“The window of time when people are willing to accept behavioral health help is sometimes narrow,” said Kelly Gillooly, M. Ed., LCADC, UofL Health system director of Behavioral Health. “With PeaceNow, the 3-4 month waiting period has been reduced to days and eliminated in some cases. The virtual environment allows us to see many referred patients immediately or on the same day.”

A PeaceNow pilot program began in July 2022, opening first to referrals from UofL Physicians. In its first six months, more than 1,200 patients have been served. Today, referrals are accepted from all providers,��mental health therapists, school counselors and social workers in Jefferson County and surrounding Kentucky counties. Future plans include adding Indiana counties, following regulatory approvals.

“Physical health and behavioral health cannot be separated. One influences the other and I see the impact of both with my patients,” said Traci Edwards, M.D., UofL Physicians – Primary Care. “Primary care physicians are ideally suited to refer for behavioral assessments since we know they already have the relationships, know the health history and are located all across the community.”

Referrals to PeaceNow are open to patients age 12 and above with a range of mental and substance use concerns, including:

• Depression
• Anxiety
• ADHD
• Substance use disorders
• Bipolar disorder
• Schizophrenia
• Trauma
• Grief
• Other mental health

“Individuals seeking care for their mental health are often met with long wait times before they receive appropriate treatment. This delay increases the likelihood that their symptoms and condition may worsen before care is provided,” said Nancy Brooks, executive director of the National Alliance on Mental Illness, Louisville chapter. “The access to more immediate professional care that is now being offered through PeaceNow will help many individuals bridge the gap between the onset of mental health concerns and proper diagnosis and treatment.”

Telebehavioral health assessments, through PeaceNow will be performed by a clinical psychologist or a licensed therapist, with additional referrals to the appropriate level of care. Some brief therapy may also occur over the telehealth platform. All care will be supervised by psychiatrists and psychiatric APRN’s, who will also provide clinical services to patients.

“The virtual assessment may not entirely replace the need for in-person therapy, but it is a critical new access point,” said Robert Caudill, M.D., UofL Physicians – Psychiatry and Depression Center and professor of psychiatry at University of Louisville. “By launching PeaceNow, we hope to make behavioral health more accessible and expedite the connection of patients to definitive care.”

Older adults may be referred through PeaceNow to the at the University of Louisville Trager Institute.

“Our focus at the Trager Institute is on older adults. It is estimated that 20% of people age 55 or older experience some type of mental health concern, such as anxiety, severe cognitive impairment, depression or bipolar disorder,” said Anna Faul, Ph.D., executive director of the institute. “Combining the PeaceNow team and the Trager team, we believe that we are filling a void in our community that will lead to better health outcomes in the future.”

More information on PeaceNow is available through your primary care provider, mental health therapist, school counselor, social worker or at:��

Now she is creating a sponsorship program to assist area children with clothing and supplies once they can go back to school.

UofL News talked to Miceli about her efforts, the support she has received and what needs still exist in the flooded communities.

UofL News: How have you been able to help those affected by the July flooding?

Chelsea Miceli: My work has varied greatly from day to day. I have assisted in coordinating hot meals to remote communities. I have prepared meals and delivered them door to door. I have taken up donations and delivered them to homes throughout Knott, Breathitt and Perry Counties. I helped find individuals to sponsor a Perry County High School football player who lost all his sports equipment. I worked with national disaster relief food organizations to create hubs for food pickup for those that still do not have access to roadways. I connected the shelters to resources to get oxygen for those staying in the shelters. I assisted in finding a location for a birthday party for a young girl that lost everything. I assisted in connecting affected individuals with showering and laundry services. The Trager Institute and Republic Bank Foundation Optimal Aging Clinic staff and I worked to coordinate services for the Deaf and Blind community that is being sheltered at Hindman Settlement School.

UofL News: What makes the work personal for you?��

Miceli: As a resident of Whitley County who has family members across Eastern Kentucky, I understand the value of Appalachia and the history surrounding the culture which makes these individuals and their families so strong. When the recent flooding disaster hit in Eastern Kentucky, I knew I could not sit idly and watch those that I have an obligation to serve suffer alone.

When a disaster of this magnitude takes place, it is an immediate call to help your neighbor. Given my connection to this region and these communities, this work is very personal to me as I understand the geographic remoteness of this area of our state. These communities already face structural and systemic inequities such as generational poverty and trauma, oppression and a lack of resources in rural areas, and this disaster will only exacerbate these challenges.

These are my people, the people that I want to serve, the people that I feel could most benefit from additional services, the people that I know need advocacy and the people I know that are appreciative of the simplest act of kindness. ��

Living and working in this region, I know that the communities of Eastern Kentucky are tough and resilient people, yet we all need help from time to time. I have delivered supplies and food to homes where people have said, ‘I hate to take it if someone else could use it more than us.’ The culture of wanting to work for what you have and always lending a helping hand is something that is instilled in our communities from birth. ��

UofL News: What specific skills and experiences have helped you in this work?

Miceli: As a recent graduate from the Kent School and now a Trager Institute and Republic Bank Foundation Optimal Aging Clinic employee, my educational and professional background has instilled in me the value of taking action. During my time in the MSSW program and as an intern, I learned the importance of trauma-informed care and the long-term implications that you can have on someone’s life through acknowledging what they endured.

Throughout my time helping in Eastern Kentucky, my main goal has been to offer dignity and worth to individuals who have lost everything. Taking the time to stop and hear their stories and let them know that someone is there for them and is working with them is the best service anyone can offer. ��

UofL News: How has your position at UofL and hat connection been helpful?

Miceli: As a program coordinator with the Trager Institute and Republic Bank Foundation Optimal Aging Clinic, I develop and facilitate services, provide education, training and supervision to our student interns and facilitate collaboration and services with partnering sites across Eastern Kentucky for our projects funded by Health Resources & Services Administration grants. One of the core missions of these projects is to provide workforce development and services to rural communities across the state. ��

The team has been instrumental to my flood relief work. I have reached out numerous times needing assistance in identifying contacts and resources to provide services to these individuals. Without hesitation, they connected me to individuals and organizations that could assist with high priority needs of the communities including oxygen, hearing aids and sign language interpreters.

The staff has gone above and beyond to help me serve these individuals, most of whom they will never see nor meet. Without their help I don’t know if my work in Eastern Kentucky would have been as fruitful.

Our partner sites across Eastern Kentucky have faced many challenges during this time as well, primarily Mountain Comprehensive Health Corporation. However, any time I picked up the phone and explained a need they were quick to act and put me in contact with individuals and resources to resolve the issue. ��

UofL News: Tell us about your project to gather supplies for students as they go back to school.

Miceli: I am working to create an ‘Adopt-a-Student’ sponsorship program. We will ask sponsors to purchase a backpack, clothing essentials (e.g., socks, shoes, underwear and two outfits), along with basic school supplies to be distributed to students in Knott County when they are able to return to school. With so much uncertainty surrounding when school will begin, this gives us time to begin gathering items in hopes that as students return, they will not have to worry about having school clothes and supplies. Given the financial hardship the parents are already facing, between clean-up costs and restarting their lives, the goal is to relieve some of the burden on them as well. This program’s goal is to let the students and parents start this school year without additional stressors during this trying and difficult time.

An has been created for school supplies for the students. To contribute to the Adopt-a-Student program, contact Miceli.

Some of these include yoga and tai chi classes, nutritional counseling and acupuncture. Recently, the institute also began offering a six-part drumming series dedicated to the caregivers. The current series ends June 13, but the institute plans to host the series again at some point this year and, in fact, hosts the program a few times each year.

According to Payton Kruer, Trager’s caregiver program manager, the somewhat-new series has generated a positive response thus far from participants. ��

“The drumming series was brought to Trager as a fun, whole-person strategy that promotes socialization and offers a healthy, non-strenuous workout,” she said. “On a deeper level, it builds bridges while fostering nurturing, support, camaraderie, self-respect and respect for others.”

Kruer adds the program is not about drumming, but rather using the drum as a tool for communication and personal expression. Drumming circles have been also proven to reduce stress, boost the immune system and increase energy, release negative feelings and create a sense of community. One peer-reviewed published research study conducted on long-term care workers demonstrated a 46% improvement in mood disturbance (e.g. depression, anxiety and anger) from such programs.

Using drums, and music making in general, has been a healing technique for ages. Trager began incorporating HealthRhythms model into its services about two years ago. HealthRhythms was established about 15 years ago and has since been used by more than 3,000 trained facilitators around the world. Locally, it proved successful with the Kentuckiana Regional Planning and Development Agency and the agency’s former director of social services, Barbara Gordon, introduced it to Trager when she was brought on board as the director of community engagement. ��

Trager employees, including Kruer, and Kennette Rightnour, FlourishCare specialist, have been trained on the HealthRhythms program and have been conducting the drumming series for the past two years. Each series is six weeks.

“Something that was not an expectation I had when I was trained is that every group is different. We’ve gotten to do it with a few different populations, age groups and locations and each group has a different way to approach the drums and making music together, thus creating a new and inventive sound that amazes me each time,” Kruer said.

Trager has partnered with a few local agencies, including the AARP and the VA, to offer the program to caregivers in the community. Kruer said the caregivers enjoy having a safe space to express their daily emotions openly as they care for their loved ones.

“By utilizing HealthRhythms, we have an opportunity to not only utilize the program for our wellness for an hour but give people the tools to use music on their own in the future for self-expression, self-care and any other benefits they may feel after the series,” Kruer said.��

The drumming series also fits into Trager’s overall programming. Kruer said the institute is working to increase its wellness services, all of which are updated regularly on .

The investment will support the renovation and development of a new dynamic Student Collaboration Lounge in the UofL that will become the heart of the student educational program. The funding also will enable the build out of UofL ’s Culinary Medicine Training Kitchen.

“The University of Louisville’s mission includes preparing professionals who will have a significant impact on our community and the commonwealth. Our nurses are frontline heroes and today’s announcement will only improve their experience and training,” said UofL interim President Lori Stewart Gonzalez. “Thank you to our partner Kindred Healthcare for investing in UofL’s School of Nursing and our community’s next great generation of nursing leaders.”

“Louisville’s ability to stand out as the nation’s epicenter for the future of health care innovation relies on a robust and well-trained nursing workforce across the care continuum,” said Kindred Healthcare LLC Chief Executive Officer Ben Breier. “On behalf of the Kindred Foundation, and me personally, we are proud to support the development and training of the next generation of nurse leaders through our investment in UofL’s School of Nursing. Our hope is that we can support well-trained caregivers and positively impact the health and well-being of our entire community.”

The essence of the 3,485-square-foot Student Collaboration Lounge renovation positions UofL nursing students for success by encouraging them to engage with one another, to share ideas and to develop collectively. The new Student Collaboration Lounge features spaces to support collaboration in both open and private places, including an open kitchen area built to resemble a modern café.

The innovative Culinary Medicine Training Kitchen will help train the health care workforce of the future address barriers to healthy eating by increasing students’ and patients’ sense of preparation, confidence and comfort; help erase misconceptions about popular diets; facilitate learning how to make healthy food flavorful with spices and herbs; provide basic cooking techniques and address food access and other equity issues.

By providing an evidence-based curriculum that supports various delicious and healthy ways of eating, participants will be better prepared to explain dietary approaches and offer strategies to support this foundational component of wellness to their patients.

“One of the most important lessons I’ve learned being a 24/7 caregiver is there is always too much to do. My care receiver’s needs are continuous and I must find and prioritize time for myself to do the things that are important to me and make it possible to continue on,” said Sally, a participant in the Caregiver Program who asked to be identified by first name only. “The caregiver support group is one of those things. Talking with and listening to the other caregivers makes me feel less alone, allows me to vent when things are really difficult, gives me ideas of how to make things easier and almost always includes a shared laugh that otherwise can be few and far between.”

A “caregiver” is anyone who cares for an older family member by helping them with daily activities such as transportation to and from medical appointments, grocery shopping, household cleaning, cooking or meal preparation, medication management or helping them handle finances and bills. Some caregivers also may provide more advanced care for their loved ones such as help with bathing, walking, toileting, dressing or feeding.

The program is offered at no-cost to caregivers through a grant funded by the through the Older Americans Act and the Cabinet for Health Services. Caregivers living in Bullitt, Henry, Oldham, Shelby, Spencer or Trimble County are eligible to participate in the program.

“We are pleased to be able to offer this program free of charge to those who are caring for older family members in some of Kentucky’s more rural counties,” said Payton Kruer,�� caregiver program manager at the Trager Institute. “Being a caregiver is a very important job, but it can be overwhelming and difficult to know what to do when it comes to creating a strong support system for the older adult you are caring for, especially if you live in an area that is more isolated from potential resources. We are here to help by providing tools and resources needed to ensure your needs as a caregiver are addressed as well as to help you improve the life of the person receiving your care.”

To participate in the or for more information contact Kruer at 502-588-3322 or payton.kruer@louisville.edu.

“It would be impossible for us to fulfill our mission of innovating the aging experience without first ensuring the safety and health of our older adult patients and staff during the pandemic,” said Anna Faul, executive director of the Trager Institute. “This partnership with LoDI has been beneficial for us to understand what we need to do to return to normal capacity when the positivity rates are at a level that would be absolutely safe for our patients and staff.”

Through the collaboration, LoDI and Trager Institute leaders established capacity and utilization estimates to allow Trager staff to transition from telehealth and work-from-home policies to hybrid policies allowing a return to in-clinic visits for patients and location-based work for Trager students, faculty and staff.

LoDI, housed at the , is dedicated to developing innovative delivery processes for industries including manufacturing, service and health care. Students and faculty at LoDI recently worked with businesses in the oil and refinery field, a public utility and the .

For the project at the Trager Institute, a team led by Lihui Bai, co-director of LoDI, used a simulation model to determine a safe volume of traffic that allows proper social distancing at the Optimal Aging Clinic. In particular, the study team, which included Monica Gentili, Arsalan Paleshi and LoDI Fellow Shahab Sadri, simulated operations at the clinic to determine the maximum number of clinical staff, patients, faculty and students, as well as Trager faculty and staff, that safely could be present in the building.

The results of the study will serve as a guide for Trager Institute leadership in determining the percentage of clinic appointments that must be kept virtual and the number of learners and institute staff and faculty who safely could resume on-site activities. The clinic will implement the guidelines provided by the study once coronavirus infection rates in the community reach an acceptable level to resume in-person visits.

“Our study found that patient and staff movements at key common areas throughout the facility are within the safety measures of a COVID-19 environment,” Bai said. “We were happy to be a part of this collaboration by applying our simulation model to study the traffic patterns at the Optimal Aging Clinic. We look forward to extending this study to evaluate other operations measures such as utilization and possible improvements in a joint future research with the team at the Trager Institute.”

“We are grateful to the LoDI team for their expertise in helping us determine safe and efficient operating procedures at the clinic,” Faul said.

More than 150 nursing homes already have enrolled to participate in the Trager Institute’s network training hub, including all of Trilogy Health Services’ senior living communities. The institute’s goal is to enroll as many nursing homes as possible in the network, focusing particularly on facilities in Kentucky.

As an official training provider, the will provide training for enrolled nursing home staff to engage with experts and peers and share cases for real-time discussion and advice. The weekly one-hour virtual training sessions will take place over a 16-week period using the – an “all teach, all learn” methodology developed around case-based learning and active engagement.

“We are more than ready to embark on this journey of fighting COVID-19 in nursing homes,” said Anna Faul, project director and executive director of the Trager Institute. “Nursing homes are in critical condition when it comes to fighting COVID-19, not to mention the social isolation their residents have been experiencing throughout the pandemic. Providing a training program that not only follows the same collaborative, integrative approach we advocate at the Trager Institute, but also gives nursing home staff the shared knowledge and best practices they need to provide safe care while reducing social isolation for residents, is exactly the type of health care improvement we need for the older adult community.”

In addition to Faul, facilitators on the training team include Laura Morton, program director for nursing homes and assistant professor in the UofL Department of Family and Geriatric Medicine, Ruth Carrico, professor in the UofL Division of Infectious Diseases, and Christian Furman, professor of geriatric and palliative medicine, as well as UofL faculty specializing in quality improvement, compassionate care, mental health and community engagement.

Participating in the network will provide nursing homes with practical information, skills and resources needed to protect both residents and staff from the virus.

“At Trilogy, the health and safety of our residents, employees and families is our top priority,” said Leigh Ann Barney, CEO of Trilogy Health Services.��“We believe participating in the ECHO infection control training through the UofL Trager Institute is another layer in our efforts to combat COVID-19 across all our campuses. We are excited to be part of this valuable program.”

Eligible nursing homes that actively participate in the network will receive $6,000 in compensation in recognition of the staff time involved, along with a Quality Improvement Certificate positioning them to receive a portion of the $2 billion available to nursing homes from the federal Provider Relief Fund authorized under the Coronavirus Aid, Relief and Economic Security (CARES) Act.

To learn more about the National Nursing Home COVID-19 Action Network or to participate, visit the on the Trager Institute website.

“We are thrilled to be able to honor this year’s Gold Standard of Optimal Aging cohort through such a special recognition,” said Anna Faul, executive director of the . “It is our tradition to invite the honorees to a luncheon to celebrate their inspirational and vital role in our community. Instead of an in-person event this year, we are celebrating with a creative social-distancing video tribute as well as a variety of other media recognitions. We are thrilled to have so many leaders recognize the incredible strength of our state’s older adults during this difficult year.”

The ninth celebration of UofL Trager Institute’s Gold Standard of Optimal Aging honors individuals age 85 or older who are outstanding models of optimal aging and exhibit inspirational involvement in various aspects of their lives, despite any challenges they may face.

Recipients of the Gold Standard of Optimal Aging are recognized each year in September, the Trager Institute’s Optimal Aging Month, as part of the institute’s effort to foster a more age-inclusive community.

“What makes this award so special is that it is a recognition of the active and ongoing contribution older adults make in our families and communities,” said Christian Davis Furman, medical director of the UofL Trager Institute. “This year, more than ever, we have been inspired by the example of the older adults in our lives as we navigate the current pandemic. The whole Trager Institute team is deeply humbled by their inspiring stories and grateful to be able to celebrate them, even from a distance.”

Furman was one of the original creators of the Gold Standard of Optimal Aging in 2011.

The 2020 Gold Standard of Optimal Aging honorees:

This year’s honorees include writers, avid bowlers, musicians, artists, immigrants, activists and educators. Many are active participants in the . These individuals volunteer all across the Louisville community in hospitals, homeless shelters, meals on wheels, assisted living communities, veterans’ services, the Red Cross and more. Members of this year’s cohort also are long-time advocates for social and racial justice and environmental protection. Several honorees have been active in their community’s COVID-19 response by helping to make masks for health care providers.

Profiles of the 2020 honorees are now and the video tribute will be added to the page Friday, Sept. 11.

��

“The UofL Trager Institute is thrilled to offer this new acupuncture set of services to our community,” said Anna Faul, executive director of the UofL Trager Institute. “These new services available at our Republic Bank Foundation Optimal Aging Clinic are part of a broader effort to provide a one-stop shop of comprehensive services that support long-term wellbeing.”

Acupuncture is the anchor of traditional Chinese medicine that involves the placement of fine, sterile needles into specific points on the body to heal disease, restore balance and promote health. AcuBalance providers say the services offered at the UofL Trager Institute can help address a wide range of both neuromusculoskeletal and internal/mental-emotional including:

• acute and chronic pain
• arthritis
• fibromyalgia
• addiction and recovery
• autoimmune issues
• cardiovascular health
• indigestion and digestive health
• cognition and brain health
• reproductive and sexual health
• hormone and thyroid health

These services are known as integrative treatments because they are to be used in conjunction with a primary care physician.

Colby Helton and Andrea Helton, offering services at the UofL Trager Institute, are fully licensed to practice acupuncture and traditional Chinese medicine in Kentucky, having passed four National Board Exams through the . The providers have completed a four-year master’s degree in acupuncture and TCM that included over 3,000 hours of didactic education as well as 1,000-hour clinical residency programs. Colby Helton holds a doctorate in TCM, which required an additional 1,200 hours of didactic education, including additional training in gerontological acupuncture, clinical experience and a doctoral capstone project.

“We are elated to offer acupuncture services in partnership with the UofL Trager Institute at the Republic Bank Foundation Optimal Aging Clinic,” Helton said. “We bring a unique approach to our acupuncture and body therapies as we have extensive training specifically in providing acupuncture to older adults. Our services also will be a great resource for individuals needing pain management support and those looking for anxiety and stress relief. Utilizing an integrative approach and in collaboration with primary care, we can help patients with nearly any condition, from chronic pain and inflammatory conditions to hormonal and emotional imbalances.”

In addition to offering integrative services designed to help individuals achieve optimal health as they age, the new acupuncture services at the UofL Trager Institute may provide anxiety and stress relief specifically related to COVID-19.

“Over the past few months, we’ve seen a dramatic increase in anxiety, depression and stress among health care providers and caregivers, especially our frontline and long-term care workers. Without proper self-care, health care workers face a burnout like we’ve never seen before, which can turn into varying degrees of psychological crises and PTSD,” Helton said. “Integrative therapies like acupuncture help offer significant relief and reprieve by addressing the biological, mental and emotional components of stress and burnout. Specifically, we work to increase parasympathetic tone and reduce stress reactivity, which can balance the mood, sleep cycles, energy, cognition, digestion, cardiovascular health and even immunity. Essentially, we can help our fellow health care workers navigate the COVID landscape with a bit more ease and grace.”

Acupuncture services are available to any member of the community, with appointments available Tuesdays and Thursdays from 1to 6 p.m. To make an appointment, visit the , or call 502-588-4340. Services are provided on a private payment structure.

In addition to the mental health implications such as depression, studies gathered by the����demonstrate that prolonged social isolation can lead to other health complications, including cognitive decline, high blood pressure, heart disease and a weakened immune system. These side effects are particularly concerning during COVID-19 when such comorbid conditions put individuals at higher risk for adverse reactions from the virus.��

is developing technologies and services to reduce social isolation while maintaining social distancing.��

“Social distancing does not have to mean social isolation,” said Anna Faul, executive director of the UofL Trager Institute. “We are working with community partners to bring technology and social supports to older adults facing increased social isolation due to the current pandemic.”

In April, for example, the UofL Trager Institute and Dr. Brent Wright, of the UofL School of Medicine, introduced SmartGlasses technology to long-term facilities and primary care offices. This technology allows a health care professional who is with the patient to put on the web-connected glasses and dial in with an attending physician. A camera and microphone attached to the glasses allow the physician to see and interact directly with the patient in real time.

Recent awards of nearly $190,000 from multiple organizations will allow the Trager Institute to support the expansion of additional resources, including:

• Telehealth and teletherapy for residents in long-term care facilities
• Training of staff and students to offer virtual interdisciplinary care coordination and chronic disease management
• Caregiver resources such as training, support groups and counseling services focused on Jefferson County and surrounding rural counties��
• Specialized mental health services for older adults to reduce social isolation and depression ()
• A state-wide, virtual-friendly visitor program that provides patients, families, caregivers and nursing home residents and staff with resources to reduce social isolation

The funding is provided by the Geriatric Workforce Enhancement Program CARES Act, the National Family Caregiver Program Title IIIE (Administration on Aging) the Health Promotion and Disease Prevention Title IIIE (Administration on Aging) as well as others throughout Kentucky.��These grants have created statewide partnerships and expanded the footprint of the institute and of the university.

“Given the expansion of social isolation in our community, our team has prioritized the dissemination of technology to community-dwelling older adults,” Faul said. “In addition to the currently funded efforts, we are looking forward to the possibility of additional funds that will allow us to provide iPads and Bluetooth technology to vulnerable community-dwelling older adults in Jefferson County and several rural counties, to establish a mini-virtual health clinic network across multiple Appalachian counties and to disseminate innovative contact tracing efforts through app-based, wearable devices and AI-based services.”��

If you or someone you know is experiencing social isolation or loneliness, contact the care team at the Republic Bank Foundation Optimal Aging Clinic at the UofL Trager Institute for assistance. The care team can be reached at 502-588-4340, Option 1, Option 1, or at��tragerinstitute@louisville.edu. Additional resources are available at��and��, which provide social interaction programs as well as other essential services such as in-home care and food delivery programs.��