Hello. And thanks for joining us. This is disruptors at work and integrated care podcast, where all of the topics will be with subject matter experts, practitioners, and providers, leaders, and managers who are implementing. Integrated health projects all over the world. I’m your host, Dr. Cara English.

Welcome to disruptors at work and integrated care podcast. I am your host, Dr. Cara English. I’m the CEO of Cummings Graduate Institute. And I am really excited today to be joined by Napoleon Harrington, who is currently a student in the Doctoral Behavioral Health program at Cummins Graduate Institute.

Napoleon has a lot of great professional experience in advocacy in the professional organizations. And he actually a founder of his own organization called Ambassador Counseling and Resource Group, which is a clinical mental health practice that offers therapeutic services for, children, families, and adults.

He also serves as an adjunct faculty member on topics related to psychology, mental health and human service services. And Napoleon has been recognized by civic organizations and by government officials. And in fact, he recently in 2021, the mental health counselor of the, of the year award. So we are excited to talk with him today, um, to hear more about that award and about the leadership.

He is the past president of the Michigan Mental Health Counselors Association. Um, Napoleon is currently living in Auburn Hills with his college sweetheart and wife faith, and with his 18 month old twin daughters, Isabella and Amani. So welcome. Welcome to the podcast Napoleon. I’m really looking forward to hearing more about it.

Well, thank you very much. I’m really excited to share my DBH journey has been outstanding so far, so I’m very excited about, becoming a disruptor in the future. And apparently I’ve been a disruptor all along in disguise, but now it’ll finally be manifested. So, I’m excited to be, to be here.

I’m so excited for you to talk a little bit about the mental health counselor of the w of the year award. Can you tell us a little bit about that and, you know, please share about what that was like earning the award in such a challenging year for mental. Well, I’m humbled to have won the award number one, against many of my colleagues who have done some remarkable work from ranging, from research to developing new kinds of therapies, et cetera.

But to be recognized in 2020, which as you, as you mentioned, pandemic year and had been very critical in mental health, I was very humbled to have won the award. It was presented by the American Mental Health Counselors Association, who represents professional counselors across the nation.

I was awarded it. They did a ceremony in June ,and I was able to virtually accept the award, which was a first, and it was exciting, too. Exciting to accept, and one of the first things I could only think to say is that this award is not mine alone. It is in conjunction with everybody who has ever invested anything in me.

And also, more, more recently, for the work that we were able to do at Michigan’s Capitol, producing legislation that was very critical and I just happened to be a guy in the right place at the right time, willing to try. I think you might be on the verge of being a little too humble there, but I appreciate it.

You know, just the fact that you noted that it takes a team because oftentimes in our, in our profession and in the world, we do see one person who’s being awarded or one person who’s being highlighted, you know, in the news or in the professional organization. And the work though is really based on a team.

So I’d love to know a little bit more about the team. Um, and about the legislation. Would you mind sharing a little bit about that? Sure. in many of us growing up and I might date myself a little bit only watch schoolhouse. And knew that much about a bill. Yes. I’m just a bill sitting on Capitol hill, that song.

Exactly. Um, so that’s pretty much what I knew about it. Uh, I was not very involved in politics initially at all. Um, and to this day I’m still not really, um, but it does take a really strong understanding of how political processes work in order to produce a bill. And so at any rate, w w the mission.

Professional counselors had to address a couple of things that were going on with our, um, our, our, our scope of practice and with the work that we do. And so we needed to make sure that it was, uh, codified legally, um, how we do the work. So not to get too far into the details, but what we chose to do is we produced.

Um, some language to address some of the concerns that, uh, the department of licensing and regulatory affairs had with our, um, with our current bill. Um, and because the department has one job, which is to make sure everybody’s, um, in sync and they’re doing the right thing. Just the right amount of pressure for us to, uh, put the bill together and make things work.

Um, well, as we were, we’ve been working on this for, uh, years to, to say the least I was president for four years and the normal term. It was just a two year turnaround, uh, but got reelected in order to kind of finish the job. Um, and so the, uh, I guess the long story short, but it’s a very long story. Uh, we started, uh, many years actually preceding me actually.

Uh, there was a team of, um, uh, Jim Blondeau, Sarah Shaffer, um, Irene I’m a Toronto, uh, and, and a couple of others who have been putting together some really significant, um, language to address the bill. And because the bill had been addressed, but the department of licensing and regulatory affairs was not necessarily satisfied.

We had to go back and forth and back and forth. And, um, the clock was ticking and some glitch in the system is what we will identify it as some glitch in the system made it, so that. The clock would actually end on our ability to produce our answer to the concerns that the licensing and regulatory group had.

And what it would have done is severely limited. Our ability to practice it would have disenfranchised, at least 10,000 counselors and hundreds of thousands of folks who depend on those people to provide services. And so long story. Again, is that, um, we mounted one of the largest and, and, and it kind of brings chills to me again, when I get a chance to talk about it.

Uh, legislators at Michigan’s Capitol said that we mounted the largest response, uh, that the capital has ever seen. Uh, and it came from a group of, uh, licensed professional counselors and other mental health, uh, supporters. Uh, we had thousands of people who, uh, literally. Came to protest at the Capitol or showed up to speak and, um, all off the initiation of, uh, uh, the work that we had been doing to produce the answer for the department of licensing and regulatory affairs.

So it started off as house bill 43, 25, and, uh, it was codified into law, uh, PA 96, uh, in 20. Oh, I’m sorry, 20, 19, 20 19. Okay. And so can you tell us, um, is the legislation, you know, aimed at licensure for mental health counselors and in the, the licensing board requirement? Yes, it is, uh, it was primarily to make sure that we still had the capability to diagnose.

Uh, and in terms of looking toward the future, uh, the idea of portability, we, we needed to make sure we cleaned up the language to ensure that the efforts towards portability was, uh, would be successful in the future. Um, and we needed to clean everything up. So, uh, it was a big fight and, uh, uh, a surprising fight.

Okay. Most counselors as we were kind of chatting before we got started with this, um, most calls there’s kind of take the, I’ll, just sit back and watch approach and the conversation toward advocacy. Uh, it got, uh, a lightening storm happened in Michigan. And so, uh, I’m very proud of the team and we were able to Mount something really special historic in back, uh, and, and.

Some conversation that we were able to really, uh, save the profession in the state. Yeah. That’s an amazing accomplishment because you’re right. It is very difficult, even in the best of times to Mount, um, or just to bring people together to, you know, catalyze that kind of advocacy movement, you know, like you said, people are very hesitant to get involved.

There are lots of worries, especially among counseling professionals, um, you know, towards their licensing boards. Many people are very afraid to be on the radar. That’s, that’s definitely something we face here in Arizona. Um, because. You know, traditionally have not been there licensing boards, aren’t there to support professionals.

They are there in, in, you know, by governor appoint appointment, um, to protect the public. And they’ve taken that to be very punitive, um, and scope. And so, you know, it doesn’t take much to get on the radar in some states. And so people will. Avoid that at all costs. So tell me a little bit about the strategies that the team you, you and the team used to get that kind of engagement.

And I I’m imagining that it must’ve been incredibly difficult, but. Was any of it done during the pandemic or did it all happen prior to the pandemic? The timing is amazing because it all happened pre pandemic. Um, because if it would happened during the pandemic, I’m not confident that we wouldn’t have been able to successfully do what we had done.

Um, and so some of the strategies that we were able to use, um, I think the first one is being. Pull together a team of people who were very conversant in things like, uh, law, um, people who understood political process, um, also, uh, people who were very content experts at the practice. Counseling. Um, that was very critical because you get those minds in the room and you’re able to shape a conversation that, um, and layman’s terms, people can understand whether they’re, if you’re from a political background, when they were able to read, um, the, the language that was produced from the political E’s perspective, they were able to understand it.

Um, all of the professional counselors that read it are mental health professionals. Understood it, because it also had their language in it. So putting together a team of minds in the room that were very clear about their role. Um, the other thing that was really important, uh, social media, um, it’s one of the greatest distractors in the unit.

But it is a very useful and powerful tool. Uh, psychologists say that it’s a paradox of progress. Uh, it can, it can divert you, but it can also really help you Mount one of the largest, uh, campaigns that you would ever need. Um, and so. Our conversations went viral. I would make videos. Uh, others would make videos that would, um, basically give marching orders or tell people what should be done or what is actually happening.

Um, and so that was important. Uh, a very good social media strategy. And then just the sheer idea of being consistent with a message, um, hold close to the close to the chest. What messages needed to be. Produced at specific times. Um, Hmm. But if everybody in the choir is singing the same note, my goodness, we sound great.

But if we’ve got everybody in the choir, singing something different at different points in different times, we’ll then we sound disjointed, which makes it very difficult for our cause to sound believable. Yes that, oh my gosh. I’m so glad that you mentioned that because I think that’s something too that a lot of people don’t understand is that while the group itself may have a lot of different messages that they want, and a lot of different voices that want to be heard, if the message isn’t clean, clear and concise enough, it is not ever going to be communicated in a way that can be used for, for policy purposes.

Yeah. And we got, we had some, some, some difficult times with, uh, other counseling organizations that were with us. Cause they, they would wonder, well, why aren’t you giving us the information? And it was very strategic and it was no, no disrespect, uh, toward the organization. Um, but it was really about making sure that the right message got across and thank goodness it happened because, um, we were able to, um, Successfully pass our legislation, uh, clean without any objections through, uh, through the house, through the, um, Senate, uh, through committee meetings, uh, it was, it was, uh, it was, uh, uh, Wonderful sight to see.

Uh, we had an amazing, um, uh, we had an amazing firm that was there to help support us, uh, Acuitus end, um, and Andrea, who we call Saint Andrea now because she just worked her political willpower and magic on, uh, on Capitol hill and, and did a fantastic job. That is, it’s really a beautiful story. I, and I can think of so many different, you know, policies that are needed.

Uh, state level, federal level, um, that it would be Butte, a beautiful story to be able to put that model, the model that you used into practice, because I don’t think there’s, uh, an American or, you know, a citizen anywhere in the world who can say that there isn’t a need for healthcare improvement, whether you have, um, you know, third party system like we do, or, um, a national health system, like many of the European countries, Australia.

Um, in Asian countries have there there’s always an improvement that can be made. And I don’t think that there is a lot of involvement outside of the professional organizations, even if you’re a member of a professional organization. I don’t think they’re, like you said, I think a lot of professionals are like, I’m busy enough.

I don’t have time. And I don’t like policy. So you don’t want to be involved, but just as your experience exemplifies, there are so many times where if you don’t show up, you may lose more than, you know, you’re about to lose and being able to treat patients effectively using the science and the evidence and the research that you know is best practice and needs to be applied.

Absolutely. I, I can’t tell you how many times we would go into meetings and have the DSM right next to us and have, uh, other, um, materials that, uh, that verify the work that we do. And as you spoke to research, I mean, the research was critical to help to, uh, advocate our, our, our points. So it was just a, it was an all out effort.

And, uh, it was great to have, uh, the support of even non mental health professionals that, um, would be there to support us. Um, there were plenty that, um, went against our, uh, when it gets to cause, uh, but they have their, they have their right to, um, and it just demonstrates that our evidence was strong enough to discredit any point that would, uh, attempt to take away our ability to diagnose, et cetera.

Yeah. And I think that’s a good point too, because you know, anytime you’re looking at policy, there will always be those who disagree with what it is that you are trying. You know, they’ll, they’ll find a way to pick it apart, but if you lean heavily on the evidence to support your cause, it’s not opinion, it’s not, you know, The whole facts over feelings, feelings, over facts, dynamic.

It really is rooted in science and best practice and best health outcomes. Um, you know, if you can make your, your argument strong enough and you have the support of a, of a well-oiled machine behind you, um, it, it sounds like you, you really found the keys to success. So I’m really happy for you guys.

Thank you for that. And, and the ironic part of that is the, the, the machine was very small. It was a very small machine and it, it taught me a whole lot about it kind of gives me the David and Goliath feel. Um, it taught me a whole lot about being able to respond to major, uh, events with just a few committed individuals.

I think Margaret Mead said something about that, that a few small committed individually. Uh, never underestimate what they can do. Um, so I, I I’m, I’m, I’m eternally grateful for the efforts of, uh, the folks who, um, helped to put together this, this whole response. And a lot of Michigan mental health folks are remarkably happy now.

Oh, I’m glad to hear that because, you know, goodness knows that due to the secondary pandemic, Of mental health that we’re now facing and, and certainly substance abuse combined, um, you know, and, and included in, in that secondary pandemic, we really need as many high quality well-trained mental health professionals and advocates is as well.

Have available. And we really need for insurance companies to remove and be looking for access barriers that they can remove. And so, you know, if it’s an issue of, um, scope of practice that needs to be removed, um, you know, outside of Michigan, that really needs to be addressed. Um, tell me a little bit about nationwide.

Are there other states that have legislation similar to what Michigan, um, was able to pass? So at this point, I’m not very sure about who’s, uh, the national landscape, because things have shifted so much and priorities have changed. Um, I know that New York had some legislation that was, um, it always seems like New York has always got some legislation that from a mental health perspective is waiting to be addressed.

Um, I also am aware that, um, oh, I believe. Florida, um, that, uh, the Florida mental health counselors association was working very diligently on, on, uh, um, on some of the same things. Um, but the landscape has shifted so much because of the pandemic or, or post the pandemic that, um, now we’re, we’re really focused on kind of making sure parody is happening on a more consistent basis.

And of course parody is, is it’s a big conversation because, uh, the myth out there is that, uh, we don’t do the same thing as our counterparts who, um, may have been trained, uh, maybe two or three classes differently, but we do the same scope of the work. And so we’re looking for parody to make sure that, uh, third-party payers respect the work that we do.

Um, So yet parody is probably the biggest point of reference for us now and portability. Right? So for, for the listeners who aren’t familiar with the term parody, it really is, is a term that is applied to mean equal reimbursement. For a health care professional, for example, for a mental health counselor license, um, you know, would receive from a third-party insurance or from CMS and equal reimbursement amount as other licenses.

So this is something parody has been something that has been addressed by. Mental and behavioral health professionals, including psychiatrists and psychologists. You know, I was talking with you and Napoleon about my experiences as an undergraduate student, working from the Arizona psychological association and in the way back in the night, And, um, you know, uh, driving down to the state Capitol and picking up legislation and bringing it back so that the, the board of directors, including psychologists members from Arizona, um, and the executive director could, you know, edit and provide their input in, into the legislation.

And it really impressed upon me at the time, because parody was a huge issue for psychologists. Um, those were the days when. Equal or even inclusion of mental health benefits in, in third-party insurance plans was not a shirt. It was not mandated. We now of course have federal man federal mandate for parody, um, equal coverage for behavioral health and substance abuse, as well as, uh, physical, mental health, um, coverage that doesn’t however mean.

That we get that. And so one of, one of the ways that parody is still a major issue for mental health and behavioral health providers is the bickering between, well, what license should be paid? What there’s also of course, a lot of differentiation between the physician rate. Um, for services for, you know, a 15 minute episode of care for a primary care physician is, you know, it can be close to three times the rate that a mental health clinician might get for that same 15 minute episode of care, even, even if both of us are coming from the doctoral level, um, So it’s, it’s really still a huge challenge for, um, at a lot of different levels.

And depending on the way that parody the word and the federal legislation is interpreted by third party insurers. And, you know, whether or not there are professional organizations, like you mentioned that, you know, are maybe seeking different aims. You know, there, there are professions that want to protect their slice of the pie and that.

Hurts patients, because there are always going to be an unlimited number of patients who need mental health care. And there are literally unlimited pies. If we can just stop looking at it like, well, we need to protect our slice. You will literally have unlimited slices. Why not allow unlimited mental health provider?

Access, you know, as long as we’ve, you know, met our continuing education standards, our licensing standards, why would we place a lid on that? If we continue to have access barriers nationwide. So yeah, parody is a big issue. I would love to hear more about portability because this, especially during the pandemic became an interesting issue with tele-health.

So again, for those listeners who may not be as familiar with, um, with what we’ve been seeing over the past year, we saw tele-health, um, being. And approved mechanism of service delivery. Whereas in the past, prior to 2021, um, there was really just no ability to get reimbursed or very limited and, and, you know, really legally and professionally tricky.

Um, Just, it was very tricky to be able to provide or deliver services via telehealth for medical and for behavioral health providers. But, uh, thanks to the pandemic. We were able not only to have access to, to continue service delivery via tele-health, but also to prove its worth. In managing and maintaining health, mental health, um, as well as physical health.

So I’m wondering about, um, portability, just from the standpoint of what that means to some is that you are able to be in your state. I, I live and work in Arizona and I might have a potential patient call me from New Mexico and, and ask for a telehealth visit prior to the pandemic. No, that was a hard one.

You cannot practice even via tele-health, even if you’re a practice as a hundred percent telehealth in your state. And it’s the exact same thing, seeing a percent in New Mexico versus seeing a person in Arizona. Um, and so portability has been, um, an issue with both tele-health as well as, as you know, a physical practice.

So for example, if, if you’re, uh, You know, mental health worker or, or a physical health provider, and you want to respond to a crisis. And one of the ones I use a lot as an example is, you know, hurricane Katrina or the one in Houston, I can’t remember the name. There’s so many hurricane names. Um, You know, but if you want it to be able to respond outside of your state, we’re limited in scope of practice to just the state we’re licensed in.

So can you share a little bit about how, um, the Michigan mental health counseling association is, is addressing that or address that with the legislation? Yeah. Well, it was, it’s been, yeah. Directly, but not through the conversation of portability. It’s been by cleaning up the language in all of our, um, in all of our, uh, in our bill, uh, and making sure that, um, if, if anybody picks up our bill and reads what we do.

W how much does it mirror? What other states say that they’re professional counselors, even if it’s named something different, which is a challenge for professional counselors across the board, do we do the same things so that we can easily kind of, uh, swap out our roles? So, um, so I think the primary way that we’ve done it is, is.

Consistent legislation, uh, and staying on top of what we, uh, can manage here at home, but we’ve also been, uh, relatively involved at the national level with the American mental health counselors association. Uh, I’ve served on a few committees and our executive director, uh, Jim Blondeau, uh, had at one point been president of.

The American mental health counselors association. So keeping our ear to the, to the ground of what’s happening on the national level and contributing the Michigan voice, if you will, um, to what kind of things we’re seeing and what we’re hearing and, um, and how that could help shape the national conversation.

Uh, so it portability. It’s kind of one of those, um, those hopeful markers that we’re running towards, because we’ve got a, we kind of have an image problem from a professional counselors perspective that we’ve got to work through, period. Um, and it’s primarily what language are we consistently using as a, um, As a practice or as a profession, um, you know, an attorney when an attorney starts talking, you know, uh, a mechanic when a mechanic starts talking because their language sounds the same.

Uh, do professional counselors have the same language? Are we using the same kind of, um, phrases and words? Like we’re being trained in, uh, our DBH to do, um, So in essence, we’ve got to do that. And then we’ve got to clean up what we’re called across the board. Even if there might be a variation of one word or two that can sometimes severely confused people.

Uh, so, oh, are we licensed mental health counselors or are we licensed professional counselors, uh, is one the actual license and is our title something different? So being able to clean all of that. First and I used the term and, and mom did this to me. We’ve got to clean the kitchen first before we invite guests in.

Um, and so basically if we can get that kind of thing cleaned up within our, uh, profession, then it helps to make it a lot more consistent to get the support or the advocacy that we need from the people that we’re appealing to or stakeholder. Absolutely. And you know, you and I were, were kind of talking a little bit prior to, um, beginning recording here about, you know, the need to really look at how to do that as doctors of behavioral health as well.

There are, and have been a couple. Um, professional organizations that have been established, none of them have yet gotten really the, the penetration of, um, awareness among DBH, um, professionals in terms of membership. And we really just don’t have yet that advocacy in terms of a professional organization to help us clean up the kids.

Yeah. And I think, I think once something like that happens, I mean, we’ve got a group of cheerleaders in our program already that are ready to beat the drum, but what would happen if we had a corporate drum that we were all beating and that unison of that voice would announce that DBH is, are coming and it wouldn’t be.

A surprise that you would have a DBH sprinkled here or a DBA sprinkled there, we would have actual integration teams looking for DBH is to bring them onto their, uh, to bring them onto their, their, their teams or their organizations. Um, and so. I I’m, I’m a huge fan of seeing, uh, us being able to advocate for ourselves and just kind of let everybody know, Hey, we’re not just that we’re coming, but we’re here.

Uh, and how important that is? Yeah. I had a really interesting experience during the pandemic. I attended a virtual, um, conference. It was a national conference, 2020 mama’s a national organization that does a lot of. Advocacy and continuing education around maternal health, maternal mental health, and maternal mortality and morbidity across the United States.

And I attended their 20, 20 virtual conference. And, um, one of the first sessions that I attended, uh, had a panel and one of the panel members introduced herself as a doctor of behavioral health. And I just about fell out of my chair. I thought, oh my God. Here’s a, here’s a woman. I don’t know. Who’s a DBH and you, and I know that there aren’t a whole lot of DBH is nationwide.

So when you meet one, who’s actually presenting at a conference you’re attending, that’s a big deal. Um, and since that time we’ve, you know, connected further and, and had some good conversations. She actually lives here in Arizona. I same state. And so we’ve had some good connections in some conversations about it.

Um, how to really, uh, increase awareness of, of ourselves in the state of Arizona and what we can do for our state in terms of healthcare improvement, both of us are working at the policy level with the Arizona department of health services. That is really a role that, you know, as a clinical training program, most.

Um, most training programs for behavioral health, really miss out on the entrepreneurship piece, as well as the policy and legislation piece. And, and this leads back to the, you know, I don’t like politics. I’m going to, you know, see what happens kind of approach. Um, and as you know, in the Dr. Behavioral health program, entrepreneurship is one of our three pillars.

Um, you know, but for the last couple of years I’ve been saying we really need a fourth pillar, which is policy and advocacy. So tell me a little bit more about how you see doctors and behavioral health contributing to policy and advocacy for healthcare improvement at the state and federal law. Well, one of the main things that I’m noticing, uh, as a finishing first year student is we have a very dynamic role in the, uh, in any integrated system.

We have the ability to, uh, To not only stretch across, uh, one discipline to the next, but we also have the ability to kind of stand alone in our own as well, which kind of serves in a very, uh, it, it, we create a vacuum in a way, um, that integrated teams would be very, uh, they, they would love to have, so I see us in a way.

Being able to use, um, what are, uh, you know, the, the core of our training to not just educate, but to make sure those conversations related to parody are actually happening. Um, not only that also having the ability to. The, the, um, content experts on, uh, all things that are behavioral health, um, because as the shape of a, uh, third party pay continues to change and it will always be dynamic.

It seems to fit the work that we do, and we should be able to speak to the concerns that they have. So we would probably be one of the best suited folks to, uh, consult with third-party payers on how to approach certain conversations. And that’s one of the, one of the things that really impresses me about the program is the conversation, um, clinician driven primarily, but this whole conversation related to consultancy has really like, just blow things up for me.

Uh, and I’m, I’m, I’m really interested in that. I still clinician at heart, but, uh, that consultant piece is very critical, particularly at the political level. Because we live in a society that is governed by policy and because we’re governed by policy, it’s important to be able to have a content experts should be holding, uh, the content expertise.

And so our contributions to that conversation to policy is very creative. I absolutely agree. And, and I really liked the idea of, of, you know, um, going back to your statement about being able to look across professions, you know, we kind of are an interprofessional professional. We, you know, we, we do have the training and medical literacy, um, for, you know, most, uh, behavioral health clinicians.

They may have. Some small amounts, um, in a training program, not likely because the, you know, standards for, um, NBCC have not changed, um, and, and are unlikely to change unless we do something about that. Um, you know, I think most, uh, consumers of mental health, um, services would like to believe that their therapists know something.

Deep about a medication that they’ve been prescribed. Um, and we, you know, in our opinion should, and that’s why medical literacy is, is one of our three pillars and the DBH program. Um, and behavioral health interventions, of course, that’s our second pillar. And that really speaks to the clinicians at heart that we all are.

Um, and then our third pillar, you know, of entrepreneurship, being able to just even have those three, which some people see them. Um, mutually exclusive, you know, the idea of being a clinician and being an entrepreneur, uh, before I became a DVH student, I really did not understand that I was an entrepreneur.

I understand that entrepreneurship just simply means finding a need and filling it and, and that, that can encompass healthcare improvement in a huge way. And I, and I agree with you that, you know, sort of that backing room idea of, you know, being in the room. With an interprofessional group. You know, it really, everybody else kind of looks like, well, somebody should do something about that.

Or, or what do we do about that? And as a DVH I guess what I learned is that I’m usually the someone, and I’m usually the person who can help the group come up with the what? Yeah. Cause when you have, uh, when you have psychologists in the room, psychologists speak from a psychological perspective. When you have professional counselors in the room, they speak from a professional counseling perspective.

But what somebody who’s probably in a general society is thinking about it, just thinking about behavioral health or mental health, uh, and they don’t want to know, um, Each facet is saying, they want to know what’s the general conversation. And so as DBH is we hold the content expertise to be able to speak to that direct need.

So we, we kind of cut out the middleman, which I got to say that carefully, because if it wasn’t for us middlemen, now, we wouldn’t be able to get this policy stuff taken care of. But as we grow the DBH, uh, population. They become very critical to like really linchpins to the conversation. Yes, absolutely.

And I think too, you know, being able to, we have such a strong patient and family focus, um, you know, patients that are family focused care. So, you know, Across the program, our conversations tend to go, well, what’s the best thing for this patient. What’s the best thing for this family. And yes, we have to have a mind to the bottom line.

Otherwise we can’t keep serving. So yes, you know, but we will not let the beam counter, which is, you know, the, the person designing the algorithm to make sure that the company is profitable. What is best for the patient, because it will almost never be what is right for the patient. And it will almost always be what is just best for the bottom line.

And those two might be diametrically opposed within a part of it. It’s just making sure we have that really strong voice of advocacy for patient centered family centered. Or person centered care, depending on, you know, where you’re coming from, um, as, as part of that professional group. And you’re absolutely right, that we are likely the best person to be consulting the third-party, um, payment systems.

And, and certainly with CMS. As well about, you know, what it is that is best. And, and we can definitely do that from a population health perspective as a DVH. And I think that’s something else that we were really missing, um, prior to entering the program. I know I never had any education in population, health management or, or a stepped level of care, um, to be able to design that prior to becoming a DBA.

Yeah. And as a practitioner, uh, another critical piece of that conversation is the whole return on investment practitioners don’t necessarily consider return on investment. A very important part of that conversation, but it’s what drives healthcare. And so the DBH, uh, as the emphasis is placed on ROI, we’re really, um, we’re also able to speak to that.

At the forefront of our training and is really a key element to making any policy and, um, policy kinds of decisions. Yes. Protect the public for sure. Um, but we also need to make sure that we’re managing the dollars of our, uh, municipal. Appropriately, you know, that’s such a good point too. And I think it has been left out so often.

One of the things I remember Nick coming sane at, um, and for those of you listeners who don’t know Nick Cummings, he’s, he’s, you know, the founder and the visionary behind the DVH program, as well as, you know, really the idea of, um, Healthcare integration, you know, um, looking back into the sixties and seventies, you know, for primary publications on medical or excuse me, the eighties for medical cost offset and return on investment publications.

Nick Cummings really demonstrated the, the benefit of having, um, a hired, you know, possibly even full time, um, psychologist or behavioral health provider working in an integrated way with primary care or specialty medical care providers. Not only does it, does it pay for itself in terms of the position because of the reduction in unnecessary medical procedures, um, and tech.

That are related to the lack of education and training that physical health, private medical care providers have in diagnosing and identifying a mental health condition that is exacerbating a physical condition. But, you know, so not only can we pay for our own positions with the reduced medical costs, but we also are improving health, health care outcomes.

So again, it speaks to that. Um, the, um, Institute for healthcare improvement’s triple aim. And it also plays into our fourth thing, which is, you know, making sure that there is joy in work for healthcare professionals. Again, there’s a differentiation in systems of care that do not speak to that force. Aim.

Um, and, and really aren’t pursuing the triple aim in policy and in systems like that healthcare simply becomes exponentially more expensive because there is no calculation of return on investment. It’s just simply, you know, the purchasing of more tests and, um, You know, more MRIs, more CT scans, more x-rays, more blood and lab work.

Um, you know, and it’s really not even looking even a little bit and mental health and stress. Um, so when that’s left out, we leave, you know, the human out of. And it contributes to the, the, the turnover that happens so consistently in healthcare. And I mean, it’s, it’s, it’s amazing when you run across somebody who’s been in healthcare for 20 years and they still love what they do.

You wonder what motivates them. And oftentimes they, they found, uh, they found some secret sauce that allows them to consistently do what they do. More consistently across the board. Um, you had folks who were able to meet that fourth aim and organizations that were able to invest, uh, in their pot, in their, um, working population to increase that four thing.

So I, 1000% agree with you as well. Yeah, we’re starting to see some, some good models that are emerging. Cleveland clinic is, is doing some great things, but, you know, I, I, my dad recently had to have a quadruple bypass surgery on an emergency basis, and I looked at the research. I’ve done training. And I’ve also taught courses on working with families in terms of, you know, caring for individuals who are recovering from a cardiac bypass graft surgery, which we call a cabbage.

Um, and so, you know, for individuals who are recovering, there are a lot of, um, mental health, um, You know, indicators one, one big one is depression. Um, but another one is sleep. And after a surgery like that, you get very little sleep and there’s a lot of coughing. And, um, you lose so much of your independence after a surgery like that.

You can be, you can go from like my dad, 70 year old, who was completely independent and playing pickle ball one day to completely and utterly dependent on machines and humans to keep him alive for the next several years. And he’s still recovering, you know, he’s, he’s doing better now, but one of the things that I was reading that the Cleveland clinic was doing, and, and that was, you know, just a standard practice in, in, in Europe, um, is this thing called a pro thorax, uh, vest, which is essentially, it, it almost looks like you’re a police officer and you know, it buckles it.

Yeah. And it has these pads that go on either side of the sternum to really splint it because it’s a bone that needs to heal and it needs to be splinted. And the outcomes were just, you know, incredibly improved based on this one thing. And so we asked at the hospital if they were using a vest and they said, no, and, um, you know, my dad.

Sternum ended up coming apart. He had to have a second surgery because his sternum came apart because of the coughing that happens. Um, so my sister lives in Ireland and she happens to know, you know, she’s a hell, she’s a veterinarian and a surgeon herself. And so she ended up learning that she could get ahold of a, of a pro thorax best from one of her friends there.

Got it, brought it over when she came to help, you know, be part of the caregiving team. You know, my dad’s outcomes since having that best have just been completely different. So we asked, you know, Hey, if they’re doing this at Cleveland clinic in the United States, and you know, it looks like there are ongoing trials that are really proving that the evidence is clear.

Um, you know, that that health outcomes are a completely different story for people who have the best in all of the key indicators for a successful cabbage surgery. Every provider that we’ve talked to just said, oh yeah, that’s really neat. I wish they had those here, but they just shrugged their shoulders.

I can’t do that. I’m a DBH. My sister definitely. Wasn’t okay with that. Uh, you know, knowing that it’s something standard in her country. Um, and you know, my mom has primary care. Caregiver was going, wait a second. Um, we’ve worked our whole lives. We from Medicare eligible, why isn’t this happening for us? Um, and so, you know, that’s, that’s really just one of those ways that we as doctors, a behavioral health need to say, hold on, are you looking at this return on investment?

Because my dad had a readmission. He had to have a second surgery. He had to have a five day hospital stay. And then he had to have an extended 14 days, day in a cardiac rehab hospital following the second surgery. And they weren’t even going to let them do that. We had to basically push the issue with case management, because I said, there’s no way he can go home.

He can’t even get up and up and out of the bed by himself. So, these are just things that, you know, a DBH in a family. Can you get huge difference? Um, but you know, as far as the return on investment, It makes no sense to not have something as small as a little buckle best available for the number of surgeries, cabbage surgeries are.

Oh my goodness. There happened in a hundred. Some of the surgeons are doing, I don’t know, 10, 15 a day. Wow, just in our area. So first one, first and foremost, my sincere prayer to your family and, and, and all of that. That’s a, that’s a lot to manage, but a lot of your advocacy speaks to the leadership. Um, we’re able to, um, to exhibit when, when you have the information, um, some leaders become leaders by accident and others are leaders because they have information to be able to find answers or find things that are either outside of the box that aren’t being utilized.

And that kind of leadership quality only comes from consistent. Um, the research comes from being able to be conversing in. Different, uh, arenas like that medical literacy language, um, and being able to be interdisciplinary. And so, um, those skillsets are built and developed mostly when, uh, you take the time to, to, to nurse them in, uh, like a DVH is yes, you’re right.

You’re right. And you know, of course when it happens to you personally, it feels like a much fiercer. You know, way of, of, you know, having to advocate for your own personal family member or for yourself. But I immediately went to, what about every other patient on this floor? They don’t have a sister in Ireland that can bring this vest for them.

What are you doing for them? And so I don’t know if that’s the DVH in me or just the human service, you know, human service professional, and, you know, Counselor in me, but I, I didn’t sleep for a couple of nights just thinking about everybody else on the floor with my day. Who didn’t have that vest and whose outcomes were likely to be much poorer because of it.

And there were certainly people in that hospital, you know what my mom and my sister and I had to take turns because we’re still under COVID rules. And the hospital only allows two visitors per day, period. Not at a time per day. So, you know, my, my mom and my aunt and me walk in at 10 o’clock in the morning when visiting hours start.

That’s it for the day somebody dad had, you know, three, four or five different family members, jockeying for position to go in and, and, you know, help improve his mood and, you know, advocate for his needs. Whereas there were many other people on that floor who had no one with them. And we kept saying, my God.

What are their outcomes going to be? So you’re right. A hundred percent, you know, it’s definitely something that you can’t forgive once you begin, you know, studying as a DBH. Um, you know, but, but, but certainly I think it’s a, it’s a value that we need to be able to say, look, United States, we have this incredible way of advocating both for the patient and the family and for the return on investment.

So, you know, I just recall it at a, at a, um, At a speaking engagement, when nit coming said the affordable care act is supposed to make healthcare affordable, but it did nothing to control healthcare costs. It’s not looking at return on investment. It’s simply saying everybody should have healthcare, but it’s missing the boat entirely on saying we have to make sure that we’re mandating that the return on investment research be there.

Before we just send all of these people for tests and you know, where where’s the psychological and the, and the behavioral health and lifestyle management in the portable care act it’s missing. Wow. That’s a, that’s such a critical point. And you know, the more I hear about what Dr. Cummings is say, that makes me wish I met him more, but I.

Glad that I get to interact with, uh, Dr. Cummings, Dr. Janney Cummings, uh, because the message still gets to live on and I get to hear, uh, some of those significant statements like you just, you just made, um, because it, it is very critical that we as a DVH is, and really just help health care professionals are very conscious about, uh, what it means to be a part of this system, um, that we’re not just independent cogs in a wheel.

We are literally interdicted. Cogs that we, we, we require each other and this system can only improve if we have each other. Um, and I love the idea of being a disruptor because I think I’ve been a disruptor quiet one, my most of my life. Um, yeah, but it makes, it makes sense that uh, if one of the cogs are creating a problem, then yeah.

Then the, then whoever runs the system has to go to that cog and say, well, what’s the problem. And then we go, ah, let me tell you, this is how we see it. And this is what needs to be done. And if we’ve got that, um, uh, credential behind us, it really proves our voice to be, uh, significant and things change.

Right. I, I love everything about what you just said, Napoleon. I really do, because as I look at healthcare in general, what I see is that when there’s a problem in the system, it’s the meat counters who are being the problem solvers rather than the people who are in the trenches, delivering and working with patients each and every day.

And we’re looking at the clinical outcomes as well as the service delivery. You know, we’re looking at that assembly line on a day to day basis. So we’re most likely to see that cog that is malfunctioning somehow. And we’re most likely to be able to say, we think this is what it’s about, but instead being counters have been called.

To fix a problem that they don’t know anything about that assembly line, nor the products that are on the assembly line going forth, they just know about counting money and that’s a huge, huge issue we have to resolve. And so I really appreciate the work that you’ve done because I think, you know, just in protecting the ability to continue to.

Practice and deliver services. And in Michigan, you said, we’re not going to allow this to, you know, be left in the hands of people who don’t, what they’re talking about. My mom told me when I left the house, she said, well, go do something. And so I did. Good for you. I love that and go do something. So I did have that.

You’ve quoted your mom several times. You better call her after we talk today, I will. I will. I texted her this, I texted her early this morning and told her, her girls miss her she’s out vacation and enjoying enjoying life. Yeah. And she’s, uh, she’s, she’s loved, she’s loving it. And so, uh, I’ve had to tell her her, her girls are missing her.

Her girls are missing her. Well, now you can text or not to, you know, make her answer a phone call on her vacation, but just to say, Hey mom, I cited you three times. The podcast moms need to know that stuff. I’m a mother. If my son cited me, I would be so proud. Well, my, my mom, she goes, cause I, I it’s all the time I, I come from, I come from a single parent family.

Uh, and so, um, she literally, she had all these idioms and these quotes and these statements that were. That kind of served as, uh, you know, w w when those statements that come from a dad that say, father know best, she had those statements and those kinds of suffice, if you will. I mean, I know a whole lot of therapy helped, but, um, literally those statements were like those, those key things.

And so I held on to them and they were, um, they like, they were great. And so anyway, um, she, she, she, every time I’m doing something she’s like, well, did you tell me that you didn’t know. Yes, ma’am, I’m here. I’ll send you the link and, you know, on your smartphone.

I love that. I really do. And I, you know, I think it’s important. You, you mentioned right off the bat, you know, that, um, that you did not achieve this alone, that you know, that the investment in people, you know, um, helped you get to where. You are, and also helped you achieve and accomplish, you know, the, the awards that you’ve won.

And I truly feel that that is something that we all need to have that ability to say, look, you know, we, we are the products of what’s been invested in us and, and that too is important, you know? So going back to the idea of having that strong professional organization, You know, that just means that we can even, you know, we have more resources to invest in young professionals because we need upcoming professionals to know what we know and, you know, we need to be able to share our experiences and, and success formula, you know, with them.

And, and truthfully beside everybody who does something great, is somebody who gave them the space to do that great thing. And, um, my wife was, uh, I’d be remiss to even mention the fact that she was pregnant with twins, um, during that time where I had to shuttle back and forth to Lansing. And, um, and those were some really long days and some difficult times, and I don’t know how the ladies just made it.

I mean just marshmallow, but she’s made a steel in her spine and she, yeah. And she was able to able to do it and then deliver. And there’s another story that goes along with that. Um, but she, uh, she’s done a remarkable, a remarkable job. And so I appreciate everything that she’s allowed me to do. And it’s been a, it’s been a fantastic ride.

Well, I love hearing that because, you know, we’re only as strong as our, as our family, you know, the structure of our home has to be solid so that we can grow, you know, deep roots in the earth and, um, reach high with our branches and leaves. So, you know, I think I mentioned at the beginning that my husband does the editing and production of our podcast.

He’s, he’s an incredible video producer here in Phoenix. And, he does a lot of work for us at no cost. He donates a lot of it. And when I started my DBH, we had a five or six year old, and he said, It’s fine. You go, we actually had a really small little two bedroom condo, and we set up an office in the garage.

He said, he’d go in the garage, close the door, I’ll bring you some dinner, you know? And when it’s time for the first sunny boy to go to bed, you’ll come in, you’ll do the reading books and everything and go to bed and then right back at it. And you know, that’s how we got through those years. And I always say to him, if I hadn’t had you, I definitely would not have been able to do this.

As you know, I wouldn’t have been able to do it as a single mom for sure. Or it would have been. A thousand times harder. So you’re right. Absolutely. We need to have strong, good, huge high quality relationships. And that is, you know, a 50 50 thing for sure. Absolutely. And Michigan doesn’t have those kinds of garages, but we got basements.

So that, that works. Why do I miss my business? There are very few houses out here that have a basement, but yeah, the Arizona community uses their garage. The Midwest uses their basements for sure though. Yes, no kidding. Oh my gosh. My parents never had, um, the need for central AC in the summer because the basement was always so cold, but in the winter until that day, that was where our woodstove was.

So you got that wood stove cook it and the rest of the house was fine. All right, Napoleon. Well, listen, thank you so much for your time. This has been a great conversation. I’d love to follow up with you, you know, as you continue to serve and professional organization. And certainly as we, you know, explore different, professional organization options as DBH is, I think it will be an ongoing conversation.

So thank you so much for your leadership and advocacy. Awesome. Thank you very much. I, I loved the conversation and I can’t wait to be a disruptor even more. You’re already there, buddy. Keep doing it and do it more. All right, well, we’ll talk again soon. All right.

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