Sarah Harward: How Value-Based Care Is Transforming Children’s Health

Public health isn’t just community clinics and county programs — it’s shaping the future of healthcare from the inside out. In this episode of Y Health, BYU Public Health alum Sarah Harward shares how she’s redefining population health as a Business Operations Coordinator for Intermountain’s Children’s Health Network, Utah’s largest healthcare system. 

Sarah reveals how value-based care and proactive care models are transforming patient outcomes, the power of home-visiting programs like Nurse-Family Partnership, and why early childhood mental health screening is a game-changer for families. She also opens up about “finding your why — and your what” as a guiding principle for public health professionals. 

A must-listen for students, clinicians, and anyone curious about the intersection of hospital administration and public health in real-world healthcare. 

Recorded, Edited & Produced by Averee Bates, Christy Gonzalez, Harper Xinyu Zhang, Madison McArthur, Kailey Hopkins, and Tanya Gale

Transcript

Cougar: [00:00:00] Welcome to Y Health, a podcast brought to you by the BYU Public Health Department. I'm Dr. Cougar Hall, a professor here at Brigham Young University where the, you are a student parent, or BYU fan. This podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health, so whether it's global or local, we will discuss how it pertains to you. 

Just kick back and relax as we talk about why health. Sarah Harward, welcome to Y Health. Thank you. So excited to be here. This is so awesome. We actually had your mom on the podcast about, I don't know, two years ago, 18 months ago. 

Sarah: Yes. 

 Cougar: And so this is turning into a family affair. This is awesome. 

Sarah: It is. Yeah. 

Yeah. Here I am and 

 Cougar: you have to remind me because. Were [00:01:00] you and your mother in the same MPH cohort, by chance? 

Speaker 3: Yes. 

 Cougar: That is so cool. Yeah, I don't know. I, that's probably the only time that's happened in our department, uh, to have, you know, mother daughter combo come through and graduate. 

Sarah: Yeah. It might be. It was a blast. 

 Cougar: Lots of fun. It 

Sarah: was so fun. Yeah. 

 Cougar: Lots of late night. Mother-daughter study sessions? 

Sarah: Uh, no. Not really. Independent on that. Yes. Yeah, it was a lot of FaceTime calls, a lot of calls like, Hey, have you done this yet? That kind of thing. 

 Cougar: Were you competitive comparing scores on papers? 

Sarah: A little bit, and she was usually higher than I was. 

She's 

 Cougar: a good writer. She was hard. I mean, she's an accomplished writer. She is. So yeah. She's 

Sarah: so 

 Cougar: good. You're not too shabby yourself, Sarah, I'm sure. Thank you. So well, thank you again for joining us on the Y Health Podcast. If you'll take just a minute, introduce yourself to our listeners. 

Sarah: Yeah, so my name is Sarah Harward. 

I grew up in Orum, so I'm from around here. I earned my bachelor's from BYU in exercise and Wellness back in [00:02:00] 2014. And then in 2021 I decided I wanted to go back for my Master's of public health. So I started in the fall of 2021, graduated in 2023. Um, for my internship during my MPHI was the administrative intern at Primary Children's Hospital in Salt Lake. 

And then when I graduated, the, a new position had just been created, um, called the Business Operations Coordinator on the Children's Health Network team. So that's what I've been doing ever since. 

 Cougar: Okay. Can you explain a little bit about what the Children's Health Network team does? This is really cool and there's, I have so many questions. 

Sarah: Yes. So the Children's Health Network through Intermountain is a network made up of community pediatricians, so people external to Intermountain and. With how many providers are a part of this network? It, it encompasses thousands and thousands of children in [00:03:00] Utah County, salt Lake County, really throughout the state, and we work on quality improvement projects with them. 

We have network managers on my team who help them with. With population health efforts, so vaccines, screenings, that kind of thing. And as a business operations coordinator, I provide project management support to the team. 

 Cougar: Cool. Now there's, I've. A couple of different directions we can go, but I, I, I wanna start with our student listeners 'cause we have a lot of students who listen to this podcast. 

So they're earning an undergraduate in public health, maybe health science. Some of them are looking, you know, to work for the county health department to work for a nonprofit. Some of our health science majors are more looking at professional school dentistry, physical therapy, medical school. Um, there's a percentage of those who are really looking at hospital administration and, and so you're talking about the business [00:04:00] operations. 

And how did your MPH prepare you for working with, is this the largest hospital in, in Utah? I have to think. Intermountain. 

Sarah: Yes. It's the largest health system in Utah. 

 Cougar: Yeah. Yeah. Sorry, I said hospital health system. Thank you. Um, tell me how your MPH set you up for that and is it. Is there some, is there some overlap between public health and hospital administration or healthcare administration? 

Some of those things? 

Sarah: Absolutely. And I wasn't sure that there was, when I started my MPH, um, when I was looking into MPH programs and things like that, I had read that one of the things you can do with an MPH is to go into hospital administration, and that didn't sound super interesting to me. Honestly, even when I read the title of this position that I'm in now, business operations coordinator, I was a little deflated because I thought, I don't wanna [00:05:00] be working in business. 

I want to be helping improve the outcomes of children's health and, and things like that. But. I was so wrong to, to be a little disappointed because that's exactly what I get to do in operations and on this team. Um, it's really interesting to talk to a lot of people who I work with who have gone into hospital administration who. 

Started their journey wanting to go to medical school. Mm-hmm. Because they wanted to help people and you know, all the reasons why a student would go to medical school that was there for them. But then for whatever reason, medical school didn't work out. And so they found hospital administration instead. 

And they are realizing that they get to do very similar things, um, still helping people still help improve lives and improve health outcomes for. For big populations and, and it's really, really cool. I [00:06:00] also work with a lot of people who have a clinical background, so they have been to medical school and now they're able to see patients, but also work on the administration side of things, and they're very well rounded for that as well. 

 Cougar: I love it. I've always told my students, I'm like, Hey, yeah, there are some differences for you that are going to medical school. You'll deal with patients and treatment For those of you that really wanna work in a, in a, in a truly public health setting, it's populations and it's prevention. But there's so much overlap today because we both realize we need each other. 

Yes. And if it's about people and in improving health outcomes, we have to come together. And it feels like you're right at that intersection. It's pretty cool. 

Sarah: Yeah. Yeah. It's a, it's a really cool place to be. I feel very fortunate that I'm there and that I found it. Um, and there, I mean, I will say too, there are a lot of positions who, that I've looked into, that I've talked with my leader about and things like that, only [00:07:00] to find out that people have a clinical background than, and they're more, the, the position is more geared for people with a clinical background or it's required mm-hmm. 

As a leader. And so I think those are the people who are in a really good spot or who have a clinical background, but also. Want to be in administration, but there are plenty of us who don't have clinical background, who can still make a big difference in hospital administration. 

 Cougar: Yeah, no, for sure. We need both. 

Mm-hmm. And when we say administration in this context, how much of that is decision making? Is allocating resources, is is really like just one step above what we do in public health, which is program planning and saying, here's what we want to do. Is, is there some overlap there? 

Sarah: Yes. Yeah, there's a lot of overlap. 

In program planning? I mean, it goes hand in hand. Right? Okay. Okay. When you plan the program, you do need to figure out resources [00:08:00] and things like that. Um, if you think about kind of a Venn diagram mm-hmm. Where on one side you have finance and those are the people who have their MBAs, who have, you know, a strong background in economics and finance. 

They are setting things up for us where we can use their tools to. Figure out what we need for our programs. But then you have us on the other side where that's not the primary focus of our jobs is figuring out budget and things like that. That's just a small part of it. 

 Cougar: Yeah. So you have the needs assessment folks that are saying, Hey, these are the hotspots. 

This is really where if we, if we're gonna get upstream, as we say in public health. And then you come together at the table and you say, here's how we can use these resources to get the best outcomes. Yes. Am I getting closer? 

Sarah: Yes. Yeah. No, exactly. And I was really worried when I, before I started my internship, I was worried that I wouldn't like it very much because it was just so. 

Businessy, I guess, for lack of a better word. Yeah. And [00:09:00] so, so much in finance and things like that, that's just not what excites me. And so I didn't, I was hoping that it, that that wasn't all there was to healthcare administration and there's for sure so much more than just that. 

 Cougar: Love it. Well, it sounds like you love your job too. 

Sarah: Yeah. 

 Cougar: Um, let's get down on the ground level then. What are some of the programs that you're working with? And I'm thinking of prevention. I'm thinking of actually interacting with certain populations that maybe are at risk or are, or what we'd call vulnerable, uh, in the valleys where we live. 

Sarah: Yeah. So I will say in my position and in a lot of healthcare administration positions. 

There's, there's not a lot of face-to-face patient interaction, and so I can speak a lot about this one program in particular called Nurse Family Partnership or NFP, and [00:10:00] I have in the two years that I've been involved with that, I have actually met the clients in that program one time, and it was for a focus group. 

Where I really focus my effort, me and my two colleagues at Intermountain, we meet with the healthcare department leaders who employ the NFP nurses, who, they're the ones, them and their nurses are really the ones who are on the ground doing the hard work of home visitation. 

 Cougar: They're the heroes here. Yes, 

Sarah: they are Uhhuh, 

 Cougar: but it cascades down. 

I mean, none of this happens unless you are prioritizing this and helping, and yeah. Whether it's the training of the trainers, but I mean, there, there's, there's some type of cascade down to where yes, those nurses are actually doing home visits and, and helping those in need. 

Sarah: Exactly. Exactly. And we get to be in this really cool position where Intermountain brings the funders, these [00:11:00] very wealthy people who have. 

Some really, really cool priorities with their money and they want their money going towards these programs and they help us be in the position of offering that money to these programs within the County Health Department and things like that. 

 Cougar: Very cool. Tell us some of the things what, uh, the NFP. What are some of the challenges they face? 

And I, and I'm thinking of the population of I'm, I'm guessing mothers. 

Sarah: Yes. 

 Cougar: Mm-hmm. Um, what are some of the challenges they're facing and how are we navigating that? 

Sarah: Yeah. So, uh, I guess a good way to explain this would be to kind of introduce NFP. Yeah, please. Yes. And by the way, this is not the only home visitation program. 

There are a lot through United Way and through. The, I mean, the state has an office of early childhood at early childhood and of home visitation as well. NFP is just one [00:12:00] player in. A game of a lot of players, but NFP specifically, it's a national organization and it employs registered nurses to be home visitors. 

And the clients that they're visiting are first time mothers. They are in 28 weeks or earlier of pregnancy. They, I believe they need to qualify for Medicaid. Or there, there's some type of Yeah, they need to qualify for Medicaid. There's like a, an income level requirement for them. Sure. Cut. Yes, exactly. 

Yeah. 

 Cougar: Yeah. Um, are, because you're, you're one of the administrators over this program, at least here in, in these valleys where we live, um, what are some of the challenges that these, uh, either early in pregnancy or early in. Parenting that these mothers are facing. [00:13:00] 

Sarah: A lot of 'em, I mean, the biggest thing probably is relationships, whether that is with their partner or with their families. 

A lot of times it's a little bit of everything. And substance use has been a big issue. They just really don't have much support and it's not like they just woke up one day and they boom. All their support was gone. It was, it's been a lifetime of it. It's been, you know, a hard life for them. And now they find themselves in this position where they are pregnant for the first time. 

A lot of them. You know, it wasn't on purpose pretty much. Um, and now they have very little support where hopefully most people listening to this, they would say, well, you know, once I had my first baby, or when I had my first baby, I had my mom, or I had my mother-in-law, or I, I had a very [00:14:00] supportive spouse and we had. 

Stable jobs. Um, they, these mothers in this program don't have hardly any of that. There's a lot of teen moms as well. 

 Cougar: It, it's just so fascinating 'cause when we studied public health, we realized it's all interrelated and we can go back to childhood. I know when you were here at BYU you studied ACEs. Yes. 

Uh, adverse childhood experiences and, and if we just start stacking some of these risk factors or some of these challenges. Um, so often it is the social support that buffers us from those things. It's relationships. Yes, it's family, extended family, church, community. When, when you don't have those things, oh, those, those challenges, you know, those barriers become steeper and steeper, intolerant, toler to, to overcome. 

And in my, in my former life as a high school teacher and for a time period at the alternative high school where there were, um. Where [00:15:00] there was a higher percentage of young mothers, um, it, it felt to me like, and I don't have research on this, but I'm sure it's out there, that one of the reasons they wound up. 

An unexpected pregnancy was they were seeking for that social support they were seeking for that connection, they were seeking for that safety, uh, that they didn't have maybe provided in a home or provided in a community or that extended family. So you start to look at this and you realize, oh my goodness, there's all these, is, is this a web of, of challenges and experiences? 

Uh, really hard to fault someone. I'm not able to, I'm, I'm not able to be judgmental like I used to be after interacting with this population and realizing, I think this is what I would do too. I think I would be seeking for that support, that safety, those needs that were met for me in my home and through my extended family and my religious group. 

Sarah: So, yes. Yeah, and that was [00:16:00] something that my eyes were open so much as I studied public health here at BYU. It really opened my eyes to how many factors are at play for someone in that position. Mm-hmm. It's not just a young woman who made a a stupid mistake and now it's all her fault that she's in this position. 

It's so much more than that. Yeah, and that's really cool to be working with a group of people who all recognize that same thing and who want to help out instead of judging and things like that. 

 Cougar: Well, how amazing too that there are donors with this who are viewing this challenge through the same lens and the Intermountain and your team is saying, yeah, and, and we can help them where they're at. 

And at the same time we're getting upstream because there are, there's this cascade of challenges, uh, that come after that unexpected pregnancy. 

Sarah: Yes, [00:17:00] exactly. And NFP actually, so their model. They stay with the mothers until the child turns two and then they graduate, have a little graduation ceremony and things like that. 

And then what's really cool is there are programs that kind of help them move. They can move into those other programs that are geared towards families with. Older kids. 

 Cougar: Yeah. Yeah. 'cause the challenges persist. 

Sarah: They sure do. You're a mother. Yes, I am. Yes. And 

 Cougar: even with all the supports that we have, uh, there's still a, a, a very high percentage of us who experience postpartum depression. 

Speaker 3: Mm-hmm. 

 Cougar: Um. There's, there's all sorts of challenges that come with, you can talk about socioeconomics, you can talk about, uh, you know, interpersonal relationships. Uh, marriage. Marriage can be wonderful and marriage can be really thrown off. Mm-hmm. Um. With parenting challenges. And so I, I'm probably preaching to the choir here, Sarah. 

You're like, I'm [00:18:00] a mom. I get it. 

Sarah: Well, yeah, I mean, I am a mom and it's hard enough as it is. Yes. Thank you. And so when you hear about these challenges that these mothers are facing, I can't imagine having, going through all of that with all these extra challenges heaped on you. 

 Cougar: Yeah. Yeah. It just stacks up, piles up against you pretty quick. 

Uh. You mentioned when we were offline, you were, you were teaching me, and you'll need to let me know where I need to send my tuition dollars because this has been an education in just chatting with you. Sarah, you mentioned, uh, it's, it's a term that I've heard this, this value-based care, but I've only heard it. 

So if you'll educate me again, I need lecture number two from you, and maybe there's some in the audience that could use this lecture too. But as you're working in this space. You're working with programs that are helping young mothers, we're we're working with children, I'm sure, with mental health and physical health and with pediatricians and really [00:19:00] trying to improve this whole system. 

What is value-based care though, and where does that intersect with all of these things we're talking about? 

Sarah: So value-based care, you can kind of think of it. As almost the opposite of fee for service care and fee for service is what our nation has used historically, where you go to the doctor, they, he bills for that instance of care. 

Your insurance pays a certain amount. Um, if you have a high deductible or, or not, you, you get a big bill for going to see the doctor, right? Value-based care has kind of turned that on its head and. It's been around for a little while. It's relatively new, but value-based care incentivizes doctors for to have better health outcomes with their patients. 

And so, for example, Medicare, they're a big player in the [00:20:00] value-based care world. They will give the doctor, let's say. $5,000 for a particular patient who may need a, a hip replacement. And I'm just making these numbers up, that's probably not even close to what it really is. But, um, so they're given $5,000 to keep this patient healthy. 

So now the doctor who would originally bill $15,000, let's say, for a hip replacement. They are now very incentivized to keep that patient healthy and not needing a hip replacement. And so now the doctor might be talking about weight management strategies or some more holistic, less expensive options than surgery, and so it's. 

The way, I guess what else that looks like is [00:21:00] screening and you know, trying to get upstream of chronic illnesses like cancer or high blood pressure or things like that. 

 Cougar: So it's not just that, hey, we think, uh, you know, that our physicians or are just. There's all sorts of unnecessary procedures and, and you know, the incentives are such that they're rewarded as long as we remain sick. 

I, I, I, I mean, there's a cynical side of us that may think that, and maybe there's some truth to that, but it's, it goes way beyond that kind of initial cynical concern. Mm-hmm. To where, no, we're trying to get upstream, we're the incentives are such that you're rewarded. When your patients do change behaviors and do engage in, you know, prevention efforts. 

And so now, and I love that you used the term holistic because now I'm not just talking to you about the procedure. Now I'm saying, okay, here's how we could address your stress. Here's how we could address, [00:22:00] uh, what is very much related to your stress and to some of your interpersonal challenges. Um. You are being overn, nourished, or, you know, I mean, on and on and on. 

So now we're starting to say, ah, I, I'm not just a specialist in this one particular procedure. I'm gonna try to help you establish wellness and you can move forward seeing me less often. Exactly. Is that close? 

Sarah: Yes. Yeah. Yeah. No, that's a great, that's a great rephrase of it. Um, and if you look at the health outcomes. 

In Americans, we need something like this. Yeah. You know, we spend, our country spends the highest amount of healthcare, and yet we have the, some of the lowest and worst health outcomes in the, in the world. Yeah. Um, especially among wealthy nations. And so yeah, it's time, it's definitely time to move that way. 

And at Intermountain, the [00:23:00] executive leaders have actually adopted. A different phrase than value-based care, although we still, you know, work in that. But we like to call it proactive care. And I really like that word for it, because that's what it is. It is being proactive about it. It's anticipating and preventing health issues. 

And, you know, Intermountain still provides some of the best healthcare for people once the issues come. But we would like to prevent them and anticipate them. 

 Cougar: I love it. So honorable. It is. It really is, and it's, it's absolutely what we need. Mm-hmm. There's no doubt about that. On a side note, can I share, just because as, as you're talking about this, this is a total paradigm shift in healthcare. 

It really is. Mm-hmm. I have a brother who I have great respect for, he's a chiropractor, and I referred a friend who is having both knee and back pain to my brother. And then, you know, and now you're like, [00:24:00] oh man, I hope my brother comes through. 'cause this is a, this is a dear friend. And, and he went and he had an adjustment and a consultation and I think it went well. 

And when my friend was leaving, he's like, so, you know, do you need to sign me up for 52 visits, you know, every Tuesday? And, and my brother actually, he. He said no. Um, ideally you won't need to see me again. He goes, if you're serious about your back and your knee pain, then we need to strengthen your core and we need to get you on, um, a nutrition plan that's gonna help you lose some weight. 

And then, yeah, I don't think you'll need to see me. He's like, if you have time now, I can give you some exercises. We can step back here. Uh, in his strength training, you know, facility resistance training. Spot of his office and I can show you some core exercises that are gonna, are gonna, it's gonna take you a month, but you, you're gonna start feeling a lot better. 

And then I can also put you on a meal plan. And anyway, my friend came back and he goes, uh, [00:25:00] that's not the experience I've ever had, whether I'm at a chiropractor or at my, you know, primary care physician. Always, we'd like to see you again. We'd like to see you again here. And they're just stringing me along. 

He goes, your brother just said, yeah, ideally you don't need to see me again. Like, if you're serious about this, let's strengthen your core and get you eaten a little better. And I was like, wow, that's really cool. I was like, yeah, well that's my brother. He's awesome. I told you. You know, and but that, those, those incentives, the incentive is to really No. 

I'm doing my job. You're not gonna see me again. 

Sarah: Yes. 

 Cougar: That's where we want to go, I feel like. Exactly. 

Sarah: Exactly. I mean, that sounds like proactive care at its finest. 

 Cougar: Yeah. Oh, cool stuff. Yeah. So this is exciting that you get to be right in this space. And using this public health lens to really influence care. 

Speaker 3: Yes. 

 Cougar: Okay. Exciting. What else? What else has got you really excited? 

Sarah: Um, right now [00:26:00] I am focusing on and very excited about early childhood mental health. Um, as part of our, so the work with our network, um, they have been focusing on providing. Mental health care to kids in the primary care setting through a model called collaborative care. 

And so that's really where the efforts have been focused, because I'm sure everybody knows mental health among youth is like at an all time high. Yeah. And there are, there's so much that needs to be done about it. And so. The focus has been, you know, let's screen these kids and address these issues right now to get them the help that they need to combat these, these issues. 

And our physicians have done a great job of doing that. There's some really great work going on to, to address these issues. But at the retreat last fall with all of these leaders and [00:27:00] providers in our network, the question was asked, you know, what should the focus be for 2026? They had already decided on 2025 by that point, and unanimously the group kind of said. 

Well, what can we do so that these screeners stop coming back so high, the scores on the screeners and what, what can we do to make it so that these kids aren't struggling with their mental health in the first place? And what everyone decided on was, let's get even more upstream of it and start addressing early childhood mental health factors. 

ACEs being a big one. Mm-hmm. So that's, that's where the efforts are now. I'm working with our medical director and other executive directors on our team to bring programs that have a focus on early childhood mental health, um, to these, to some of these practices. Ideally [00:28:00] all the practices. We're focusing on three right now, for example, and. 

I'm amazed at how much work it is just getting this program implemented in these three practices, and this is all for 2026. It hasn't even happened yet, and so we're hoping to get these programs started and established and then kind of scale it to all the practices, ideally. 

 Cougar: Yeah. Okay. What does it look like? 

Is it, is it making this part of the discussion with a young mother? Is it, is it looking, um, and identifying, okay, here's a few talking points, whether it has to do with screen time or recognizing emotion or more free time and, and play. Um, or are there, are there services that we're directing parents to? 

So is that, is it at like a behavioral medicine level where it's like, here are the things you. Want to do in your parenting approach to help your child become more emotionally resilient, um, or to, you know, to avoid whatever it is. And I'm, and I'm really just thinking about [00:29:00] phones and screen time and some of these things, but mm-hmm. 

There's so much more I'm sure. Or is it directing traffic to here's, here's another service or agency that you can access. Anyway, more detail. Sorry, Sarah. 

Sarah: Yeah, no, um, it's all of that. Okay. And where they get sent or what resources they are given depends on the need. So you can think of it as like a pyramid where, and it's a tiered approach where in tier one, top of the pyramid, everybody gets screened and the screeners are asking, you know, are you facing. 

Major stress are you, um, facing food insecurity? Um, and then it kinda works its way down to the more intense questions like, are you experiencing any intimate partner violence and things like that. And depending on what they answer yes to, if anything, then their provider can set [00:30:00] them up with resources ideally. 

The resources are happening in the primary care setting. We've found that when they're sent elsewhere, the the loop is really hard to close. Hmm. That the provider doesn't know if the family has followed up with those resources. They don't know if the therapist, for example, had an opening anytime soon for them to get into. 

They don't know. What happens to them. And so there's some really great resources and platforms that are trying to close that loop and to make the resources more accessible. 

 Cougar: So, so maybe I'm confused. The, the screening, we're screening the mother? Yes. Or, or are we screening the child 

Sarah: so. We're screening the mother. 

Okay. And a lot of times that will uncover some things that the child is struggling with. 'cause these are very, very young. These are babies. Oh, okay. We're talking about, yeah. So these screeners [00:31:00] are given at, well-child visits at like two weeks, six months, nine months, 15 months, those kind of things. Okay. 

And so. Obviously, you know, you're not gonna ask a six month old if they're under a lot of stress. Right. You know, you, it's, it's the parent. If the six month old is under stress, it's because their parents are under stress. It's parent. Yeah. 

 Cougar: Yes. Mm-hmm. Okay. That makes perfect sense. Yeah. I always have this lens of like the form where public school teacher and, uh, so as soon as you talk about children and mental health, I'm thinking, oh, here's this. 

7-year-old who doesn't have the coping strategies they need at this point to, to process the stress and this. Okay. Yeah, 

Sarah: there is that too, for sure. 

 Cougar: But. If you go upstream, it's occurring. It is those early, early after childhood experiences. 

Sarah: Yeah, exactly. And we're hoping, you know, the thought is that when we ask that at their 12 month well child visit, they can, the provider can address some issues so that child doesn't grow up to be the [00:32:00] 7-year-old who's having all of these problems. 

Mm-hmm. Because of an ace that's occurred or, or other things. 

 Cougar: Yeah. What a, what an inspired program. Parenting is so hard. 

Sarah: It's, 

 Cougar: and I, I felt like I was totally ready. 

Sarah: Mm-hmm. I had 

 Cougar: had a wonderful childhood myself, my wife and I had a great courtship, great, great early marriage, uh, college educated. Both have good jobs, benefits, and I'm like, I think I looked in the mirror like six months in and I thought I was so overconfident. 

Speaker 3: Yes. 

 Cougar: By the way, that hasn't changed. 26 years later I'm like. Like, at some point someone's gonna call me and say like, Hey, who do you think you are, man? You can't do this. Yeah. That, that's parenting right? Isn't it? Yes. So yeah, if, if I, I just, it's hard for me to fathom if I didn't have all of that built in support. 

Yes. Uhhuh, um, just. How much more challenging this would be. 

Sarah: [00:33:00] So much more challenging. Exactly. Yeah. And it reminds me of some really cool data that our analysts have found, and that is that when the mother is screened for postpartum depression, her visits to the emergency department are decreased. And not only that, but her children's are as well. 

The children are seen in the ed far less. Mm-hmm. 

Speaker 3: Um, 

Sarah: when their mothers just have been screened for depression. And of course there might be a few other factors at play there, but we have found that just them just getting the screening, um, influences a lot just because they know someone's aware. 

Speaker 3: Yeah. 

Sarah: They maybe they screen positively and they've been given some help where they, they wouldn't otherwise. 

 Cougar: Uh, well with awareness comes compassion. Mm-hmm. And, uh, a lot more self-compassion and understanding. Yes. Like, well, why is this so hard? And then, oh, well this makes sense. And [00:34:00] yeah. And, and not that then we throw up our arms and say, well, I'm a victim. 

I can't, I can't do this because I have this challenge or that challenge Uhhuh. Um, and I suppose that could happen, but that I don't, I don't see that a lot. I actually see people are like. I am, I'm extending more grace. Mm-hmm. I'm, I'm receiving more grace from my savior, and I'm, yes. I'm just being a little more compassionate. 

Speaker 3: Yeah. 

 Cougar: And I'm, I'm just, I'm, I'm, I'm judging myself and measuring myself slightly differently. 

Speaker 3: Yes. The 

 Cougar: reality is I still need to get through this. But now at least it's not this black box of, I don't know why I am having these feelings. I don't know why. Yes. I'm frustrated. I don't know why I don't have the patience I, I thought I would have. 

And Exactly. I think, I think that self-compassion and then, and then being willing to accept that help and yes, access those resources is a game changer. 

Sarah: Exactly. It totally is. It totally is. 

 Cougar: Oh my goodness, Sarah. Okay. I talk too much. You are a blessing. Thank you so much. [00:35:00] Um, I've taken a lot of your time. 

Is there anything else I should have asked? I'm a terrible podcast host. Oh, you're good. Anything else you'd like to share? One or two tidbits maybe for a listener. I think we've already covered some things for students, but for the general listener out there, any, any. Why is advice here? Sage advice? Oh, 

Sarah: um, that's a deep question. 

Yeah. 

 Cougar: I didn't give you any heads up either. 

Sarah: Um, you know, as I've been thinking about my time at BYU and after as well, um, we hear a lot about, you know, find out your why and have that, you know, like, have that drive everything else. But I realized that. As I was a student and since then as well, um, finding out my, what has also been so, so important, and it's not something that I have done very well in [00:36:00] some instances, but the more I think about it and the more time I can spend determining that, what, um, the better I'll be and the more, I guess guidance and. 

Plan going forward all have is by finding out about what as well. 

 Cougar: Explain that a little deeper for me, 

Sarah: so well, okay. I'm gonna go back to the students for a little bit. Yeah, please. Yeah. Um. They, some of them might be applying for fellowships. Yeah. Through That's, so that was something I didn't know about before I started my administrative internship, or I had just learned about them as I was starting my internship. 

But I know we have a lot of students from BYU who are. Like in the MPA program or MBA program who go and get healthcare fellowships and some in the healthcare administration fellowships, I should say. And I think there are a handful, even in the MPH program as well, that are interested in these [00:37:00] fellowships. 

And I, I applied for a handful of them and got rejected by every single one. They're so competitive. Mm-hmm. Um, and I did make it to the final round of one. Though back in Oklahoma, they flew me back there. It was this really intense day of interviews. And in one of the, the interviews, they asked me what my five year goals were and I was able to tell them like, you know, I want to become a service line director within the hospital. 

And they asked me, okay, what's, what's your 15 year goals? And I was completely stumped. Mm-hmm. And I shouldn't have been, I should have had. This great plan, even if it was just an answer for that, but I had not taken the time to really think about like, where do I wanna end up and what do I wanna do? I think I have this like kind of high level like nebulous idea of what I wanna do [00:38:00] because I have that why. 

But as for the, what I wasn't sure. And it was a really, it was, I cringe when I think about how badly I messed up on that question and in that interview. And so, um, but, but even like in my life now, just thinking about what do I want to be doing in the next 5, 10, 15 years and why, um, I really think that we need to have that, you know, not planned out to the detail. 

'cause you never know your. What's gonna happen, your interests and your passions might change, but just having an idea of where you wanna get to and how you're gonna get there. 

 Cougar: Advice. I love it. Can I add to that? I know, yes. This is supposed to be about you and I keep talking so much. Oh, please. But we always talk about the why and students can always articulate their why. 

Speaker 3: Yes, I'm 

 Cougar: in this major 'cause I care about people and I want to improve health outcomes, or I wanna make a difference in the world sometimes. In fact, most of the time I think the what? [00:39:00] Is nebulous. It's like, I don't, what are the jobs? I'm not sure. I just, mm-hmm. This is who I am. This is in my DNA, but I don't know, like, you know, my parents asked me, well, where will you work? 

I'm like, I don't, I don't know. And I am so thankful for BYU now. Now this is my context. I'm sure that other universities are doing the same thing, but BYU has put their money where their mouth is in providing. Um, tremendous experiential learning opportunities, um, and really, really focusing on, okay, here's an internship and here's a stipend. 

We, we, we, we want you to have these experiences. We want you to, to, you know, to go here to interact with these great people. And the one of the results is we're broadening our understanding of what is possible. Like how are, how are you supposed to know? Yes, Uhhuh. And so. We're getting broader exposure. 

There's, there's, um, a much [00:40:00] more diverse, you know, menu of opportunities. It's not just take this course, take this course, finish this semester, graduate, get outta here. We we're, we're totally turning that on its head and we're on its ear and we're saying, no, there's all these experiences. And as you, as you really jump in and you, you know, stretch yourself a little bit and en engage in these different things, you might realize that. 

You know, I, I was totally turned off by business. I was, that wasn't my thing. And now you're here and you're like, oh, if this is business, I can do this. Exactly. Yeah. And so it's just about that, it's that exposure. I don't know that we, you know, and the what changes, but that why is consistent. And so I just, man, for me it's just, it's putting faith in the Lord and trusting that as these doors open, maybe I wanna peek my head in and see. 

What, what's this about? And, and maybe I, maybe this is me. Maybe I can do this. So [00:41:00] it's, it's just about those opportunities and exploring those. 

Sarah: Yeah. Well, and he knows us better, right? Like talking about the Lord and his hand in things. I was devastated when I didn't get the fellowships, but there have been so many times since then. 

Where I've said to my husband, I am so happy to be in this position and not in a fellowship. I'm so grateful that it didn't work out, even though it was so hard in the moment. 

 Cougar: Sarah, thank you. You have blessed us, blessed me, blessed our listeners, and thanks for all the good work you're doing. You represent BYU and our programs so well. 

Sarah: Thank you. Thanks for having me. 

 Cougar: Thank you for joining us today. Catch us on our next episode, and don't forget to subscribe to Future Y Health episode.