Getting Help: What Does Evidence-Based Care Look Like?

Throughout our conversations, we’ve often touched on the idea of “evidence-based” care. This episode takes a closer look at what that really means, defining the criteria required to earn the evidence-based label, and how it translates into real-world treatments. Listeners will also gain practical tools to identify the type of care they may be seeking and what to look for when choosing a provider.

Transcript

SPEAKER_03 0:00

Unsilent, Candid Conversations about Suicide Prevention podcast is brought to you by Jefferson Health and the David Farber Aspire Center. The following podcast discusses mental health, depression, suicide, and other sensitive topics. This podcast is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. If you are experiencing suicidal thoughts or in crisis, call or text the Suicide and Crisis Lifeline at 988. Welcome to Uncilent, Candid Conversations about Suicide Prevention. I'm your host, Amanda Blue, Education Director at the David Farber Aspire Center. These are my co-hosts, Dr. Matt Winterstein, Center Director, and Dr. Lucas Zullo, Clinical Director. Today we're going to take on a pretty big topic, but it's something that we have talked about and we talk about regularly here, and that is the concept of evidence-based care. We talk about the fact that we provide evidence-based care here at the Aspire Center. And I think it's a good opportunity for us to talk to our listeners about what that means, why they should maybe know what that means for them or for their loved ones who are seeking care. I think it's a good time to start. I'll let you lead this off, Lucas, with a definition for us, uh, for lay folks about what is evidence-based care.

SPEAKER_02 1:23

Yeah. So I'm really so excited to be talking about this because I feel like this is a term that is so frequently used uh in describing mental health and therapy nowadays. And it's really important to understand what exactly that is. So when I say I want to have this conversation, I first want us to take actually a really big step back. And I want us to first think about, you know, when we talk about therapy, what are we referring to? The way that I think about it, you know, as a clinical psychologist is really kind of two main categories. Is there's care, like the care you're receiving at the Aspire Center, which is really very focused. I call it a clinical intervention. And so in that realm, you have maybe a clinical diagnosis or clinical manifestation of certain symptomology that requires a certain rigor, a certain high quality to the care that you're receiving. That is where I view evidence-based care is being provided. And what it is, is it's a type of treatment that is standardized in a certain way due to research and science, and it's been studied and shown to work for a specific population, for a specific outcome, for a specific timeline. So all that specificity is really essential to understanding what that definition is. Because of that, because it's standardized in a way for a specific application, it can then be disseminated and folks can learn how to apply it. And we call that evidence-based because we have a demonstration that it works, it has an outcome. But I think what's really important and nuanced part of this conversation, so then a second bucket, a second category of how I view what is therapy. That's more kind of supportive therapy, also called talk therapy, which is it's different in focus, is that this is for the folks who are wanting to have maybe a sounding board, someone to talk through a difficult problem, maybe like a breakup or how to ask for maybe a raise or something like that. That is a different form entirely. And I think part of what we'll be talking about today is the application of when is evidence-based care appropriate. It's not always the right option. It's not always the best option, but I want to denote the difference in application because it is categorically different than this other bucket, which is more supportive in nature.

SPEAKER_03 3:29

So I think those are very important definitions and also a lot of good context and background about different types of therapy. And it is confusing when we use the term therapy for everything that involves somebody getting care for a behavioral health problem, right? That is a little bit confusing. So it's good to know that. So, Matt, I'm gonna throw this one over in your direction, which is Lucas described where it is sometimes necessary to have evidence-based care and not necessarily always what would you need as a patient to understand about that when you're looking for a therapist?

SPEAKER_01 4:08

Different people have different needs. You know, some people come in and they're very clear that they're experiencing symptoms of major depressive disorder, for example, which includes um difficulty sleeping, includes problems with eating, but it also includes sadness, sense of not wanting to participate and be involved in some of the things they used to enjoy before. Knowing kind of what you're targeting matters. Now, not everybody goes to therapy and says, I know exactly why I'm here. I've had plenty of patients walk in the door and go, my primary care doctor sent me here and I have no idea why I'm here. That being said, as a therapist, one of our primary jobs, at least initially at that first appointment and possibly second or third beyond that, is to really get a good understanding as to what are you struggling with? What are the issues that you're experiencing, what do you want to see change such that whatever it is that you're here for feels better in some capacity. And so you go through that sort of assessment evaluation process to identify like what are the issues? And so I'll I'll use DBT as the example. If somebody comes in and says, um, I'm really struggling because um I'm just having a hard time when people tell me that I can't do this, or, you know, I've been working so hard at something, but there's always barriers that always feel like they get in the way, and I just can't handle it. Like when things come up that get in the way, like I struggle with that, and then it ends up creating another problem on top of another problem, and it just gets worse and worse and worse. That suggests that we're struggling with perhaps distress tolerance. We might be struggling with some form of emotion regulation. Um, and how then do we develop some strategies, some skills, et cetera, to address that? Because if we can handle those things, we might feel considerably better in how we are interacting, interacting with other people. And so in that instance, we'd say, okay, well, DBT, for example, might be a very effective intervention for working with somebody who's struggling in that capacity. But other people come in and, you know, again, as Lucas said, sometimes it's I'm not getting along with others, which again could be an evidence-based approach for that too. Um, but it could be that they're just, I'm not sure how to handle this situation. I really need to think through it and talk to somebody about this to learn more about it. You know, that may not require that type of rigor in terms of the care. It doesn't mean that the therapists are not effective. It just means that they're not using what we're calling evidence-based approaches to getting there. They can be very effective in helping people just in a different way.

SPEAKER_03 6:30

Right. It's about, it's more about suitability, right? It's about ideally having a really good assessment of what's going on and what your goals are, and picking the most appropriate course of treatment with the most appropriate provider. Ideally, you can rely on whatever provider you go to to help you develop the clear picture of the issue and the goals, and then decide what's the best treatment model for you. Um how would someone know how to f ask the right questions? So if I want to go see a provider because I have this issue that I'm struggling with, there's a giant list on the internet of therapists, and I could pick one that happens to be down the street from me. But how would I even know how to start?

SPEAKER_02 7:23

It's really hard because you need to know what to look for. You can go to pretty much any private practice right now, go online, and you will see Alphabet Sue. You will see all the acronyms. You'll see I do DBT, I do CBT, I do ACT, I do family systems. And if they're listing all of that, I'm gonna argue pretty quickly. They're not trained to fidelity in probably any of this.

SPEAKER_03 7:47

I'm gonna stop you there and say, what does that mean? Because people need to understand what trained to fidelity means.

SPEAKER_02 7:53

Yeah. So trained to fidelity is when you have really taken uh classes or coursework or trainings that include supervision to say that I am doing a treatment, a therapy consistent with the science, consistent with the trial that was done in an academic setting that has shown to have the outcomes that I'm hoping to work towards. So that I can do things in a way that's similar to the way that it's studied, so that I can have a similar outcome in my own practice. That's what I mean to fidelity. And so you can see all of these lists. And then I would highly encourage you to say, help me to understand which of these you deliver. And can you just tell me a little bit about maybe the training that you've got? I will bet you that most responses you'll get is say, oh, well, you know, when I say I do CBT, I do CBT informed care or I do DBT informed care. That can mean anything. That can mean I bought a book and I'm gonna maybe reference some of the language and now it's informed by that one chapter that I read. Versus if you get a response that says, hey, I was actually trained to fidelity in dialectical behavioral therapy. I did, you know, a four-day, all-day workshop. And then for a year I did consultation calls monthly, and I have the certificate that says I did these, you know, like 50 hours in the certification. That's a very different response. And that lets you know that this is someone who's able to deliver this protocol and this intervention to the rigor that is consistent with maybe how it's been studied. But again, I need to highlight that is that what you're looking for?

SPEAKER_03 9:28

Right. Yes. So as you were going through that, that's exactly what I was thinking is kind of laid out for you by somebody else that has said, I think this is something that you would benefit from full model DBT, for instance. And then understanding what that means and finding a provider that, to your point, has been trained to fidelity would matter. Whereas in the uh in the example you used, Matt, where somebody who is maybe just having some difficulties in a relationship needs some sounding board as you as the term you used, that's not important that the person that I see is trained in DBT to fidelity. So it's kind of understanding all of the pieces to know how you need to proceed and ask and understanding the right questions to ask, but but first, I guess, understanding what is the appropriate level of treatment for you.

SPEAKER_01 10:22

I think it's important again to kind of re-emphasize the fact that sometimes patients don't necessarily know what they want or what they need. And the truth is sometimes they might be heading in one direction and discover that they need the other thing. So, for example, they may be seeing somebody who's not necessarily providing evidence-based care, they're supporting their work in whatever area, but the therapist then begins to understand that the challenges that person's struggling with would benefit from evidence-based care. And then sometimes it works, I don't want to say the other way, but it does occasionally work such that somebody who's engaged in evidence-based care might still have a lot of additional issues to work out once that they have developed an understanding, a skill set in terms of being able to apply those things to life. And so sometimes you then transition from evidence-based care into a different type of therapy after that. I don't want us to sit there and expect that, you know, folks that are listening have a real clear understanding as to which is which and how do I go from this to that. Like this is part of the skill and the knowledge base that your therapist should have to be able to understand what is most effective.

SPEAKER_03 11:23

We certainly don't want to give anybody the impression that you need to know exactly what the issue is and what the appropriate treatment is before you step through the door to work with a provider. So, yes, these are all things that are just good to have a basic understanding around so that when you seek care, you maybe could understand what some of the options are and why some are more appropriate than others. If you or someone you love is in crisis, the David Farber Aspire Center is available as a resource for all areas of suicide prevention. You can reach us at jeffersonhealth.org slash aspire. When we talk about evidence-based care, this is not something that everybody is out there doing. So why not?

SPEAKER_01 12:10

It's a great question. This is sort of a history lesson of the day, right? Um The reality is it's probably only been in the last 15 to 20 years that evidence-based approaches have really hit rigorous graduate school training programs to the degree to which they are right now. So if you've got a therapist who's, I would argue, over 40, the likelihood that they were trained in an evidence-based approach for suicide prevention, specifically for suicide prevention, um, is pretty slim unless after they graduated from graduate school, they went on to seek out training from an expert in the area to get certified in that work. All the stuff that Lucas talked about in terms of all those extra hours of doing the work and consultation calls, if they've done that, then that's there. But there's few and far between that have done those kinds of things. Um, folks who are more recently coming out of graduate school are far more likely to have actually had that experience of some level of training, but not everybody is being trained to fidelity in some evidence-based approach specifically for suicide prevention. And beyond that, I'll say that there are some graduate programs that don't address any of this at all. And it's really, again, as a consumer who's seeking out therapy, this is where, you know, Lucas was talking about ask the questions. Where did they get their training? How did that evolve? Like those kinds of things. Those are really, really important questions because I could do five different modes of therapy. If I wanted to do five different modes, I could watch some videos and I'm pretty good in terms of just developing a therapeutic relationship with folks, but that's not what we're talking about here. It's it's a different, different approach, and it takes that extra step after graduate school to really get good at it. And I, and one would argue, even if you went to grad school or did a postdoc for four years, like Lucas did, to get trained to fidelity. You know, it still takes work beyond that. We always can improve.

SPEAKER_03 14:07

As with all professions, there are people who are very good at what they do and people who are less good at what they do. And some of that is certainly based on the amount of training that you've had, the education that you've had either either to get to the place where you're working or even beyond to the point that you made four years of a postdoc program. Um, some people elect to really specialize, as you did. Um, and not all of these evidence-based programs, using DBT as the example, are just universally applied to whatever um the issue might be. So that takes us a little bit to how we provide evidence-based care here at the David Farber Aspire Center. And again, in a very specialized setting related to suicide prevention. So I'm going to give you an opportunity to address that.

SPEAKER_02 15:05

Yeah, um, before I get to that, there is just a little bit that I want to add to what Matt mentioned, is I think there's also issues with this, with the rigor side of things, is that first people need to understand it's a tremendous amount of work to continue to stay up to date and evidence-based. For example, I am very fortunate to have excellent training in both my graduate training as well as my postdoctoral training in dialectical behavioral therapy. I had people who actually worked with the developer of DBT herself, Marsha Lenahan, train me in DBT. And that was, I was very fortunate to have that opportunity. But I need to keep working at it. I need to stay going to conferences, for example. I need to stay up to date with most recent material. They just released a new manual this year in DBT. It's my responsibility to read that, to understand that, to maybe get some support in implementing that if I have any questions. So it's a lot of hard work. Um, but to also answer the question of why isn't everyone doing it, is it also comes down to training. Because something that I explain to people is we use the word therapist to describe someone who is doing therapy, but that encompasses a wide range of professions. Because who does therapy? Well, we have people who are clinical psychologists, for example, doctoral level providers, we have also people who are psychiatrists, who have uh an MD and who are providing therapy. We have also people who are master's level. And then within that, a wide range. For example, we have licensed clinical social workers, we have LPCs, uh, licensed professional counselors. Um, so we have all these people with all these different backgrounds, with all these different graduate training experiences, post-training experiences, and also different settings. Those are, I just listed like six variables. So all of those are at play in saying what type of therapy is being delivered. Just uh, I'd say an opinion that there isn't as much quality control as there can be in the field of mental health as it relates to therapy. You know, you work with an MD and they have you things like board certification. Well, actually, board certification is optional for clinical psychologists, and most of us don't get it. There's no real incentive to do it. There are some hospitals, for example, a children's hospital that I worked at said, you can no longer work here until you're board certified. That is a requirement, right? Very few settings require that. And so it's about the, I'd say, as peers, the standards that we're holding ourselves to and our each other to, that is not quite as far along as other disciplines, I would say. And what I mean by that is you can go into a private practice and then that's it.

SPEAKER_03 17:50

Yeah, I I want to make one just personal observation about that, having I think I've brought this up maybe in our past conversations about seeing therapists that are often reluctant to uh refer out a patient who ultimately might need a type of care that they are not as skilled in or trained in, et cetera. Um, I'm sure that that probably happens in the medical community sometimes as well, but we certainly see it happening in the behavioral health community where um because the training in some instances is so broad, there's a belief that I can manage anything through my experience in talk therapy, for instance, when it may or may not be the most suitable care. And uh not trying, no, no, certainly no disrespect to uh therapists in general, but as I said before, in all professions there are people who are better and people that are not. Um and I think that the again, the educated consumer is what enables people to actually get the care that they need to get. And without the education, it's very difficult to do that.

SPEAKER_01 19:03

You're getting at a very ethical question, which is as a provider, if I'm not trained and competent in providing care in a certain area, it really is unethical for me to maintain and keep a relationship with you, a therapeutic relationship with you, and treat you for something that I'm not competent in treating you at. Um and it it's a tricky spot because I think you're right. There are some people who are like, oh, I could do that. Oh, yeah, I could do that. Um, and could they? Yes. Do they have a core skill set one would hope to be able to kind of navigate therapy broadly? Sure. Um, but to do it well and to do it in a way that's helpful for patients and in a way that we know wouldn't harm patients it's questionable.

SPEAKER_03 19:56

Yeah, and I think it's more delicate in the therapeutic relationship because oftentimes you have a long relationship with your therapist that's fairly intimate. And so when your therapist says to you, Well, we've reached this place where I think this might be better care for you, and this is not something I'm particularly skilled in. I can imagine a world where patients go, Wait, I have this relationship with you. You know my whole history, you know my story. I don't really want to go and start fresh with somebody else. Right. So that's a little tricky as well, I'm sure.

SPEAKER_01 20:29

But but that's where the therapist needs to be able to step up and say, look, I understand that and I appreciate how difficult this is going to be for you. But I'm here to best support your needs. And your needs right now are to get this and what I provide is that. And, but I will help navigate finding you somebody who can do this. I'm not going to abandon you until you get this. Um, but that somebody else is going to be more effective in helping you achieve the outcomes that you're looking for, and I will help you get there.

SPEAKER_03 21:00

And that I think kind of touches a little bit on the specialization care that we're we're talking about, right? We provide that, in fact, specialty care here at the David Farber Spire Center. And um, we've talked, we've addressed it in a couple of ways, mostly through your education and background. But so DBT, for example, is not uh is not just an uh a treatment uh for uh people at risk of suicide.

SPEAKER_02 21:32

That's correct. Yeah, is there are many applications of DBT. There are many applications of evidence-based practices. CBT, especially. I mean, we see there's CBT for anxiety, there's CBT for depression, there's CBT for, you know, phobias. And so there are so many applications of our evidence based tools that are available to us. Um, the Aspire Center, as we've mentioned, is a suicide prevention specialty center. So we have many evidence based tools at our disposal that are used. For suicide prevention. And by highlighting that we are a specialty center, I've had that conversation that Matt has just highlighted with many of our patients who have said, We have actually wonderful news for you. You are at a point where you're no longer eligible to receive services at the Aspire Center. You're able to stay safe. You're able to navigate these thoughts of suicide. And there is more work to be done. You need to focus now on maybe symptoms of OCD or an eating disorder, that you are now able to stay safe, but you need to work on this in your next chapter of your care. The Aspire Center does not offer those services. And to use really clear language, that as a licensed provider, it's outside of ethically my bounds of competence that I need to, as an ethical provider, refer them to someone who does evidence-based care for that specific treatment target. And so being able to have those conversations and also understanding the scope of services in a clinic is essential for uh a consumer to have kind of incor informed consent about the care that they're receiving.

SPEAKER_03 23:04

I think that makes sense. I I don't know what the numbers are, but I'm gonna guess that a large percentage of the patients that we see come in with things in addition to suicidality, for instance.

SPEAKER_02 23:17

Yes, many times it's actually the barrier to them getting that care. Because we have someone who wants to start care for, you know, an O for OCD, for example, but those providers will not see them if they're actively suicidal and just made a suicide attempt last week. So we need to give them the tools so they feel comfortable keeping themselves safe as they then start the next chapter of their care journey.

SPEAKER_03 23:40

Based on that level of care and very specific care that we provide here and I know this, of course, because I am here, but for our listeners, you are not able to just hire a therapist off the street essentially and bring them in here, right? There's there's a there's a big big learning curve, so to speak, to be able to provide the level of care that we provide here um effectively. So you want to talk a little bit about the training that goes on by the folks that come here to provide the service that we provide.

SPEAKER_02 24:17

Definitely is, I mean, as you mentioned, just you can't just hire someone off the street and ex and hope for them to be successful in a suicide prevention specialty center. That takes a really specific type of person with a particular type of training. So the interview process is is rigorous, uh making sure that they feel like they understand what they're signing up for and that I can support them in doing this work sustainably. But I think another piece, though, is part of the interview process is in another episode we talk about different elements of care. For example, trauma-informed care. And we as a field have really agreed that when we say evidence-based care, it doesn't just mean adherence to a certain clinical protocol. It's also the values in which it's delivered, right? So we talk about an equity approach to care at the at the Aspire Center, but we also talk about a trauma-informed approach to suicide prevention. We as a field know that we progressed past just CBT or just DBT by the book as being enough, but we need more, right? And so when I talk to people, I ask about what values drive you. Tell me about your approach to services, tell me about your approach to just mental health care in the field. And so when we have that also that foundation from a values perspective, then we're able to support that additional training if there is maybe some needed to get that that um clinical skill at the level that we feel more comfortable with. What that looks like at the Aspire Center is we have the people who developed the evidence-based interventions train our providers themselves. We've had the developers of many of these interventions provide trainings both virtually and in person. And in terms of the training that they get from me, they get regular supervision, regular support, we have weekly didactics. So that it is, it is constant training. There is never a point, actually, that providers don't have regular supervision for me, don't have regular homework assignments for me, because that same um responsibility that I hold myself to in terms of always growing and learning, that's the attitude and the approach that the Aspire Center clinical team has as well.

SPEAKER_01 26:21

You can always improve. I mean, I think the other thing that I want to highlight on what Lucas is mentioning right there is that it's always about learning. It's always about growing. And it, and again, it's about finding the right people who can do the work, but also it's difficult work. It is difficult work. And what I'm committed to and what we're committed to as a center is making sure that we're taking care of our providers and making sure that they are getting their needs met through the process of doing this work too. So identifying people who understand the concept of self-care from time to time and understand what it means to have a caseload of 20 people who are all coming to you and saying, I have thoughts of suicide from time to time. Um it's a it's a difficult, challenging um area of work. And we not only find people who are skilled in doing the work, but we want to make sure we're taking care of them too.

SPEAKER_03 27:09

Your your values around the work you do have to be aligned with us first. Yes. And then beyond that, you need to be one of those people that didn't just go to school and think they're done, right? You you went to school, you got the basics that you need, but you're interested in pursuing a particular field to um to fidelity, to use your language, uh, so that you fully understand the best approach for dealing with people that the specific population of people that we deal with here. And I I can say that I don't know anybody else that does that, but I might my my knowledge might be limited and and I might be a little bit biased. But I think that understanding uh the kind of requirements to participate in care here makes should make people feel really confident that that everybody here is held to a particularly high standard. Are there things that are new and things that we're learning even today in the field that we are able to continue here in the Aspire Center?

SPEAKER_02 28:20

Definitely. I think one of the most relevant and and and timely pieces of our research and our science is learning that when we say evidence-based, we're asking the question, evidence-based true. And we really ask the question of who was this intervention developed by? Who was it developed for? And the answer is that it's often a specific population that isn't always generalizable to everyone. And so we, especially as clinicians who are also scientists, who want to say we want these evidence-based approaches to be evidence-based for everyone, being evidence-based for all settings. We're saying, how can we grow that evidence base? How can we test these interventions in a wider range of settings and most importantly, tailor it to the communities who need it the most, who would benefit the most from it, and historically have not had access to this level of care. So that we are growing that uh applicability and generalizability, I'd say right now, today.

SPEAKER_03 29:19

In the end, for me and hopefully for our listeners, and after listening to what you both have had to say about training, education, and suitable treatments. I think what I understood, if you're looking for some kind of supportive sounding board, that might be one type. If you have a diagnosis, you might be looking for evidence-based care because now you understand exactly what the diagnosis is, and somebody can help you with the most appropriate care for your diagnosis. That informs the questions that you might ask, right? So if you're now looking for a therapist because you want to talk through something with somebody, maybe just having a conversation. And many therapists will actually have a conversation with you on the phone before you come in for your first visit. That might be a way to find out if you're a match and you feel comfortable starting down the path with that individual. But it might be that you need more specialized care. That might be where evidence-based care comes in. And those questions might be more specific about your training and background and education. All behavioral health care is not equal. And it uh it really depends upon what your needs are, how to have them met, and how to understand what the questions are to get there. Thank you both for all of that information. And we'll leave you now with another hopeful story, and we'll see you next time. Until then, stay safe and stay connected.

SPEAKER_00 30:52

Hi, I'm Erica, and this is my story of hope. I am a nurse and I've had like a rough maybe five years since COVID. The final straw that sent me to the Aspire Center was the relationship that turned into harassment: my mom dying, my cat dying. Before I started at the Aspire Center, I was really struggling to just complete very basic tasks other than getting up and going to work. I lost a lot of weight. I couldn't eat or I would get so anxious. Every morning I woke up and I was disappointed that I had to figure out how to make it through another day. Like it wasn't a blessing. I thought people nobody cared and that nobody would miss me and that I would be doing everybody a favor if I just removed myself from the equation. I remember my dad talking to me on the phone and trying to, you know, like, I don't want to lose you. I'm getting texts from my manager with the suicide hotline. My boss's boss is cold calling me on my day off just to make sure that I'm okay. I was at like the very end of my rope, and I eventually ended up at the psychiatrist's office at Jefferson, and I was given two options. Uh, you can try the Aspire Center or you can go to the emergency room. Uh, and I chose the Aspire Center, um, and I'm really glad that I did. I started out with the individual therapy for the first couple weeks. You start out doing mindfulness exercises, and then you were working through like conflict resolution and emotional regulation, and what ended up being um a really important lesson for me was the radical acceptance chapter. For me, with what was going on in my personal life, I was trying to navigate relationships that weren't fulfilling what I needed out of the relationship. Like there were boundaries that I needed to be holding that I wasn't doing anything for. It was just, and I just thought maybe if I just try really hard or do what I'm supposed to do, what I want will eventually end up happening. And then radical acceptance told me you just need to accept it for how it is now. Plan your behavior and your feelings and your thoughts around what is now, and you can't get hung up on what if, well, maybe because what if might never come. And then I've, you know, stalled another year of what could be happy memories, and I could actually sit there and look at like the choices I was making, shape my boundaries to be protective of me and to have my life be what I want it to be versus what somebody else is willing to give me. Now I'm I'm doing really, really well. Work is going well, like my personal life is going well. I'm able to start, I was able to start doing my hobbies again. I'm fostering cats again, I'm going for like walks and things around my neighborhood, I'm running errands, like decorating, I'm hosting events. I joined a choir this time last year. Getting out of bed and brushing my teeth was usually all I could do before I started crying. I'm glad that I was able to find the Aspire Center and get the resources and the support that I didn't even really know that I needed. Like the Aspire Center 100% saved my life. For me, sharing my story is what it means to be unsilent. Speaking out instead of holding it in and reminding others there is hope. I'm Erica and this is my story of hope.

SPEAKER_03 35:06

We'll leave you with that story as a reminder that there is help and hope. Remember, suicide prevention is a community effort. Each of us has the power to listen, support, and save lives. If you or someone you love is in crisis, call or text the Suicide and Crisis Lifeline at 988. Counselors are available 24-7. The David Farber Aspire Center is available as a resource for all areas of suicide prevention. You can reach us at jeffersonhealth.org slash aspire. Until next time, stay safe and stay connected. Stay in touch with us at the David Farber Aspire Center. You can find us on Instagram, Facebook, or our website at jeffersonhealth.org slash aspire. This podcast is brought to you by Jefferson Health and the David Farber Aspire Center. Our hosts and executive producers, Dr. Matthew Winterstein, Center Director, Dr. Lucas Zulow, Clinical Director, Amanda Blue, Education Director, our producer, editor, and audio mixer is Chandler Kilgore Parshall. Our Director of Photography is Lydia Ruth Connor. And thank you to the many members of the Aspire Center staff who have connected us with our hopeful stories and continue to support us.