Pediatric Care Outside the Walls of GBMC

Amiyah splits time between living with her great-grandmother and mother, who is often homeless. The 11-year-old is often separated from her siblings and lost her grandfather and beloved dog at a young age. She doesn't have a relationship with her father. The heavy load of emotional stress she has experienced in such a short time without having the coping mechanisms often learned in adulthood has led to behaviors that can only be dealt with in a residential facility.

Amiyah, and others like her, make their home at St. Vincent's Villa, a residential treatment center in Baltimore County providing trauma-informed care to children aged 5-14 who need more support than can be given in a community setting. The emotional and behavioral challenges children like Amiyah experience as a result of their trauma and stressful home lives can cause serious psychological stress that experts at St. Vincent's help them to work through. Being at a residential treatment center allows them to just be kids while under the supervision of trained professionals who give them the skills they need to cope.

Staff are experts in complex psychological needs, but what about routine medical needs?

That is where, through a partnership with GBMC HealthCare, Dr. Rachel Burgan comes in.

Dr. Burgan is St. Vincent's part-time community outreach physician. She was in private practice but connected to the GBMC network roughly 10 years ago and looking for a change when GBMC's Chairman of Pediatrics, Tim Doran, MD, put out a call in his newsletter for a part-time physician to serve this population. Dr. Burgan knew it was meant to be.

"Interestingly, I had interned at Villa Maria when I was in college and just out of college for two summers, so I was familiar with the population and decided that might be the change I needed," Dr. Burgan said. "This is a difficult population and I think sometimes they just don’t get to be a kid, so I find it very rewarding to be able to give them as normalized of an experience as possible. I made it a point from walking in to treat them the same way I treated any kid walking into my private practice so that they can have a positive experience with a healthcare provider."

Dr. Burgan provides routine medical care to children at admission and periodically throughout their stays. She is also available on-call if staff have concerns over anything from medications to rashes to bed-wetting issues. Prior to having a dedicated physician, staff might have taken a child to the Emergency Department for minor concerns, an inefficient solution for all parties. With Dr. Burgan at their disposal, kids receive the best care when they need it and staff feel supported.

"She's just a joy to work with," Kevin Keegan, Family Services Division Director at Catholic Charities, said of Dr. Burgan. "It's really beneficial to have her. It would be so much more complicated without her. It's definitely a savings of time, just from an efficiency standpoint, but beyond that she's just so good with the kids and she works so well with the team. It would be a huge loss if we didn't have her."

Children in residential treatment care – just from the nature of their backgrounds – often have fragmented medical care. St. Vincent's takes the opportunity, while they are in residence, to ensure vaccines are up-to-date, follow-ups with specialists are scheduled and recommendations for further care are provided, which is all facilitated and executed by Dr. Burgan.

Dr. Doran, an advocate for the partnership, believes it is GBMC's duty to serve the community in this way.

"We've provided services in pediatrics that have given back to the community because we think that any hospital has that responsibility," Dr. Doran said. "Our role is not just to help with illness, but to help the community at large, that includes the institutions within our community. St. Vincent’s Villa provide vital services to young children who have suffered major emotional insults.

"The population that Dr. Burgan serves at St. Vincent’s Villa presents unique clinical challenges. She delivers care with equanimity and a positive outlook. Her enthusiasm provides a milieu of healing and hope, characteristics that inculcate her colleagues with a sense of commitment.to their work. She gets involved with the kids, and is an advocate for them helping to arrange whatever services they need."

For kids like Amiyah, having this kind of care and attention can make a world of difference in their young lives – just having a familiar face that cares. For Dr. Burgan, the work touches her life as well.

She said, "To see the incredible work that other people do with these kids and to see the positive changes that you see from a kid from when they walked in the door to when they leave us is amazing."

Photo above courtesy of Catholic Charities of Baltimore/Peter Howard; Amiyah, a former resident, with Carmen, a rehabilitative facility dog from Paws4People.