Innovation meets empathy: Expanding access to care through technology

0:00:45.4 Kate Monti: I feel like I've always had a front row seat to health technology in my life. So, my father and grandmother are both type 1 diabetics, and my grandmother was diagnosed with Parkinson's when I was in high school. And so I had this really interesting front row seat to watching how medical technology changed the lives of how they navigate those chronic conditions, right? And so my father, when I was younger, manually testing his blood sugar, manually dosing insulin, using needles and prickers and all of these things. And today my grandmother and my father manage almost all of their diabetes care from their smartphone, which is just amazing to see. I think I felt really inspired by seeing how much people's lives can change when we make it easier to manage conditions within the sort of ways they're interacting with technology already.

0:01:35.0 Host: Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. Join us as we dig into important health topics, stuff that affects the health of all of us at a population level, from the microscopic to the macroeconomic, the social to the environmental. From cities to neighborhoods, states to countries and around the world.

Our guests today are two passionate leaders in healthcare technology and innovation, Kate Monti and John Piette. First, Kate Monti. She's co-founder, president and CEO of Avela Health, a company revolutionizing care for neurodivergent families. She also served as chief operating officer at Workit Health, a virtual addiction treatment program. Monti has dual master's degrees from the University of Michigan School of Public Health and School of Social Work. John Piette is a professor of Health Behavior and Health Equity, and Director of the Center for Managing Chronic Disease at the University of Michigan School of Public Health. He focuses on using health technology to improve care for chronic pain, diabetes, substance abuse, and mental health disorders in the US And Latin America. Monti and Piette came into our studio to talk about the challenges and joys of working in the field of healthcare technology. So, let's sit back and listen in.

0:02:58.3 John Piette: Kate, I know that now you're at Avela, and I want to talk and hear more about that. But before that you were at another startup called Workit Health that I understand was helping people in recovery or that were struggling with a substance abuse problem. And maybe you could tell us a little about that.

0:03:18.7 KM: Yeah, absolutely. Well, yeah, so I worked for a company for about eight years called Workit Health, which is actually an Ann Arbor based startup. And what we were doing, and it's still doing, is providing digital substance use disorder treatment. So what that means is that people who are looking for treatment for alcohol use disorder, opioid use disorder, are able to connect with a very broad care team directly from their smartphone or computer. So we connect people to psychiatric care, to medication assisted treatment, to psychosocial support, basically. Very tailored care experience for people who are looking to get into recovery. And it's interesting, I do feel like I have a sort of funny background in falling into it. So I think to back up to what brought me to my master's programs, when I came to the program, I did research on food insecurity and how grocery applications and technology in that way were changing the way we interacted with food deserts and food access. Then started to go through a very personal experience of getting my cousin into recovery. He was struggling with a substance use disorder in a really rural part of Michigan.

0:04:21.3 KM: I was doing some grassroots work on substance use disorder in Ann Arbor in Washtenaw County. I just remember at night being so frustrated and feeling like I go to work every day trying to increase access to recovery solutions and trying to get people help. And then I go home and I call and I'm told, there's nothing for you. We don't take Medicaid. You can drive him to Wisconsin. They're like, there are no solutions. And I think that was really what motivated me to look at entrepreneurship and sort of technology as a way to increase access. Because I found myself saying, like, I know I'm changing lives in Washtenaw County, but who's going to change lives for my cousin in northern Michigan, where there is no public health school, there is no incredible medical institution, there's nothing for him. And so plug for the networking events that happen at the university: I went to a Women and Entrepreneurship event and one of the co-founders of Workit was talking and I just remember sitting in the audience being like, wow, that is the kind of thing I want to be a part of. And so that sort of launched me into Workit Health, where I got to spend almost a decade really using technology to increase access to care for now tens of thousands of people.

0:05:22.2 JP: That's fantastic. And I really appreciate you sharing some of that personal background as well. I'm originally from Wisconsin, so that's also kind of ground zero, unfortunately for, what we now call “deaths of despair”, the substance abuse, alcohol, drugs, overdoses, suicide. I 100% agree that people just don't have access to the type of services that they need. It's just too complicated to navigate. In addition to my UM life, I'm in the VA and the VA was kind of a perfect breeding ground, I guess for me. Because, as I'm sure you know, many veterans travel ridiculously long distances to reach their usual source of care. Especially when someone's in the throes of a substance abuse disorder, they're not necessarily motivated or able to organize their life to travel two hours to find weekly substance abuse outpatient treatment. So how did you find your way specifically to that company or that group of people that shared those interests?

0:06:23.0 KM: What I love about Workit is that it was founded by, the term we use a lot is patients as designers. It was founded by two women who were in recovery themselves, who I think were grateful for the systems of care that they had had the privilege to access in their own recovery journeys, but were looking around in AA rooms and in their communities and just seeing it not work for so many people. And so I think one of the things that really inspired me early on was just the tenacity and the passion that the team was bringing to a willingness to dream big enough, that something like that could exist. When we started Workit was 2016, 2017, and we were explaining to the DEA that mobile care didn't mean a van, it meant literally on your cell phone. Right. It was such a novel concept then, I think now it seems a bit obvious post pandemic, but I just felt so inspired that there was a group of people who were willing to just do something, to do the thing. Right. I think it's so easy when you have these big dreams and ideas of like, well, what if you could just get medication assisted treatment from your smartphone? It's easy to think about all of the reasons why that won't work.

0:07:23.4 KM: Right. All of reasons why that's complicated or challenging or difficult. And I think I just felt so inspired watching someone stand up and say, “This can exist, it should exist, and I'm going to make sure it does.”

0:07:33.6 JP: Yeah, that's fantastic. And I do want to talk about what you're doing now, but staying with that for a minute, that's what I've encountered many times from many of our well meaning colleague. One for example is they would think people with substance abuse disorders or people in rural areas, they can't or won't access these technologies. They don't have sophistication. I was on an advisory call for the VA and talking about some of our work and one of the, again, well meaning advisors to this research center said, well, "what about the half of people in Detroit who don't have access to the Internet?" And I'm sure you and I both know that that's grossly underestimating the use of technology in those areas. So tell me about that experience, because both the pushback from the community thinking that, are you kidding me? Substance abuse users are not going to access services this way and how you've dealt with increasing access through the use of these tools.

0:08:33.5 KM: Such a good question. When I think about access, one of the things that surprised me with Workit was, it was about putting the technology into people's hands, but it was also about increasing access to groups of people who would have never chosen an in person solution in the first place. Largely due to stigma and privacy. Or what we call “NIMBY”, right, Not In My Backyard. We've had teachers go through the Workit program, we've had politicians go through the Workit program. We've had people who would have really never gotten care in the way that they needed it because there was too much stigma in their existing communities to access in the first place. I think putting it online was profound and made a difference for a lot of people, particularly in rural communities. We took a real passion or a real focus, I would say, to developing the technology to be widely accessible. Could someone use it in a library bathroom? Could someone use it in a McDonald's parking lot? I'll never forget one of my initial engineers literally being in a McDonald's parking lot and me saying like, how's the Internet bandwidth? So I think it's about sort of understanding and developing the technology in a way that is accessible.

0:09:34.0 KM: Using a wide range of cell phone devices, smartphone devices, we have a lot of government funded devices that access the Internet that way. When we talk about access and digital health, who are we creating access for? But also to your point, who are we creating a new gap in access for as well, right? Like by proxy of putting it online. If you don't offer an in person solution, right, you've now made it inaccessible for a group of people as well. And so I think both. But I remember just being really struck by people coming into the program who just had something so private, so de-stigmatizing and so accessible but available. They just would not have gotten care at all.

0:10:11.5 JP: No, that's absolutely, absolutely the case. We do know, particularly in rural areas, that access to the Internet or being online or smartphones is less. It's one of the least covered parts of our country and certainly in the world, but still, it's more than 50%. It's more than 50% of the people who have access to nothing right now. Right now, they have nothing, and you're giving them access to something. So that's really wonderful.

0:10:39.6 KM: Yeah. And I think also sometimes with digital health, we're quick to critique its shortfalls with a sort of implicit assumption that the traditional solutions are better. Right. So sometimes this happens in digital health. We'll say, well, using digital technology is unsafe. Right. What are you doing with my data? Or what about people who can't connect? Or all of these sort of critiques that feel unique in the digital health space. And my comment is always like, how is that different than traditional care? I don't really know what my doctor's office is doing with my data. I probably should. I don't really necessarily know what access the traditional healthcare system's offering people that are in rural communities. And I wouldn't argue it's better. So I think sometimes, too, I try to balance, like, what critiques are sort of fair, right? And what should we be thinking about? But also, like, is it better to not do something because there are unique challenges to it when we're still increasing access broader than what we'd have if we did nothing at all? It's certainly imperfect. It's never going to be a complete solution. But is it not better to broaden that net in some ways, even if there are additional considerations, than to do nothing at all?

0:11:43.2 JP: No, that's 100%. That's 100% true. Yeah. One of the things that we hear, 'cause we ask for a lot of patient or client or participant reports about how they're doing, are they taking their medications or are they drinking in this case? And people say, well, "How do you know? They could be lying." And exactly, like what you said, "Why do you think when they go into the clinic, they're not behaving in the exact same way?" And what would be their incentives for misreporting things like that? Yeah. So there are a lot of kind of special concerns about technology. We'll get into it in a bit. But in our work, we work a lot internationally and specifically in Latin America, and their equation about things like data Security is just different. I mean, we have asked. They have a lot of apps. It's very common in countries like Colombia, where just like, for a restaurant in downtown Ann Arbor, you could say, I need to get seen in this clinic. And four clinics will pop up. They'll say, this one has an appointment this afternoon, that one has an appointment tomorrow. Just like if you were going out to eat.

0:12:46.2 JP: And one time I asked someone, like, "Are you worried about data security issues?" And they said, well, "We did think about that, but it just seemed like, so useful." Which made all the sense of the world.

0:13:00.0 KM: Yeah. I think in some ways when you give people the choice, they'll gladly volunteer the information they need to receive more flexible, more tailored, better care. But I do think we have a responsibility to ensure they know kind of what they're offering us in exchange for that convenience.

0:13:14.9 JP: You mentioned, Avela, which is what you're doing now. So why don't you give us a little bit of background about what Avela is and what you're mission is?

0:13:23.1 KM: Yeah, thank you for asking. So, Avela, I think I alluded to this at the beginning. Right. But we are a program that's working to support families who are sort of raising their hand and saying, "Hey, something might be going on. We're not really sure quite what, but we feel like something about our experience is different." For some families, that may mean they've already received a diagnosis or a screener from their pediatrician saying that your child may have a neurodivergent need. For some families, that may mean they've done some Googling but have no idea beyond what they've maybe done a self assessment or something like that. For some families, that may mean that they're already in a care setting and are raising their hand, saying, "This care setting doesn't feel quite right for us." Really where Avela was born was, I think, through a couple of interesting places in Robin's and my work together at Workit. Robin was the CEO, and so we worked together for eight years and became parents during that journey as well. Right. Both of us had our children, and I think becoming a parent for both of us was a very interesting exploration into a lot of our values and belief systems and substance use disorder in other areas of our life that we weren't necessarily expecting.

0:14:29.5 KM: And what I mean by that is, as I started to have my son, who's now three years old, I would describe him as a spirited little boy. And about a year and a half ago, he completely stopped sleeping, just completely stopped he was a great sleeper. Zero to one and a half. I thought I was a genius. Turns out I was not. He completely stopped sleeping. That was really challenging. That was the first time that for me, the paradigm of parenthood was different than what I had sort of expected it to be, right. We were in this great little bubble. It was wonderful. And all of a sudden I was like, this is not right. Like, kids should sleep. They don't, but they should. I was going through that experience. And then Robin was also going through the experience with her daughter of saying, like, "Hmm, I'm not sure the setting is exactly what's right for my daughter, or this experience that we're having is exactly right." We took two different sort of journeys together. I asked my pediatrician, they said “Kids don't sleep”. I was like, that's sort of a dissatisfactory answer.

0:15:24.1 KM: I started Googling and Reddit and Facebook and mom groups, and I just started seeking more tangible information. Robin went through the process of having her daughter assessed by neurodevelopmental experts, that type of thing, and also found that experience sort of dissatisfying, right? And was sort of like, "I'm not getting what I need out of this either." And so we were having a personal friendship conversation, not related to work, just two friends commiserating about parenthood and the challenges of it. And Robin said something that still to this day sticks with me, which was like, "Kate, isn't it kind of weird? This feels like addiction felt 10 or 15 years ago, right? Where the status quo for families who need something different is completely unclear. The options for families who are diagnosed with something like autism are these big, intensive, expensive interventions. Feels a lot like inpatient rehab. And there's really not much else. And if you want something else, you're left to your own devices to find it." And the more we started talking to our peer groups and to our friends and to our family members, the more we found that everybody was just figuring it out on their own, right? People were patching together out of pocket solutions, apps they'd found, communities they've created.

0:16:32.0 KM: There was really nothing in this space that was solving the problem of, like, what do I do? Where do I go? How do I decide what's right for me? And I need something different than what the world is offering me in this space. And we just felt so sort of shocked, I think, at the similarities between the two spaces. I attended a conference where it was a dual autism/addiction conference, which was sort of funny and probably alludes that the world caught on there were similarities before I did. For the first time ever, I went into the autism side. I had spent a decade in the addiction side. By the end of the conference, my big takeaway was, I don't know why there's a wall between these two topics. The conversations I heard on the autism side of that conference were the exact same conversations I had heard on the addiction side for eight years. I think it was those types of realizations and moments coupled with the fact that for most people with addiction, I would say that they have some recognition of their own neurodivergence. We said, oh, these two spaces are not all that different at all.

0:17:27.1 KM: And that I think cascaded into this idea of like, well, we've had so much success on addiction and in substance use disorder, democratizing access to these evidence-based interventions. Can we do something similar on the Avela side? And so it's a very long winded journey. But I think it's such a profound insight to notice that the jump was really not a jump at all. It was an iteration of the work and an attempt to go upstream to a problem I've been trying to solve for a decade and say, how can I get to these families sooner? Not at the point of addiction, not at the point of recovery, but like at the very origin of when that child's identity and connection to the world is being developed and formed.

0:18:00.5 JP: That's fascinating and that's cool that you're able to have that continuity with your colleague Robin in both groups. I'd never heard that. This is the first time I've heard about some similarities between people that have substance use disorders and who are neurodivergent. Say a little more about that. What are some of those similarities?

0:18:21.2 KM: I think on maybe a clinical level, and I'm not a clinician by background, so I'll talk from sort of my experience working in the community, being with people. A lot of substance use disorder is the result of this sort of self management of other conditions. Whether it's untreated mental health, whether it's trauma that hasn't been navigated, managed because of a lack of resources. There is a significant amount of substance use disorder that is the management of the feeling of I don't fit in. I just feel this constant Frenetic-ism trying to exist in society. Substances made that tolerable. It made me feel like I fit in more. It's interesting because when you think about the experience for neurodivergent individuals, we're coming into a movement now where neurodivergent is starting to be celebrated more and more. Right. We're starting to have really interesting conversations around sensory friendly workspaces and accommodations for people who read or write or learn a certain way. But it hasn't been that way for a very, very long time. Right. The status quo has been, you are different, how do we help you fit in? And that's how a lot of the current interventions approach autism.

0:19:26.0 KM: Right. They say, "You are somewhere above or below the baseline. How do we get you to baseline?” It's not that surprising to me that when you have generations of people whose entire approach has been, "I don't fit into the world the way it's designed for me." And the entire conditioning system has been, "We're going to help you be more normal." There comes this moment of reckoning where they're like, I've been band aiding it together with substances and anxiety and mental health. It eventually breaks, right? Eventually. Like your ability to kind of band aid together those strategies just runs out. You're running on fumes eventually.

0:19:58.3 JP: Can you say a little more about Avela. Is it, you know, app or service? And I imagine you develop with a lot of the people from those communities giving you advice and input and helping you decide what it should be doing.

0:20:11.2 KM: Yeah, well, in a lot of ways, Avela was born out of, in a very similar way to Workit, the lived experience, right. Of both Robin and I. But also one of the first things that happened when we were going through these experiences is we turned to our communities. Robin turned to her AA community, to her peer groups, to her friends. I turned to the same thing, Facebook groups, Reddit groups, et cetera, and arguably got some bad advice, but also got a lot of good advice, like better care than I was getting from my traditional care settings. And so the first thing we did in Avela was started to pull people together and say, what happens when you get a group together and really understand what they're looking for, what they need, what they're not finding in traditional systems. And we learned a couple of interesting things. The first thing we learned was how isolating the experience of being a neurodivergent parent is. It is really hard to find other neurodivergent families because everyone is burnt out and maximized and using all their spoons, right? All of everything they have is going towards navigating life.

0:21:09.4 KM: And also, as a neurodivergent family, you don't really fit into any traditional spaces. Maybe your kid struggles at the park, so you can't go to the park, or they struggle at birthday parties or school. You hear a lot of families talk about the feeling of, like, I just don't like how people look at my kid or look at me, or I feel judged or I feel like I don't belong. And it's hard enough to be a parent. So then to imagine being in all of these isolated communities and not really feeling like you fit in anywhere, it's just incredibly hard on families in a time where they really need community. They really need to be able to vent to their best friend or sit with another person who gets it. So the first thing we heard about was a real need for community, a real need for people coming together. The second thing I think we heard from families was we need to understand what to do today. The experience is you often, you go to your pediatrician, you maybe get a screening, you maybe go all the way through the process of getting a diagnosis.

0:22:02.0 KM: You get to this place where someone is like, "Yeah, your child has autism,” for instance. And then you're usually handed a paper with a list of places to call and you're sent on your way. And I think that's profound because I think we underestimate the grief or the heaviness of what we've just done to a family where we've sat with parents and for the first time validated that probably years of hopes and dreams and expectations and thoughts about what parenthood and motherhood or fatherhood would be like. We've said, "You're right, it's going to be different." And I just think as a parent, how that feels to have that moment where, like, that validation that this is gonna keep being hard and this is not gonna be what I thought is really challenging. And then you're handed a piece of paper and sent on your way. So we were hearing from families just like, I need more. Like, I feel this huge desire to do something immediately in that moment, right? As a parent, you're like, okay, how do I get my kid into the best treatment, into the best services, into all the things they need to be the best they can possibly be?

0:23:05.1 KM: And at the same point, I'm personally dealing with this incredibly heavy life shift myself. A big approach to Avela is making sure that we do two things: hold families through that experience of asking what's next? Connect them to the right resources, make sure they understand exactly what they can and should be doing when it comes to school, all of those things. But even more than that, I think what makes me smile or feel hopeful or just like, what I really love about Avela's approach is, we sit with the family. We have a whole part of our program that's focused on processing those emotions and that heaviness that comes with that diagnosis. Because so often it's easy to focus on like, how do I get an IEP (Individualized Education Program) at school, how do I get my kid into treatment, how do I do the things? And as parents, I think we've probably all had this experience. I think it's a bit universal where we kind of bury down how we're feeling to get the job done. And what we find is that my chief clinical officer has this statement that I really love: People do well when they can.

0:24:00.0 KM: And I think about this with parents and what you're asking is a parent to do well and you're not asking if they can. And so a lot of our approach is sitting with families and making sure that they're in a position to be able to do the best they can and make informed decisions about what's best for their family. And I think that's a real missed opportunity in a lot of the current approaches.

0:24:18.1 JP: Yeah, no, it sounds incredibly valuable. We in the research world, or for myself as a professor teaching about technology interventions, they often have great randomized trial results. We're really excited about them, but they don't really have penetration out in the real world. They don't really have sustainability. So I'm sure there are challenges. So what are some of the biggest challenges to making services like you're developing available to people?

0:24:47.5 KM: That's a great question. I think the initial challenge was finding the right people to build with. The first thing we said was we knew what we wanted the world to be and we needed that clinical partner to build with. And what's interesting, and I think what you're alluding to is a lot of the best people for that job are in very established settings, they're in academia or at universities or working for large institutes and they're doing these incredibly valuable large funded studies, et cetera. Right? And so it was hard because when we were looking for like, who are the people we think really philosophically get what we're trying to do?, there are people who probably didn't want to work for an early stage venture-backed startup. Which is totally fair. It is much riskier, of course. Absolutely. And so it took a while, I think, for us to really find the right partner to build with, to really understand that it wasn't just an evidence-based intervention, but it was something broader than that. And we're really fortunate to do so. But it was a challenge early on and I'm very excited to say now that we have an incredible chief clinical officer who I really think is going to build an amazing program, is building an amazing program.

0:25:50.0 KM: I think the other challenge is just understanding the best way to develop the program to fit into family lives. Families are busy. They don't have time to sit in hours of treatment a week, even though that's often what we find from the evidence is what works best. We're looking at these high dose, kind of deep interventions with families, and I don't have time for that. I'm a full time worker, my husband's a full time worker. Our kids are in daycare. So I think it's about really using the technology to understand where are people going and how can we model our intervention off of the places that people are already consuming care?

0:26:24.8 JP: So just briefly then, what would be, for lack of a better term, the business plan, like who's going to pay?

0:26:31.1 KM: That's a great question. Yeah, it's an important one. We feel pretty strongly that like, health plans should be and are incentivized, I think, to cover the Avela program. And I think we've been really privileged to have wonderful health plan partners from early on who are dear friends of ours in addition to great business partners, and who really understand and think it's important to try to do what we're doing. They see the downfall. And it's interesting, health plans are put in a tough position on all sides of this equation. They are federally mandated to pay for a very expensive solution that's hard to afford, which is the status quo for autism today. Parents aren't always satisfied with it. So you have like a high cost, you're kind of losing on desirability and you don't really have a lot of options to give families as alternatives. So when we talk to health plans, it's interesting because they understand the value of continuing to do what they're doing, but they're also very eager for additional options to give to families. So there's a high motivation on the health plan side and I think that that's really important.

0:27:30.2 KM: And I think a lot of companies, there's sort of this trend in digital health, to start with D2C, private pay, direct-to-consumer. Like really, will people use it and then go to health plans? And I think taking a different approach and saying, like, does this meet the incentives, and the way that health Plans think about solutions first has made Avela's trajectory different.

0:27:50.6 JP: So one of the things I talk about with my students here in the public health school, I use the term “bilingual”. And by bilingual sometimes I mean literally bilingual. I often mean having a good appreciation or deep knowledge like you can get in programs here at, UM, about more than one area. So you need people that have deep understanding of the technology. But if they do this alone for, say, substance abuse, it's probably gonna fail because they don't really have an appreciation for what the systems are like or what the people's lives are like. On the other hand, if you have people who just have experience in training in social work or public health, but don't have an appreciation in technology, they also will not be able to make progress. Tell me what you think about that and how you feel like you've been able to become bilingual in that sense of understanding the public health issues as well as the tech issues.

0:28:49.3 KM: Bilingual is such a fun way to state it, because I think about that phenomenon in many different areas of my work. So I think first, you're right. I think digital technology innovations in general are most successful when you have a collaborative team of experts who are contributing their domain of expertise, pushing the thinking of other people. I was in a call the other day where Avela. Right now, we're working on developing what we're calling sort of our core care pathway. So this is sort of what do we assume most families who come to us will receive as their care journey. And then of course, you sort of branch off into tailored experiences from there. And I think, I was sitting with my chief clinical officer and myself, and we had a very sort of clinical and operational perspective to that answer. Well, they'll come in and they'll do their intake paperwork, and then they'll get scheduled for their first appointment. We were thinking very literally, and we're working with this new technology that I'm really excited about, and they were sort of challenging our thinking on what the technology could do for that experience.

0:29:43.0 KM: They were like, well, if you want, we can make decisions about the way the care journey happens based on these different inputs. It doesn't have to be this like, first, second, third, et cetera. I'm such a linear operational thinker that I don't know that I would have jumped there in terms of the capacity for an individualized experience in the technical world that way. But to your point that that conversation may have never happened had both of those groups of experts not been in the room. And so I think having the opportunity to sit in those conversations and build a team where you say, okay, do we have the right domains of expertise together? And are we creating a culture and a world where we're cross-pollinating opportunities that we see and bringing them together to create the best experience for the member? It's what I love about entrepreneurship in general. I think, like, we take really good public health initiatives and we push them through a D2C lens, a direct-to-consumer lens. We think about it from the member’s perspective first. And I just think it creates an experience that's very different than when you're thinking as an interventionist about what someone on the other side might want.

0:30:45.6 KM: One thing I feel really fortunate to have had the opportunity to do is that when I was entering my graduate programs, there was already an established dual master's program between the School of Social Work and the School of Public Health. It's easy to kind of look back and see how all the dominoes fell. I don't know that I had that much intentionality at the beginning. It felt intuitive to do both to me. It felt intuitive to say we need to see things from both lenses in order to really understand how we're going to build interventions that bridge the gap. The two from like the community interventions that many social workers are doing to the public health interventions that we're developing, testing, et cetera, especially community health workers, are such a beautiful bridge, I think, of experience as well. And so having the opportunity and the facility to explore in a rich and intentional way those multiple pathways was really helpful from the university perspective. It would have been very hard to justify doing an entire master's program in social work and then doing another master's in public health. The ability to have those natural synergies and for the schools, I think, to recognize the importance of giving students the opportunity to spend time in multiple different programs with multiple different perspectives, I think gave me a flexibility in my thinking as I approached company building.

0:31:57.6 KM: I couldn't really divorce my public health hat from my social work hat because those programs had been intentionally developed for me to sort of build a framework and a perspective on the world that considered both.

0:32:07.7 JP: Yeah, no, that's really interesting. And that is a very popular combination for people here at the public health school to be involved in social work. Another one that I'm very interested in, is bridging public health or social work with the School of Information that we have here at UM. I had in interesting guest speaker in my class on digital interventions. I was teaching a few years ago in public health. It was someone who was the CEO of a startup in the Bay Area, and they said something really interesting. They were speaking to my public health class and they said, you know what? "We don't need more engineers out here in California. We got tons of people that have very good technical skills, but they don't know about the content. They don't know what should be the priorities or how to engage with these communities or how to kind of of do those mixed methods research studies to really develop and do the usability testing." And that was really, really interesting. But they need people that can be fluent enough to talk to nerdy engineers.

0:33:07.8 JP: And meet some of the things that are important to them.

0:33:11.0 KM: Yeah, that's right. My public health program class comes back in handy constantly. When I'm asking questions like, “Are the programs that we're developing for our members working?”, my social work degree comes up all of the time. When I say, "Are we ensuring that we're building with the local community as we develop an intervention? Are we hearing voices? Are we integrating the perspectives of the people in the locations that we're serving?" Yeah, it's exactly right. There's a lot of incredible talent out there, and I think it's really served by people who can bring a research-to-practice bridge to companies that wanna do really innovative things, have a really strong social mission, but need those individuals who can come and say, like, here's how we can take what the research does, work and implement it in this way.

0:33:49.2 JP: Kind of wrapping up and thinking again about people who might be listening to us: current students, prospective students. Would you have any advice for them? I've said some of the things. I'm very opinionated about some of these ideas, interacting with a lot of students. On the one hand, like I've said many times, I love the strength of being by what I've said is “bilingual”, having expertise that cross boundaries in a particular community of, say, the recovery community plus technology or the neurodivergent community plus technology. That's a great strength. On the other hand, I use the term deep knowledge. I mean, not just to be a dabbler. It's important to really gain deep knowledge in things. Those are kind of my ideas. But I'm really curious if you had something you might have done differently or advice you'd give to some of those maybe more junior people coming into the field.

0:34:47.7 KM: Well, it's interesting. I think it's easy to look back and wish you had done, a series of things differently when you reflect. But I often find myself saying, "Wow, if things had not happened exactly how they happened, I may not be in this very seat today." And so a lot of ways I have gratitude for the way in which my journey meandered to where it is. But I think in terms of when I reflect, I have a younger sister, so I feel like I give her this advice a lot, and I hope she listens to it. I think a couple of things. One, I love what you mentioned about the School of Information, the School of Social Work or Public Health. Be intentional about stretching your education experience outside of the focus area you've chosen. It's important to go deep, to your point. There's so much richness. I'm so grateful I was at Workit as long as I was because I think it really did create this really rich perspective that I only got by seeing the continuum for so long. But I also think having the chance to interact with engineers and hear how they see the world, or product leaders or app designers, like those things have augmented the way I think about interventions.

0:35:48.0 KM: And so when you're thinking about your program and what you're going to focus, try to take classes in schools that feel less intuitive or less natural to you. Whether it's the School of Information, the School of Business, kind of push yourself to see the work that you're doing or the passion you're developing through different lenses, and think about how those lenses change the perspective you have now, what you might want to do over the course of your career. And then I think the last thing, which a lot of people gave me this advice when I was a student, and it was kind of, I would roll my eyes, but now I'm gonna give it anyway: Go to things and talk to people. It's so easy to not. But I kid you not. If I had not been bullied by my roommate to go to a Women and Entrepreneurship event at the School of Public Health one night, I would not have met Workit. I would not have worked there. It would not have changed how I think about what will be the rest of my career. And so I think being comfortable being uncomfortable and going to things and listening and thinking about how you can be a part of them, and emailing the CEO and just being like, "Hey, can we talk?"

0:36:46.8 KM: There are things that everyone told me, and I was like, I'm never gonna do that. But I did it. And it really did make a difference. And I would have never had the opportunities that I've had, had I not just been like, well, can't hurt to try. So I think those are the two things that when I reflect, really I think had formative meaning in where my journey went.

0:37:05.0 JP: Yeah, it can't hurt to try. That's a really great advice. And it is kind of a common frustration among faculty, if I can say, students are so respectful of our time and they think, "Oh, I shouldn't contact." And we are always wanting to be open. I would say that's almost universally true that people.

0:37:24.6 KM: Or they'll tell you if you're not.

0:37:25.0 JP: Or they'll tell you if you're not. "Not this week, man, not this week. I got like deadlines or things to do." Just a quick follow up. On the tech side, have you felt the need or done work to get more knowledge about that, about the development side, or by osmosis, do you feel like you get the respect of those people? Sometimes they might think like, oh, you don't really know what you know. How has that worked out for you?

0:37:54.7 KM: Yeah, I think absolutely. So when I came into work and now in my role at Avela, I manage all of the different development processes of bringing the intervention live, which means I work every day with our engineers, our product leaders, et cetera. And I absolutely did not have the lingo when I started. And I think it's a couple of interesting things. I think everyone can respect someone who says, "I don't know what I don't know," and who comes to a collaboration with a healthy dose of open-mindedness and humility. So, to come to an engineer or to, I just did this this week when I was on a call and I was like, I'm going to answer this question. I do not speak the language you're asking me to speak, but I'm going to tell you what I see from my perspective and you and I will get there. And I think that that respects someone's expertise and shows you as a collaborative person of saying, hey, this is where I wanna go. Help me get there. I think that has taught me a ton, because it's forced me to be an active listener versus just a driver.

0:38:49.8 KM: It's forced me to take the position of this is how I see it from my lens. Help me understand how to see it from your lens. And so now I would say I, after a decade, have a lot more utility in things like basic product development, engineering. I built the initial version of Avela's tech stack and then I brought an engineer in and said, rip it apart. But I think that came through being an active listener and being an active collaborator in those partnerships to be able to have a front seat to learning from the people that I brought around me as experts.

0:39:17.4 JP: So if listeners wanted to get in touch with you or learn more about Avela, where would they go?

0:39:22.3 KM: We have a website, it's new and developing, so if you go to it, you'll be able to learn a little bit about who we are and what we do. They're also always welcome to email me. I said you could email the CEO. I'm going to put my money where my mouth is. You can email the president. My email is just [email protected]. Shoot me an email. And I'm always happy to have coffee or have a chat and, maybe there's an opportunity that'll land in your lap that way.

0:39:42.8 JP: That's very generous of you, Kate. Thanks very much for this conversation. It's been really great talking to you and I wish you all the best in this important work.

0:39:51.4 KM: Thank you. Yeah, thank you for the time. It was really a pleasure.

0:40:00.1 HOST: Thanks for listening to this episode of Population Healthy from the University of Michigan School of Public Health. We're glad you decided to join us and hope you learned something that will help you improve your own health or make the world a healthier place. If you enjoyed the show, please subscribe or follow this podcast on ITunes, Apple Podcasts, Google Play, Stitcher, Spotify, or wherever you listen to podcasts. Be sure to follow us @umichsph on Twitter, Instagram and Facebook so you can share your perspective on the issues we discuss. Learn more from Michigan public health experts and share episodes of the podcast with your friends on social media. You're invited to subscribe to our weekly newsletter to get the latest research, news and analysis from the University of Michigan School of Public Health. Visit publichealth.umich.edu/news/newsletter to sign up. You can also check out the show notes on our website, population-healthy.com for more resources on the topics discussed in this episode. We hope you can join us for our next edition, where we'll dig in further to public health topics that affect all of us at a population level.