsels that handle other parts of what risk management is, and I had the opportunity to serve as their global president last year. So it was a crowning achievement to my career thus far.Amy: That is an amazing story, and it's exciting to me to hear how many people really fall in love with a career path or even get exposed to a career path through associations, because I think a lot of folks--because I didn't know about associations, and I think that's true of a lot of people, especially if you're first-generation in the professional workplace or a first-generation college student. You know, you may not realize that these associations are even out there and that they're a wonderful way to explore different career possibilities and network with people, find out what they like about their job, what they would change about their job if they could, and really get exposure to a lot of different disciplines along the way.Robert: Absolutely.Amy: So what's been the biggest surprise to you about risk management that you weren't expecting when you decided to take the leap?Robert: Well, let's see, I think the biggest thing I found was that I think the connectivity of it is a universal language, and I think going to the convention, to the annual conferences, that was a big thing for me, seeing so many people kind of doing the same thing. Then I realized I wasn't on an island by myself. Handling the issues that we were having in my company, sharing some of the best practices, the peer-to-peer connections, and then the networking aspect where the first time you go you don't know a lot of people. The second time you know a few more. They introduce you to some people. And after about three, four years, all of a sudden it's like a family gathering all over again. You're seeing people you hadn't seen before. They're gonna introduce you to more people, and so your network just gets bigger and bigger every year.Amy: That's fantastic. So what do you think the future holds for talent needs in risk management? Do you see this as something that's going to be--that there will be more jobs in this field, or do you see it as something that maybe artificial intelligence will be taking over? You know, are you going to be working with machines and robots in the future, or do you need more people in this space?Robert: Interesting thing about that, and this is one thing I've been championing. I've been talking about the 21st century version of risk management. The 21st century version of risk management is a person who bought insurance to protect any liabilities for the company. That was the basis for risk management, an insurance person and the person who bought the insurance, and the person who set up the policies and [?]. It has since expanded into a multi-dimensional I guess job description, because IT falls under risk management. HR falls under risk management. Finance falls under risk management. Safety falls under risk management. Audit falls under risk management. So all of these disciplines, any business, anything that a business is associated with, has an element of risk, and so the 21st century risk manager is not gonna look at things so much as "How much insurance do we need to have in order to cover our loss?" They have to look at risk management now from the aspect of saying "What are we gonna do to save the company money by putting processes and procedures in place to stop and mitigate the losses that we have?" Or, and here's the challenge for the 21st century risk manager, the unknown unknowns, the things you don't even know that you don't see. Yes, the company is doing great. We've had a three-year positive trend of losses and things that are happening in that regard, but what else is going to happen around the corner that we don't know about? That's what the future of risk management is. So in a visualization of risk management, that is very key, it's very critical. The next generation, we're looking to them to help lead us in that regard. So my push and my passion has been for 21st century risk managers, they're the ones who understand technology, AI, blockchain. All of the things that are out there that are coming on the horizon. You still need people to manage that level of risk, whether you're working with machines or whether you're working with AI, which is being done right now in the insurance field. AI is now writing insurance policies. So there's a lot of things that still need the people side to drive that and to understand and to direct AI to do those things, and I think my exposure this past year having traveled around the world a little bit has shown me that around the world there are a lot of things that are happening in spaces that we haven't even touched here in the United States. There's a need for people to understand how we can fix these problems. So I talk to college students now and I say, "Do you want to be a risk manager? Here is your job. Find the process solutions and problems." You say when you go into a company and say, "We don't really know what's going on." You're new to the organization and you start asking questions. Before you start asking questions about "Why are we doing it this way?" Ask yourself that question and come up with the answer. When you go into the next meeting and you ask that question, "Well, why are we doing it this way?" And they say, "Well, we've been doing it this way for 20 years and it's working, why?" When you come up with an answer or a solution that they didn't see, then you're the risk manager. All of a sudden now you're the problem solver. You're the one who's gonna help them save money, be relevant, and be able to take that company and move forward with it. The other thing I'll say is that the future of risk management is critically tied in with strategic thinking, because we are raising a group of students now who are getting risk management degrees. They didn't have that when I went to college. That just–that doesn’t exist. And so now people are coming out of college with risk management degrees, or they’re taking things that are tied in with that – actuarial, underwriting, or even on the broker side. Those are all things that they need to know in order to help their company go forward. So I tell people go into a company, and it doesn’t matter if–’cause there’s not a lot of risk management jobs that you can get right out of college. There’s not a lot of entry-level jobs that are like that. There's some companies that have risk management positions that they don't know what they call it. They'll put you into a different category, but it's really dealing with risk management. The thing I say to them is understand the mission and vision of your organization. Find out what that is, because that's your basis. That is your starting point to have a conversation with anybody in your company. Once you understand what the mission and vision is--becuase everybody's connected to it. They have to be. That's the basis of the company. So when you look at that, that's your catalyst to move forward. So yeah, 2020--risk management, oh, there's development in the 21st century. So Amy, here's another point to the whole thing. Persons like myself who have been in this industry 35, 40 years, for the next 10 years, there's a statistic that says 400,000 of us are gonna be sun-setting off into other pursuits. Who's filling that gap? So there's a need, a drastic need, for people to fill that gap who, in my opinion, know technology, have grown up on technology, know digital technology, they live, eat, sleep, breathe it. They're the folks that we need to have to understand how to take this to the next level, because there are things that aren't even regulated right now. We're talking about AI. Let's talk about drones. Let's talk about autonomous vehicles. There's no legislation for that. They're still trying to figure it out. So who's gonna figure this out? So there's definitely a need for that.Amy: Perfect. And what you're bringing up is the intersection of private sector initiatives, you know, public sector initiatives. There are community implications for this beyond the companies, beyond the legislators, but, you know, just really in small towns and cities and in terms of education. You know, schools need to be prepared for this. One of the things I love about the insurance industry as a whole is that it intersects every other part of the economy, and risk management is a little bit broader even than insurance in that it intersects all of these things but it also overlays them in a way that maybe some other disciplines don't. So I like the advice about if you're a strategic thinker this is a great place for you.Robert: Exactly. Well, you know, most organizations righ tnow, their focus is on strategic thinking. They're looking at leaders who can put them in a position to be more successful. Anybody can write a policy and can say that we're protected, but what does that really mean, and what did it really mean to the organization? Do you need a $10 million writer? Who knows? But that's the person who needs to examine that and find out what it is that they really need. And what are they doing to prevent the incidents or the issues that are happening? What are they looking at so far as other methods and means of making the company more successful without an expense? So I kind of look at--a friend of mine used the expression, "Loss prevention is profit retention," and a lot of times you don't think about it from that perspective, but that's really what it is after you put the elements in place.Amy: Is brand preservation, reputation, does that fall under the risk management umbrella as well? Robert: Absolutely.Amy: And I'm thinking specifically about some of the companies that we've heard about in the news lately where they have not--they've clearly not had diversity among their decision-makers, and they've made horrible, horrible mistakes in the marketplace--and very hurtful mistakes--in terms of how they've treated their workers, how they've treated their consumers, how they've established their brand. Do you see marketing as being maybe a primary stakeholder or maybe a future primary stakeholder in this work?Robert: I would say absolutely so. And to your point, we've seen a lot of things where even in marketing we're advertising that they've taken some polarizing images under the guise of "Oh, we didn't know it was offensive," but at the same time it bought them publicity. So there's, like, a double-edged sword with that. There's an ethical component I think to everything I think that most people are missing, and the ethical thing is not that it's the right thing to do, it's doing the right thing, and doing the right thing means you have a responsibility to your shareholders and to your public, where a lot of times people will focus on their rights. "We have a right to advertise this." "We have a right to market this." "We have a right to display this." And they don't look at the responsibility as the other side of that. So to answer your question, marketing, yes, that's a very big issue, and there's a risk management process that's tied in with that, because the thing you have to look at is if we market the wrong thing, how does it impact the bottom line of the organization? Nike did something just recently with a person who the NFL did not really want to be involved with. It was something that was controversial, kind of brought people's attention to something, but at the same time there was a backlash behind it too. But I think one of the--when you talk about marketing, one of the commercials for the Super Bowl was the one where "you call it crazy," and it talked about women and how they were "crazy to do that," women wanting to play sports or wanting to run in a marathon or, you know, she wanted to do these things, but she's too emotional or she's--and they're talking about all these things and--hold on, if that's the case, just show them what crazy is. Great advertisement, right? But the reality is that people still don't understand that that level of diversity is what is needed because women are the buying power. I mean, you have women as 60 or 70% of the buying power of this country. You're not going to cater to that? So the funny thing I found just in my travels is that now the hotels I've been staying at--I've noticed this in the last eight, ten, twelve years--are using more and more comforters and duvets and things like that. They didn't have that before. Why? Because there are more women travelers. Women want more comfort, and so they distinctly designed that to say "Well, we're adding more comfort to your stay." Everything is designed around comfort now. I don't mind it. So yeah, I don't think I would have asked for that because, you know, if I have a sheet I'm okay, but a duvet is kind of nice to have, you know? But there are a lot of things that if you don't include the population of which you're serving, you're missing out on a big part of humanity and what risk management is all about. Amy: Absolutely. To your point about hotels, if I go to a hotel and there's not enough counter space for my makeup, I don't stay there again, and the reason I don't is because I know that there were not women involved in the design of those hotel rooms, because no woman would design a bathroom where she didn't have a place to put her makeup. And so it's like, clearly you didn't want me bad enough to invite me back, so.Robert: So if you feel that way and you just happen to share casually with a friend who shares with another friend, now you have people where there's--and business people are not going to a certain chain. There's a reputational risk that they didn't even realize. So then the people who are marketing and saying, "We want to drive more revenue," or things about growth and sustainability, "We want to drive more revenue, and we know that men like to travel and do this." If you're missing that side of demographics, like you said, that becomes this whole silent killer. The next thing you know, boom, [?].Amy: Yeah, you'll spend millions of dollars renovating your property. You better make sure you get all the stakeholders in the room before you cut that check and before it's finished, because then it's too late. So I was wondering if you could tell us a little bit about--you've already alluded to RIMS, but I know you're doing some more work in RIMS about future talent and diversifying talent in risk management, but what are some--so we'll just start there. What are some of the things that RIMS is doing to engage a different kind of workforce maybe than risk management has seen in the past?Robert: Right. So I think one of the things that--timing is always everything, right? And I am the first African-American president of this organization. So we've been in existence for about 67 years, so [?].Amy: Congratulations.Robert: Thank you, thank you. That was a milestone in itself. And I reflect back on a time when they asked me to be on the global board, and the person who called me was a friend of mine, but he was also involved in that whole process of selecting the next person that comes on. And first I thought he was kidding with me. I said "Yeah, whatever. You don't have any diversity on the board, so." And then we're going around and around and I said, "Okay, so is this, like, a backdoor deal?" And he says, "Robert, you can't get into the back door with this organization. You can only get in the front, and it's only by the way of what you do and your merits and leadership and things like that." I was like, "Well, okay, so--how did that even happen?" So as time goes on, and so now as a president, as I was thinking about my presidency and what I wanted to do, my thing was about legacy, and my thing focused on the fact of we need to know where we came from to know where we're going. If we're talking about risk management being relevant, yes, we need to understand our past, but we also need to understand the future and where we're going. Diversity is important. If you don't have diversity, then you're not gonna be relevant. Society is dictating that, they're insisting on it. I saw that in my travels around the world, where they're importing diversity, they're importing the talent, because they want to have what that is. Companies here in the United States are global. The majority of the big companies have a global presence, and if they don't include the type of marketing, like you said, as a woman, that doesn't have space for your cosmetics, then you're losing out on that part of it. So when I think about--what I wanted to expand on as president was diversity and inclusion, that it needed to be something where we get past the conversation of this as it's now something that we talk about. I want to get it to the point where it needs to be a verb. And so we took that, RIMS took that perspective, and we constructed a task force to delve into whether this was something that as an organization we wanted to be involved with, and I'm pleased to say that the board of directors created a new council, a diversity and inclusion advisory council, that was launched this year, and I was asked to be chair of that council. So we've got international presidents. We've got women, men. We've got the LGBTQ corner covered. We have every element covered when we talk about so far as what we want to do as an organization, 'cause we have to walk that talk in my opinion. So as a result of that it becomes more of a thing where we say "What is the next step?" So what RIMS is gonna look at, we're gonna dive into this using the collective firepower of the people on this council, and some of the people on this council are already in that field, from a global level to a local level to an international level. As a matter of fact, my vice chair is from New Zealand, just to kind of give you a perspective that way. But she brings another perspective to that. So what we want to do is we want to take this and say, "Okay, how do we help the next generation understand what this is? How do we help risk managers understand what that is?" As a part of the risk management discipline, D&I, or a diverse group, is a must. It can't be something that we just continue to talk about, but I'm really excited about this. There's just so much. You know, Amy, when I started my presidency, people were reaching out to me, and the first group that reached out was Women of Color, and they asked me to speak to their group, and from there I spoke to the National African-American Insurance Association, and then there was a Latin organization that asked me to speak to them. So there was an influx of people who were coming in, and for the first time RIMS decided that we wanted to have a D&I meeting at our conference in San Antonio last year. It was set up for about 100, 150 people. I'm standing in front 'cause myself and another person were speaking. People were filling in, and they were filling in, and then they were bringing more chairs in, and they filled all the chairs they brought in, and the last count was about 250 people that were crammed into that room over something that we thought might be a good idea, and that I think was a catalyst for us to say "Okay, you know what? We need to take this thing even further." So I'm honored to be able to lead this council going forward, but I just think that there's so much that's already been done that no one knows about. That's the second part. A lot of organizations are out there that are doing things that no one knows about, and I think from the inclusive part we can't just say it's the big organizations who are doing these things. There are other groups that are doing things as well. Let's bring them to the party and have them included as well. We need to hear their voice.Amy: Absolutely. It sounds like, with a response like that, that there was some pent-up demand and that people were excited to have an opportunity to learn more and to participate in this and even to see, you know, the head of the organization be a history maker. That's exciting to me, that other groups said "Oh, wow. You made history. Come talk to us." I think that's phenomenal.Robert: It is. Last year would have been a whirlwind without that, because I wanted to make that as my platform. It became almost double what I would normally have done or what a president would normally have done, and so, you know, everything is about opportunity, right? So right place, right time, right people, and you have to have a passion for it, and I believe in it. I firmly believe in it, because if you don't--I mean, I have found in my experience that if you don't have a different perspective outside of your own or people who look like you, then you're gonna be doing the same thing that you've always done and thinking that you're successful. Patting yourself on the back, "Yeah, we did a great job." Did you really? Who did you compare yourself to? Who did you ask? So, you know, when I bring my significant other into a situation, I say "What do you think about this?" and get her perspective, and "Man, that's something I didn't even see." So I think that's the benefit, yeah.Amy: So you've obviously done a lot of work to help people feel included in your organization. When do you feel included? Robert: I think that's kind of hard to define, because on the surface people can say, "Yeah, we invited you to the meeting. We need you to prepare a report." I think when you become included is when you're part of the decision-making, and when someone says "What do you think?" outside of the normal group or the people who are called on. I've found that for me, when I have a meeting, when I have a lot of folks or a lot of different groups in the room, I try to make sure that every voice is heard. That's not how it happens in real life. What happens in real life is that--and my daughters have already attested to this, 'cause I've asked them, and they're all professionals. They're all in that business world. One's in defense, one's in pharmaceuticals, and the other one's a nurse. And it's the same thing. The great ideas that they got get shot down because it wasn't their idea, but then someone else picks it up and all of a sudden it's their idea. So I think the inclusiveness is when somebody says "What do you think?" And they take your idea and say "Okay, well, why don't you run with it? Why don't you lead this project?" So the duty of RIMS as an organization is that that's exactly what they do, which is exactly why I'm here today, because every time I kept saying "How come we're doing it this way?" They'd say "Well, what would you do differently?" I'd say "Well, we should do that." "Oh, great. Why don't you lead that project?" And so I ended up leading projects and then becoming treasurer and secretary and vice president and president of the local chapter, and then you get onto a committee and "Why don't you do this?" And now you're on the board. "Why don't you do this?" And then you're president. So that's the thing right there. So in my company itself there's still a long way to go. I think in big companies, because there's such a culture that exists and that culture is a thing you need to understand, and that's what I tell a lot of young people. If you're going to walk into an organization, you need to understand their culture. Figure out what their culture is first. Understand the culture. Understand the language you need to speak, and by that I mean that there's certain expressions that opens everyone's ears. There's certain things that happen that everybody says "Hm, okay. That's pretty interesting." And it doesn't mean that you have to assimilate, it doesn't mean that you have to change who you are. It just means you have to understand the language. Now, you have to bring your spin to it, because as a woman you're gonna bring a different perspective. As a minority, you're gonna bring a different perspective. As an LGBTQ person, you're gonna bring a different perspective. Those are needed, and so I think that my drive for D&I now is to highlight the value of all of those different values, but it's a mandatory thing. Right now we're creating positions, but I don't see the action that needs to be behind it enough where it comes a norm where it's like--okay, let me use history as an example. Back in the 30s and 40s, a secretary was a man. It was not a field for women. Now when you talk about a secretary, they don't want to use the word secretary. It's an office manager, but it's mostly women. So we see the trend has changed, and so now people don't even blink twice when you say a secretary or an office manager. "Oh, yeah, of course it was a woman." So that's where we need to be when we talk about a diverse workforce. It needs to be something where we're not trying to put a checkmark and just saying "We checked the box. We have this person. We've hired a black man, a black woman, a gay person, or a lesbian or a trans person, and they're now on our group," but are they inclusive? Are they inclusive? Are they part of the group? And are they accepted for their voice? And I think that's a critical thing. The second part to the inclusion is that it also has to be inclusive of thought. We have five generations in the workplace right now. There's no inclusion of thought 'cause the younger person that comes in, they could have some great ideas, "Yeah, yeah, yeah. Okay, Robert. That's great, that's great, and we'll hear from you later." So therefore they have all this energy, you psyche them all up, you told them "Run with this project," they come back and they get slapped down. So after a while you stifle that growth, you stifle that creativity, and I think that the whole generational issue is another problem that we've got. We've got to be able to bridge that gap. So when I talk about diversity and inclusion, I'm thinking about diversity of thought, I'm thinking about inclusion of thought. That's a critical piece as well.Amy: Absolutely. Robert Cartwright Jr., thank you so much for you time today. Thank you for making history and for sharing that with us.Robert: Thank you, Amy. Appreciate it.

51 - So Amy and Hunter decided to do another episode of therapists on film and television. In part because they realised that there was an over representation of male therapists in the previous episode and mostly because it is the holidays and they really enjoyed doing something a bit lighter. In this episode they play and talk about clips of therapists from Web Therapy, Pure, Lars and the Real Girl, Newsroom, Blades of Glory, The Sopranos (including Dr Melfi’s supervisor), the Sixth Sense (for the obligatory child psych content), Kath and Kim (for an Australian angle), Two and a half men (because Hunter’s brother loves that show) and of course the excellent Good Will Hunting. Hear Amy and Hunter discuss what is good therapy and what is not, including diatribes about CBT for OCD and whether ACT is appropriate, as well as the best way to engage a child in therapy. Don’t forget to check out the excellent episode discussing Good Will Hunting on the @schoolofmovies podcast feed for a great discussion of trauma and therapy : https://player.fm/series/school-of-movies-2361951/good-will-hunting

Hey guys! This episode is an intro to my plant based life! I love this episode because one of my BFFs is on it!! Amy played a huge part in what inspired me to try being vegan in the first place and she has been an on going inspiration all along the journey. Amy and her sister, Callie just started a blog, https://www.greatergoodgarden.com/. Greater Good Garden is all things plant based health and wellness. SO Amy and I had a chat about all things plantbased, (think plant-based 1010, the beginning of each of our plant based journeys and we also answer a lot of our most commonly asked questions. You can find Amy on Instagram, @greatergoodgarden. Below is a list of resources, our favorite books and documentaries! Documentaries: (all on netflix) Forks Over Knives Cowspiracy What The Health Books: Becoming Vegan by Brenda Davis (vegan bible- deep dive into all things vegan) How Not to Die by Dr. Michael Greger (foods that help us live our healthiest/happiest lives and prevent/reverse disease) Proteinaholic by Dr. Garth Davis ( a surgeons perspective on re-examining protein and how much we need/ what kind we need) Cookbooks: The Plantpower Way by Rich Roll and Julie Piatt (inspiring recipes and guidance- also my (Amy's) first vegan cookbook!) Thug Kitchen (an unfiltered cookbook with some really fucking delicious plant based recipes) This Cheese is Nuts by Julie Piatt (the holy grail for the cheese lover) Plant-Powered Families by Dreena Burton (kid-approved recipes for the whole family) Podcasts: Rich Roll Podcast (favorite podcast! From gurus to CEO's he has a little bit of everything for everyone.) Dr Michael Greger's Nutrition Facts (Dr Greger is a pioneer in the plant based movement and owns nutritionfacts.org. His podcast episodes are short and sweet and will always leave you feeling enriched with info) --- Support this podcast: https://anchor.fm/shirley-hagel/support

Ever wondered what the difference is between a breastfeeding counsellor and a peer supporter? Turns out these titles all have specific meanings, different levels of specialism, knowledge and experience. Also turns out that Jen knows all about the differences. So Amy sits back and lets Jen explain all you need to know! This is an episode for really valuing those specialist breastfeeding colleagues we work with; for knowing our limitations and for recruiting extra support when families need it. If your area doesn't have good enough access to specialist breastfeeding roles feel free to use this episode to underline their importance to commissioners and service leads and advocate for your families. Resources: Comparison of different health roles and their coverage of WHO checklist for lactation http://www.worldbreastfeedingtrends.org/GenerateReports/report/WBTi-UK-2016.pdf

Amy Cunningham is a progressive funeral director and the owner of Fitting Tribute Funeral Services in New York City. A former journalist, Amy co-authors a blog, The Inspired Funeral, with Kateyanne Unullisi. Full Transcript: Intro: This is Tanya Marsh and you’re listening to Death, et seq. The Fall semester just started at Wake Forest, so we’ve gone to episodes every other week for a little while, but the students in my Funeral and Cemetery Law class this semester will be helping me with some episodes, so you can look forward to some interesting topics. In the near future, you can look forward to an interview with Josh Slocum, the Executive Director of Funeral Consumers Alliance, and a conversation with my friend Tim Mossberger, the unofficial archivist of The Avett Brothers, about their music and mortality. But today’s episode is an interview with my friend Amy Cunningham, who is a progressive funeral director in Brooklyn, New York. Amy went to mortuary school in her 50s and embarked on this second career with an incredible amount of energy and empathy. She is the owner of Fitting Tribute Funeral Services and she is one of my favorite people. I hope you enjoy our conversation. Tanya Marsh: I am sitting with Amy Cunningham today in Brooklyn. Thank you, Amy so much for joining me on Death, et seq. Amy Cunningham: Hi Tanya. I’m very excited to be here. Tanya: Amy, I think of you as a non-traditional funeral director for a couple of reasons. You don't come from a funeral family. This is your second career. And you actively promote home funerals, green burials, and a number of other of “non-traditional” processes, rituals, and methods of disposition. And you do all of this in a state, New York, whose licensing makes it particularly difficult to be a non-traditional funeral director because of the licensing requirements. So can you just share your story and what motivated you to become a funeral director? Amy: Sure, it started with my father's death in South Carolina in the care of hospice and you know down there it's obvious to people in the small towns who to call when they need a funeral director—they know the funeral director from the Chamber of Commerce, from Rotary. So when my dad died we gave him a magnificent music-infused funeral service in the Presbyterian Church. I was amazed by the sweetness of the funeral director down there. I came back to Brooklyn. I was then a journalist writing about Buddhism meditations, spirituality, the new spiritual marketplace in the United States, how families were into marrying and mixing faith within their family system. I came back to Brooklyn after Dad's funeral and said to my husband, “gosh I admired that funeral director so much. I wonder what it would be like to be a funeral director. I wonder how you go about doing that.” That was in 2009, and six months later I was enrolled in mortuary school here in New York. It was a very rigorous demanding year and far more embalming and chemistry and science education than I ever anticipated. I'm not bitter about that now, but I was then. I got through all that and then took six months to, at the age of 54, not many funeral homes are eager to hire a mother of two who's had a career in journalism that doesn't seem applicable to the funeral biz. So it took a while to get a residency. But I did land a good one with a marvelous man who trained me and then I stayed there for three years and was always consistently interested in meeting the needs of families with a lot going on in terms of their faith constellation. The average family I meet with in Brooklyn these days—someone's a lapsed Catholic, someone's Jewish, someone's going to Buddhist retreats and practicing yoga. And they're trying to figure out how to arrange a funeral for a grandmother who had no faith at all, but then became a Mormon in the nursing home where she fell in love with the chaplain who was a Mormon and people come to me in that state. And when I sit with the family like that I feel I'm really in my sweet spot that I can truly help validate them and show them that they are not atypical that this is really the way we are right now in the United States. We can build a good ceremony. Tanya: I like that phrase “faith constellation” because that kind of pushes back on the notion—a notion about America in general, but maybe Brooklyn in particular, that we are increasingly unchurched and without faith. But that's suggesting that you actually have this sort of diversity and these mixed families of different ritual backgrounds, different faith backgrounds and so trying to find the middle ground or factors that are common to all of them, something that's meaningful. Amy: And yes there's a core of spirituality there and there may even be prayers or poetry that is loved within that family. So it's finding the right mix of language and music and the flowers and the right casket for that kind of group. They've got a lot going on so they want to keep it simple. And they're terrified about being ripped off or paying too much and too many people come in quite uninformed so to guide that kind of family through an experience that that then leaves them in an exalted, uplifted place is very meaningful work and I love it. Tanya: So what would you say your goal is as a funeral director with respect to families and the funerals that you're trying to accomplish. Amy: While I do a lot of alternative services, home funerals, green burials, witnessed cremations, I start out a bit simpler than that. I just want to give them a kind of ritual, a separation ritual that will be meaningful to them and that will endorse or include the values of the deceased and also send them out of the cemetery or out of the crematory that day off to their luncheon or whatever meal they're going to have after the service send them off in a place where they feel that that deceased person was loved, honored take good care of, and that we really did as a group the best job we possibly could. Tanya: Do you tend to deal with people more on a preneed basis? Do you have a lot of people come to you in advance to arrange their own funerals, or do you find that you're dealing more with families after the fact, or is it a mixture. Amy: Increasingly, as I get better now I've been very fortunate to have some good press, people are coming to me in advance. But I would say more frequently they're calling me the night of or two days prior to the death and the care of hospice occurring. A lot of my folks are dying in the care of hospice. I'm making inroads through hospice and getting known to hospice workers as someone who will take not only take great care of the deceased person but manage that complex family constellation. Tanya: And so mostly you're serving people in Brooklyn? Amy: Brooklyn and Manhattan, and Queens recently. Tanya: And then where are their families located? Are the families predominantly local. Or is an aspect of it that … I mean is part of the reason that people are calling you sort of at the last minute because the families coming in from out of town and nobody has made any arrangements. Amy: Some of that. I'm calling people who are in hospital corridors. But the cell phone will say they live in Portland or Cincinnati or Florida. So a lot of kids with parents dying here in New York because that's got that's got to be a challenge. Tanya: If you're not from a funeral family, you're not inheriting a funeral home or buying into an existing funeral home that has a book of business. Amy: Right. Tanya: Because most funeral consumers, the studies show, don't shop around. And there's an incredible reliance on using the funeral home that you've gone to funerals at before, to stick with a funeral director or a funeral home for multiple generations. So what are some ways just from a marketing perspective, getting started as a new business owner that you've tried to use to combat some of that. Amy: I used my background in journalism to develop some PowerPoint presentations that are purely educational or are not sales pitches. I just show people what a cremation is. What is cremation history. What did cremations look like in ancient Rome. And I started delivering those presentations at the Park Slope Food Co-op. Now we have 15,000 members in an alternative grocery store here in Brooklyn. And then my little show kind of took off and went on the road and Greenwood Cemetery now has me giving those kinds of workshops monthly and that's been great for all of Brooklyn. If someone asks me for a business card I may give it to them but it's not about spreading the word of my company, it's more about just giving them the facts because I think all funeral directors need to see themselves as educators. Death is a rather complicated today and there are a lot of important decisions to make involving thousands of dollars. And families will really feel cared for when they feel like they've been educated not just sold a bunch of goods. Tanya: Is it that younger people? Older people? Amy: It's neat. A lot of older people sometimes maybe couples in their 50s, 60s, 70s saying to each other “we really got to get going on this. We want to spare our children the struggle of putting a funeral together for us.” But then also I'm seeing people in their 20s and 30s are interested in funeral planning but also looking at careers in the end of life sphere. And I love these kids. I'm really impressed with the young people I'm meeting. I tell older people are in good hands because these are the people who are going to be taking care of us. And I think the book has not yet been written on how 9/11 influenced a whole generation of people. and deaths awareness and Caitlin Doughty’s books and all the great articles that have been running in The New York Times about getting ready for death and how to face it with dignity and courage. All of that is feeding a culture of young people who really want to get involved and help do death differently. In whatever way that means. And we used to say … I lead a Death Cafe at the cemetery now and it used to be said that death was the last thing any family wanted to discuss. And it was a forbidden topic. I don't find that to be true anymore. I think podcasts like yours, everything that's going on, has made death much more interesting to folks and a great topic to contemplate daily, just as the Buddhists advocate that life is improved through death and contemplation and then awareness. Tanya: The rural cemetery movement of which Greenwood was a part of, Mount Auburn Cemetery in Cambridge Massachusetts as a part, were designed in part to give lessons to the living. They were designed as places of contemplation. I mean that was a thing that was part of our culture not that long ago a century, a century ago, and that we've really lost connection with. That acknowledging death and its inevitability and trying to think about how we want to deal with it both for ourselves and for the people that we care about doesn't have to be a scary icky saying it's actually an affirming thing right. Amy: Right. I may be a funeral director because I spent two weeks every summer of my girlhood in Texas and my grandparents used to take me to church every Sunday. And then after church we would drive to the cemetery. It wasn't even a topic of conversation. We would just go pull weeds up look at the stones and say, oh you know, there's Aunt Mildred. And then just go out to lunch. Nothing was really spoken, that was just a ritual that we had. Tanya: I mean I used to go to Nebraska in the summer of visit my grandparents and my grandmother and I in particular we used to go around to all the cemeteries in the county and she'd point out to me who all our people were. We'd pull grass. We were just in Nebraska about three weeks ago and cleaned up some grass around some of the tombstones, and I think I put on Facebook that were visiting my grandmother. Amy: It’s a lovely thing. Tanya: It's a connection. It's a connection through the generations and your relationships with people don't end at death. So Amy, you've talked about people coming from a whole diversity of backgrounds and positions of faith or ways of looking at the world and what some of the common factors in a good funeral might be. So have you thought about what makes a good funeral regardless of your background? Amy: I think even folks who are secular do well to study the structure of a religious funeral, because there are keys to the high notes and the important moments there. Even the terminology and the names of things are wonderful to study. I was just looking up the “death knell.” They used to ring bells when deaths occurred. There used to be callers out on the street, centuries ago, who would notify the community of the death. Today we have Facebook. We toll the bell in a completely different way, but a good funeral involves acknowledgement of the death, an announcement, an obituary, something like that. Tanya: An acknowledgement to the community and by the community. Amy: Right. And then kind of separating process. You know not all deaths occur in the presence of family. But when that death has occurred in the hospital room and family members are standing there weeping…we need to figure out how to, if there's not going to be a home funeral, preferably, it's wonderful to advise the family, if you get them early enough and can educate them, to spend some time with that deceased person and alert them to the fact that it is perfectly legal to keep that deceased person in a hospital room for three or four hours, or if death has occurred in a home in the care of hospice, that person doesn't need to be whisked away. We shouldn't be afraid of the body that we can actually sit there, cry, tell stories … hold the hand of the deceased, comb the deceased’s hair, maybe dress them, wrap them in a shroud. There's things that we can do at these moments that are very beautiful. So a good funeral I feel involves some involvement with the body. That doesn't mean if it's not your tradition, or not your inclination to be with a deceased person's physical body, you can sit in a quiet chapel at the crematory or at the funeral home in the presence of the body in a closed casket, you're still with the body, the body is still there. So I help people who are intimidated by too big an old fashioned deathbed experience to at least maybe sit in the funeral firm for a moment and have something like a visitation. So the announcement, the body, and then some kind of acknowledgement of the meaningfulness of that deceased person's life through a eulogy, through could be a written statement, something often in the context of a service, I think is great. And just feeling like you said to that person everything you had to say and that if you loved them, you said that in the presence of their body even when life is no longer going on within it. And then I think there should be something having to do with friends and a meal or you know these are the the bits, and I divide it up and look at it. And every family does part of it differently and some families try to forego a lot of it, but if they can just have one piece of it, then I feel like they have something they can talk about later and share with their friends that we did the best we could. We gave mom a good send off … we looked through photo albums. There's just there's a lot to it. And the days that unfold after death in the family… we call it a liminal time and space. Sometimes I call it sacred. If someone is secular and they don't like that word it's a special time. It's not every day you have a death in the family. So do whatever you can carefully try to seal yourself away from work and find activities that that will help you honor that person. It could be as a small ritual as if your grandfather washed his car every Saturday, you could start washing your car every Saturday. Some kind of little funny thing that brings that life back to you. You could change your Facebook password to have that person's name in it. Little teeny salutes to the value of that person's existence. I think make for a pretty good funeral. Tanya: We’ve also talked about that you think the start of a good funeral is with the transfer process and there are improvements that the industry more generally could make to the transfer process. Amy: Tanya, if I could make one change in the funeral business, if I could just help the industry see that that transfer from the place of death is the beginning of the funeral. This is where the healing will begin. To train the people who are coming into hospital, walking down the corridor with the rolling funeral home stretcher or cot and orchestrating a transfer from that bed where the deceased person died in and taking … it's a changing of the guard. It's taking a deceased person out of the hospital or the home and into the funeral home and doing that with grace and art and respect. And so many families come to me and say “oh my god my mother died and these guys came and they asked us to leave the room and then we heard the zipping of this bag and then they left as if they didn't want to talk to us anymore. And that was that. And we felt there was a tremendous rupture and sadness and that's when we began to grieve.” That's an unfortunate moment. So I like to go to hospitals with flowers in my arms. I greet the family. I speak to the deceased person by name. And everybody seems to feel good about that … that they know they're giving me permission to transfer that deceased person and take them into my care. But on a slower schedule, at a pace that they can tolerate, and including them and asking them to put music on a cellphone so that when we walk out the door and down the hospital corridor there's some kind of ballad in the background that articulates something about their love for that person. I have a very pretty cot cover. Nothing's ugly. I put flowers in the arms of the deceased so often. There might be flowers on the window sill that have been languishing there through the whole prolonged end of life period. So I take those flowers and I put them in the deceased’s hands and we cover with a pretty cot cover and we only cover the face when the family has told us it's OK to cover the face. So it's a moment and it's a … I make it a thing. I've tried to bring pageantry and a kind of ecstasy back into the whole period and make people feel like home. Okay, now we can go home we can bathe we can be ourselves for a while and let's get ready for the next phase of this thing. Tanya: I think it's so interesting because I've had a lot of conversations so far with people talking about the diminishment of the ritual as in the funeral. But you're talking about imbuing this whole period right after death with ritual that I think we have not had more broadly speaking right. And you're right. I mean the death of a person is such an abrupt transformation. Psychologists and sociologists have talked about, how at least in Western culture, we view human remains as unclean and that part of the funeral ritual like embalming and dressing and putting makeup on is and making a person look more alive is a way of socially transforming this unclean thing into a clean thing because it appears to be alive. Which is I think sort of, more traditionally for the past century, the way that we've all kind of viewed this and so if you look at it through that lens, yeah, take the unclean thing away immediately and then make it presentable again to be given to the living but you're sort of rejecting that idea. And I don't think you're alone in that. I mean I think there are a number of people who are rejecting that idea and saying that it is in fact that abrupt transformation or wrenching away the body that is unhealthy right to processing grief and saying goodbye. Amy: I think of it energetically and I feel like there's still even after a death has occurred a life energy in the room. So I happen to feel, at least it's very helpful to me. I don't know if a soul exists. It's very helpful to me as a funeral director to believe that one does because I comport myself as if the soul is watching me at all times. And it's a mindfulness practice. You have to feel that that deceased person has their eyes on you and that's a lovely relationship. It's not scary. It's a great thing. I talk to deceased people. I that kind of energy in the room. And I think people respond very positively to that. My funeral families seem to like me for that reason. None of us know. But it’s a good idea to just trust. Tanya: So I I've been asking this question of a lot of people and plan to continue to do and to do so and I think your answer just sort of showed your hand on how you might answer it. But do you think that funerals are for the dead or for the living. In other words, should we be respecting the wishes of the deceased with respect to their own funerals. Or should we be focusing more on what those that they've left behind want out of the whole process. Amy: This is the great mystic question. Actually, it was discussed in the first week mortuary school. And I think the technical answer is that it is for the living. Tanya: What do you mean the technical answer, you mean the answer that funeral school… Amy: Yeah, that you're wanting to engage that family in in a meaningful experience and that they are paying for a meaningful experience. But the wishes of the deceased certainly have to come in there. If grandma was a strict Roman Catholic, many families come to me saying we don't go to Mass anymore but grandma would want us to do this. This is what we're doing. Or they might adapt it a little bit, change it slightly. But I do think sometimes the wishes of the deceased can be disobeyed. And this is my example of that. It's not what you think. A friend of mine's mother said “I will haunt you,” as she was dying, “if you give me any kind of funeral. I don't want any funeral.” And they didn't have a funeral. And months later my friend was saying you know that was like Mom's final deprivation. We should have done something. So I think sometimes dying people may insist they don't want much but I think we can give them more than they ask for. Tanya: Well I think it's interesting especially since you mentioned that in the first week of funeral school that this was something you talked about, because the position of the law, and this has been true since Roman times, is that it's the decedent's wishes that matter. Right now part of this I think in the Anglo-American system had to do with the established Church of England and Christian doctrine about you need to be buried in consecrated ground. You needed to have, you know, the priest or the minister preside over your funeral if you were going to be resurrected eventually. So it was so important for the deceased that there remains be treated in the correct way and their eternal salvation rested upon that. That it was like a social contract. I'll take care of you, if you take care of me. And it was sort of an assumed baseline of what the decedents were going to want. Amy: It’s fascinating. Tanya: So the attitude of the funeral industry is so opposite to the tradition of the law that that's just it's really fascinating to me when you have these kind of incredible tensions and disconnect between two different institutions that are both sort of longstanding. No wonder people are confused, right? Amy: And that makes the appointment of agent to control the disposition of remains that are very important for people who whose wishes run contrary to the wishes of their families and that they want to make sure that they're protected. Tanya: Well and you know a practical problem that I've heard a lot of funeral directors say is that especially if a person died and they didn't have a spouse or their spouse predecease them and they have children where they have you know some other category of people who get to make a decision and that there's disagreement within the category. Divorced parents making a decision for a deceased child or children making a decision on behalf of a parent that you can have real practical problems and try and sort it all out. And that's the deceased left behind instructions then that's going to be a lot easier for everybody. Amy: Exactly. Tanya: So what kind of conversations do you have with people on a preneed or an at-need basis in terms of what kind of goods and services that they're looking for from you. In other words, why are families or soon to be decedents coming to you and so some other funeral establishment. Amy: Well one thing that I offer, and I'm very clear about on my website, is that I make every effort to make the funeral eco-friendly. So my customers tend to come to me because they know I'm going to offer them a simple casket and they also are not interested in embalming. My customer almost uniformly … I think maybe I might have one or two embalmings a year. And I don't mean to upset embalmers or be anti-embalming. It's just interesting to note that my customer is wary of embalming and not desiring that. So they may even ask about it, “You're not going to embalm.” And I say as you know, that's what I say on my website, I make every every effort not to embalm. I partner, I have my registration at a Jewish firm and it has a very large refrigerated space. So all our deceased people live back there, they are kept cool and can last a long time without any chemical intervention. That's … I've found that there are enough New Yorkers who find that important that they come to me and trust me. Tanya: And so a lot of people are coming to because of environmental considerations. Amy: Yes. Tanya: And so you have observed that their objection to embalming is part and parcel of their environmental considerations? Or is there something else going on with their objection to embalming? Amy: That’s a great question. I think they want as little intervention as possible. And here's the key word—they want an authentic experience. They want authenticity the whole way. Tanya: And they're viewing embalming as antithetical to authenticity. Amy: Yes. And I feel that there's a new generation of funeral customer who wants to see what death looks like. I recently had a family that even said “don't even close Dad's mouth.” A lot of funeral directors would find that outrageous, that of course you're going to close the deceased’s mouth for them. But this family said he looks fine. And they want things as natural as possible. And they're sometimes very amenable to viewing with very minimal care. They say goodbye at the hospital. They may take a glance or sit with the open casket for a time and they don't feel that chemicals are useful to them. And this is a customer that wants to watch money. But I also feel like they might be shopping at Whole Foods where they may be paying a bit extra for an organic apple just because it's organic. Tanya: Right. So interest in driving down the price of the funeral is not something that you've observed is a primary consideration. Amy: I tell that to other funeral directors as the good news of this thing because this customer wants it real and is willing to pay for that. Tanya: So what does a home funeral look like in New York City? Because it's always seemed to me that the urban areas were some of the first places where funeral homes became popular and widespread because people simply didn't have enough space in their own parlors. They had to go to a funeral parlor. And you still have some of the space considerations and people don't have cars. I mean you have a lot of sort of practical constraints in a city like this that you don't have in many other places that would that would seem to complicate a home funeral. So are you looking at home funerals and for the folks that come to you, it's like a whole range of different options? Amy: Sometimes a home funeral in New York is a delayed transfer or pickup. I'll get a call from a family they'll say “we've just called hospice. Mom is dead. We'd like four hours.” And I say “great you know let's set a time. Let's send text messages to each other. You tell me when you're ready and we’ll come over.” That's a mini home funeral. You don't need any dry ice for that. Sometimes it's an overnight. We've done quite a few of those. Sometimes it's a longer, more prolonged ritual. I had a Tibetan case where we kept a deceased gentleman in an apartment in Bushwick Brooklyn for almost three days. Tanya: You used dry ice? Amy: I left dry ice there but that particular gentleman was an advanced tantric practitioner. He visited with the Dalai Lama before his death. That gentleman was almost incorruptible. He was magnificent and knew how to die. And if ice was used, it was very little. Quite fascinating. But that was a great experience. But there have been other times where we brought deceased individuals into a brownstone in Brooklyn and laid them out in the parlor in the old fashioned way and then taken them back to the funeral home in the casket that night. So you're right, we have smaller living spaces, I think where the family centered funeral is really inhibited in New York and only at the point of families ever using their own cars or carrying someone out onto West 57th Street. That's not gonna happen anytime soon. I've had conversations with Josh Slocum about this. Much can be overcome that the city does pose some obstacles. Tanya: You mean just the practical realities of living in the city. Amy: I envy the Texans who can put granddad's casket in a pickup truck and take to the cemetery themselves. That's a tall order here in New York. We still have and that's why part of my business is rather conventional. I still use hearses and sometimes limousines. We have old fashioned cortège going to the cemetery and cars in sequence and all the old trapping, but New Yorkers still gravitate to that and want a little bit of pomp and circumstance. Tanya: So you mentioned witnessed cremations a couple of times. And I think that's really interesting to talk about. Because I've been to … Fresh Pond Crematory and toured that and that's a fascinating historical place that is really set up to and oriented to witnessed cremations for people from a whole bunch of different faith perspectives. I mean I think they've made a real effort to be to be inclusive in that way. But not every state has witnessed cremations or makes it very easy to have a witnessed cremation. So what do you think is valuable for families if anything about experiencing a witness cremation? Amy: Witnessed cremation has gone up a lot in my practice in the last two years. I think some people want to accompany their loved one the whole way as far as they can almost as if it's to the edge of a kind of grave they want of an experience. It's not that … I am careful with my language … it's not that they want it but they find benefit in the witness. What is a witness—it means that after the chapel service at the crematory or a funeral home, you can go to the area of the cremation plant or facility and witness the casket entering the cremation chamber or retort. The door is opened. Generally at Green-Wood the casket is on a lift, a hydraulic lift, it lifts up to the height of the retort and then the men gently guide that vessel into the chamber … Tanya: I've been I've been to the crematory at Green-Wood as well, and so the family is standing in a separate room, right? And so there's curtains… Amy: They’ve redesigned it. We’re going into the retort room now because it's so beautifully styled and designed. It's so beautiful back there. The metal of the doors is a kind of bronze and they're symbols of the world of antiquity back there that are very touching and moving. When that chamber opens you see a sort of arch of brick on the top of it and the glow of the embers. You don't see flames but if the family opts for this they can push a button on the wall that then lowers very slowly the door of the retort. It has a kind of magnificence to it. And certainly a finality. I don't use the word closure because there is no such thing as closure. You're going to carry this loss with you for the rest of your life. But it does make people feel like wow I took it as far as I could. I was with her every step of the way. And I was sort of available for every emotional aspect of this experience. People's knees buckle a little bit but they walk out of the room saying “Wow I've never seen anything like that before. Thank you.” Tanya: So that really challenges the notion that people are opting for cremation primarily because of cost. I mean because it was I guess it all has to do with the ritual that surrounds it because the pushing the button and the witnessing seems very similar to a graveside service where you're where you're putting a handful of dirt on the casket. Amy: Yeah. People want to do things even in a time of grief. And when I think of my male compatriots and my teachers in the industry who I love. I notice that in their lovely masculine way they've been depriving people of experiences because they feel that those experiences aren't good for them. And they say we will take it off your hands. We will do it for you. We are here for you. And it's very nice. And some families like that but increasingly families are saying “no we want to do that. We want to be there. You don't have to take it off our hands. We want to pay you to allow us to be there and be fully present.” Tanya: That we're going to get more value as a family from involving ourselves in the process. Amy: I recently had a group of people, a family, seated in the home with the deceased person present. They had on their own after death lit candles, put rose petals around her body, bathed her, brushed her hair, and then they were ready for me to come. I ended up coming with my own two man stretcher which is like a fireman's pallet. And I didn't call the man at the firm that I used to help me with these transfers. I went by myself and we were on the upstairs level of a two-story townhome and I said to the people assembled: “Listen, I thought about you guys, I knew that you have dressed her and cared for her and been here all this time. I thought that you might want to help me carry her out down the stairs.” Not every funeral director would be comfortable with this because there are liabilities, what if somebody stumbles. What if… it's always gone well for me, I don't know how to explain it any better, because it's like this family would have paid more to have the experience of carrying their loved one out of the house. That's an extreme example. But when we got to the bottom of the stairs we put this lovely woman, we covered her respectfully in gorgeous fabric. We put her in the back of my car. I closed the door. I turned to them and the gratitude was amazing to observe. These are very small ways that we can include families and continuing to love the person that they are now missing and help them in their adjustment to the new reality. Tanya: Let me ask you a final question for you but before we get to that this is sort of a mundane question. A lot of the things that you described doing do not fit with the general price list. Amy: Yes. Tanya: So how do you try to forge this new set of services? The gorgeous fabric, the involving the family, and transporting the body, the transfer process. A lot of these things that you're talking about—you did a direct burial not too long ago and there is a play list that you played. These are all services and incredibly important touches. But I'm just wondering how you reconcile that with a very formalized set of requirements imposed by the Funeral Rule. And then also sort of the established norms of how this industry works. Amy: I recently found myself standing in a Bed Bath and Beyond looking for some kind of piece of fabric or throw to put over a casket in the deceased person's favorite shade of robin's egg blue. And I stood there asking myself “how do I get this onto the Price List?” The GPL is not working for me. In time all I can imagine is perhaps getting so well-known for this kind of lovely series of gestures that I could raise my non-negotiable…my arrangements fee. It doesn't fit anywhere else doesn't it well. I mean there's no hourly wage, there's no funeral preparation hourly fee or something like that. I'm not able to monetize it yet. All I'm doing is building my brand and getting the word out that I'm available to you to do these kinds of things right. Tanya: Right. Because I mean the GPL is set up for … even though you still have this non-declinable fee for covering a lot of your profit and, you know, your services in the cost of goods. But if you're not doing an embalming that's out the door. Amy: The caskets aren’t expensive and they’re not marked up. Tanya: So that's a real challenge for people who are sort of pursuing a nontraditional kind of a path. That is much more service oriented. But the question is how do you accurately communicate the cost of those services to families. And right now there's transparency and fairness and that you're getting fully compensated for your time and expertise right and that they know what they're getting themselves into. That's the challenge. Amy: The guys at the funeral home watch me arrange rose petals in the interior of the casket where the deceased is never going to be viewed. They say, “Amy, just close the casket.” Well I want to finesse the shroud a little better. Yeah, I don't know. I mean I don't think I'll ever have any feeling of … I have to learn to protect myself, I guess. But I would love to sit down with others in the industry and figure out how we can offer these kinds of things and really save the funeral industry in so many words because it's not working the way it's set up right now. Tanya: So my final question is what sort of advice do you have for people who are considering following a path like you have. What have you learned? What would you do differently? Do you think that this is a path that others should follow? Amy: I think there are so many opportunities for thoughtful people in this business. And it's such fulfilling work. I would never discourage anyone from getting into it. However there are so many impediments and barriers to entry and hoops to jump through. My husband used to watch me studying late into the night in mortuary school and he'd say “honey this is like a hazing. I can't believe this. You know you want to just do good funeral services why are you having to memorize every bone in the foot.” So one thing I do say is that you really have to want to get into it, if you're in any way unsure then maybe it's not for you. It tends to be a business that is so hard to enter that you really have to want it more than anything else and almost see that there's no other path for you. If that requirement is satisfied then go on, get through the school that will maybe be one of the worst years of your life. But it's only a year you'll get through it. You'll be proud of yourself. Your family will be proud of you. And then try to negotiate the best residency you possibly can in those states that insist upon that yeah. And the embalming requirements are really tough and each state is different. So I was advised to just show my boss what I was good at. And I think he acknowledged after about four months of having me back there in what is known as the pit that really wasn't my gift. So I got through that part with all the legal requirements for residency and licensing in the state of New York and it's good to know a bit about embalming but I don't want to say it's going to be obsolete. There's always going to be a call for it but I don't know that the emphasis in the in the mortuary schools needs to be so focused on it. Tanya: Well there's definitely been some studies have indicated that the number of women who are interested in becoming funeral directors is artificially depressed by the embalming curriculum. Large numbers of women have said that they would be much because they're more interested in the I guess you call “front of the house.” Amy: Right. The suits, yes. The people who want to sell the funerals. Tanya: Well or just be involved in the experiences and helping people have a meaningful experience and funeral but they're not interested in the embalming side of it. And so coupling those two different professions into one. And the requirements to become both into one has cut down on a lot of people who would probably be pretty funeral directors Amy: Yeah, yeah. I am finding that the men in the industry I'm around are very moved by what I do and don't criticize me or make fun of me in any way at this point because they see that this is sort of why they got into the business themselves in the first place. I help remind people of the gorgeous nature of this work. And I think we all need each other and can work together and make for a new way for families to say goodbye. Tanya: Well I think that you are an absolutely inspiring funeral director and you're so positive. And that we could all learn a lot from the experience that you have and what you're trying to bring to families. Amy: Thank you thank you so much. You know by the way I have a blog that I write with Kateyanne Unullisi, a Seattle funeral celebrant, called The Inspired Funeral. And a lot of these ideas are on there. We divide the whole end of life period into nine different moments and we have readings for each of those moments and a lot of good material. Tanya: I'll put that in the show notes. Amy: My life as a journalist continues. Tanya: Awesome. Thank you so much Amy. Amy: Thank you.

Dr. Amy Connery has had a really interesting career in psychology. She started out as a “regular” psychologist, then decided that she wanted to respecialize in neuropsychology. So Amy quit her job, went back for another post-doc, and continued with her dreams. She talks with me today about respecializing in neurpsychology, getting into- and out of private practice, and one of ... Read More The post TTP #9: Dr. Amy Connery – Respecializing in Neuropsychology & Performance Validity Testing with Kids appeared first on The Testing Psychologist.