Convening 2: Policy, Workforce, Integration, and Love

Physical and psychological safety is a key tenant of ensuring a resilient and supported workforce. In a session titled Strategies to Support Black, Indigenous, and People of Color in Leadership Roles, participants listened to an illuminating discussion between three leaders of color in mental health: Keris Myrick, Director at the Jed Foundation and Co-Director of The Mental Health Strategic Impact Initiative; Dr. Jorge Partida, Chief of Psychology at LA County Department of Mental Health; and Jei Africa, Director of Behavioral Health and Recovery Services (BHRS) in Marin County and member of a Learning Lab Team. The panelists spoke about the need for more diverse, intersectional leaders, as well as the challenges that come from being in a leadership role. For some, speaking out against inequities or the status quo may lead to punishment, yet in other spaces, occupying a leadership position means going above and beyond the typical role and responsibility to support equity efforts and ensure that people of color feel safe and supported in the workforce. Additionally, they stressed the importance of mentorship, to develop personal relationships, mentor people of color towards professional development and leadership opportunities, and support psychological safety.

Collaboration is a vital factor for success in primary care and behavioral health integration. While many sessions focused on the necessity of collaboration, Brenda Goldstein, Chief of Integrated Services at Lifelong Medical Care and member of a Learning Lab Team, led an interactive discussion of the challenges organizations face when collaborating internally and externally to provide integrated care. A theme that emerged was the difficulty of sharing data between providers. One participant pointed to the lack of trust that people receiving services have for the behavioral health system that has been perceived as excessively controlling, which impacts the ability to collaborate and share data across systems.

Mutuality is another key tenet of primary care and behavioral health integration policy work that was discussed often at the convening. During one session, Michelle Cabrera, Executive Director at CBHDA, Linnea Koopmans, Chief Executive Officer at LHPC, and Andie Patterson, Senior Vice President of Strategy at CPCA spoke about upcoming policies of interest in California. Michelle highlighted specialty behavioral health payment and documentation reform under CalAIM, as well as DHCS’ Comprehensive Quality Strategy and the “No Wrong Door” policies, all of which would support progress towards integrated care. Andie emphasized the Comprehensive Quality Strategy as a uniquely unified vision set out by the state that puts the patient at the center of the system. Additionally, speakers discussed the role of Alternative Payment Methodology (APM) and the benefits it would bring to Federally Qualified Health Centers, in many parts because of the increased flexibility to provide integrated behavioral health services. Lastly, speakers emphasized the Enhanced Care Management (EMC) benefit of CalAIM, which will provide holistic, comprehensive services to an individual through a layered approach of primary care and behavioral health care that seeks to align payment, metrics, and care services. All of these policies depend on mutuality between primary care and behavioral health, and between payers, providers, and patients to ensure quality, integrated care.

Peer support and engaging people with lived experience as experts in providing care is a major topic of interest for Learning Lab and State Roundtable participants. Two convening sessions focused on the importance of peer support. First, participants heard from Jennifer Tuipulotu, Program Coordinator for the Office of Consumer Empowerment, and April Loveland, SPIRIT Peer Vocational Specialist in Contra Costa County. April and Jennifer discussed how Contra Costa is improving peer inclusion, by educating the behavioral health workforce on the role of peers, increasing the employability of peers with lived experience, and creating a culturally diverse and inclusive peer community. The purpose of this peer program is to encourage hope, resiliency, and empowerment, and to help individuals identify, develop, and sustain support systems.

Additionally, participants heard Community Medical Centers’ Chief Executive, Alfonso Apu, in conversation with James Mackey, a community health worker and clinical therapist with lived experience. Through building the Transitions Clinic Network, an evidence-based program that improves outcomes for people returning from incarceration, James and Alfonso shared how they have recruited, trained, and supported staff with lived experience. As James shared his personal story of incarceration and life with his new role, Alfonso articulated strategies Community Medical Centers has used to create an environment for James to thrive. Strategies included senior leader commitments to hiring individuals with lived experience and stigma reduction through the inclusion of staff with lived experience on medical teams.

One way that choice and agency manifest in the care system is through patients having ownership over their care, as well as providers having agency over the type and quality of care provided. Dr. Palav Babaria, Chief Quality Officer at the Department of Health Care Services (DHCS), described efforts to increase this type of agency in the care system when she provided an overview of DHCS’ Comprehensive Quality Strategy. The goals of this work include engaging members as owners of their own care and defining the clinical and process outcomes that each service provider is accountable for. Additionally, Dr. Babaria talked about the role that the Medi-Cal enrollee advisory council plays in informing DHCS’ policy work. This session also included a robust discussion with questions regarding Sexual Orientation and Gender Identity (SOGI) data collection challenges and lack of interoperability across electronic health records, particularly between primary care and behaviroral health. Dr. Babaria expressed interest in learning more from the Delta Center California integration and policy work as it continues to progress.

Lastly, cultural humility is an essential tenet to providing quality care, and it begins by supporting a diverse and representative workforce. A team from the Department of Counseling at San Francisco State University spoke about the importance of counselor education to create an equitable, integrated workforce. They highlighted education as a means to enact change at a policy and practice level, by serving as the pipeline to train Integrated Behavioral Health leaders. Many barriers for retaining students come from curricula that are rooted in white supremacy scholarship. Fourth year student Michael Wright shared his personal experiences as a Black man in the counseling program, and the difficulty of entering a field comprised of mostly white women. “When I first started the program, I felt I had something to prove. I knew the curriculum wouldn’t be representative or reflective of the work I would want to be doing for my community.” Now, he said the curriculum is becoming more culturally responsive through pedagogical changes, leading to more diverse student recruitment and retention.

Cultural humility can also come in the form of trauma-informed care. Dr. Ritchie Rubio from the San Francisco Department of Public Health shared strategies, tools, and resources to provide trauma-informed care in a tele-behavioral health environment. He explained six key principles of trauma-informed care: understanding trauma and stress, safety and stability, cultural humility and responsiveness, compassion and dependability, and resilience and recovery. Dr. Rubio provided a three-part tactical model for navigating how to help clients in a trauma-informed capacity. Lastly, Dr. Rubio went through various tools and technology to support trauma-informed care in a virtual setting. This includes using YouTube, iPads or audio to facilitate mindfulness practice, body scanning, and breathing training, as well as the use of art therapy, ecomaps, and virtual rooms with people as digital avatars.