How One Woman Is Transforming Rural Healthcare Access in Maine: Anni Pat McKenney

Lisa Belisle:

Hello, I am Dr. Lisa Belisle, and you are listening to or watching Radio Maine, our video podcast where we explore and celebrate creativity and the human spirit. We are sponsored by the Portland Art Gallery in Portland, Maine, and today in our studio we have with us Anni Pat McKenney. She is the director of the Coulombe Center for Health Improvement at MaineHealth. I'm intrigued. Anni Pat, welcome. Thank you for coming in today. I'm intrigued by the fact that you have a background in occupational therapy and an interest in geology. Such an interesting constellation of things you bring to our conversation today. So where to start? Let's start with, tell me about your job. What is the Coulombe Center for Health Improvement?

Anni Pat McKenney:

Well, thank you again for having me. So glad to be here and talk a little bit about the work that I do and how I've gotten here. So the Coulombe Center is a community health project. We're part of the MaineHealth system and really started about 10 years ago based on the private donation from Paul and Giselaine Coulombe, who are local folks in the Boothbay region, which I'm based in, and really just wanted to provide funding to support the health of the community in which they live. We did some assessments and determined that youth were really going to be our focus. And so for the past 10 years, it's really about program development, responding to the community, listening to what the community needs and acting on some of that. So a lot of our work over the years, especially when we put Covid in there, has pivoted several times, but the work has really been focused on mental health and access to care for the youth in our community. It started first with the Boothbay region and larger into the whole county of Lincoln County in which we are placed.

In recent years, we've really become way more focused on our connection with schools. We know that schools are overwhelmed with the amount of needs that children have and families have. LincolnHealth, now called Lincoln Hospital, has been involved in school-based health centers for many years, actually 20 plus years in some of the schools in which we work. So in recent years I've really been promoting and expanding our school-based health center programs.

Lisa Belisle:

Talk to me a little bit about that. What is a school-based health center?

Anni Pat McKenney:

It is literally a mini doctor's office in a school. We have nurse practitioners that are placed in each of the high schools. They're generally placed in high school locations. They have support staff there that help them have appointments, but you can have acute care appointments, you can have management of chronic disease. We're there for students, we're there for staff. We also have behavioral health clinicians placed in all of our schools, able to see individual students for behavioral health needs. And so that's the basic structure. And then we're connected just like any practice within the MaineHealth system to our electronic medical records. So we're often referring students back to other specialties or other practices within our system. And likewise, helping to get some students who aren't connected at all to healthcare services in general. Maybe they're new to the area, maybe their parents don't have insurance and they need help getting connected with MaineCare or other insurance support. So it's a really diverse group and diverse model. We actually are part of a state grant program too in the last five years, which has allowed us to really expand the services that we provide. So as I said, we started in Boothbay Harbor. We've been at Lincoln Academy, which is in Newcastle where I live and went to school. And then we're also at Medomak Valley High School, with Wiscasset Middle High School. And just recently in Morse High School, which is outside of Lincoln County, but still in need of services.

Lisa Belisle:

What has it been like to see some of these things roll out in a place that you went to school?

Anni Pat McKenney:

It's really unique. As I said, and as you alluded to in the beginning, I've sort of taken several journeys in terms of the work that I have done, although I never did really follow through with studying geology all the way through. It was definitely a declared major at one point. And really, based on the fact that I just loved being outdoors and grew up in Maine and loved camping and hiking, but really knew that what I wanted to do professionally was to be involved in the community and to make a difference in the community where I live. So I didn't know that I would live literally just down the street from where I grew up, but that's the way that it worked out. And it's been wonderful to really be part of the community that also raised me. We as Mainers are constantly accepting new people all the time. I do feel like although there's generations of folks that have been around for a long time, we also have new folks coming in all the time as well. So even though I'm in the same community where I grew up, I'm meeting new people, I'm engaging in new projects all the time. So it's never boring.

Lisa Belisle:

Having also grown up in the community where I came back to and now live and have lived for a long time, raised all my kids here, they all went through the schools. My brothers and sisters whose kids are currently in the schools, I can relate to what you're saying because the school that I went to isn't the same school that exists now. And what I love about the work that you're doing is that you are involved in meeting the kids where they are and you are bringing services to them rather than expecting that they're going to try to intersect with traditional healthcare in the way that it's been offered at least over the last few decades. And I think that's really important.

Anni Pat McKenney:

It's huge. It's really at the heart of the work that we're doing. I think it's easy to imagine that many of the kids that we're seeing probably wouldn't be receiving this care otherwise. That's not always the case. But it certainly is true for many of the students that we see. As well as we just know that families are very busy and we are in a very rural community. Even though we're only about an hour from Portland and some larger city centers of Maine, lots of folks have two parents working and your student may go to school a half hour away, you may work 40 minutes in the other direction, and then your doctor may be 20 minutes in the other direction. So it really is about allowing students to stay in school, get the care that they need. And I think part of the beauty of the way that we do it in our clinics is that we are also part of this larger MaineHealth system. And so we're really connected and able to move patients, kids, back and forth easily. And the behavioral health piece is just really huge. Lots of times kids are missing a whole day of school if they have to leave for a therapy appointment. And our school clinics allow them to be a more integrated and less disruptive part of their day for sure.

Lisa Belisle:

I would also hope that the schools are a place of safety for these kids in general. And so what you're doing is you're saying, okay, this is a place of safety and we're going to bring somebody to this place of safety who is also safe, and we're going to create a space for this healing to happen. And I think sometimes, particularly in modern healthcare, healthcare can be very intimidating. It can be a place where you go to and if you're a child, a lot of the time you're thinking, oh, this is where I got shots. This is where I was asked embarrassing questions. If I'm a teenager, there are things that would cause somebody to disconnect from healthcare as it's set up currently. But if you're going to the school where this is where your friends are, your teachers are, people are taking care of you, hopefully, again, best case scenario. So I think there's a power in that.

Anni Pat McKenney:

I absolutely agree. I think we really are partners with the schools in which we work. We get to know the school nurses, we get to know the administration, we get to know teachers. And often there's warm handoffs. It's not the student walking in cold without an introduction from one of those already trusted folks. And then once we're there, I think we do become those trusted folks as well. So as I said, generally speaking, we have a medical assistant sort of as a coordinator of the site, and so they really become that trusted person that is seen by students all the time. Sometimes we're co-located right in the nurse's office, so maybe they're going in there for another reason, then they meet our staff, and then when they might need our services, we're there and we're a familiar face, much less intimidating than having to go to a doctor's office for sure.

And we do give immunizations. We do have shots in our clinics, but we do find that oftentimes it is much less intimidating for students to have their shot right at school. We have done large flu clinics, we've done large COVID vaccine clinics during that time, and sometimes parents are really worried about sending their kids, and we do younger kids as well going to their schools, and they're a little worried. And oftentimes they do better when they're just in line with a bunch of other kiddos and this is what we're doing today, and they do great.

Lisa Belisle:

So first of all, immunizations generally I'm in favor of, just because traditionally this is sort of the one touch point with patients when they're younger, that they come in and they get so many shots over the first, let's say 15 to 18 months of their lives, and then it's just this association with healthcare that's not fantastic. However, what you're describing is, well, a shot is just a part of all of this. If we can create a place where you're going to talk to the medical assistant, you're going to talk to the nurse, you're going to talk to people that you trust, that they're not going to do anything that's going to hurt you, then you can talk about bigger issues. One thing I wanted to point out is the use of the medical assistant, because I think expanding our healthcare teams and acknowledging that there are a lot of people that can intersect in really powerful ways to really wrap around a student or a patient really of any sort. And so I love that that is the model that you've put in place, because some of the best healthcare providers I've ever worked with are medical assistants.

Anni Pat McKenney:

Absolutely. As I said, I've been sort of intimately involved in the school-based health centers for the last five years and really trying to examine what staffing patterns that we need in each of these school locations. Each school is very unique. It has its own sort of culture and needs, but time and time again, we've realized that those medical assistants are really the lifeblood, the anchor I often call them, in terms of each individual site, and that if they're there, then we can bring in those providers, higher level folks, nurse practitioners who are wonderful as well, but for less hours and really be much more efficient. And the support that they also provide for the behavioral health clinicians is huge. So that's absolutely true for us.

Lisa Belisle:

One of the things that I know that we think a lot about with children is the impact of early life issues, let's call them, and younger and younger, and understanding that people can have had these adverse childhood events and internalized them in ways that even if they're preverbal, we may not understand are going to impact them later in life. What is it that your organization is doing that is addressing some of these early life issues and even in a preventive way?

Anni Pat McKenney:

Great question. I think that that is absolutely true. Actually, one of the roles that I was filling when I was an occupational therapist actively, I worked at Jackson Brook and Spring Harbor Hospital on the kids unit there. So a lot of firsthand experience seeing some of that early childhood trauma. And absolutely, a lot of the study and work that I did in preparation for being an occupational therapist and in that role is, zero to five is so important and so much of how we develop occurs during that time. So I think we are supporting kids in a variety of ways, and obviously we're mostly seeing kids once they are in school and sometimes high school. So a lot has happened in between there. But we have assessments that we're doing. I think there's a lot more focus in healthcare and certainly within the MaineHealth system around doing depression screenings and the adverse childhood experiences questionnaire that you referred to, really addressing it head on, asking folks what they have experienced and recognizing that offering support, group work is something that we've also dabbled in. And certainly, again, my background working at Spring Harbor, that was a lot of the work that we did.

So support, so that folks know and kids know that there may be others that are experiencing the same sort of struggles. And really, as I said, being partners with the school, we're there to support them. And one of the things that drew me to occupational therapy is really the fact that you're looking at a whole person. Sometimes people think occupation, it's about functioning in your job, but it's really about functioning with the work and the job that you have. So for kids, that's going to school and that's being a kid. And so I think that that background has allowed me to sort of approach the work in a way that I'm constantly looking to help people be the best that they can and function at their highest level. And certainly we know that the life experiences that you bring to each day is certainly a big part of that.

Lisa Belisle:

As I was listening to what you were saying, I was struck by that. So I used the word adverse childhood events, and I think in the back of my mind, I knew that we had moved into calling it adverse childhood experiences. I know we've moved from social determinants of health to social drivers of health, and I think that evolution of language is so important, because we often think a thing happened and this impacted this person and they're traumatized by that event, as opposed to the context that somebody grows up in. It may not be a specific event, but just having grown up in that context is certainly going to impact their lives moving forward and certainly isn't going to determine their lives, but it is going to drive their life. And so when I hear you say, I want to join this person and help them live the best life possible, what you're saying is acknowledging the experiences, acknowledging the drivers, but joining them and saying, okay, where are you now and where can we get you and how can we optimize your future path, as opposed to just sticking with, well, this thing happened, it'll never go away, and you're traumatized forever.

Anni Pat McKenney:

That's pretty depressing in and of itself, isn't it?

Lisa Belisle:

Absolutely. And I love that you're saying, well, this is what they do. They're children, so I want to help them. And our organization wants to help these children show up and be in their lives in a way that's optimizing what we can offer to them and what they bring. So tell me about your decision to go into occupational therapy.

Anni Pat McKenney:

So again, as I said, I sort of knew that I wanted to do something that mattered. I actually was born in New Jersey. I can't call myself a Mainer. My parents moved here when I was nine months old, looking really for a different life. My dad had been working on Wall Street, and both my parents went to Seton Hall, that's where they met. They had a religious background and they had gone on a marriage encounter weekend and had really just decided they wanted to do something different. My dad, I think, read an article in the New York Times on his train ride to the city about the Shelter Institute, which is still in Wiscasset, Maine, still in Lincoln County, where they teach people how to build homes. And he said, hey, do you want to move to Maine and build a home and grow a life in Maine?

And that's exactly what they did. And so I think that was a huge shift for our whole family. I have one older sister, so two young kiddos, and one of the reasons they decided to move to Newcastle was we have St. Patrick's Church, one of the oldest churches in New England, and that became their community. That was the folks that they interacted with, some of which were longtime Mainers, some of those were transplants from other places in the United States or in New England. And so that was sort of the culture in which I grew up, that you sort of think outside of yourself. I think I mentioned to you, my mom suffered from some significant depression when I was a child. And so although we were super high functioning and many people might not have known, I think that certainly shaped the way that I grew up, in the way that I approached the world, in that I knew things aren't always what they seem, and you never know what people and families might be going through or struggling with.

My mom had actually seen an occupational therapist and had said what it meant to her. And so it was kind of always in the back of my mind. And although I started in training as a therapeutic recreation therapist, I thought, I want to be outdoors. I want to be doing adventure support for folks. I made my way back to occupational therapy, and as I said, it really, I think, encapsulated all the things that I wanted to do and the way I wanted to approach things. It really allowed me to be creative in terms of how I treated folks. And I was focused mostly on mental health and that work and with kids certainly, and I love that job. But then when I had kids of my own and I was still living in Newcastle, working, driving to Portland, South Portland every day, I wanted to make a shift.

And so at that time, worked for my dad's construction company, which is often what folks in Maine do too, pivot in order to continue to make a living and meet the needs of their family and themselves. So that was great. And then when I came back to the workforce and they were in school, I really wanted sort of a broader approach to the way that I supported the community, and so went more into community health work, and then for the last 10 years as the Coulombe Center Director. So I feel pretty lucky to have made that journey, quite a distance and yet not that far. So I'm still right down the road from, literally two doors down from, that first house my dad built in 1975.

Lisa Belisle:

So one of the things that I know in the questions we asked you before you came in, the response essentially was having faith in a path that sort of was untraveled. You didn't know what you were going to be doing, and yet there was something around, well, I'm just going to keep moving forward. And you're describing a job or a role and even an organization and even an approach in healthcare that didn't actually exist when you started your training in occupational therapy. So knowing that there's something out there in the future that you're going to be part of it, you don't know what it is, you don't know what this looks like or how are you going to get there, but you're like, but that's there and I'm going there. Talk to me about that.

Anni Pat McKenney:

Yeah, I think you accurately described it. I'm not totally sure how it all happened. I think a big part of it for me is really just believing that if I put my best foot forward, that if I work hard and try to engage in the people that I work with, engage in the community that I'm in, good things will happen and will present themselves. I don't think I was willy-nilly about it either. So the way that I just described it sounds like a little hope and a prayer, and I don't think it was that simple either. I do think it was just sort of trying to be where I was at that moment and doing the best that I could with the work that I had in front of me. And if you can get up every day and feel good about what you're doing, then I think you're in a pretty good place. And then when the next opportunity really presented itself, I think having the courage to sort of take the next thing on, even if it isn't exactly what you had just been doing or what you thought you'd be doing.

Lisa Belisle:

You also, in responding to our questions, mentioned your parents' entrepreneurial mindset and their entrepreneurial effect upon your path, which as you're describing this, get up, do the work, be open to opportunities, move in the direction. I mean, that is very entrepreneurial. Here's something, and I know that I at the same time need to keep a roof over my head, so I'll do this work over here, but I'm just going to keep showing up and doing the best and just being open. And that sometimes is, I don't think it is willy-nilly or hope and a prayer. I mean, it's very intentional. It's a very intentional way of existing in the world, and I think it is really powerful to have parents who embody that.

Anni Pat McKenney:

Yeah, I think that's true. And I don't think you're conscious of it either when you're in that environment and growing up around it, but reflecting upon it now, I think that absolutely gave me the courage and confidence really to know that it was possible. Certainly a lot of the program development work that I've done, I think has roots in seeing what my parents did, also has helped me grow the school-based health center. Prior to that, I started up the first school summer meals program in our county with another organization that I worked for. So again, I find it creative and fulfilling to sort of look at a project as a whole and approach it sort of like a business too. How does it need to function and what are the components that need to fit into it in order for the program to succeed and for it to meet its mission?

Lisa Belisle:

So how does geology fit into this? Because, sure, you didn't pursue this, that's not the professional direction that you took, but you still committed yourself enough to it educationally that it meant something to you. So in talking to many people over many years, a lot of what I've learned is that people will return back to whatever it was that drew them initially. Do you feel that draw yourself or does that have any thread in your current life?

Anni Pat McKenney:

That's a great question. I don't know that it has a thread in my current life now, but I would say I sort of have this dream scenario of, okay, when I retire, maybe I'll work at a national park or something that's about as close to geology as I think I'd get. But really, I just was a science person. I liked science and thus the healthcare profession. And it was really more about taking some coursework my freshman year and just really thinking, this is fascinating. I love rocks and nature and how it was all created. It is fascinating to me. And so who knows what that will bring in my later life, but definitely drawn to the natural world.

Lisa Belisle:

Well, I'll be interested to see where this leads you, because I'm someone who gets very interested in things and I've given myself, I think we all sometimes need permission to kind of follow these things to completion or even just not to completion, just to be like, oh, okay, that's far enough. This thing was interesting. I got a lot out of it. I learned something. No, that's good. And I find there's a real power in that, because sometimes we do things that we don't understand at the time, and yet there's just this ongoing feeding forward that happens. And if you can stay happy in the moment and being passionate about what you're doing, then that feeding forward is really powerful.

Anni Pat McKenney:

Yeah, I do think that's one of the things that I've done throughout my career is really be okay with what I'm doing at the moment. And when that's done, then it's done. And that's okay too. Now that in my role I'm leading some younger folks and often women, I feel like I'm able to share that story through personal experience as well, to say, yeah, I didn't know what I was going to do, and thought when I took seven years off from working outside of the home, although I was still working for the business, there was some fear involved in terms of what is that going to look like or how is my career going to rebound or get back on track? But it did, and in ways that I couldn't have imagined. So I think that's one of the things that has helped me succeed is to be okay with things until they're done, and then be grateful for what I was able to do and move on to the next thing.

Lisa Belisle:

I think that would be very important for especially younger people to hear, because we are in a place, at least my observation is that with education, and I have a lot of, I love education, I love learning things, but education doesn't necessarily, it's not a prescription for your future life. You can get an education and end up doing something completely different. And I think people who talk to me who are younger, who are looking at the course of their lives, I'm like, well, I need to do this, this, and this. It's going to lead to this, this, and this. And sometimes it's like, well, actually, we don't really know where it's going to lead. Just take the next step, invest in that. And again, do as best as you possibly can, as you just said, and really engage at a high level. I think that hearing that from somebody who's been through it so that they don't feel like, oh, if you go off the path this way, then it's going to impact the next 30 years of your life and you're never going to get it back. Come on. This is not the way that the world works. So I suspect that you being able to bring that to people who are not as far along the path is very helpful to them.

Anni Pat McKenney:

Yeah, I think so. It really, to me, is about genuine engagement in what you're doing and who you work with and who you interact with. And I feel like I've also been really blessed in all of the locations that I've worked to really work with wonderful people. And I find it fascinating to just meet people and hear their stories. And so that also sort of keeps things interesting and keeps things going.

Lisa Belisle:

Well, you've just described exactly why I do this work and exactly why I keep showing up, and I'm so grateful to have people like you who are willing to show up with me and have these conversations. I really appreciate your taking the time to be here today.

Anni Pat McKenney:

Well, thank you. I appreciate being asked, and it was great to meet you and share my story.

Lisa Belisle:

Well, I hope the story continues. I've been speaking with Anni Pat McKenney. She is the director of the Coulombe Center for Health Improvement affiliated with MaineHealth. I invite you, if you're watching or listening to our conversation here on Radio Maine, to learn more about the Coulombe Center, and certainly I'm hoping we can convince Anni Pat to come to one of our Portland Art Gallery openings, which happen the first Thursday of every month in Portland. So put that on your mental calendar if you happen to be available. We'd love to see you there. But it's really been a great pleasure to talk to you about this today, and I can't wait to see where geology comes into this in the future.

Anni Pat McKenney:

Me too.

Lisa Belisle:

I'm Dr. Lisa Belisle. Thank you for listening to or watching Radio Maine, sponsored by the Portland Art Gallery, and today we've been exploring creativity and the human spirit with Anni Pat McKenney.