Taking Healthcare by Storm: Industry Insights with Dr. Nykole Gonzalez

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Nykole Gonzalez, Psy.D., a licensed clinical psychologist and partner at Northshore Psychological Associates.

Dr. Nicole Gonzalez shares her journey into neuropsychology, highlighting the interplay between neurological conditions and mental health challenges, and emphasizes the importance of culturally competent care and holistic treatment approaches.

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If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-010926-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today I am joined by Dr. Nicole Gonzalez, a neuropsychologist whose career has focused on helping individuals facing both complex medical conditions and significant mental health.

Challenges. We know individuals who do have complex medical conditions and also  significant mental health difficulties do worse overall with both of these areas. So it's really something that  we should be focusing more of as a society. Dr. Gonzalez completed her postdoctoral residency in Neuropsychology at North Shore Neurosciences and her predoctoral internship at the Erie Psychological Consortium, where she worked across inpatient, outpatient, and community mental health settings as a Spanish speaking professional originally from Puerto Rico, she brings a unique perspective to her work, especially around diversity.

Multicultural competency and supporting individuals who speak English as a second language. Throughout her career, she has conducted neuropsychological evaluations. Cognitive assessments and brief psychotherapy, while also consulting across hospitals and community-based settings. I'm excited to talk with her today about the challenges and opportunities in mental health care, the lingering impact of the COVID pandemic, which really no one wants to talk about.

But  we can learn some lessons and perhaps learn from. The lingering effects. Also, we'll be talking about the importance of culturally competent treatment and her vision for how we can better serve individuals and families moving forward. Dr. Nicole Gonzalez, thank you so very much for joining us today.

Well, thank you for your invitation. It's a pleasure to join you.  I wanted to start by finding about how you, found yourself on this path. So what first inspired you to pursue a career in neuropsychology? And what keeps you motivated in this work today? It's actually a, pretty funny story, at least on my end.

 I'm one of those people who have over time, have planned my future and every path along the way I feel like has been carefully thought out and planned. But originally I actually did not go into psychology when I first went into my undergrad. I originally went in thinking I wanted to pursue journalism which it, it completely out of the ram of psychology and of all things I wanted to focus on political science, which in, this day and age, I'm very glad that I decided to change my mind.

But it wasn't until I had already applied to  university that I then took, first year psychology course, and I remember the professor brought in  a model brain and started talking about how just a slight deficit, slight changes in specific areas could result in this bigger impact, whether it be changes in personality and mood, behavior, cognition, and how that then translated into.

The impact we see in, in day-to-day functioning. And I, I remember after the first couple of lectures and some conversations I had with her outside of, the class time that  I then became just fascinated by the connection between brain and behavior and how neurological changes can influence cognition, emotion, personality and overall identity.

Around the time my grandmother had also been experiencing some neurological events  TIAs in nature, and we had kind of subtly seen some changes in, in her functioning. And ultimately  she went on to develop vascular dementia. And I remember at the time my family trying to understand what this concept was and how it was impacting her day-to-day.

And I always think back in, in how we interacted with her and how we handled situations  as they came up.   knowing what I know now, I, I wish we would've done things differently, but we just, we didn't have the knowledge. We didn't know how to navigate those uh, events and circumstances as they were coming up.

And then later in, in my early adulthood, my stepdad was then diagnosed with Parkinson's, which  again, another neurodegenerative process manifesting differently, but with its own challenges. So those two individuals very close to my inner circle were probably the, force behind  me pursuing neuropsychology specifically after knowing I wanted to go into psychology.

Wanting to be more specialized  with neurological conditions  was really the driving force behind that specialty and just really wanting to be able to help individuals themselves navigate these diagnoses.  But also being able to be a, a source of information, a source of support to families so that they could better understand what's happening, not just medically, but personally and interpersonally.

How to help them understand the changes as they come about, but also how we go about helping that person continue to have a meaningful life. And I think that to answer your, your last question, my patients really keep me motivated. I don't always get to be the person that necessarily gets to deliver good news, and  I feel like most of my patients don't necessarily want to come in to see me, especially knowing that they are struggling in some way.

By the time that they're coming into my office, there's already been changes that either they have noticed or that their families have picked up on, or perhaps it's impacting. Their day to day in some capacity. So there's definitely a lot of  fear, anxiety that comes in to those initial appointments, but being able to be the person that.

Yes, has to deliver the news in terms of what the diagnostic impression is, but also helping them feel understood and empowered in many ways to move forward still having a purpose and go about the, their lives in a meaningful way, preserving their dignity and overall quality of life is really what keeps me going day to day.

I will just say, I loved how you described  the way you see approaching mental health very holistically.  Not even just with the individual but with their families. And then  the idea to provide meaning to make life meaningful for these individuals. I think sometimes that's lost in treatment.

Yes. Mm-hmm. So we, I, I mentioned in the beginning and before we came on, we were saying that  we  kind of crossed paths briefly in a, one of the nursing homes in the area.  So these individuals have serious medical conditions. Mm-hmm. So these. Individuals that you are seeing on a daily basis, so they have their medical conditions, they have significant mental health challenges.

What are some of the biggest difficulties you face in providing care for this population? I would probably say that it's, finding that balance between the medical and the psychological to make sure that neither one of those gets neglected. in many of, of the conditions, the neurological conditions that, that we see.

We have psychiatric manifestations of various neurodegenerative processes, whether it be dementia, Parkinson's, ms.  We tend to see mood and behavioral changes that come about. Because of the changes organically in the brain, but also we have individuals that at baseline also have a mental health history  whether that be depression, anxiety, bipolar disorder.

That at some point in their lives then go on to either develop a neurodegenerative condition or sustain impacts related to stroke or brain injury and really being able to. Make sure that we're addressing both whether it be standalone mood symptoms, but also making sure that we're giving the medical piece, the attention that it needs is probably the biggest challenge.

And you know, you mentioned as there are paths crossed in, in nursing homes, I find that especially in, in facilities. Is helping the staff understand the manifestations of those  mood and behavioral symptoms. I often hear things like they're doing it on purpose.  They're refusing care because of whatever reason that they're so behavioral and.

 find that a lot of the challenge comes from helping the people around them understand that this is not something that this person is doing on purpose to be difficult or because they don't wanna help themselves. Oftentimes it comes due to the fact that they lack the insight. They have deficits that are impacting their ability to.

Regulate basic emotions, regulate behaviors, manage impulses.  We see changes in personality and we can see individuals act in ways that perhaps to them is, unusual and that causes confusion. So a lot of what we try to do, especially in those settings, and certainly we do it in the office setting as well, outpatient  is providing a lot of education so that those who are around them know how to adjust to these changes.

And help the person still get the care that they need. And with that helping coordinate what kind of services they would require, whether it be bringing other professionals on board to help make sure that we are not just treating the underlying medical condition, but also whether we need a psychologist such as myself, a neuropsychologist.

In some other settings, if those are not available  social work to make sure that we are also providing  the emotional support needed so that we are kind of treating these conditions holistically. It certainly requires a lot of time  patience, and I, I would say advocacy as well. Yeah. And  I will say I've seen it many times as you mentioned, how staff reacts to these behaviors.

Mm-hmm. I've heard it as well, they'll say, oh, they know exactly what they're doing. Right, right. So, Interesting. 'cause I I gave a session at a conference in West Virginia, a long-term care conference and they asked me to talk about how staff could kind of change their approach to these mm-hmm. individuals. And so it's so important, and it does  just making, having staff change the way they react to mm-hmm. You know, behaviors associated with dementia  for an example is it makes a huge difference across the facility. It does. And I think reminding them that despite of these labels, these diagnoses, this is still a human being.

Yeah. And  there, there's some just kind of basic needs  that should be met despite whether we understand where these behaviors are coming from. And sometimes that's even hard. Yeah, agree. So you're a Spanish speaking professional. Yeah. So you have a unique perspective on multicultural care.

 What do you feel makes navigating the behavioral health space, especially challenging for people who speak limited English? So. People always, they hear language and they think that it's just communication, whether it's verbal or nonverbal communication. And, it's really be, it goes beyond that.

 the way I view language, at least it's connection and it's the way that we develop trust with others. So when I have patients with limited English proficiency. I often see how they face barriers at different steps of, their journey.  From understanding changes within themselves, how they go about accessing resources, workup, and being able to then meaningfully.

Describe to different professionals what it is that's going on and how it's affecting them. I think access is probably one of the biggest barriers or challenges I should say. Interpreters aren't always accessible and even when they are. You're now having to rely on a third party. Someone that the person oftentimes is meeting for the first time, perhaps uh, minutes before the appointment, and having to relay information that can be quite sensitive and not always comfortable to share.

So the fact that they have to rely on this person, it can be a deterring factor. Then there's also the cultural layer  stigma  beliefs about mental health and then expectations about care, which can vary greatly depending on where the person is coming from. And that's something that if the provider that they're working with  doesn't have the sensitivity or, or or the competence to.

Acknowledge their limitations. That can, That can also be a, challenge for patients because it, can impact  how they're gonna develop that connection and that trust with that professional. And then perhaps even follow their recommendations for further workup or treatment options and those sort of things.

It can lead to patients feeling misunderstood. Or unfortunately at times caused them to disengage from treatment entirely. It's a shame, and I'm sure this happens. You know, I said I was gonna talk a little bit about the COVID Pandemic, and I kind of wanna link it to this question maybe briefly.

  If you could just say what you feel if the mental health of non-English speaking individuals is still being affected by the COVID-19 pandemic  I'm just, I'm very curious about how different groups were affected by the pandemic  and I think oftentimes these certain groups, their voices really weren't heard.

Definitely. I mean, I, I think that that's still something that we're gonna see the effects probably for many years to come. I think the pandemic magnified existing inequalities in healthcare and with non-English speaking communities we saw the higher rates of, Illness, but loss in isolation.

That is present  at baseline, but I think was just magnified by the fact that they then were faced with having limited access to mental health support. I'm sure that you've had other providers that even probably yourself, experience   as we transitioned from not having access to face-to-face care.

Having to rely on phone appointments, video appointments, when it was possible.  it was not always feasible just because of the person's means. Now we are talking about some socioeconomic factors that were added, barriers to people being able to reach out and get the supports that they needed.

So I, I think even now I see ongoing anxiety, grief of burnout not just from patients, but also caregivers as they're trying to get back into the community  integrate themselves again into  a quote unquote new normal, a new world and reestablish care, not just medical, but mental health as well.

There's still some kind of concerns in terms of kind of just being out in the community and the risk that possesses. I think that I, not just for non-English speaking, I think that as a society overall, there's still a healing process that has probably just begun as we've kind of resumed, like again, that quote unquote just new normal.

Yeah  I will agree. I still feel like I mean, I was in nursing homes during the pandemic.  Still feeling the impacts. I can't imagine  they're, if they're individuals who were living in nursing homes during that time  they were just so heavily impacted.

  And you think if you were in a nursing home and you didn't speak English, like  That's a lot. Well, and we think of the pandemic and I, think the first thing that always comes to mind is how it impacted people's access. But I the other piece that is always present is as and I, guess I can only speak to the Spanish speaking population, but as a Spanish speaking person, we are.

We, we tend to be kind of very nonverbal  in our interactions. We use a lot of facial expressions and hand gestures, and there's some kind of cultural pieces that are embedded in how we communicate, and how we interact with others. And  I think of the impact of having the masks and social distancing and how all of that was also such a change  in how we had to, how we communicated and interacted with other people.

Yeah, definitely. So you were born in Puerto Rico, so Yes. Coming from Puerto Rico and building your career across many different settings, how has your personal journey shaped the way you approach your patients and their families? I, it always reminds me of the importance of community and that sense of connection. I've had the opportunity to work in different regions, but also in different systems whether it be outpatient or inpatient settings. And  I think a lot of those experiences has really reinforced the idea  the belief really that patient stories are shaped by their cultures values.

So I, I usually try and always. Approach my patients with kind of that same humility and, curiosity. I always kind of have in the back of my mind, and I don't just do this with  my Spanish speaking folks patients that are coming in with, from other parts of the world. I always think about what matters most to them when it comes to their care rather than just assuming what's best for them.

Based on clinical findings. Regardless of what they're presenting with  whether it be  dementia, stroke, brain injury, always keeping in the back of my mind how their culture and value is going to impact the way that we then formulate their treatment plan. So  I try and be very cautious when it comes to that and I, if I can have those conversations with them kind of openly.

I always try and do that. And if there's barriers  again, going back to the idea of a stigma you know, different views on whether it be changes in cognition or even mental health challenges  I try and encourage just a very open conversation about what they feel comfortable with. The other piece is also being aware of what my own limitations are in terms of what I know and what I don't know, and being okay telling them  I may not be well versed in.

Their specific culture or their specific traditions and being open to having them teach me so that we can incorporate those pieces into how we go about caring for them, making sure that their needs are met but also making sure that they're getting the best care that they need from a clinical standpoint.

That's so wonderful to hear. So I am very curious myself about brief psychotherapy.  So could you explain what that is and what kinds of individuals benefit most from this approach? Yeah.   When we think about psychotherapy um, it's really a, focus, kind of time-limited approach that targets specific goals.

Oftentimes, in my experience, when I do brief psychotherapy, it's often in the, like nursing home setting or for example, an inpatient rehabilitation. So. In certain situations, the patients are only there perhaps for a specific period of time as they're working on rehabilitation because of specific changes from a medical standpoint.

So in, in those settings  I usually try and find ways to help them cope, either with the medical diagnosis itself  changes in their day-to-day functioning. In these situations, patients are usually presenting with some type of functional decline from their baseline. They're having difficulties with day-to-day activities, so helping navigate how they cope with where they are at that stage, at that point in time helping kind of navigate that adjustment process, which can sometimes come with some  mood symptoms.

And then help them navigate  concerns  anxieties that they may face. If, for example  they are going to rejoin community, return to independent living and what that's going to look like if that's a possibility. Or helping navigate bigger conversations if the person is then now for the first time, facing the possibility of having to.

stay either in the facility long-term, if we're talking about you know, going skilled nursing or if they are going from inpatient rehabilitation to a long-term care facility. So helping them really just kind of develop some specific tools some coping strategies to kind of help navigate that adjustment process.

The mood symptoms that we see during that recovery process or during that treatment period. But also providing support without doing, committing to kind of long-term therapy, which is what we normally do, kind of in like an outpatient setting. I can see how that would be really helpful.

And in the inpatient  or long-term care setting and I,  I think it's almost needed for everyone, I'll say. Yeah. No, definitely. Definitely. That's.  In your opinion, what is the most pressing mental health challenge or challenges facing the United States right now?  I'm sure it's gonna, it's gonna be hard for you to find one that being sarcastic.

Yeah. I mean, So if, we're thinking of specifically in terms of diagnosis or just in terms of access to care? Oh, maybe, oh, well, maybe both. Maybe both. Yeah  I definitely think access remains  one of the most pressing challenges.  I think we've made a lot of progress when it comes to bringing awareness, but not necessarily in terms of having available resources or even affordability for care.

but I, I think that there's definitely a lot of anxiety And just trying to navigate the maybe fears of uncertainty  whether that be, how, what the world's gonna look like in, in a year, two years from now  changes and from a socioeconomic standpoint I definitely   I foresee there's gonna be some exacerbations in terms of just anxiety and depression because of some of those dynamics.

But I. go back to kind of the other piece of this question, and I also worry about just kind of the access and making sure that regardless of where people are, that they have the opportunity to be able to find, trained professionals that they can  seek out for specific  whether it be just managing day-to-day stressors or  being able to help navigate mood changes as we continue to see changes from a, just as a nation overall. so a related question, and my last question, and I like to ask this of almost all my guests. If you were in charge of healthcare in the United States, what is the very first thing you would do to improve access or just improve the care of in mental health services overall?

 I would probably invest specifically in  a workforce that includes both like diverse and community-based care.  A lot of that may require integrating mental health in every aspect of care, not just as a separate or a specialty service, but having access  even at the primary care setting.

I think It's challenging sometimes for patients when they go in and their, their primary care doctor, their family doctor is their first point of contact. And then at that point they then get referred, okay, so you need, a psychologist, so let's put this referral in. And now it's several weeks before this appointment is processed and maybe it's a couple more weeks before the appointment comes.

So being able to kind of integrate mental health in every aspects of, healthcare I, think, would be important, but also making sure that the workforce has just basic understanding and training when it comes to diversity and how different mental health conditions can manifest differently.

How different cognitive impairments can manifest differently. So certainly in a very biased way, just because of where my interests lie I, would love to see more training. When it comes to having culturally competent clinicians, I would love to have more bilingual individuals as well integrated into the medical and behavioral health system.

Again, within the primary care setting, neurological settings and facilities.   I don't know how feasible that would be, but I, would love for that to happen.   we talked about you know, the limitations with the pandemic and I, I've always held strong to the belief that. Mental health, medical care shouldn't be a privilege.

It should be part of kind of standard and equitable   healthcare for everyone.   and I know that that's not necessarily an easy venture, but I don't think it's impossible. I will agree with you. I also do not think it's impossible, and I hope you get your wish on all of those things.

Yeah. Dr. Nicole Gonzalez, thank you so very much for joining us today. If individuals want to find out more about your practice, how can they do that? Yeah, so we have our website and it is  north shore psychological associates.com and we can also be reached at our office phone number, which is  814) 877-8013.

We have  a great team of neuropsychologists.  We have, fellows that do training with US practicum students. We have a group of  counselors, master level counselors as well within our practice. So we, we definitely have  a great team that, that's working for us  and trying to, just making sure that we can make a difference in the Erie area.

Yes. And you also have an Instagram page. I heard a new Instagram. We do.  My colleague  Dr. John Glass and myself have just recently started this endeavor. We started doing just kind of brief reels  and posts on Instagram just with the idea of wanting to provide some education to the community.

It's still very new. We're in the, I, it's still early stages, but we are, we're getting some good feedback and. Certainly taking on topics for discussion. So if there's anything in specific people want to hear about they can message us directly and we can prioritize those discussions. Excellent. I think that's at North Shore Psychology.

Yes. Okay. We will link it in the podcast. Beautiful. Thank you again for joining us, Dr. Gonzalez. Oh, thank you.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.