Gregg Masters 00:05
This is PopHealth Week on HealthcareNOW Radio. PopHealth Week is brought to you by Health Innovation media. I’m Gregg Masters managing director, the producer and co-host of the show Health Innovation media creates thought leadership content that supports your value proposition via original or curated digital assets for omni channel distribution and engagement. Connect with us at www.popupstudio.productions. Joining me in the virtual studio is my partner, co-founder and principal co-host Fred Goldstein, president of Accountable Health LLC. On today’s show, our guest is Linda Riddell, MS. Vice President Strategic Initiatives at the Validation Institute. Linda is a population health scientist, poverty educator and independent validator with 30 years’ experience in healthcare, public and private health insurance and health policy. She specializes in measuring outcomes for health and wellness programs such as coaching, behavior, incentives and novel interventions. Linda is also the founder of Health Economy LLC, focusing on health policy and health data analysis. And with that introduction, Fred, over to you. Thanks so much, Gregg. And Linda, welcome to pop Health Week.
Linda Riddell 01:29
Thank you
Fred Goldstein 01:30
It’s a pleasure to have you back on and talking about some issues. We’ve obviously done some work with validation Institute and other things like that. But today, we’re gonna talk about something really interesting and completely different in a sense. So why don’t we start Linda, give our audience a little sense of your background.
Linda Riddell 01:43
So I have a Master’s in Health Policy and Management. The way this part of my work evolved was that in graduate school, I became very interested in the mashup of poverty, the social, biological, cultural, financial, medical factors all colliding together. And I’ve maintained that entrance ever since.
Fred Goldstein 02:06
So what you’ve done and we’ll get into this a little bit is in an area of essentially social determinants of health, but really looking at poverty and its impact on people. Is that right?
Linda Riddell 02:17
It’s a very much overlooked aspect of poverty, is that it changes the way the brain works.
Fred Goldstein 02:24
So what do you mean by that?
Linda Riddell 02:27
So well, I’ll give an example. We’ve all had, our brains be a little more crowded, because the pandemic made simple things complicated. So things that you didn’t have to think about before, like your school would be open for your children on Tuesday. Or that there would be toilet paper and cat food on the grocery shelves when you got there. So all of these things became deliberate, effortful things, and it took up space, and your brain, it took up some of your mental resource. So the same thing is true. When somebody is coping with poverty, there’s always a crowded, too many things demanding attention, and not enough bandwidth, for lack of a better term to address them all.
Fred Goldstein 03:25
And so there, and you said it actually changes the brain in the sense,
Linda Riddell 03:30
yes. So I’ll give this example. And this will tell you that you never want to be a sugarcane farmer in case you were thinking of that as a backup plan. But sugarcane farmers are paid once a year. And these researchers went and gave them as called a Raven’s test or fluid intelligence test, right before their harvest when the majority of them had pawned something in order to get by. And then again after the harvest, and they had gained nine IQ points, the equivalent of nine IQ points by simply having the relief of their harvests being over and their annual paycheck arriving.
Fred Goldstein 04:17
So they were cognitively better able to do the various aspects of a IQ test, because they didn’t have essentially the impact stress or their head filled with I’ve got something pawned. I’m worried.
Linda Riddell 04:36
How am I going to get it back? Yes. Right. Right. And we’ve all done something like this during the pandemic. So if you had a relative living in a nursing home, maybe you called every three or four days to see what the status was, and forgot that the reason you were calling so often was was because it was your grandmother’s birthday that you wanted to get there for right now. Or you know, you’re so focused on getting everyone’s COVID test before the Christmas dinner if that you completely spaced out your that your daughter in law hates cheese cake, I mean, just you can’t keep track of so many things.
Fred Goldstein 05:17
So what did this lead you to then do?
Linda Riddell 05:21
Uh huh. So I wanted people to understand poverty in a in a different way. So there’s a lot of conventional wisdom about poverty and one of the conventional wisdom things is that people who are poor make poor decisions. And so I created an experience for people to have their own brains crowded. And for them to see how their own decision making, changes. So it presents as a game, it’s called Getting By, and it gives you true life experiences, all of the experience of situations, we call them scenarios in the game come from research. And you have a certain number of assets to make your decisions with your time and energy, favors, you can ask from family, favors, you can ask them your landlord etcetera, you have 40 seconds to take in the situation and make your decision. So you have to start juggling, it takes about 15 minutes or so before people have to start making decisions that they don’t like. or were not their first choice. So people have to decide, for example, do they take the time and energy to talk to the emergency room nurse who’s calling because you’ve taken your child there with asthma, two or three times? Or do you not have the time and energy for that and Hang up? Hang up? Because they just can’t understand that you can’t get to a doctor’s office.
Fred Goldstein 07:08
And in essence, what is the goal is the goal of the game to get people to better understand what the situation is like for people living in poverty.
Linda Riddell 07:19
Yes, so it, it shows them that their brains respond in the same way. I’d like to joke with people after they’re done playing about whether at some point during the game they thought about when they were going to take up yoga. Because there’s no way for you to think of any long term broad things when you’re totally consumed with the immediate. So they see that for themselves. They did the drive thru with fast food because they didn’t have the time and energy to make dinner. And then I tell them about the brain science so that a crowded brain, which is anyone has a crowded brain who has scarcity going on cannot make decisions the same way an uncrowded brain does. So, for example, smoking, there’s a lot of interest as always, in getting people to quit smoking. Well, if your brain is entirely consumed with getting through today, food, childcare, work, transportation, etc. And smoking a cigarette is calming that’s valuable to you. Calming is valuable to lung cancer at some future date is nowhere on your radar. It’s just not relevant. So there’s actually a piece I think it was in the Huffington Post that says was something like, why I smoke? And it was a person saying, exactly, it’s calming today. It’s like, it’s kind of like self care. And so your doctor saying you should quit smoking. That’s the only time that I have with my sister in law on the back porch, or that’s my break from the kids, or whatever the case may be. Lung cancer is just not relevant.
Fred Goldstein 09:09
So well, who’s, who’s your target audience for this?
Linda Riddell 09:13
So it’s any organization that needs to work effectively with low income children’s schools, for example, for adults, right now, I’m only focused on health care organizations and schools.
Fred Goldstein 09:29
And they then can get this game or have you come in and play it as understand is that right?
Linda Riddell 09:35
Yep, there’s a couple of different ways. We’re going to have an online version available that people can just license and use. And I have some schools doing that, because it’s, you know, for medical students, for example. It fits within their curriculum and what they are teaching. And another method is that I can facilitate them playing the game and the debrief do the debrief. And we’re exploring also some follow up services to help the people apply what they’ve learned.
Fred Goldstein 10:11
So who’s, who’s using it now, or what’s sort of been the reaction to it?
Linda Riddell 10:17
People, people, I don’t want to say they have fun. Because it’s not fun. But it’s for someone who has the idea that people are in poverty because of the poor decisions they make. It’s very eye opening to, for them to see, I make the same decisions when my brain is subjected to that. We all do. And we can look at the pandemic as for our own examples of things we’ve messed up, or forgotten, or whatever. So it’s an aha moment I’ve had, oh, like federally qualified health center people come and play. And the woman said, this certainly puts motivational interviewing in a whole new perspective.
Fred Goldstein 11:14
So, you know, for those who didn’t know, what is that? What do you mean by that? Or what did she mean by that?
Linda Riddell 11:20
So lots of healthcare providers are taught motivational interviewing to coach patients into healthier behaviors, right. And so, when you are doing that, you’re making a lot of assumptions. So one is, and this is going to sound ridiculous, but one is that they would improve their health to stop smoking. It might not. Because there are 1000, other factors affecting their blood pressure, their air quality, their stress level, their biological selves, and how they are in the world. Being a little bit calmer from smoking, actually might be a good thing. So knowing that what the person is coping with is really the driving health factor, what I encourage healthcare providers to do is connect with something that’s, I call it in the tunnel. So we’re, you know, a person is tunneled on the immediate connect with something in the tunnel that’s relevant to them. So the person who’s smoking maybe has a toddler, the toddler is in the tunnel, if you could encourage them to smoke a little bit less around the toddler. Because the toddlers health is important to them, that’s a win, and it will help the toddler. So there’s a lot of imposition of middle class values and goals on these on people who have lower social economic status, fewer resources, based on assumptions. And the help can’t get to them. In a way. It’s like it’s a different language.
Fred Goldstein 13:09
So So in essence, what you’re saying is, as you said, it’s a different language. If we don’t, if we don’t understand this difference, then our approaches are just wrong.
Linda Riddell 13:20
Yeah, it’s not going to help. It’s like, and I’ve been involved in, you know, charitable efforts that make have made these mistakes. So for example, you might have a program for your church or whatever, that gives away winter coats. Fabulous. And you had this idea? Well, let’s give everybody a printed list of places that have boots, we’re only doing coats, or that have food, we don’t have food, whatever. Print culture, that’s educated culture. So to us, we could use a printed list and say, Oh, I can go to XYZ church and get groceries. You might as well have printed it in Swahili. That’s not how an overwhelmed brain can take in new information. A brain in that circumstance is going to take a new information by storytelling. So Oh, you’re here to get a winter coat. I know that your neighbor. I don’t know if any of this would be confidential information. But I know your your neighbor also goes to woodfords Church to get groceries you could ask her about that can work with someone they know. It’s a relationship. And it’s a way they can get information for storytelling. Or making, helping them to be the storyteller to help others. Fabulous. It gives them a sense of value and pwer that they are sorely lacking, missing in their life.
Fred Goldstein 15:06
And if you’re just tuning in, you’re listening to PopHealth Week, our guest is Linda Riddell, Ms. Vice President of Strategic Initiatives at the Validation Institute. So do you teach the various ways to go about being better at this?
Linda Riddell 15:26
So what I do, I have this, I call it the 8x. And it’s I know, it’s eight factors, things that might be weighing on the person’s mind that are hindering them from receiving the help you’re offering. So one of them is called fabric, but it’s about clothes. And diapers, which are clothes for young kids, that kind of thing.So what I want people to do is sort of walk through their service with I call it awkward eyes. As they they said, okay, the person arrives on the doorstep to my clinic, they got here by bus, to get on the bus, you have to have a shirt and shoes. And if the child is older than five, you have to have bus fare for them to. If they look through these factors at every step, it can trigger them say, oh, yeah, I assume they have clothes to get on the bus, or that they have childcare for their child or that the bus schedule is convenient. So it’s a way to force them to look at all of their assumptions. I don’t have a prescription for how they respond. I’m introducing a new lens for them to consider.
Fred Goldstein 16:51
Got it? And so there’s there’s one side of it, which is the the coach or the or the care coordinator, whoever who’s communicating with them? And obviously, you’re you’re trying to teach them to do things differently. What are the are the key factors? Obviously, if you take people out of poverty, that reduces those stressors, those levels below the brain? What are some of the things that can be done? To take some of those those out? I mean, what are some of the things that you see as approaches to help care coordinators or something else do something to reduce some of that brain overload that people are getting?
Linda Riddell 17:38
Yep. So one really important thing is hope, which is a positive orientation to the future. The important thing about hope, though, is not to impose your hopes, just like we were saying, This person would have better health based off smoking. That’s not their goal. So if care coordinators, for example, could ask, what is your goal around this? And how can I help you to work toward that goal, creating some positive orientation to a future, some sense of mastery, and problem solving. That’s huge. And that can have a ripple effect on how they approach other problems. Maybe eventually, they’ll quit smoking. But I often say and I’m really not joking, the best thing that care coordinator might be able to do for that personnel status, is to get their car tuned up.
Fred Goldstein 18:36
Right? So there’s things you could do to you know, that’s what I’m trying to think about are what are the things that a care coordinator, or or another person that interacts with them that you could do to reduce those various impacts? And, and do that, it’s like, back in the day, you say, you know, people can’t focus on their health because their life gets in the way. So let’s solve their, their life issues. And I guess this is sort of a similar thinking.
Linda Riddell 19:06
Yes, it’s a little, it’s a little more indirect, in terms of what you want to connect with is their priority. So like, one of my mentors is, Donna Beegle are very prominent in poverty world. She’s now Dr. Beegle. She dropped out of high school, and a guidance counselor tried to persuade her to stay in high school so that she could get a better job. And don’t herself will tell you if the guidance counselor had told her, You should stay in high school to be a better mother. She might have said, so. Part of the disconnect is that the educated people running these programs have goals that they think are self evident, and they’re not. So to connect with what their goal is, and maybe something completely different. Like if I could get to work on time ever Day had a reliable car that would improve their health, probably more than blood pressure treatment. It’s about connecting with what’s important to them and in a language and a channel, that doesn’t create more barriers. So for example, assuming that they can get the bus to get to your clinic .
Fred Goldstein 20:21
So let me throw this one at you Linda, and you are, you know, a person who sits there and validates the results of programs. And you’re very good at that. And analyzing did that did the analysis they presented with me or the data they presented with, to me really make sense? Is it is it structurally right? You know, can it be validated? So have you done anything or seen anything to show improvements in places that implement this.
Linda Riddell 20:56
So I do have a partnership with a residency program at a local hospital, and they are going to assign it to a resident to do as a research project. And I do plan to develop some other partnerships, I have other hospitals that are interested in using it, and to do some follow up, instead of just the training. But as I said, also to help them brainstorm on how they apply what they learned, and then how they track that.
Fred Goldstein 21:25
Yeah, I recognize it’s early, you know, it’s like it takes a while one to get the thing out, and then do some measurement gets people involved and get enough to make it statistically significant, and all the rest of it. And, but, but it will be fascinating to see what the various impacts might be on improved health outcomes, you know, various depression screenings or stress screenings orthing like that retention. And ultimately, costs maybe, you know, obviously, there are a lot of issues ahead of that that need to be that would show some real significant gains, and be fundamentally important that you know, before you get thinking about cost, but just to be able to, and I know, having worked with these populations for a long time, those folks in individual lower socioeconomic status, it is getting back to the basics, in a sense. And if you solve the basics, you can see some great improvements. But it really is fascinating to hear about the impact on your brain and overloading that ability to make decisions and et cetera.
Linda Riddell 21:50
retention Yeah, like to say, it’s not that people in poverty make poor decisions. It’s that poverty itself shapes the decisions,
Fred Goldstein 22:37
that that is a fascinating way to look at it. So where are you taking this to? Now? You talked about the, you know, some of the groups and healthcare and things and you obviously this program you’re doing with this residency, which will be fascinating to see that study? Where are you, where are you going with it now.
Linda Riddell 22:55
So I have a real goal around this, to connect with K through 12. Educators, in part because even a single teacher, even a single bus driver can make a difference in a child’s life. And having that difference happen early on in their life. You know, the ripple effect is even greater. I mean, even like, you know, there’s studies showing that kids who got Medicaid coverage, grow up to be more productive citizens, are more likely to be employed, all of those kinds of things. So this is in a, maybe a smaller scale, but I just love the idea of getting to a teacher who can affect children.
Fred Goldstein 23:43
So yeah, let me get to that, because we had fascinated me with the way you started this and talked about the sugarcane. And, and so this is, in my mind, this is a fundamental issue that needs to be solved just for education.
Linda Riddell 24:01
Right? So, for example, one of the situations in the game is that when you’re in the game, you’re a single parent, but your sister in law, or Sister Sister in law comes over with her six children, because they’ve been evicted. So you’re a low income person in the apartment, you are risking getting evicted by having six people camping out in your kitchen. So do you take them in and risk eviction? Do you try to get them to shelter them you face all of those options? Here’s the kid coming home from school. And his teacher has the idea that kids should have homework because it teaches them how to be responsible if you do his homework, right. So what what that child learns instead, he doesn’t learn responsibility, he learns the school is a place where he can’t succeed. And so that feeds itself
Fred Goldstein 24:51
and that’s what I was gonna ask you too. So it seemed like the the issues being dealt with it from a adult parent perspective is there a child perspective, or are you thinking about developing a child perspective to this? Wow
Linda Riddell 25:05
Yes, I’ve had educators play, the National Education Association played at one of their conferences. And what I did, I had them do an exercise, I had them pick out the situation that they hated. In became the one that really bothered them. And to step into it as a child, and coming to school the next day, but yeah, I’ve had a lot of people give me different ideas. I had a, I had a guy the other day played, his background was in the Department of Corrections. And he said, you can have a scenario card that says, you get arrested, and it wipes out all the assets on your board. . Yeah.
Fred Goldstein 25:44
Yeah. When you think about all those fundamental issues that occur or that people are dealing with, pretty overwhelming, I would imagine.
Linda Riddell 25:52
Exactly, exactly. And, and we’ve all been overwhelmed with the pandemic, right? We were all stressed. It’s all in the news about how stressed everybody is. It’s because simple things got complicated.
Fred Goldstein 26:02
Well, just imagine, as we know, the impact of laying the pandemic on lower socio economic groups.
Linda Riddell 26:08
Yeah, and already, food and retail are, you know, were highly impacted by the pandemic. They already had unpredictable schedules for their employees. So it kind of made a bad situation worse.
Fred Goldstein 26:22
Amazing. Well, it’s fascinating. Thanks so much for coming on and talking about Getting By. It’s a fascinating game, and really appreciate it.
Linda Riddell 26:29
Thank you for having me.
Fred Goldstein 26:30
And I’ll send it back to you, Greg.
Gregg Masters 26:32
And thank you, Fred. That is the last word on today’s broadcast. I want to thank Linda riddell, MS, Vice President of Strategic Initiatives for the Validation Institute. For her time and insights today, do follow Linda’s work on the web at www.LindaRiddell.net. And that’s Ri d d e l l. And finally, if you’re enjoying our work at PopHealth Week, please like the show in the podcast platform of your choice. Share with your colleagues and do consider subscribing to keep up with new episodes as they’re posted for PopHealth Week, my co host Fred Goldstein. This is Gregg Masters saying Bye Now.