On Today’s episode, Dr. Karen Nelson is joined by Stacie Frandrup, supervisor of the initial assessment centers and care management department at Melrose. Karen and Stacie will discuss the initial assessment process and the important role care managers play in a patient's recovery.
On Today’s episode, Dr. Karen Nelson is joined by Stacie Frandrup, supervisor of the initial assessment centers and care management department at Melrose. Karen and Stacie will discuss the initial assessment process and the important role care managers play in a patient's recovery.
For a transcript of the episode click here.
Dr. Karen Nelson 00:01
Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that will find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose center, welcoming you to Melrose heals, a conversation about eating disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Stacy Frantrip, Supervisor of the initial assessment centers and care management department here at Melrose. We'll discuss the initial assessment process, and the important role care managers play in our patient's recovery. Now, before I begin, I invite you to take a deep breath, and join me in this space. Welcome to the podcast. Stacey.
Stacy Frantrip 00:58
Thank you for having me.
Dr. Karen Nelson 01:00
I'm so happy to have you here with me today we're actually going to be talking about starting treatment and that initial assessment process here at Melrose, we're also going to be talking about the role of care managers. But before we talk about all of that, I would love it if you could introduce yourself and tell us about your role here at Melrose.
Stacy Frantrip 01:19
My name is Stacy fantrip. And I am the supervisor of the care management department and the initial assessment centers at Melrose our locations. Burnsville, St. Louis Park, St. Paul Woodbury Maple Grove.
Dr. Karen Nelson 01:30
So talking about today, our topic is initiating or starting treatment at Melrose, I think it can be extremely anxiety provoking when we're about to start something that we might not know all the steps. And so today, we're going to be talking about this merging of the care manager role, but also what it might be like to initiate or start or explore potential treatment here at Melrose.
Stacy Frantrip 01:58
So care managers are there to help answer questions to help coordinate care within Melrose, if a patient is, you know, starting a new group, or perhaps, you know, the recommendation is to be admitted to our residential program. We're there to help answer questions about what it's going to be like, you know, and help relieve some of that anxiety, I think for patients too, and and then also coordinate care outside of Melrose. So if a patient's heading off to college, somewhere out of state, we're going to help look for resources for them. Or perhaps they're needing some resources for chemical dependency support, we're going to help find those too. So just really, you know, looking for coordinating and helping patients with all of those steps, we like to sort of call ourselves the care traffic controllers. Love that.
Dr. Karen Nelson 02:38
Love that. Well, let's talk about you for a minute. How long have you been a care manager here at Melrose?
Stacy Frantrip 02:45
I have been with Melrose for 17 years. So a really great way to be involved in a patient's care to help them I really love the initial assessment process. I love helping patients, that's probably my favorite part is really helping patients in the beginning and helping them find that there's just a little bit of courage to come in for that first appointment and answer some of those questions and help them realize that we're here to help. And we're really partnering with them in this journey, you know, so that's very rewarding.
Dr. Karen Nelson 03:14
Absolutely. So that piece of that personal connection, let's maybe focus our attention on that initial assessment process. So initial assessment actually is just fancy words for first appointment at Melrose. Let's talk about what that might look like, or kind of what that process might be. There's often a lot of emotion that comes up, right?
Stacy Frantrip 03:38
There's a variety. I mean, I think some patients are worried about what that appointment is, like, you know, what do I have to do. I try to help patients understand that we're partnering with them, we are here to give them information to help them make this decision to enter into treatment. And, you know, it is a voluntary process. And we are very friendly and inviting and the beautiful space. And you know, it's not institutional, and it's just wonderful. So everyone is here to help. So I really do see that piece of it, that anxiety that folks have, sometimes it's families that are coming in, and maybe the child doesn't want to be here and families are afraid of bringing their child in and maybe there's going to be screaming and crying or they just are you know, a little worried about that. And I usually tell families, that's okay, that's part of it. And we're used to it, we got this, we will meet you where you are and that we're there to support you. I love that, such a good message.
Dr. Karen Nelson 04:24
Well, let's kind of start with maybe that first phone call. So someone either has been recommended to contact Melrose or maybe they've seen some advertisements or, you know, they have some interest. What might that first phone call look like?
Stacy Frantrip 04:47
Well, there's a couple of different phone calls. Maybe it's your doctor is calling us and just asking about how soon can I get my patient and if your doctor is calling us, we definitely want to hear from them and coordinate care with that referring provider and Sometimes, like you said, it might be a billboard that you've seen a need to say, Oh, wow, I think I'm gonna call Melrose, for patients giving us a call that first phone call is answered by our wonderful call center agents. And they're just going to ask you a few simple questions about what kind of eating disorder symptoms you're struggling with. It is simple, it's not an invasive conversation. It's just stating the facts about kind of what's going on. And so those questions and those answers are going to help them choose the right appointment for you. If you're really struggling with some more severe symptoms, we're going to make sure that you see a medical doctor to assess what's going on, and really make sure that we're meeting your needs, both medically and psychologically.
Dr. Karen Nelson 05:40
Absolutely. So that initial kind of screening, maybe is a word that we might use, we're just kind of assessing which provider you should be scheduled with for that initial assessment.
Stacy Frantrip 05:51
It's not a scary screening. It's very warm and friendly. And pretty fast. I would say, most intake calls are, Gosh, 10 minutes, maybe. I mean, it's not long.
Dr. Karen Nelson 06:00
Do we do any assessments virtually here at Melrose?
Stacy Frantrip 06:04
We do we absolutely do. We have therapists who are doing virtual assessments, but in that initial call, when you're reaching out to Melrose, that call center agent will, depending on how what you're answering, they will schedule you with either that therapist virtually, you can also see a therapist in person, if you don't love virtual, that's okay, we get it. So we're gonna meet you where you're at?
Dr. Karen Nelson 06:24
Well, I love that kind of distinction. You know, in that early questioning phase, where they're asking about some symptoms, they're determining which provider is most appropriate to do that initial assessment. I actually do between four and six initial assessments every week here at Melrose. And those assessments are specifically for patients who are struggling with binge eating disorder, those patients will see a psychologist for their initial intake, other diagnoses, potentially, if you're engaging with symptoms, such as purging or severe restriction, or if there are potential medical complications, oftentimes, then the assessment would then be done with a medical provider. Is that correct? That's correct. So let's talk about during that initial assessment, Stacy, how may care managers become involved in that initial assessment?
Stacy Frantrip 07:17
From the beginning, when a patient calls if they have further questions, and maybe they're a little hesitant? They're not sure they can be transferred to us, they can talk to us about their fears, their anxieties? Or maybe it's gosh, is my insurance gonna pay for this? You know, what's my out of pocket expense? Going to be all those kinds of questions we can help with? And we can talk about what treatment looks like here? And answer what that feels like what that looks like, is this going to be a long treatment or shorter course of treatment, we can help parents understand what that commitment is going to be to treatment as well, I think that's important to have those conversations right away to kind of understand and what the expectations are going to be. So we can do all of that before patients ever even seen.
Dr. Karen Nelson 08:00
So many detailed spaces that you're just really joining the patient, and you know, providing that nurturance, compassion and kind of guidance, right? I mean, this is brand new. So it makes sense that we need some guidance and some support
Stacy Frantrip 08:15
can be overwhelming. Yeah. So it's, we're there to help answer questions. And maybe it's just answer them many times to you know, you got to call again and say,
Dr. Karen Nelson 08:23
What did you say that day when That's right. What was that again? Yeah, we're there to answer.
Stacy Frantrip 08:28
Yep. Yep.
Dr. Karen Nelson 08:29
I love it. Well, let's kind of go through an example of if someone, it's been determined that they do need an assessment here at Melrose, and it's been determined that their diagnosis or potential diagnosis may be best met by seeing a medical provider, what might that look like?
Stacy Frantrip 08:49
So it's about a two hour time commitment. And patients can be seen by a medical provider and all of our locations so Burnsville, Woodbury, St. Paul, Maple Grove, St. Louis Park, you can see a doctor and all those locations for your assessment. And when you arrive, you'll check in with our frontline staff. And then a nurse will take you back and collect vitals, do a height and weight, they'll draw labs, sometimes urine sample just depends. And you know, that process with the nurse, they're going to gather medication, information, reconciliation, things like that. So that's about, you know, 20 minutes, 30 minutes or so, and then the doctor will then come in and meet with the patient and do their diagnostic assessment. And that's about an hour 45 minutes and then the doctor will provide the recommendation for what you know is next. And that's typically when the care manager comes in and kind of wraps things up and helps answer you know, those questions about what's next. And then oftentimes patients are scheduling to you know, if outpatient is recommended, we do schedule appointments right away. So I always tell patients bring your calendar.
Dr. Karen Nelson 09:55
If I am a parent, am I able to be in the room with my child or Can I bring a loved one with me to that initial appointment?
Stacy Frantrip 10:03
Yes. So definitely, that is just fine. You know, there's parts of it that the provider will want to perhaps do solo just with the patient. If you know, patients really young, obviously, parents are going to be with their child. But if you're an adult, and you want to bring a support person and a loved one, and you want to maybe even bring them in for that recommendation piece so others can hear what's going on, that is totally fine.
Dr. Karen Nelson 10:24
I think that's really important, right? Again, that aspect of the unknown or worry or fear, it can be helpful. Of course, we want a loved ones with us. Absolutely. And we completely understand that for sure. So let's go back to you had mentioned that part of that initial assessment with a medical provider is gathering labs help us know about that a little bit, what might that be? Or what does that look like?
Stacy Frantrip 10:49
Promise, it's not too scary, and they will help you if you have anxiety around it, you know, we can lay down whatever it takes, like we're going to be there and help you through it. And it's really to check electrolyte imbalances, potentially, your nutritional deficiencies, and we just really want to get an idea of the eating disorder has affected a person's medical stability, and labs can really help us determine that.
Dr. Karen Nelson 11:10
So really thorough when people are like, well, you know, why does it take so long, right? It's like, well, we're checking in looking and assessing at a lot of aspects. I think that is really that place of just being really thorough, and wanting to make sure that we're not missing any pieces. Absolutely. So let's talk about you know, as they're doing labs, you know, you had mentioned, we're kind of looking for potential nutritional deficiencies, you know, electrolyte imbalance, what might the EKG report reveal?
Stacy Frantrip 11:39
Well, it's going to talk about your heart rate. So you know, if your heart rates low, you may need to be hospitalized for that that might happen on a telemetry unit at Methodist. And that's just to kind of stabilize further and make sure that everything's okay. We're not in acute hospital setting. That's why we partner with Methodists to stabilize patients in those circumstances, that doesn't happen very often. So it's not something to be scared about, it's, and if it does happen, you know, we're making sure you understand every step of the way, what the process looks like, sometimes labs, there might be a low potassium or something like that. And it may be too low for us to treat. And so that might need to happen at the hospital with an IV and then we're able to get the patients back once those have stabilized a bit more. So it just depends. an EKG can also show some abnormalities that the cardiologist needs to check before they come back.
Dr. Karen Nelson 12:29
That's a lot right to hear, like, wow, that's a lot of things that potentially may be happening, or a lot of data that is gathered, I think, you know, just acknowledging that emotion space of talking about these things that I literally may have spent my whole life trying to hide. And if there's just so much emotion present, I think we really just want to acknowledge, we get that and we won't leave you alone in that space. You don't have to do this all by yourself. You don't have to know all the answers. Like that's why we're here. And I mean, literally, I think I said at the beginning of the podcast, right? What is an assessment? It's the opposite of the secret. We're literally talking about it. And so it can feel overwhelming. It can feel just really overwhelming. And I think the message that we want to send is that we're here and we will support you in that space. Exactly. I think what has become so clear, as I've done this work is that secrecy wants us to not talk about it. That space of shame often keeps us very stuck. But we want to provide the acknowledgement that we see you, and that hope and recovery are really possible. But we can't do that. If we're not addressing it and acknowledging it. And that I mean, the initial assessment is like the first step, right? I mean, it's like, we got to do that before we can do anything else.
Stacy Frantrip 13:57
Yeah, let that secret out. Let it go.
Dr. Karen Nelson 14:01
Let's maybe pause Stacey and talk about what may happen when a family has decided that their child or loved one does need to come in for an assessment. But they potentially may be worried about some resistance from their child, or they may worry that their child it becomes, you know, quite distraught or upset. Have you ever experienced that?
Stacy Frantrip 14:24
Well, first of all, it's very normal. We see that all the time. So I don't want parents to feel ashamed of it or worried that their child might misbehave or something like that. Because that's, you know, that's the eating disorder. And we're used to that and you know, that is that piece where that's what we need to do and work with parents and to work with the kiddo and help them feel safe and comfortable and know that it's okay if your kid is screaming or crying are very upset or very distraught. That is okay. And actually a good thing. You know, that's right. They're here and they're expressing emotions and we're working through it.
Dr. Karen Nelson 14:57
When I tell parents to we understand As we know, that's the eating disorder, right, the eating disorders just been outed. And so there's a lot of emotion around that. And that's where we'll meet you, you know, this is our specialty, we will develop a plan and create some safety and nurturance to not only kind of calm down the parents, but also really listen and hear what the child is saying. But then also continue on with our recommendations and insight that we're giving that family about what next steps might look like, several years ago, I was in an initial assessment, and they had some potential concerning concerns about eating behavior. But what it was really what it came to be was more kind of generalized anxiety. And there were some, you know, disordered eating patterns that were there, they did not meet full criteria. But what I was then able to do was, number one, kind of help them understand what was happening, and then give them those resources to, you know, general mental health care in the community with kind of a plan or an idea of what to do next. And, you know, again, I think not only eating disorders, but just mental health struggles. You know, sometimes those are just really hard things to talk about. And thankfully, there's a lot of wonderful skilled professionals here that can help you determine what is really going on. And then how can we best assist and help? I think it's just so important.
Stacy Frantrip 16:25
I feel like you're touching on that assessments, also, figuring out CO occurring disorders. Yeah, so you know, that we may recommend treatment at Melrose, but we might also say, wow, you know, DBT is really going to be helpful for you. At the same time, as Melrose, let's get that set up, or maybe chemical dependency treatment might need to come first, you know, maybe this person needs detox today. And we got to figure that out. And then we're going to recommend admission, and Melrose and we're gonna partner with that program to get you here.
Dr. Karen Nelson 16:59
So we're establishing all of those recommendations right away to DBT, for people that might not know stands for Dialectical Behavioral Therapy, it is a skill based therapy. So people who potentially may be struggling with a lot of emotional dysregulation, in conjunction with maybe the work that they're doing at Melrose, to manage the eating disorder, it also may be a recommendation that you engage in this therapy, to just kind of help manage emotion, let's talk about if there is a patient that they need to be admitted to the AR intensive residential program. What might that look like? Or how might you help them understand what that stay might look like?
Stacy Frantrip 17:38
Well, you know, sometimes, before a patient comes in, you know, perhaps they know that they need admission, so we might have those conversations before their assessment and talk about what to pack, you know, and kind of, you know, what does it feel like, what does the room look like, and those kinds of things and usually direct patients to our website, we have a fabulous video on the website that shows a picture of the room and a patient's in it. And I always kind of say, it looks like a like a posh dorm room, it's pretty nice, it's warm and comfortable, it doesn't feel like a hospital space, you know, it doesn't feel like that clinical feeling, it just feels warm and friendly. And, you know, there is a packing list on our website, too. So you know, patients can come prepared, or maybe family comes prepared, because they just know that's going to happen. And you know, that's great when we can prepare people that way. But it might not be, you know, a prepared admission, it might be an unplanned admission. We weren't planning on this today. And so that's the conversation that we're having is talking about how, you know, kind of readiness for change, like motivating patients a little bit to just sort of say, Let's this, we got to do this today, you know, and that there might not be a choice there, they may need to because it's medically necessary. And probably we can't allow them to go home because they're at risk, you know, of severe stuff. So it's talking about that and helping them realize that this is necessary. And our whole goal is to partner with patients and help them you know, make this decision on their own and want to be here, even if the eating disorder is kicking and fighting and screaming and saying No way. We're gonna help your voice come out and make that decision and say, I'm going to do this today.
Dr. Karen Nelson 19:13
Let's kind of go back to, you know, if admission is recommended, but there may be is some hesitancy you know, is it sounds like that's a place where care managers become intimately important.
Stacy Frantrip 19:27
So if a patient comes in and you know, first of all, let's say the doctor's has established, this patient needs admission might even just be to like our partial program might not be a hospitalization, there might be hesitancy around even just doing outpatient. It could be all of it. If it's okay for them to wait and clinically, they don't need to go in today, then yeah, we're going to be there to help answer those questions about what programming looks like and you know, try to ease that anxiety a little bit and like I said, that might be similar to before you come in, it might be several phone calls to us and helping to bridge that gap between the beginning and starting and Just answering all those worry questions were there for that 100%.
Dr. Karen Nelson 20:03
Again, the more we know, the better, it helps us start to kind of organize what it's going to be like the I, it makes sense that I'm worried and anxious about something I've never done before the I'm returning to treatment, but it doesn't mean that I still potentially might have some worry.
Stacy Frantrip 20:19
That's another really good point. So we work with patients and someone like me, who has been here for a long time, I'm gonna have patients call me who have been here before. And you know, they're gonna say, hey, Stacy, I want to do things differently. This time, I'm in a different spot, maybe I've addressed some other stuff going on. And I know, you know, I really, really want to focus on A, B and C, could you let the team know? Or, you know, or there might be additional worries going on this time around and concerns, things that have changed. And so again, we're that, that liaison between the patient and the team to pass that information along and to advocate for the patient and their needs. Or they may have serious insurance concerns this time. And they didn't before and how do I navigate that? Because I've been there and this is totally different. So we're there to help guide through those things too.
Dr. Karen Nelson 21:06
Well, I think sometimes, you know, a barrier to accessing treatment. Number one is the unknowns, like you said, that insurance piece or what if I have to take time off of work? I mean, that's often a question yes, that I get from adults. Tell us about that. Like, how might you help someone navigate that?
Stacy Frantrip 21:24
Adults oftentimes can qualify for FMLA. And we can help with that paperwork. And, you know, sometimes it might just be a note that needs to be written for school or something like that. And we can do that, too. It just may be an intermittent FMLA, to be able to do some outpatient treatment, or all those things are an option. Sometimes patients don't have FMLA benefits. So then it might just be problem solving and helping them maybe, you know, have that conversation with their boss or leader, that might be a scary thing, and just guiding them on how to talk about asking for help, you know, and it's okay to not talk about that you're doing eating disorder treatment, I tell patients that too, you don't have to say that. If you don't want to, if you're not ready for that you don't have to right now you can just say I need to be hospitalized for a medical concern and my need X amount of time off, because they might not be quite ready to talk about that yet. But they're ready to come here. So you know, I might just guide someone on how to do that.
Dr. Karen Nelson 22:18
I think it's also important to call out you know, care managers can be really helpful in just supporting patients as they are initiating and progressing through services while at Melrose, anything specific that you might be able to kind of name or talk about if a patient identifies as LGBTQ plus, or if they are from another culture, and there may be some kind of cultural concerns or worries, care managers often can facilitate support in that space. Oh, yes,
Stacy Frantrip 22:48
definitely, we're going to help connect you to the right provider here that feels like the right fit. So you know, talk to us about those things and those needs, because we want you to feel safe and comfortable with that person that you're going to be working with. And so we definitely know everyone's specialties here. So we can get you matched to the right people. But, you know, we're gonna order interpreters when needed, or, you know, work with frontline on that. So Park Nicollet, and health partners have wonderful interpretive services. And so we can get someone here that that speaks that language, sometimes we have parents who don't speak English, but patients do. So we're going to work together to make sure that, you know, we provide the right support.
Dr. Karen Nelson 23:25
Absolutely. I mean, and I think that's the message that we want everyone to hear is that truly you everyone is welcome. You know, we want you to feel comfortable and safe. This is a really, it can be a nerve wracking or a scary first experience. And so we are here to help surround and support you kind of walking through that, you know, sometimes I might not even know what I need. But I can say about what makes me feel scared. And so sometimes just saying those things out loud to a care manager, or your initial assessor, the, you know, practitioners that's initially assessing you, they can address it, right? If it's like, well, what if I get a therapist who doesn't get me? Well, tell me about you. And so let's make sure we get one that does get you. I think another point to add, Stacy is you know, if we have patients who may identify as LGBTQ or are from you know, other cultures or have some cultural concerns, again, we're really meeting them where they are. And we're asking potential questions to help build comfort, right. So we may ask questions about preferred pronouns are preferred name, we want to create some space where all patients feel welcome and safe and supported, and that we really just want to meet you where you are. And so it sounds like a lot of those conversations are just building connection and helping them feel safe.
Stacy Frantrip 24:49
That's exactly right. Yeah, definitely talk to patients, you know, when they call in and perhaps they're struggling with binge eating disorder, and they didn't really know that was a thing. Like what is that? Yeah. And so that sometimes that first conversation –
Dr. Karen Nelson 25:01
Wow, there's help for this, you're not alone.
Stacy Frantrip 25:05
So, exactly. So that's a, you know, a very hopeful conversations. You know, when patients call to schedule, it's always like, Alright, we're here.
Dr. Karen Nelson 25:13
I think it really speaks to that place of holistic care, right? I mean, the care manager, it feels like they are really instrumental in kind of holding it together, right? I mean, there's so many aspects of care, and it makes sense that it can feel overwhelming for a patient to navigate that, and what beautiful support care managers can offer. I'm interested to know, when you think about your job, Stacey, what is the most rewarding part? What do you think?
Stacy Frantrip 25:43
Oh, gosh, well, you know, I think some of those stories of really connecting with patients to help them come in, I can remember some patients that I've worked with where it was so hard to just even walk in the door. And you know, I remember I just met someone in the vestibule. I just said, Okay, here's step number one. Here we are this is it. That's a memory that I'll always have, because that patient did come in eventually, and was admitted. And I think, Wow, maybe wouldn't have if that option wasn't there for her.
Dr. Karen Nelson 26:12
That's really huge. Any hard parts of your work?
Stacy Frantrip 26:17
It can, you know, it's an emotional process, like you said, so we see all of that emotion. And definitely, there are days that are hard, and, you know, stories that are hard, but I know that patients are getting the help that they need. And they're on this journey, that they're going to get better, you know, and so you have to, I have to remember that. And it's just, there's hope.
Dr. Karen Nelson 26:40
That's right. When I think you know, we have this unique perspective, right? Because we've been doing this work as long as we have. There's so many success stories, so many. I mean, we just watch people get better. Yeah, we see it every day. Yes. And that feels so hopeful. It does it does. Well, what would you say? As far as you know, if there is a patient who is listening, who may be anxious or worried about or, you know, what might it be like to go ahead and make that, you know, phone call for initial for an initial assessment, any recommendations or suggestions, call me. We'll talk what might you say on that call, if there, you know, any, you know, kernels of wisdom that you might share with them when they're not ready?
Stacy Frantrip 27:32
Yeah. Well, I mean, I guess I would say that's okay, this is your choice. This is, you know, you need to be ready and, and want to want this right now. And so, it's okay to say that and maybe it's not that you don't want to engage in treatment right now. Maybe it's just you don't wanna engage in treatment at Melrose. And that's okay, too. Maybe that's my job right now is to help you determine that I'm just really looking for like an individual provider in the community because that feels the safest for me. And hey, I have a whole list of, of therapists that are awesome, that I can help, you know, direct you to if you know, Melrose, isn't it right now? That's okay. You know, just want to help you figure things out. Right, you're here and you don't We don't need all the answers right now. We don't need to know ads. We don't need to know, you know, like, exactly how long this is going to take or, you know, sometimes that's where it goes those conversations, you know, because that's that anxiety. But really, it's just let's talk about it all. And and realize, like, this is a journey, it's I tell patients, this is kind of a marathon, it's not a sprint, and I'm not gonna figure it out right now or in two days. So just take one step at a time.
Dr. Karen Nelson 28:43
I love that. Absolutely. Well, Stacy, I can't thank you enough. I've just so enjoyed our conversation and just appreciate all your insight. Thanks. Me too. That's it for today. Thanks for joining me, we've covered a lot. So I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, take notice. Pay attention, and we'll take it as it comes. I'll talk to you next time. Melrose heels a conversation about eating disorders was made possible by generous donations to the park Nicolet foundation