Speaking of Design

Listen, Mental Health Matters: Don Parker, Hackensack Meridian Health – Carrier Clinic

In the fifth episode of “Listen, Mental Health Matters,” Brian Giebink, HDR’s behavioral and mental health practice lead, speaks with Don Parker, recently retired president of behavioral healthcare transformation services for Hackensack Meridian Health in New Jersey. From schools to group homes to care facilities, Parker describes strategies for bolstering the continuum of care and discusses the critical issue of expanding services for both children and adults in a time of unprecedented need for mental health services.

Duration:: 34m
Broadcast on:: 24 Jun 2024
Audio Format:: mp3

I'm John Torrick, and I'm Danny Sullivan, and you're listening to Speaking of Design, bringing you the stories of the engineers and architects who are transforming the world one project at a time. Today, we bring you another episode of a special podcast series on behavioral and mental health called Listen, Mental Health Matters. As part of this series, Brian Geebenk, behavioral and mental health practice leader at HDR, visits some of the world's leading health care providers for candid conversations about the challenges they face and the opportunities to transform the patient and caregiver experience. I'm Brian Geebenk, and I hope that by listening, the series helps us consider new perspectives in our quest to create transformational mental health facilities that improve the quality of life for individuals and families and promote a shared sense of community. And now, as we recognize Mental Health Awareness Month, we bring you Brian's conversation with Don Parker. He's the retired president of Behavioral Health Care Transformation Services at Hackensack Meridian Health's Carrier Clinic in Belmede, New Jersey. This is Brian Geebenk, I'm here with Don Parker at Hackensack Meridian Carrier Clinic. Yeah, I'm the president of Behavioral Health Care Transformation Services, so all my responsibilities are behavioral health, but the idea is that we are in the process of transforming care in each of the elements that we deliver, and so during my time, we've been merged in with the Hackensack Meridian System for the last five years. I've had funding, I've had government support, I've had all kinds of resources, which when you're an independent psychiatric hospital, you scramble for it. Most of the scrambles end, you get the last piece of the action. And so we don't, we go to the front of the line during the last year, I've raised $25 million to build a new children's wing here at Carrier Clinic, and we are going to be delivering care for younger children, which is something I never thought I'd be doing in my career, so kids under 12 years old. Those children only have 12 beds in the entire state of New Jersey to go to, which means they back up on our emergency departments, they don't get the care they need, and they are, unfortunately, if they're that young and they need psychiatric and patient care, it is a serious case, and so we have designed an entire wing of our new facility for under 12-year-old kids, and it will be dedicated to making sure that those children can return whole back to their families, generally they're victims of some type of trauma. When you, when you have a psychiatric issue, you have a little bit of nature and nurture, but most, mostly it's nurture, and so we, we try to get them in the right place at the right time, and yet them going so that their teenage years, which are usually both formative and challenging, end up being successful. You said you raised $25 million, so here's, here's the sources. We got $10 million from government, so what I, my successor is going to be, and this is not intuitive, he was the chief of staff for the CEO of Carrier Clinic, he also was in charge of government services, so I get a roll of decks from him, that's the old term, but I get a list of connections with him that are unparalleled, and during the pandemic when everybody else was only focused on the pandemic, we were focused on getting ourselves ready for what we knew would be a post-pandemic of epic proportions, and we're in it, and we're overloaded every day, I have a waiting list, I have, I have 14 hospitals where I have emergency room services I'm responsible for, for psychiatric services, every morning I get up with a hundred people waiting in those beds to get into psychiatric care, inpatient care, that means they're serious, and so what we've tried, what we tried to do during the pandemic was anticipate what we would need, changed our models of how we treat in the emergency rooms, so that we're quicker, we use an empath model, and then we knew that we'd have to manufacture a whole cadre of services, so we started on the outpatient side, one of the largest outpatient providers in the state, we are the largest inpatient providers, state and fourth largest in the country at this point in time, we have 584 inpatient beds, so that's a lot of presence in the inpatient world, but we have enormous capability of interacting with patients given the depth and breadth of our organization, so we went right to our primary care and pediatric practices, and we got federal money to help us add clinicians into every one of those practice, we did 130 practices, social worker in their offices, doctor sees something, they're all trained to pick up psychiatric issues that don't necessarily present themselves during the exam, they pick them up, they go to our social worker when they're done, social worker has the ability to call in, we have a telepsychiatry hub around the clock, and they can call in and get a consult within and out, and that consult will be with a pediatric specialist, and then if they need long-term care, they're coming here to carry your clinic, we need 40 plus bed adolescent unit, I also have a residential treatment program for 120 kids, and I have a school, a private school for children with psychiatric issues for 130 students, so in any given day, we'll have 250 kids on the campus, so they are our primary audience for care here at Carrier Clinic, you mentioned a couple of things here that really caught my attention, the first one was, you mentioned during the pandemic, you were really looking forward beyond that to solve that, and you changed your model, specifically, you mentioned the ED, the empath, you went to the empath model, can you talk a little bit more about the empath model, and we understand generally what the architecture is of the space, but how did that model change outcomes? So what we do, rather than doing a quick diagnosis, and then waiting for somebody else to take care of you, we take care of you in the ED, we'll start your care there. So I've got, again, my telepsychiatry network gives me immediate access, so we've got a cart, we wheel into the room, or in many of the cases we're now installing the screens in the EDs, we're renovating our EDs to actually accommodate the empath model, and so it makes it real, it's not a small screen on a cart anymore in most of them. We also redesigned several of our EDs to be functional interactive capability, and now we've built interactive into our new inpatient unit for children, we're doing now in the EDs so the kids can gamify it a lot of what we do. So we've done that, we did the pediatric program, we now are adding beds here at Carrier Clinic, we brought on a number of additional therapists. During the pandemic, we started 64 new residencies, we had residents here, we have our own medical school, our medical students get more opportunity to get into residencies in psychiatry. We met that demand, we added 17 fellowships, those fellowships, six of them are four adolescents, so we have our own supply, we do a program called, we invest in you, in your last year, we give you a stipend which would be equal to your sign on bonus if you're going on the private way into practice, and we give it an increment. So you start making money, we call it earn while you learn during that last year. We lock you in, we know exactly when you're coming, we know when we can expand, we're not out recruiting, we're not using local tenants, there are people, we've trained them, they've been through our system, they're ready to go, so we can do things faster, we don't have to go through the normal kinds of things that people have to go through. We bought two nursing schools, nurses, every nursing group rotates through Carrier Clinic, and they had to do all their psychiatric rotations with us out of our nursing schools. I've started a certification process for mental health technicians at all the local community college. I'm vice president of a board of a community college, I'll be president elect next year. We developed and started the curriculum, gave it to the three junior colleges using it, getting them certified so that they can make more. So a certified MHT makes more than an MHT, and they're trained, and they've got greater skills, and they're better in our managing our milieu, so that we built the capability, in our job we knew we could build faster, your capability than we could build buildings. And then we've looked at a whole variety of different ways that we can move you outside of the system and keep you from entering an institutional world. I have always believed in not withstanding the fact that I've built and run institutional programs that as soon as we get you an institutional world, we train you to live in one. And if you're going to be living in an institutional world, it's not likely you're going to want to leave it. And if you do leave it, you're going to want to come back. It's safe. It's safe. You can get up every morning and not have to worry about where your meal is coming from, who you're going to be interacting with, whether you're going to go to school. Your choices are limited when you're in an institutional world. But many people adopt that, which is what happens with prisoners. That's why I started my world in corrections. I believe in, we used to, don't wait, we integrate with our model. And so we got you out quickly. And we do that here. On our campus, we opened up another group home during the pandemic, took out a house that was the president's house here, and we turned it into a group home for young women who are transitioning from institutional world out to the real world. And so they're going out to college and they're working and they're cooking and doing all the things that they need to take care of themselves. And then they graduate a year later from us. So we built another group home over there was so successful. So we kind of taken this campus and reshaped it all so that it can meet your needs at just about every level of psychiatric care that you may require during your adolescent years. Incredible. You're really covering the whole continuum of care. We talked about the continuum of care a lot in our work as architects, but it's in the community. It's in mental health. You mentioned the school. The school is a very, I think, unique piece to the continuum of care. And it's at the top of all of our minds, especially in K-12 area. There's a lot of kids struggling with, whether it's at home or academics or friends, and there are a lot of mental health challenges that come along with that. And then in the higher education setting as well. We hear it seems like constantly in the news. There's every day. There's another sad story coming from a university campus. Can you explain a little bit more about where the idea for the school came from? And how that works on your campus. You obviously have teachers. So you have trained education professionals. Are there also social workers in the room or are there mental health? So the way the school is organized is that obviously you have small classrooms. That's really important. Our ratios are generally seven to one. In addition to the teacher, three, two classrooms has a social worker assigned to it. And the social worker's office opens up into the classrooms. And any time that somebody's having a tough day, very quietly we'll whisper to Don, go over, just go over and check in with your social worker. And that social worker's attached to you for all four years. We have very little turnover in our school. So it's a great place to be and people enjoy working there and they can see the results of their work. Which is hard to do in most jobs and behavioral health. And that proximity allows the social worker to be part of your class without it being stigmatized. You don't have a social worker in there working with you while the teacher is teaching. He owns the classroom. You're there as a social worker to aid in a bat and to deal with issues that come up in them. We don't take you out of the classroom. You're part of that. That's a milieu that you're in. And then that creates a more effective way, we think, to manage the behavioral issues that come there. And we don't take a teacher who's not, even if they're specially trained, that's not their career. So their ability to do what a social worker does is not the same. Some of our teachers usually are great at it, but not everybody. And so this assures that we've got quality and that we've got long-term relationships and those social workers are working with a kid for up to four years. I mean, we've got kids that come in 8/9th grade and spend their entire high school career. And now, several years ago, we opened up a middle school. So we're taking 7th grade to 12th grade. And we do things like every student plays an instrument. At an instrument playing, it creates growth. It creates new ways of thinking about things. It takes engrams in your brain and connects them that other things don't do. And so we do music therapy, but the playing in the band, it's a different level of camaraderie as well. And our teacher is spectacular. We have an incredibly dedicated staff. We have almost 1,400 staff on the campus. And from the moment that you come on our campus, you're going to feel differently. Now, I've got two buildings that are coming down. I'm not going to be here for the last rock. I wanted to take the whole campus to a new era. And you've heard me about investing in the old buildings in the campus so that the spirit doesn't go away, only the building. And so we have two new buildings that are going up in the coming year. One is a family resource center. So anybody's coming here will be able to get family resource capability. So we're going to work with you in a non-threatening way. You're not going to therapy. You're going to be there with a bunch of other parents and we're going to be doing groups for you and things like that. And then we'll be taking other third-party individuals, like teachers, firemen, policemen, all into that. We do emergency psychiatric first aid for all of the providers in the area. We have contracts to do that through the state, through the grant that we got. So we make this a milieu, but the milieu is big and the milieu is diffused because we take from a lot of different areas. So just about every school you can go to, as somebody that's been trained by character, we're going on concentric circles farther and farther out because we get farther and farther out now. That strategy allows us to have connections that we can call upon to interact with kids if the kids are having problems. And it's not us. You know, somebody that's been trained by us. So that makes a big difference, I think, on whether we can keep you from returning to caring. Recidivism rates are fairly low for an area that has such a level of chronicity to it. And then each of the staff here want to be here. That's a big difference on a job. You don't come to work in a psychiatric hospital unless you want to work in it. It's too tough, it's too risky, it's too emotionally rollercoaster, it's got a lot of elements to it that make it tough to work here. So you better be ready to work here and you better be ready to handle things that are going to disappoint you. A lot of victories, but there's also a lot of disappointments. And you can't control a lot of that because other things that impact that. So if you may be a great teacher and you don't teach somebody, it's not likely that you're responsible for it. But to get people not to feel that because we've got dedicated people, it's a fine balance that we've got. Buildings are very influential in that. Maybe that's where you're going. I was going to ask, so staff recruitment and retention is so challenging in all of health care and behavioral mental health care, it's even more challenging. You mentioned your staff are here because they want to be here and they're very passionate about the work. How do you encourage them? Why are they so passionate? Why do they want to be here, maybe compared to somewhere else? I would take it back to my early experience of being a social worker when I was eight years old. And so I went to 11 schools in 12 years. My father was in the military. He got transferred every year. I had to go in and make friends and then leave those friends usually by the end of the year. Sometimes I go to two or three schools in a year. And so I unwittingly became a social worker early in my life. And I found out how to get in, make friends and get out without damaging myself. And I used to share that with my friends, a lot of meltdowns and military kids. I have built up a reservoir of skills over my career to do that. And I seek out people that have that kind of long term commitment to this kind of work because they're tried and true. And if I can help them not burn out, which is frequent in our business, that's my job. I don't want you to burn out. So I've got to keep it interesting around here. I've got to keep it beautiful. I've got to keep, I've got to keep this an environment that you can feed off of. And that's where the architecture from my point of view and the art itself comes in. I be a advocate of healing art for 30 years. So how it could help early in my career when I was running a mental health center and how we decorated and organized the space. And I built that into my major contribution in every place that I've gone. And so far it's paid off. People that are here like what we do. I don't spend a lot of money either. I buy all the art. I'm probably the largest purchaser at home goods that you can ever imagine. They have some unwittingly beautiful art and healing art. There's a bunch of properties about the art that I know all the home goods in this area. And I'll shop, you know, and go on and buy stuff. And I also have to have disposable art because it gets hit, it gets beat, it gets ripped, it gets flashed. So you know, you can't invest great money in that and think that it may not happen. That happens. Now if I go out, hang paintings with the maintenance crew. And so I'm out doing probably 30 paintings in a day. I also rotate the art. So it's never the same in the different areas. So that's a tool for me. My appreciation for art led to my appreciation for architecture, ultimately. Because in my estimation, it's the same process. And that you are an artist, you just draw straighter lines than I do. So that makes us kindred spirits. So every project that I've done, I work art into the project and is really in a substantial way. I really appreciate what you said. It's like you changed the artwork over time. What's hanging on the wall today may not be there any year. You're going to constantly change it and you're always procuring more artwork and swapping it out. And I think there's something about that change that keeps the environment fresh for the staff. You can't always change architecture as quickly. Obviously, architecture has an important role to play in the environment and the appearance of the care and all of that. Art is a simple way to give the patients some change over time, which I think is really neat. So my ultimate interest is to be able to do digital art around the organization. I won't be here to guide that, but my colleague, Trish Tool, who's going to take over from the here at Carrier, will, we will use some digital, still use what we've been using to try it true, because you can't put digital screens everywhere in a psychiatric hospital. And all patients don't react to digital in the same way. So we're going to be doing blended art now and then we'll figure out whether it has an impact on what goes on in terms of the maintenance and durability of the art, and then we'll declare a strategy. And that may continue to evolve. When we're doing a new building, my first build here, I had a very slim budget. And so I wanted an outdoor area for all the patients and their families to be, and I wanted to put some sculpture in. And so I had a friend of mine who's a art, a sir, keep an eye out for me. She called me up one day about a month after we built the building, and it was built. So it's inside. So whatever I was bringing in, it was going to be tough to get it in once I built it place. And so she called me up. She's a partner. Get down here with your paycheck book. I got a piece of sculpture for you. It's called the Phoenix, and it was on a yard sale in Farhills. Farhills is a really high-end area. I jumped in my car, buzz sawed it down, or I didn't get a ticket, I showed out. And there it is, sitting, and it looks like it's custom made for us. And so I buy for 1,200 bucks, I get it priced at about 80,000. And the guy, he said, "Where are you going to put this?" I said, "Give me 1,200 bucks, 100 bucks a month for the effort, you got it." And so I got the jobber who puts the Christmas tree at Radio City in every year. He lives in this area. I said, "I need you." Because I got to plop this over the top of the building down into this. He says, "Oh, it has no problem." So he comes in. He charges me 200 bucks to do it, and it's there. And we put a pedestal up, and it's a gorgeous piece of art. And so I've done that all over this campus. I had an Amish family come in and build our barn, so it would be unique. And I've had delusion horses that were donated by the Rockefeller family. They used to pull carts up in the Catskills, and they had an accident, and severed the tethers on the back horses. They rushed the front horses, break the feet of the front horses, knock a hoof off of one of them. And then they should have been euthanized. They weren't. The Rocadels put them in slings for almost a year, had them attended to every day, rebuilt their hooves, got them back, and then trained them as equine therapy horses, and donated them to us. And endolution horses cost about $300,000 of horses, and they gave them to us. And they are stunning. They are just, and they're huge. I've had two other horses donated to us, or equine therapy. I have donkeys. I have goats. I have peacocks, and so the patients love it. We don't ride. Everything is about guiding a horse through activity. It's one of the highest ranked things. At night, I have heart players come in. I have eight heart players that come in every night, and they play a small harp, and they play music for our patients. So we took our sleep scores from here to here. We raised them by about 40 points, and so our patients all comment. It's usually the number one thing that they comment about. It actually has a whole science behind it. This is called Vibrocoustics. Vibrocoustics from a harp player, I originally started looking at this from the harp players point of view, and they hold their harp right on their, what's called the thymus gland. Thymus gland is right under your breastplate, and it tea treats all the cells in your body or immunologic system. It's pumped up. When your thymus properly working, you won't get sick. You can thump your thymus, so the religious activity of thumping your chest, that's about hitting your thymus gland. And your thymus gland will function again if you thump it periodically. When you're under a lot of stress, thymus shuts down. That's the connection between stress and getting a cold or something like that. That's the physiologic connection. Also, the fibrocoustics from it, from the harp music, hit the patients. They actually go out to the patients, and no, there's no magic of this. This is just the music, and some music you process from your ears, and harp music you process from your thymus gland. And so our patients, we didn't have a lot of COVID. We had COVID, but we didn't have a lot of it. And patients come and usually get better with us physically, because I attribute it to those harp music. I have an open mind. I'm right down the street from Princeton. I can bring the Princeton folks, and we do a lot of research together. They don't have a hospital. So I have a lot of students that roll through here. Students add to the environment. They come back with ideas. They help us in a variety of different ways. You're creating a village here. And the village has a lot of different talents, skills, and people that are involved in it. They all find a way to work together to make this happen. The context and the tenor of everything that happens here is constantly evolving, though, as a result of that. This is incredible. You seem to have a very holistic campus, right? You're investing the continuum of care. You're providing quiet therapy, harp therapy, we can call it that. You have artwork. Do you have... Peacocks. Peacocks. You have compassionate staff. What are some of the challenges that you've had to overcome to get here? So one of the things is I have a high energy, and the staff that I hire, generally have high energy levels. And if they don't have one, they find one to keep up with me. And this is not about me, but because I'm here as a CEO, you should be influencing every aspect of the treatment from the hiring all the way to the, fortunately, firing. But also every step in between, and that's motivating people, that's putting the right people in the right positions, that's mentoring people so that they can take the right positions, that's having interaction with them around their families, knowing their names, it's being intense. I'm up here by myself during the week, my wife... My schedules are pretty crazy, I put a lot of hours in. I stay up here. I have a house down in South Jersey about an hour and 45 minutes from here. And my wife calls it absence makes a hard growth on her stage. That's why we're still married after 45 years. So but I can work early morning, the way that night, I don't know that I do, you know, I don't do that every day, but I do it a lot of days. You addressed stigma a little bit, you mentioned that I think another big barrier is funding. You're doing a lot of amazing work you have. It sounds like you're contributing out of your own pocket, but there are work you probably have... I set the stage. Can you talk about funding a little bit, how you're able to financially support everything that you're doing? Well, when I came here, I have always run programs with financing challenges and wherever I've been. And I've done a bunch of different things. I was a court administrator for a number of years running court systems and I've worked on the behavioral health side, I've worked on the hospital side. I've worked for a company called Atlantic Air Down at the hospital down in South Jersey. I ran all the businesses outside of the hospital. I created all different kinds of things. I never look at something in a usual way. I opened up the first convenient care, convenient care as menoclanks, things like that in New Jersey. I opened the first ever in grocery stores. And so what I wanted to do with convenient care was influence your food intake. Food hurts, exacerbates and heals, medical conditions and psychiatric conditions. And so I had a partnership with ShopRite, I placed centers in ShopRite right near the checkout area. And so you could walk through with your cart and our nurse practitioners were trained on nutrition and could look in there and say, Hey, Don, that's not good for you, man. Why don't you try this and the customers loved it? You know, we went through with ShopRite and put labels all the aisles. And so you shot, my mother used to shop once every two weeks. We shot three times a week. We're generally going in, getting food for tonight, maybe tomorrow night if we're lucky and then tout. So we're in there a lot. And if we wanted to help you overcome your diabetes or your congestive heart failure or you go down the list, it all has a food connection. And so we were able to speed up the trip because you don't have to read any of the labels on anything. You just pick it out because it's got our, I've had our, my cariologists go through from our health system. It's endorsed by them. And then if you had any concerns, you could have our nurse practitioner check it out. And instead of giving you medication, I went to all of the large manufacturers of nutraceuticals. And I said, I need from you large discounts so I can get everybody taking your nutraceutical. And so I got them and I could get you started and instead of penicillin, I could get you started on something was going to build your resistance. And I gave you a coupon that paid for half of the product. We were part of your life. What a better place to be part of your life than in your grocery store. So I use that same principle everywhere. I look at what's being done. I look at ways to do it differently from the design point of view, all the way to the operations. And then I go about changing, and I'm a change agent, but I'm a relentless change agent. And here doing a psychiatric hospital starts with what I've designed. It is incumbent upon me to find funds. That's one of my major jobs to make all of those things happen. And so that means government relations. That means private citizen relationships. That means organizational activity, all of which end up producing things. One of the best things I've done is have my successor come from that world. That was his world. And so everybody's saying, well, wait a minute, he doesn't have experience in behavioral health. I said, no, he's got experience in getting money so that you can deliver the behavioral health. And you're the expert. He's not going to pretend that he's the expert. His job is to get this funded and so we during the pandemic, we nailed money down because people were worried about just immediately dealing with the pandemic. We knew, and I'll just give you one example of this in the Erickson's eight stages of growth. He's a psychologist, probably had in your psychology class. The first one is trust versus mistrust. It happens between one and three years old. And during that time, for the most part, children are nonverbal, so it's actually zero to three. And their test that they have to solve is trust versus mistrust, and if they're nonverbal and then your parents and influencers are wearing a mask, they lose 80% of the communication. So I think we have just begun to see what's going to happen with our children. Erickson's theory, and I don't believe completely in this, is if you miss that, that becomes something that haunts you the rest of your life. You either trust you much, you trust you little. And you can see that in people. If they've had a very tough childhood and they've not been able to trust the people around you, they're suspicious all the time. They don't love like the rest of us do. They don't interact the way. And on the other side, you're gullible, or if you love too much, you trust too much. And so what happens on each of those stages that kids are going through during a pandemic when we've changed the conditions, body language, incredibly important, we worked on clear things to where when we're interacting with eight people, because we knew our body language was important for them. People change profound impact, we think, but we only work with the people we had. There's millions of people out there that are going to be needing, I think, psychiatric issues. And that's why I think we're going to have a post-pandemic pandemic. We're in it that you've seen now with everybody's interest in building and changing and, you know, investing in behavioral health. As you reflect on your career, you're two days away from retiring. What are some of those things that you could reflect on or share with others, big ideas or big lessons? My big ideas aren't stopping. So I have an on-core career that has already been planned over the last year. And it's been influenced by my own personal experience. I lost my oldest son. He was in the Marine Corps, who was in Iraq, got PTSD, tried to cure himself drinking, and at 49 years old, finally his body gave up. And we buried him two days ago. And I have always had an affection for substance abuse treatment. So I'm launching a company with another partner of mine called Recovery Numb. Our addiction treatment is so ineffective. And it's not the providers themselves, it's how we provide it and where we provide it. And we take you out of your environment, it's like taking you to the hospital and expecting you to recover completely while you're in the hospital, if you had broken leg or, you know, spinal surgery. We keep you for 30 days, and there's some kind of magic that's going to happen during those 30 days. And I have a drug and alcohol treatment facility here, but we do it differently. So what we're going to do is, UD detoxing, if we can do it as non-complex detox, we'll do it in your own. If it is complex, I'm probably going to send some specialists into your home via telemedicine. And then we're going to monitor you. I've got monitoring systems that we can monitor your vitals completely. While we're monitoring your vitals, though, we're going to have a profile of you from when you were coming out of addiction to when you're at least temporarily detoxed. And so we then have that profile for monitoring constantly. And we can always tell where you are on your vitals, where you are in your recovery. And so we're going to assign a coach to you for an entire year. That coach will orchestrate your treatment. And whether it's medical treatment or psychological or it's educational, they will help you with that. And then we will, along the way, bring you in for a test of outpatient, weekends, maybe weeks, depending on what you need and how your recovery is going on, it'll all get customized for you. And for the price of that 30 days, we'll take you through a year. The difference in recovery rate from taking somebody 30 days with an 80% relapse in that first year, if we can keep you sober for that year, it's four times more likely in the future that you will stay sober. So we'll take the success rate from 20% to 70 to 80% with that model. And then we're going to be perfecting all along the way that things, ways we interact with you using technology and the technology will be the secret for us. And then we'll have intensive outpatient locations around the state. I'll have a couple of, if I was just getting right before you guys came in, I've negotiated with a team that has four inpatient units, kind of located around the country that will use if you need to actually go to some place for a little bit for a retreat. But it'd be a retreat, not a treatment. And so we're going to reinvent the addiction field. And I've got a partner who runs a program called Medically Home and his superstructure is so good, I was speaking at a conference in DC at the Leadership Institute back in December. And at the end, I was talking a little bit about recovery at home and what we're thinking about doing it also in partnership with Hackett, Zach Murray, and they're going to be one of the investors. And I said, you know, here's the, here's how we're going to play this all out at the end. The guy who owns Medically Home came up to, he was in the audience, he had spoken earlier in the day. He said, Parker, meet me at the bar tonight at seven o'clock. He said, I know it's not the right place to meet, but meet me there. And so I did. And we spent five hours, we closed the bar down talking about this, how we could work. And he's got a chassis. He had a chassis. He's got the top 100 hospitals. He's got 80 of them in the portfolio already. He's got emergency response systems built in. So I'm going to use that chassis and then customize it for addiction. And he also lost his son, same kind of situation in his mind, seen military backgrounds and everything almost. It was like, we were destined to be in that room that day. The group called that Kairos, right place, right time, right opportunity. Well, Don, thank you very much. This is very important. It was my pleasure. And I think all of our listeners are going to have a lot to do. Well, I had a really good time. [MUSIC] For more information on our Listen Mental Health Matters series, please visit hdrink.com/listen. There you'll find more on HDR's approach to behavioral and mental health design, meet our team and see samples of our work. If you like what you heard, be sure to rate us or leave a comment on Apple Podcasts, Spotify, or wherever you get your podcasts. [MUSIC]