Barbara Granger: Amplifying the Family Voice

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by Ike Evans

Barbara Granger
Barbara Granger

It is now accepted wisdom that caregivers are sorely tested by the mental health challenges of their loved ones, as well as by the need to navigate the maze of services and supports that are intended to help. A lot more needs to be said, however, about the truly transformative role that family members are playing in the move toward a more humane, person-centered system of care. For the September 29, 2014 episode of Into the Fold, I had the pleasure of chatting with Barbara Granger, Family Involvement Specialist for the Texas System of Care Initiative and a Family Coordinator for Via Hope, Texas Mental Health Resource, about the trials and rewards of caring for a child with severe emotional challenges, as well as the potential for family members to act as change agents within the mental health system.

Among the things I was curious about was how Barbara defines “family voice”:

Family voice is when a parent or a caregiver realizes that what they say is important, and that we are the experts on our children and no one can discount that. Professionals are trained to diagnose and teach parenting strategies with us, but we’re the ones who know what will work and what won’t. When we’re given the opportunity to share in the decision making for our children, it validates all the work and time and effort that we put into raising them, and it empowers us to want to help others.

Family voice really goes beyond that, though–it’s looking for opportunities to impact society and the mental health profession for all children. So when families find their voice, or when a person finds their voice and can learn to advocate appropriately with others, it is empowering for us to be able to be invited to sit in, not only on the decision making for our own children, but for others and policies, and so taking our lived experiences and using them to make a differences for others.

Our conversation made it clear that family members have more to contribute than just serving as human interest backdrops or models of stoic survivorship. Their experiences collectively amount to a fund of expertise that a a true “system of care” will finally pivot toward utilizing.

To find this episode on iTunes, click the logo:

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Image credit: Texas System of Care

Thank You, Texans Care for Children!

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by Ike Evans


Not only are the Hogg Policy Fellows doing admirable work in the area of mental health policy reform and advocacy, but through the Hogg Mental Health Policy Academy they also function as a learning community with a shared pool of experiences and sense of common purpose. Texans Care for Children, a Hogg grantee and coordinator of the Policy Academy, put together this video in which past and present members of the Hogg Academy reflect on their experiences and the role that the Academy played in their growth and emergence as effective advocates.




Are You OK? What We Can Do As a Community to Address Mental Health

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Are you ok?by Rick Ybarra

Are you OK?  R U OK?

A recent  Huffington Post  blog post with a video clip highlighted how, at times, we are unsure how to approach mental health concerns with friends, family and within our communities. Dr. Lloyd Sederer, Medical Director, New York State Office of Mental Health, joined HuffPost Live host Caroline Modarressy-Tehrani for a video conversation on what individuals can do to connect with a person they may have concerns about.

Dr. Sederer explained that if concerned about a friend, family member, or someone in your community, simply ask, “Are you OK?”

“We shouldn’t be afraid to say, ‘Are you OK?’ and to have a conversation,” said Sederer. “We need to be able to have the courage to ask and then the courage to continue to ask the tough questions because that’s what counts.”

Four simple words (or four simple letters as in “R U OK?”). Anyone can say them. You don’t have to have credentials after your last name to care.

When in the midst of gloom or despair, everyone needs to know that someone cares. The words “Are you OK?” (or text “R U OK?”) could serve as that connection to your friend, family member or that person you see on the street who may not be OK.  A person in deep despair may even be thinking about harming his/herself or contemplating suicide. “Are you OK?” A conversation starter that could change a life…or save a life.

Hogg Foundation Announces New iTunes U Collection!

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The Human Condition iTunes U artworkby Ike Evans

We are very pleased to announce a new iTunes U collection: The Human Condition: Vintage Radio Conversations on Mental Health! The Human Condition was a radio series, produced by the foundation in partnership with KUT, that ran from 1971 to 1983. The series was broadcast weekly by stations subscribing to the Longhorn Radio Network. If you have iTunes, you can download it here:

The series featured conversations on subjects that spanned the full range of human interest, including but not limited to mental health. Guests included historically notable figures such as Dr. T. Berry Brazelton, Roy Wilkins, Karl and Roy Menninger, Oscar-winning actress Mercedes McCambridge, and numerous others. There are currently four episodes available, with more on the way.

As the Hogg Foundation embarks on its 75th anniversary celebration, we are excitedly exploring avenues for the exhibition of some of the rich material in our archive — photos, documents, news clippings, and audio interviews. As much as anything we’ve ever done, The Human Condition offers vast possibilities for future archival projects as well as generating new public interest.

Stay tuned!

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The Commonwealth Fund Report: State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment

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by Rick Ybarra

I want to bring your attention to an important report and contribution to the literature released today by The Commonwealth Fund (August 28) titled: State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment.

As we know, states across the country are working to advance integrated health care as part of their efforts to deliver what I call “Triple Aim” care (care that results in better outcomes, increased patient satisfaction, and cost effectiveness) to Medicaid beneficiaries with both physical and behavioral health conditions. The efforts to ensure that Medicaid beneficiaries have access to integrated health care, however, are challenged by the fragmented behavioral health system, administered and regulated by multiple state agencies (health, mental health, substance use, etc) and varying levels of local, county and state government, and by purchasing models that separate behavioral health services from other Medicaid-covered services.

Structures that govern state administration, regulation, and procurement have not kept up with emerging and best practices in the delivery of integrated health care to Medicaid recipients with both physical and behavioral health conditions. Systemic barriers remain: policy, program, practice and financing, just to name a few. Why should we disrupt the status quo?  Turns out that persons with both physical and behavioral health conditions are among Medicaid’s most medically complex and costly cases. But beyond that, there are more effective ways of delivering care that result in better health outcomes! There is also a large body of evidence showing that patients have better health outcomes when both their physical and behavioral health needs are addressed together.

The report emphasizes there is no singular route through which all states will be able to achieve integrated behavioral and physical health care and that the best strategy (or combination of strategies) will depend largely on a state’s political climate, health care environment and political will.  So true. The report concludes that regardless of the approach, states will succeed only with a cohesive framework with policies in place that enable health care providers to deliver high quality, integrated health care to Medicaid beneficiaries with both comorbid physical and behavioral health conditions.

Where does your state stand on this important health care reform issue?  Is the political climate and health care environment in your state conducive to taking bold and necessary steps to transform the system to support integrated health care?


Into the Fold: On Coming Out

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Willie Williams
Willie Williams

by Ike Evans

The issue of whether to disclose as a person with lived experience of mental illness is always a complex one. For this latest episode of Into the Fold, we talk to Willie Williams, co-coordinator of the Austin Area African American Behavioral Health Network, about his own experiences with “coming out,” the challenges of living as an African American man with a mental health diagnosis, and things to consider when deciding whether or not to self-disclose.

Willie is a longtime resident of Austin, Texas, a city with a progressive reputation but a checkered racial history. His decades of experience in public service has given him uncommon insight into the challenges of sharing one’s mental health history in a variety of settings. One important take-away: there is no universal “coming out” story, and issues of identity and cultural background can be just as germane as personal circumstance in determining the coming-out moment.


podcast artwork










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Featured Resource Network: The National Association for the Dually Diagnosed (NADD)

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NADD logo


Our featured resource network for the summer is NADD, an association for persons with developmental disabilities and mental health needs. NADD is a membership resource network for professionals, care providers and families promoting understanding of and services for individuals who have a dual diagnosis. Persons with co-occurring intellectual and/or developmental disabilities (IDD) and mental illness (MI) are frequently referred to as a special population. It is important to recognize that this group makes up approximately one-third (32.9%) of the total number of individuals with IDD served by state developmental disability (DD) agencies nationwide.[1] In view of the high prevalence of psychiatric disorders among people with IDD, this group should not be considered as a special population, but as a core constituency in both health and human services settings.

Committed to raising the level of support for individuals with co-occurring IDD and MI, NADD partners with organizations across the nation to introduce its members to state-of-the-art mental health care and treatment and provides up to date information on assessment, diagnosis, psychopharmacology, therapy, program models, staff training, research, and family issues for this population.

Additionally, to enhance the quality of supports and services to individuals with dual diagnosis, NADD has developed three interrelated certification programs for service providers:

NADD also hosts webinars offered at varied experience levels (‘beginners’ with limited or no prior experience with the subject matter to ‘advanced’ who are experienced and versed) on topics such as modifications for counseling this population and strategies for families to use during difficult times. Each session is $78 for NADD members and $98 per session for non-members.

Finally (or once again on this blog), NADD hosts an annual national conference open to anyone interested in improving services and supports for individuals with a dual diagnosis.  This year the conference will be held in San Antonio TexasNADD Annual Conference

From November 12th – 14th, 2014.  This is a great opportunity for Texans to develop new skills and increase their expertise.


This is just a sampling of NADD’s services and network. We at the Hogg Foundation support them as they continue to advocate for improved treatment and services for individuals with a dual diagnosis and to work to bridge the gulf between mental health service systems and developmental disability service systems so that individuals with a dual diagnosis will no longer fall through the cracks.

[1] National Core Indicators Adult Consumer Survey 2011–12 Final Report (2013). National Association of State Directors of Developmental Disabilities Services and the Human Services Research Institute. Retrieved from