Convening 1 Summary

Centering Lived Experience

In alignment with the goals of Delta Center California, a central focus of the convening was the importance of centering lived experience and racial equity in project work. To learn more about these topics, participants heard from Keris Myrick, a leading mental health advocate in California, Director at the Jed Foundation, and Co-Director of The Mental Health Strategic Impact Initiative (S2i). In her presentation, Ms. Myrick introduced the phrase  “Co-Co’s” to describe the journey of creating lived experience-initiated partnerships. The Co-Co’s require involving people with lived experience throughout the process of co-planning, co-design, co-delivery and co-evaluation to implement an equitable program or policy. Ms. Myrick also stressed the importance of intersectionality in this work, explaining that “all parts of someone’s identity affect the way they perceive the services they receive as a client and how the world treats them when they show up.”

Ms. Myrick presented her Lived Experience-Engaged Organization Ladder, which describes different levels of engagement of people with lived experience in a project or organization. By using the ladder to reflect on their Learning Lab project, teams were able to think about how to best expand their engagement strategies in meaningful ways. Many teams were at the juncture of involving people with lived experience to offer input, but not at a leadership level. When asked how to approach moving to the next level, Ms. Myrick suggested sharing leadership responsibilities so everyone has opportunities to participate,  which leads to a greater sense of ownership among the entire group. Ms. Myrick also advocated for building the leadership capacity of people who are marginalized; “Building their capacity means you’ll have more people in the future who have those skills.”

Each Learning Lab Team developed three commitments to facilitate lived experience engagement and address racial equity in their Learning Lab project. When reflecting on the convening, multiple participants noted that they learned the importance of centering lived experience and want to think more about how to incorporate the experiences and perspectives of the people they serve into their project work. One participant noted, “It would be great to circle back on these ideas throughout our time with Delta Center CA, to ensure that we are truly incorporating the suggestions. It would also be good to hear how others are incorporating these suggestions in their own projects.”

Throughout the three-day convening, Learning Lab Teams had time to strengthen existing partnerships within their teams, and build relationships with members of other teams. Teams participated in small group discussions and “get-to-know-you” activities, and had dedicated time to continue building their own team partnerships and work on action planning for their projects. Teams also participated in a shared coaching session with their coach and one other team, where they highlighted challenges and discussed strategies for overcoming them.

In addition to these discussion opportunities, each team presented to the entire cohort on the history of their partnership, the people they serve, their goals for participation in the Learning Lab, and their team mascot. The team presentations galvanized the group to think about where there might be intersections between their projects, experiences, and challenges. For example, after one group shared their goal of incorporating Sexual Orientation, Gender Identity, and Expression (SOGIE) data into their EHR, another team wrote, "We look forward to hearing about your best practices. Our Electronic Health Record has a robust SOGIE section, but we have a ways to go to get that information in.” Other teams reached out to offer support for challenges shared during the presentations, sending messages such as, “These are noble goals and wish you much success. How can we help?” and “We are trying to start serving that population as well. We look forward to learning with you.” It was inspiring to see cross-team support and peer learning happening so quickly in the first convening.

Another poignant moment was when one team shared how the people they serve would describe themselves. The team works with individuals with severe mental illness who are in a residential treatment facility, most of whom have experienced homelessness and justice system involvement. Yet when they asked their clients how they would describe themselves, the individuals responded with adjectives such as “good looking, romantic, funny, good, happy, kind, optimistic, and patient.” This vignette was inspirational, and exemplified how a team might authentically center the stories of the people they serve.

Bridging Policy & Practice 

On the third day, the Learning Lab Teams and State Roundtable members came together for a shared session to learn about the State Roundtable policy priorities (telehealth and workforce) and the policy barriers faced by the Learning Lab Teams. Common challenges and frustrations noted by Learning Lab teams in breakout groups included payment system fragmentation and workforce challenges. 

Payment system fragmentation, complexity, and sustainability were common challenges among convening participants, in part because behavioral health has not traditionally been included in the medical insurance model and in part because of the complexity of California’s public healthcare payment system (which includes both state- and county-level payment systems). It was noted that conversations about improving health systems to-date often focus solely on physical health, and reimbursable services have focused on the traditional medical model, which doesn’t always effectively address behavioral health needs (e.g., housing could be the most effective intervention). As a result of these intersecting challenges, behavioral health leaders are required to spend significant time seeking funding for services, rather than supervising and training clinical staff. Lastly, of note, Learning Lab Teams discussed the negative impacts of Medi-Cal price discrimination that can result in lower reimbursement rates for community-based organizations providing mental health services, which in turn can impact their provider recruitment and retention.

Teams also discussed how the current payment systems creates barriers to care coordination given that (1) behavioral health and primary care services are often not reimbursable if they occur on the same day; (2) specific provider types are not billable in certain settings (e.g., ASWs and LMFTs in FQHC settings); and (3) payment is fragmented across the continuum of care from a patient/consumer perspective. Teams also noted that recruitment and retention are critical challenges and staffing shortages are sometimes exacerbated by licensure requirements (e.g., many candidates are not licensed yet, and non-licensed providers must be supervised).