The Origins of GRITT & Trellus Health
As any entrepreneur will attest, the road to innovation is never straight and comes with a fair number of unexpected twists. In this article, Dr. Laurie Keefer recounts how she became an accidental gastrointestinal psychologist, the origin story of the GRITT™ method, and how it led to her co-founding Trellus Health.
The Gaining Resilience through Transitions (GRITT™) method was invented by two passionate women scientists — Dr. Laurie Keefer, PhD, and Dr. Marla C. Dubinsky, MD — who, for 20 years each, had been working in their own separate research laboratories to improve the lives of patients with IBD (Inflammatory Bowel Disease).
Dr. Keefer’s research lab at Northwestern Medicine in Chicago focused primarily on predicting which patients would have difficulty adjusting to a diagnosis of IBD and the role of behavioral interventions in improving their self-management.
Dr. Dubinsky’s research lab at Cedars Sinai in Los Angeles focused primarily on predicting, using novel biomarkers and clinical disease characteristics, which patients would have the most severe disease, and developing patient-friendly risk stratification tools to ensure patients were offered the right medical therapies at the right time.
A chance encounter
While Dr. Keefer and Dubinsky’s approach to treating IBD came from very different scientific backgrounds, their goals were the same — to identify the biological, psychological, and social determinants of IBD outcomes that would ultimately lead to more personalized, timely, less costly, and more effective care.
In a true universe-aligning moment, Dr. Keefer and Dubinsky were both experiencing personal life transitions that landed them in New York City. Dr. Dubinsky, to direct the newly built Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai Hospital, and Dr. Keefer, to set up within it the second-ever fully integrated, multi-disciplinary IBD clinical programs in the world.
The journey may be accidental, but the outcome is not!
I am an accidental gastrointestinal (GI) psychologist. When I started my PhD in clinical psychology at the University of Albany in 1998, I had no idea that a psychologist would study medicine, let alone GI physiology and … well … poop!
While somewhat unprecedented, I spent the next 2 decades on the faculty of gastroenterology divisions in academic medical centers, providing psychosocial care to patients with a range of digestive disorders, including IBD (inflammatory bowel disease), IBS (irritable bowel syndrome), reflux, and even belching and hiccups!
Some of the most challenging clinical scenarios I saw were the young patients diagnosed with Crohn’s disease and ulcerative colitis (UC) whose symptoms were often severe, unpredictable, and life-altering. As a health psychologist embedded in the same location as the patient’s IBD healthcare team, I had a competitive advantage over therapists in the community — I could evaluate a patient’s biological and psychosocial determinants of health in context.
This contextual approach to IBD care turned out to be critical. There was a clear gap between a patient’s physical disease status and their behavioral and emotional well-being.
A tale of two patients
Over my years of practice, I began to observe a trend in the patients I saw.
The first group of patients approached their diagnosis with the attitude that things could always be worse, showed gratitude for their providers and the medical care they received, and didn’t let the limitations imposed by their IBD prevent them from pursuing meaningful life goals.
The second group of patients, unfortunately, and for many psychological and social reasons, approached their IBD with a sense of devastation (“This cannot be happening to me!”) hopelessness, and helplessness. They felt stigmatized, blamed others for their poor health, and struggled with identifying meaningful life goals.
Were they depressed? Anxious? Both? Maybe … probably … but there had to be more to the story. In my mind, depression and anxiety were outcomes that occurred in response to IBD, and therefore could be changed.
And then, I had a realization! Just as surely as I am an accidental GI psychologist, I became an accidental positive psychologist.
My “Aha!” moment
Put simply, positive psychology is the scientific study of human flourishing. It seeks to identify human strengths and characteristics that allow people to live meaningful, purposeful, and — dare I say — happy lives even when faced with hardship. In its applied form (i.e., the practical aspect of the science), positive psychology can be leveraged to build resilience.
I changed my scientific research questions to focus on predictors of a patient’s healthy adjustment to their condition and behaviors that led to optimal disease self-management. The science confirmed what I had seen clinically — patients with IBD who were …
- Psychologically flexible
- Accepting of their diagnosis
- Optimistic about their future
- Self-confident in their skills to manage their health
… had a much better quality of life and sense of well-being.
I simultaneously set to work developing self-regulatory, behavioral interventions that could build resilience and self-management skills. This work grabbed the attention of the National Institutes of Health (NIH), who ended up funding these studies.
The creation of GRITT
When I arrived at Mount Sinai in 2016, I had the opportunity to shift my science again towards implementation — elevating what I had been doing for 15 years on an individual level to meet the needs of a population of 12,000 patients with IBD (you read that right, 12,000 patients just at the Susan and Leonard IBD Clinical Center!)
To be successful, I needed to:
- Maintain my theoretical framework of positive psychology and resilience
- Establish rigorous methods to streamline enrollment
- Prioritize behavioral targets across the team of nurses, pharmacists, dietitians, and behavioral health specialists
- Standardize how services were provided and track outcomes, particularly their impact on unplanned care
We developed and validated the clinician-administered GRITT™ (Gaining Resilience Through Transitions) score to drive communication and coordination between patients and healthcare providers. We continued to build a community of multidisciplinary providers who shared complementary skills and resources to help each patient achieve their personalized goals.
As the success of the program grew my clinical team doubled, and the need for our patient services tripled. Our program had demonstrated that it could reduce unplanned care by upwards of 70% and it became readily apparent that we would need to leverage digital technology to scale some of our analog paper-and-pencil teamwork to improve access beyond the doors of Mount Sinai.
Looking to the future
Supported by the Mount Sinai Innovation Partners and the i3 Accelerator fund, Monique Fayad, MBA, our fearless CEO, and famous resilience researcher and Mount Sinai Medical School Dean, Dr. Dennis Charney MD, Trellus Health, Inc was in motion.
While I may be an accidental positive GI psychologist, it is no accident that TrellusElevate™ became the platform we use to deliver our GRITT™ Method — the resilience of Dr. Dubinsky’s and my patients, our complementary science and clinical expertise, and the passion and commitment of our Trellus Health Team will elevate the way healthcare is delivered for all people with chronic conditions.