The Secret Sauce

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Secret Sauce

by Rick Ybarra

While attending an annual grantee meeting this past week, I was struck by an insight that is often talked about but surprisingly little seen in the literature. Not only is it something I have seen time and time again, but it has been verified by colleagues who manage projects as well as by those on the ground who are implementing projects and programs. It is a key ingredient that distinguishes successful and sustainable implementation from that which stalls or fails to gain traction.

That ingredient is what I refer to as the “Secret Sauce.”

As a former health care provider who now works in health philanthropy, I can attest to the power of teams. Teams with a clear sense of mission and vision, working toward a common purpose, can accomplish great things!

In light of the health care transformations currently taking place, health care organizations and health care systems are seeking personnel with the right skill mix: experience, credentials, and ability to fit and grow into the new provider roles and functions. There is also fierce competition to hire skilled and credentialed health care professionals to fill immediate vacancies.

There is something else aside from the skill mix — a special ingredient that contributes to making good teams great teams!

Good teams form over time and develop into great teams. The great teams I am familiar with have an additional ingredient. They have the Secret Sauce. Their personalities become the glue or connective tissue as they work in their defined roles. People bring their personalities to the work they do. They figure out how to effectively work together and over time become a fully functional team. They work out a balance of nimbleness and keeping an eye on the goal and purpose. They accept defined roles while showing an ability to work in the space of each other’s “gray zones.” They uphold respect and dignity for all team members, from the physician to the care coordinator. They work off each other’s strengths and maximizing how to engage and interact with one another to achieve the desired result.

The results of this magical interplay for the persons and families the teams serve: better health outcomes, better consumer satisfaction, and maximizing cost efficiencies to reinvest savings into the health care system.

I don’t know if or how we can quantify the Secret Sauce. You just have to believe it exists. I’ve witnessed it. It’s what separates good from great.

The key question in my mind: is having all the key ingredients (positions, skills sets, etc.) enough to naturally bring about the Secret Sauce? Can the Secret Sauce be manufactured? Likely answer: sometimes yes, sometimes no. Something to ponder….

At the Tipping Point: Consumers in Charge of their Health Care

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Drawing of a person at the center of a circle of other persons

by Rick Ybarra

A recent commentary in the journal Medical Care drew my immediate attention. The article attempted to make distinctions between patient-centered, person-centered, and person-directed care.

This article begins by describing the traditional “medical model” of health care focused on symptoms and symptom management, typically performed by a physician or a highly trained medical professional: “The role of the professional is to decide; the role of the patient is to comply with the decisions of the professional.”

The article moves to the present, from the doctor-knows-best approach to consumers playing a more active and engaged role in their health care. The Institute of Medicine 2001 report states that patient-centered care — or health care that is “respectful of and responsive to the preferences, needs, and values” of the individual, “ensuring that the care recipient’s values guide all clinical decisions”— is a fundamental hallmark of the highest quality care.

The key take-home message is that person-centered and person-directed care approaches represent a paradigm shift away from the medical model, emphasizing collaboration between provider and consumer, and inclusion of mental, social, and faith/spiritual needs, in addition to strengths, preferences, and personal goals and aspirations.

The authors also cite the move toward people-first language, emphasizing the whole person and not just his or her illnesses. The Hogg Foundation for Mental Health, in its forward thinking, designed a brochure titled “Language Matters in Mental Health.” It remains one of our most popular downloads.

This paradigm shift depicted in the article is taking place in all sectors of the health care industry. The culture change has led many health care organizations and facilities to focus more on the design and delivery of health care that leads to increased engagement, improved population health outcomes, enhanced coordination of care, and business model efficiencies. The effects of this culture change have been associated with improved quality of life for residents, lower staff turnover, and even improved financial performance for facilities. Moreover, comprehensive culture change is associated with more beneficial outcomes than partial culture change. Reminds me of the saying: ”Going in all the way!”

Person-centered care is also associated with improved treatment compliance, positive health outcomes, and increased patient satisfaction. Some research on PCMHs suggests that they offer benefits in terms of better quality care, greater satisfaction with care received, improved access to care, and lower costs (or The Triple Aim).

The authors envision a future of health care that is truly consumer driven. But here is the news: that future is now! In order to achieve the real goal (healthy people, health families and healthy communities), consumers must be in the driver seat of their health care. I always say, “You can have the best clinicians, the best EBPs, etc. but if we are not successful in engaging and activating persons to take a lead role in the health care, it won’t matter. We will continue to deliver sub-par health care services, we won’t achieve the health outcomes we are aiming for, and we will never bend the cost curve on health care.” I say “we” because there is a share responsibility between the consumer, the health care provider, and the health care system. Together, we can create a health care system that truly meets the whole health needs of people and leads to improving the experience of care for the consumer, improving the health of populations, and reducing per capita costs of health care.

Evaluation Brief: Trauma-Informed Care Training at Two Texas State Supported Living Centers

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SSLC Evaluation Policy Brief
SSLC Evaluation Policy Brief

by Colleen Horton

The Hogg Foundation is excited to announce that a policy brief summarizing the results of the 2012 funded trauma-informed care training initiative is now available to view online! The report, titled Findings from Trauma-Informed Care Training at Two Texas State Supported Living Centers, summarizes the results of the evaluation conducted last year by the Research Division of MHMR of Tarrant County, under the direction of Dr. Kirstin Painter.

One major impact of the training, which was conducted by Dr. Karyn Harvey, a psychologist and expert in trauma-informed behavioral interventions, was the evidence of a shift in the culture of care at both SSLCs. Not only was the training successful in reducing the use of restraints, but 55% and 58% of respondents from each SSLC agreed that the training resulted in a significant or moderate culture shift. Staff members also cited reduced stress and more positive interactions with residents as a result of the training, and administrators and supervisors were recognized for their roles in creating and reinforcing structures to support improvements in care. These findings are especially noteworthy given the short time frame between training and follow-up evaluation (less than two years), demonstrating that quality training in trauma-informed care can quickly cultivate structures necessary to sustain lasting change.

Go here to download the full brief.

Into the Fold, Episode 13: Luis Zayas on Deportation Threat and the Children of the Undocumented

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Luis Zayas

It should come as no surprise that undocumented immigrants live stressful and chaotic lives. In particular,  living under the constant threat of deportation and legal jeopardy exacts a psychological toll on their children. In this episode of Into the Fold, Dr. Luis Zayas (pictured above), Dean of the School of Social Work and the Robert Lee Sutherland Chair in Mental Health and Social Policy at The University of Texas at Austin, discusses his own work on the mental health needs of children of the undocumented, and the effects of deportation anxiety on their sense of safety in the world. Read the rest of this entry »

The Human Condition

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The Human Condition artworkThe Human Condition was a series of national radio broadcasts produced by the Hogg Foundation that ran from 1971 to 1983. During its first year, it was broadcast under the title, “How Do You Feel?”. The program was hosted by Bert Kruger Smith, a guiding voice at the Hogg Foundation for over thirty years. Smith led half hour conversations with guests on subjects that spanned the full range of human interest, including but not limited to mental health. Many of the persons interviewed were national figures in such fields as psychology, rehabilitation, education, minority group concerns, aging, and criminal justice. More than 400 episodes aired and are currently being digitized and made accessible to the public with the help of the Briscoe Center for American History and students from UT’s School of Information.

UT iSchool student Stephanie Lopez worked with Dan Oppenheimer, Communications Director at the Hogg Foundation, and the Jessica Meyerson, Digital Archivist at the Briscoe Center, to make sure the radio programs will be appropriately identified and accessible in the digital repository, Glifos. Lopez worked on the less glamorous backend of the Human Condition archive project in order to bring the public mental health history in context. Thirty of the 400 digitized audio files for the Human Condition were assigned the appropriate metadata and ingested into the digital repository at the Briscoe Center. Seventeen of these 30 audio files will be accessible to the public via Glifos. Here are a couple of our favorites to check out:

A Small-town Counseling Service

Members of the community of Brenham, Texas discuss their forward-thinking counseling services for residents.The Brenham Counseling Service provides therapy for those suffering from mental illness or hardship; liaison with state services for mental illness; and advice for citizens looking to help their friends and family struggling with mental health-related issues.

Penology and Mental Health

Penology and rehabilitation expert Merle Alexander discusses the psychology of prison riots, murder, and criminal behavior and how to use this psychology to implement a more effective correctional system. By asking questions like, “Why are these behaviors taking place?” Alexander is able to suggest better rehabilitation programs.

The Scopes Trial

The famous Scopes Trial is the subject of this 1971 episode. In 1925, substitute high school teacher John Scopes was charged with violating Tennessee’s Butler Act, which made it a crime to teach Darwinian evolution in a public school. The featured guests are Jerry R. Tompkins, who edited a 1965 book on the trial, D-Days at Dayton, and Kirtley Mather, a Harvard geologist and prominent critic of McCarthyism who helped Clarence Darrow with his famous defense of Scopes.

In 2014, we began a parallel project to create a The Human Condition channel on iTunes U. This page gives an overview, along with a sampling of episodes that you can listen to.

Vital Signs: A Prescription for Our Health Care System

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Vital Signs

by Rick Ybarra

In Health Affairs most recent blog post, the new Institute of Medicine (IOM) report, Vital Signs, hones in on a proposed set of 15 core measures leading to better health and lower costs. The measures focus on a wide range of areas including well-being, addictive behavior, access to care, evidence-based care, care matched with patient goals, individual engagement, and community engagement.

The report makes the strong argument that a shared vision and accountability among health care providers, administrators, payers, policymakers, patients, and families in the pursuit of measurement and performance improvement are essential to improving the health of our people, communities, and the nation.

Safety-net organizations such as community health centers play a critical role in demonstrating improvement on these proposed core measures. The report notes that patients who receive their health care from safety-net providers experience the deepest disparities in these 15 measures. These populations have poorer health status, have lower health literacy, and may experience more significant barriers in accessing care than others. In addition, poor, uninsured, under-insured and publicly-insured patients are more likely than others to experience trauma and depression.

If safety-net providers do not attend to these measures while the rest of the health system does, health disparities will continue to widen. Furthermore, the Health Affairs blog post argues that patients served by community health centers may benefit the most from focused attention on these 15 core measures, so improving the health status for the most vulnerable populations will raise the health status for the nation as a whole.

Clearly, this has huge implications for safety-net providers working with limited resources, as they face the challenges of implementing and monitoring these measures. The Vital Signs authors offer recommendations based on their current work with safety-net providers in California for using the principles of the Triple Aim — population health, patient experience, and cost—to drive system change and deliver effective and efficient care.

Although it may seem overwhelming for safety-net providers to implement the core measures outlined in the IOM report, it is possible, since many of these measures are already collected by community health centers. The Health Affairs authors conclude that health care organizations can and should focus attention on improving measurement to support the delivery of high-quality, cost-efficient, patient- and population-centered care.

Now that’s a prescription we can all follow!

Farewell, Jemila!

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Jemila

In July we will be saying good-bye to our policy fellow, Jemila Lea. Her two years at Hogg, during which she helped to further the foundation’s public policy priorities on issues such as foster care and guardianship reform, were successful and rewarding. Among her highlights:

  • She participated on the Texas CASA Mental Health Task Force, which met over the course of a year from August 2013 until August 2014. The task force developed a report titled, “Respecting the Needs of Children and Youth in Foster Care: Acknowledging Trauma and Promoting Positive Mental Health Throughout the System – Recommendations of theTexas CASA Mental Health Task Force.” Jemila worked on a subcommittee that provided recommendations on Empowerment and Normalization of Youth in Substitute Care. Those recommendations became the basis for legislation, S.B.1407, which aimed to encourage foster youth to participate in age-appropriate normalcy activities, by allowing substitute care giver to approve or disapprove a child’s participation in activities, using a reasonable and prudent parent standard, without prior approval from the Department of Family and Protective Services. The bill was signed into law by Gov. Abbott. Jemila also had the pleasure of facilitating a panel on Normalcy, Empowerment, and Positive Mental Health Outcomes, which included two former foster youth, at the Texas CASA Child Welfare Primer held in Austin.
  • She participated on the Guardianship Reform and Supported Decision Making work group over the course of her fellowship. This provided her an opportunity to learn about the intricacies of guardianship and alternatives to guardianship such as supported decision-making. She actively tracked a number of bills aimed at amending the estates code concerning guardianship as they made their way through the legislative process this session.
  • Jemila was an invaluable help in contributing to the second edition of A Guide to Understanding Mental Health Systems and Services in Texas, the foundation’s one-of-a-kind guide to the mental health system in Texas.
  • She was part of the implementation team for the foundation’s new grant management software, Fluxx. With the flood of new proposals that the foundation typically receives during the spring and summer months, a seamless transition to the new software was essential, and Jemila was an asset to that process.
  • On June 30, 2015, Jemila contributed her expertise to a webcast sponsored by the State Bar of Texas about recent developments in mental health and disability issues in the 84th Texas Legislature.

Jemila will be returning to the Dallas/Fort Worth area to pursue her career in law.

“It’s hard to spend two years working as a policy fellow for an organization like Hogg and not come away transformed,” said Jemila. “I hope to utilize the experiences from this policy fellowship to the benefit of future clients I may have the opportunity to serve.”