Episode 76
Behind the Care: Bettering Behavioral Health Treatment

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Description

In this Behind the Care episode, we have a unique guest, Jonathan De Carlo, the CEO of C4 Consulting, who discusses specific challenges behavioral health companies face. We dive into how C4 dedicates its practice to growing and sustaining organizations that work in behavioral health management, addiction, and mental health treatment to provide quality care to the people providers serve.

Talking Points

1. What does C4 Consulting do?
   
2. What Jonathan sees changing within the behavioral health industry
   
3. What is missing in the behavioral health industry?
   
4. Finding the right resource for you or your loved one
   
5. Walls treatment centers hit with insurance companies
   
6. The challenges that come with being OON (out-of-network)
   
7. Community and family
   
8. Being active and aware of your local government
   
9. Staffing priorities
   

Quotes

”There is alot of room for growth in providing quality information and educating consumers and the public on how to find the right treatment resources. Teaching consumers, people making investments in their own well-being, or their family members well being, and providers being able to share the right information with transparency and authenticity, not just marketing, not just saying we do all things, but really being able to say here’s what we do well and here’s how we are a good fit. So I think the education of access to care, there certainly needs to be grown.”

– Jonathan De Carlo, the CEO of C4 Consulting

Episode Transcripts

Episode 76 Transcripts

welcome back to another episode of Finding Peaks sometimes I forget how to do these episodes but that’s the intro for you the crew out there listening watching excited with your popcorn ready I hope so cause we got a great episode today Brandon Burns chief executive officer for Peaks recovery centers joined by co-host Jason friezma LPC Lac Chief clinical officer at Peaks recovery centers all things clinical just in case we got to break out the tissues and dive into some CBT or something I don’t even see the tissue anywhere you all seen him do his work on this show it happens we’re live and joined today uh with uh Jonathan DeCarlo CEO of C4 Consulting and we’re going to dive into his work through C4 Consulting and all of the Consulting that you do in the behavioral health industry in that regard so Jonathan thank you so much for being down here and hanging out with us today thank you Brandon and Jason for for having us and inviting me down and the opportunity to to continue our suburb of the legacy of dialogue on improving Behavioral Health yes love it that’s what we do at all the conferences for the viewers out there I chase Jonathan DeCarlo down when I see him I’m like I gotta get in that guy’s brain also master’s degree in philosophy or philosophy of some sort of background in philosophy background in philosophy that’s why we’re so good at communicating with each other um for another episode though uh today in regards to C4 Consulting uh what is it for the viewers out there namely speaking to the industry uh insiders out there in the crew um what are you guys doing and what are you committed to as a project so C4 Consulting is a behavioral health consulting firm so we are the providers provider one of our clients calls us the behavioral health Geek Squad so we solve challenges and help create and Implement solutions for treatment providers in Behavioral Health substance use Mental Health the ABA space foster care Integrative Medicine you know the widest sense of Behavioral Health we are a division of C4 recovery Foundation which is a non-profit organization that’s been around for over 38 years invested in policy and advocacy access to care quality standards of treatment you know so our role in service to organizations is really helping organizations such as Peaks and others improve their processes their system their services whether that’s strategy growth you know financial performance program expansion clinical enhancement technical assistance training um really Soup To Nuts that everything that a provider really needs and whether that’s an individual and you know Private Practice all the way up to you know large Hospital Systems multi-state consortiums we’re an international consultancy with 30 Consultants coast to coast and one in Europe and and clients abroad uh you know really honored to partner with the folks that we get to serve and we take pride in our ability to be able to be a high integrity service provider in the Consulting world love it uh for the viewers out there of course Jason you know if you Jonathan if you’ve watched any of these episodes I always point at Behavioral Health companies websites because we’re about Hope and uh alleviating the symptomology and the depression and the Dual diagnosis and all those things our websites say we are so good at those things yet we have Consulting in our industry so it can’t be all those things and we’re not going to point in any websites or companies today or anything like that but I think a good thing to to kind of Showcase from there is uh you know in all of the experiences that you have what do you see working well within our industry you know at this time uh I know it’s a big question but you know we’ll start big and then we’ll we’ll shoot other questions through there it is I think really one of the biggest things that’s happening especially in the last I would say 12 to 24 months really has been an awareness of the need for treatment resources I think more time effort and energy both within our space and in the public Consciousness has been raised about the need and impact of Behavioral Health in communities and so I think our industry is doing well and being able to start to answer the call of community need some people May challenge that and say well it’s just a cash grab and people are just out there to make money on the suffering of others but that’s not really why people get into this industry by and large you know there are certainly corporations that see the economic advantage of public awareness being raised you know in this process but when we look at things like the opiate pandemic prior to the covid-19 pandemic and the rising need of Behavioral Health broadly both in substance use and mental health in the United States and around the world you know I think that’s something that we’re doing well is being able to be present and adaptively respond to the needs of our communities providers are really challenging themselves to diversify their services in ways that meet Community needs sometimes incredibly ethically and sometimes not so much you know they’re not so much part certainly is the downside but I think that’s one thing that our industry does well is to say we’re here and we’re present and although that may be challenging for some in a community I do think the industry is doing well in trying to improve access to care there’s a huge Runway to that of improving that but things like the mental health parity Act uh you know our starting point of you know providing resources for people to receive treatment and providers to be able to begin to have a dialogue about what is Equitable and Equitable and fair reimbursement look like and I think those things are you know on their way long way from from True equity which will come in in a later question but I think I think you know the public awareness and the ability to be present in communities is something that our Industries really improving and doing well with wonderful and then yeah as I alluded to from our our hopeful websites you know that we don’t convey on the front end of a treatment episode it’s you know what do you see as the kind of the backdrop and all the organizations that you maybe the organizations that you’ve worked with or not necessarily the organizations in particular but just at the national level you know what are we still missing or what are you seeing as kind of the the big lacunas in our industry in that regard I think quality information and educating consumers and the public on how to find the right treatment resources I think there’s a lot of room for growth with that of you know teaching consumers you know people making investments in their their own well-being or their family members well-being um and providers being able to share the right information with transparency and authenticity not just marketing not just saying we do all things but really being able to say here’s what we do well and here’s how we’re we’re a good fit so I think that education of access to care while access you know there certainly needs to be more effort grown in it I think the the education of people understanding how to pursue treatment and I have a great example of it I am a person in long-term recovery myself and I had a friend of mine in my recovery Community Reach Out looking for a resource in Southern California where he used to live and he was looking for a particular 12-step based resource and was just trying to get a hold of the local uh you know 12-step group to connect someone to and what he kept finding when he Googled was rehab.com and all these numbers and he thought he was calling the local 12-step community outreach line and they kept trying to sell him treatment and so he reached out to me and said how do I find the local you know 12-step group and I said oh Orange County California yeah go to the National website yeah and then drill down into the state and you’ll find and and he did and if he said why was this so hard I’m like because there’s competition to try and advertise for access to care so I think educating consumers on what the resources are on the transparency you know is something that both providers and communities need to work work on together you know starting with local local consortiums and platforms and groups and then building out from the local into the regional into the national yeah what do you recommend if you don’t mind me asking what do you what do you recommend for a consumer because this is a big hot button for me too like a family member is in distress I found a powder in my son’s room or whatever and I need a resource now and then you get on Google and differentiating between all these beautifully shiny websites of what to do how what do you recommend to people like that to families I think one of the resources that comes up and it may sound like a strange one but it’s called your health insurance provider and find out who their and network contracts and and have relationships with because that process requires a vetting of providers right so going to those types of actions of go to the resources you have and start there going to your Primary Care Health Physician and saying who are The Trusted sources in your community your family health practitioner you know your doctor who takes care of you and your has taken care of your children for years probably knows someone in the community that he trusts and even though he may not be able to recommend you directly to a treatment center he’s going to recommend it to someone or at least call someone that he knows that’s a trusted verify Source that’s then going to have an authentic referral that’s been vetted at some level and bringing much closer much faster to someone in your community that you know has that relationship with the right information I actually got a call from a friend of mine last night about something very similar with a family member saying hey you’re the person I know and I know you know you’re you’re in Consulting and I know you know the whole network of of alcoholism treatment providers here in Denver my friend lives in this part of town as his brother’s really concerned family needs to do something which at least talk to them you know and and that’s how it happened was he reached out to me knowing that I was a trusted resource with information so I think for a family member Google’s not a bad thing but you got to get past and realize that the first four or five lines on Google are the paid ads and then start looking at the actual treatment websites that are beneath that but go to the resources that you have yeah because your your health insurance provider um is going to have resources and they’re going to have numbers and they’re going to have advocates uh you know in their uh part that are just there to help you navigate some of those resources but family practitioners you know Medical Care local Community Resources people may find this absurd and strange but anybody who’s finding a powder in their son or daughter’s bedroom is probably had a run-in with the local authorities calling you know your your local law enforcement for resources another one because chances are they’ve worked with the local providers in some capacity to be able to know them so finding the trusted authentic sources I think is incredibly important Google gets you lost uh and it’s you know it takes skill even as a provider to know what you’re looking at uh you know when we’re looking at resources and that’s you know it’s a different uh episode I think for that one yeah in its entirety and I know you guys have covered that before but that’s you know I think starting with those yeah those resources in your life and chances are most people know someone um who’s had a mental health or a substance use Challenge and has turned their life around call them yeah yeah I like that yeah I appreciate the question I appreciate the insights and I think that’s one of the things that we’ve worked uh I want to say tirelessly it’s a big word but it’s Thursday end of the week I’m gonna use the word tirelessly on in this episode to give family systems the edge education and information they need so whether it’s an ad or a rehabs.com or whatever the link is they’re clicking on or the number they’re calling at the end of the day to empower family systems with just good questions to ask treatment centers right because you know admissions teams are generally more hungry to fill a treatment center than they are hungry to you know educate about is it around what is a best fit for the operation in that regard and empowering family systems with questions or family systems with questions they can ask providers or treatment centers around that to better negotiate whether this is going to be a good fit for not only their loved one but you know from a from an economic situation as well too whether it’s in network out of network Medicaid resources and so forth so the the you know as an out of network provider um not gonna be able to call Blue Cross Blue Shield and flying Peaks recovery centers but with that uh it’s it’s a it’s a hot button for me because uh in that way of things I agree with in network Contracting it provides greater access it lowers the cost uh uh for treatment episodes four family systems and so forth but one of the things we find ourselves kind of caught in a rut with right now and I think this goes back to you know taxable dollars and these things that we’ve talked about in the past Jonathan but I think it’d be helpful for viewers just to kind of hearing understand some of these frustrations and kind of walls that centers hits so for example Peaks recovery centers has tried to go in network but we get hit with you know uh quotes of well this is what the market will bear what they’re stating out of that I believe is and certainly correct me if I’m wrong is like okay well if you’re just going to deliver this service and you’re not gonna you know prioritize evidence-based practices or whatever then our fee for service contract looks like this but we also have this value-based approach thing over here that’s happening at the same time and I was just curious before we kind of dive you know kind of deeper into this rabbit hole about this when I think about value-based approaches to care the thing that I’m running as I try to tell the insurance company no more valuable here’s all the things we’re doing here’s our outcome data all that sort of stuff and it seems like they’re not really equipped in the background at least at this moment to you know they’re not building the systems and a they say a and then B they seem uh as if they are a little disinterested in the value proposition I’m trying to bring in at the same time and I know you’ve worked in you know Contracting uh across several you know payers and you know businesses within our industry so I’m just curious if you can uh help support the viewers out there kind of this this thing that I bring up lightly on finding Peaks from time to time but to talk more about kind of the pains within that and then what those Solutions are are not only for family systems but you know for our industry and individuals trying to go in network because the fee for service you know fee that’s lobbed over the fence in the first regard to me I’ve often talked about it isn’t sustainable I think from an industry standpoint Staffing and so forth so uh insights I know you can deal with my intangents I’m sure you heard like five questions in there but I he’ll run with it folks I’ll pick up on the on the broad strokes and run forward yeah so I think one of the great challenges for everyone involved in a care Healthcare ecosystem specifically in Behavioral Health Care uh is understanding how reimbursements actually work right so they’re the insurance company’s job is to spend as little money as necessary to provide the accessible benefit for their member they have not only goals but mandates to keep spend parameters for Health Care within a certain tolerance very complex algorithms and Actuarial tables and all this economic and and math that would drive most people insane but some really love that stuff and it’s extremely complex but it’s ultimately challenging to Value the care for a life when it comes to behavioral health care in particular larger Health Care has worked progressively and you mentioned a brand in values-based programming so what are often referred to in healthcare as accountable care organizations or acos so for certain conditions there’s a predictive set of things that you do you know roughly what it’s going to cost to treat someone with a broken leg you know how much the the initial Physician’s assessment is going to be how much time the nurse is going to need to spend you know examining it forming the cast taking the x-rays and you’re able to calculate a cost for a Continuum of treatment because it’s relatively predictive things like diabetes management uh things like cardiac conditions uh you know the the procedures for those diagnoses uh can be calculated roughly within a predictive tolerance of of what that costs to produce and what’s fair for a provider to be able to do that and Behavioral Health Care it’s much more complex because we’re asking you to as a provider to take care of the entirety of someone’s life Health medical social Financial uh you know domestic and no one individual has the same set of symptoms the same set of parameters so our industry is challenged on on both the payer and the provider side with Diagnostics that can adequately be tracked uh to say this is how much time you should spend dealing with that feeling of that traumatic wound that you experienced as a child when your parents got divorced and your dad then moved to Kuala Lumpur to be a CFO for uh you know whatever gaming company farmed him out like the reality of these things and you grow up uh you know with these challenges and these these uh you know different traumatic events and adverse childhood experiences compile to produce substance use disorder uh you know in your life which then becomes a primary life-threatening condition right right all of these things are part of the work that we do in Behavioral Health so there’s a tremendous challenge both to say to a pair this is how much time we need to accurately and and precisely assess someone to understand their needs to respond to the treatment again in other health care settings you know you know that it’s going to take six to eight weeks for that bone to heal or you know 12 months for you to lose that weight to then qualify for the diabetes Management program you know whatever those things are that are that are correlative the health care industry and the payer side of things specifically with commercial you know sources but even Public Health funded sources like Medicare Medicaid are challenged on on the values based side to create opportunities to say we’re going to reward based on performance of a combination of things and share the responsibility which in the payer world is called risk management right but the responsibility to each other as the provider and the payer and the service to the plan member the person receiving care of here’s what we’re going to do and here’s how we’re going to calculate this that’s fair for you as a person running a business paying people to provide this service to this individual and their family as well as acknowledge you know that there needs to be some margin of flexibility because not everything works the same way for end every individual highly individualized care produces the best long-term outcomes um lots of studies continue to prove that to your point the uh the systems of the payers are largely not equipped particularly in Behavioral Health to manage the Contracting that providers like yourselves are willing to put together to say we will do lots of different things to share that responsibility that risk right in order to invest in our clients care because we’ve spent time designing a treatment program that is a highly complex flexible and and a combination of evidence-based practices and practice-based experience uh we know that these things work and are impactful but have built enough room for them to be flexible to meet each person’s needs to the best of our ability as they respond to the care and that we’re willing to invest and we we feel confident enough in our service that we can even you know some might call it a warranty we can say that yes we’re we’re going to invest and say if a person needs to to come back in after in a you know a time to discharge and they’re struggling that we’re going to eat that cost as a part of this fee right this becomes the value-based proposal right of sharing risk but really responsibility as well as other metrics that are organizational Health metrics that are based on actual measurable outcomes of how treatment is measured and the changes that a person is responding to to show and prove to the payer that this is working and is effective for this individual and really outline that so in the broader Health Care System there are lots of these systems that are already set up and going for these conditions but the diagnostics for for Behavioral Healthcare are really challenging to do that with it doesn’t mean it’s impossible because there are people doing it in the country Medicaid as a mandate to increase the number of percentage of values based Contracting that they provide in their communities uh progressively over the next really 15 years but there’s another Milestone coming up at 2025 there’s a milestone to 2035 is that more than 30 percent of Medicaid contracts for federal where federal dollars are invested and spent need to be values based Contracting so the challenge you know for the payers is they’re not set up to do it because their systems are set up to spend as little as possible not to share risk they don’t know how to do the contract they don’t know how even when they design them together with providers and they say yes we’re willing to do that the actual reimbursement departments their systems aren’t set up to measure these outcomes so we have to teach the providers and we have to teach the payers how to do this together and there are lots of wonderful systems there’s you know groups in Pennsylvania and throughout the Northeast groups in California doing this work one of our board members uh Jan Pringle at the C4 recovery Foundation has built an amazing system that’s been impacting counties in Pennsylvania the saving what might some might believe is unbelievable amounts of money by doing these values-based systems that teach providers and payers how to provide better treatment and better management of the process together in a way that’s collaborative and so I think the challenge is when people look at like the fee for service model and say well you should be able to produce it for this amount of money and that’s just not real right you know the cost of production it’s not even about margin on top of that it’s just about operating expenses right of Behavioral Health Care people and this brings up a Workforce challenge that will you know we’ll probably talk about so I’ll ask you to parking lot that one for a moment but the the reality is that you know paying people adequately requires a business to have good health care good compensation to to recruit highly trained highly talented highly experienced people and that doesn’t come without an expense right let alone you know not just the human resources and the facilitation but the cost of advertising the costs of providing care of the flexibility that’s needed to be able to manage the number of hours so you know it’s a challenge rules providers and payers but the payers in particular want to believe that if you can fix costs you can fix outcome that’s not really true if you fix costs too low the quality of your outcomes is capitated by what you’re able to spend to produce it and the annual contract negotiations for a network provider typically are three to five percent it’s just inflation plus one right and if you fight real hard as a well-designed payer which we do a lot of this in collaboration with our clients of helping them renegotiate or even just get credentialed in the first place for manageable rates that are actually acceptable that they can work with but for some groups we say stay out of network because you don’t want to compromise the quality of your care you’re spending a certain amount to produce it and your outcomes are really impactful well that comes at a price right and someone has to pay it you know yeah what uh what would you say to the to the family systems that might engage with you know a company like peaks of course at Peaks we believe in each and every moment we’re Staffing we’re doing the appropriate things but I think one of the challenges as out of network providers is we are legitimately trying to use the resources that we have the income that we have to provide efficacious to care to feed the system the staff the salaries inflationary periods and so forth and it does as you’re saying come at a high cost but I think one of the major struggles of our industry especially against the backdrop of healthy and network providers is this out of number providers can get paid this much but if they don’t insert any sort of those assets they’re pulling on the systems and so what would you say about that as an issue in our industry or add to that or well I would say for family members in particular understanding the quality of care and and looking at resources like I suggested initially in that phone call is the starting point but don’t just settle for the end Network contract look at the provider and make sure they can meet your family members needs and you know I mean the cost of treatment you know the outer Network deductible amount uh honestly for for many treatment centers and this will be regionally driven um is one-fifth the cost of a funeral and I’m not trying to be dramatic but it’s usually around five to six thousand dollars of initial out-of-pocket expense for the deductible to be met that’s an investment and can be recouped it is something that you know when you work with a a well-trained providers such as Peaks that will support you getting the out-of-network reimbursement become educated about what that process is because the value often for the right provider who’s not a network that is out of network the experience of the Care Quality is dramatically higher and so working with a provider who knows how to support you as a family member because you as the family member the plan member of the holder of the policy are always going to get better response from the payer and so being able to collaborate with your provider on how do I do that and oftentimes what we find and there are companies that do what’s called patient or client advocacy with billing to help them get the reimbursement for that is that that money is an investment and it’s just like investing in college or education or Workforce training but the truth is I go back to that example of it’s you know generally a fifth the cost of a funeral a funeral these days with a headstone and a casket and all that’s 25 to 35 thousand dollars
to invest in your family members Health Care by spending a few thousand dollars to make sure they get the best care possible within your resources is the smartest thing you can do and so to work with that provider and say how do you help me if I choose you because you’re not in network and you’re out of network how can you help me make sure that we get the best value from the insurance company so ask the provider the questions what does that mean how do you assist what does billing look like what are my responsibilities what are your responsibilities and being really clear and and you know groups like Peaks and others uh you know who are high integrity authentic service providers will be easily be able to in a mouse click send you the information if they haven’t already in the process while you’re exploring treatment as a resource and be able to walk you through exactly what that is what the documentation looks like how you collaborate together to provide the best care for your family member hopefully that answers your question it does I love it that’s exactly what I was looking for I I think that just acknowledging all the different resources that exist out there and again educating the consumer on uh their opportunity within this to just ask thoughtful questions to reach out to resources that are right there in their wallet and to you know build up a platform this and I think and you know at the end of the day it’s challenging because you know out-of-pocket costs even in network you know depending on where the the the contract came from or the policy came from can be expensive in that regard but I think what we’re thinking about here is an investment and to the you know the language around the opioid pandemic if we’re gonna you know that is literally Taking Lives and we you’ve shared this now the cost value proposition of what that would look like to entertain that versus the investment being you know 20 of the cost versus an outcome like that right yeah I mean it’s just the reality I mean by the time people are experiencing substance use misuse and get to a level of diagnostic will abuse and and dependence people have already spent three or four times that on legal fees and you know other measures that aren’t treatment oriented to try and help produce change in someone’s life and so not to say that treatment is the answer but for those who qualify and meet that criteria that investment and a wise investment in the right level of care at the right time in a Continuum that really helps someone develop the stabilization they need to address the acute symptoms that they’re experiencing all the way into their long-term reintegration into a sustainable happy life in a community is the investment the people are looking for but to Jason’s point when a family member is calling they’re in one of the most distressed periods other than when their son or daughter was supposed to be home at 10 o’clock and it’s 11 30 and they’re waiting for the call yeah that says they’re in the hospital they’re in the morgue this is you know the Colorado Springs Sheriff’s Department right you know this is Bobby your friend was supposed to your son’s friend who was here but they ran out last night and I don’t know where you know that that call that every parent fears of surviving their children the reality is that this is an investment yeah you know and it’s an investment that pays off but to that point of it’s a Continuum of Care you know it’s not one and done it’s about evolving needs and evolving recovery yep I think another complicating factor that I’d like to throw in there is that we one of our core values is certainly helping families along the way too and um and we provide Direct Services to families we offer them support groups and and access to clinicians and that doesn’t really fit into good Medical Care boxes like if you break your leg you don’t provide treatment to the mom who is distraught by it like us but but we do because it we look at addiction and mental health as a family issue to address and if if the family isn’t helped like we can treat an individual as well as we can and then send them back to the same environment and that won’t work uh no matter how long or how good of work we do oh absolutely I mean it’s really and I’ll broaden it and say the family is is the core level of community but it’s really the entire Community because no one exists and lives in a vacuum and the impacts of someone’s substance use uh journey to to abuse Independence impacts the community as well it doesn’t happen in isolation uh you know no one wakes up after you know 50 years of shooting heroin in a closet that’s never affected anyone there’s lives connected to lives and so I think the the there are two parts of that I’d like to respond to one the payers need to do better in being able to reimburse for Family Services independent of the primary members treatment experiences and that is getting better but it’s a long ways away from being sustainable and organizations such as Peaks do invest in that and that’s how they invest in communities by offering you know free levels of service that are just Community integration and collaboration Partnerships and so I think to the to the bigger part of community it’s really all the resources in the community understanding each other and understanding what’s available and being able to solve the challenge that each Community is experiencing simultaneously as a family member you know getting involved in in the process of your own healing and defining your own recovery I’ll Define recovery the way that we do at C4 consulting which I’ve shared with Brandon Through The Years so our definition of recovery is the restoration of one’s Humanity so it’s not about Diagnostics it’s not about modality it’s about whatever’s impacted your life to be your highest wisest best most authentic connected self that’s your recovery so for a family member it’s not the substance use issue it’s the living with the stress of of loving someone who’s struggling you know would someone would say Financial spending issues or process addiction it’s the loved ones around all of those things right the family members have their own acute and post-traumatic stress with those events that phone call is life-threatening to a parent to a sibling to a family member right that is the definition of part of the diagnostics for you know traumatic stress you know life-threatening repetitive conditions you know these things don’t happen in isolation so really being able to look at this collaboratively as a community um and and being able to do two things one to really look at your community and how it spends its tax dollars because the circles back to the conversation right Insurance commercial insurance base rates are based on whatever the Medicaid rates are for your locality as a minimum a lot of Contracting is done initial those those lobbed rates that providers get initially are usually 30 to 40 percent above whatever the base Medicaid rate is in your ZIP code right which generally isn’t enough um to entice enough providers to do Medicaid alone let alone highly complex services that include serving families with a portion of the margin that’s reinvested in the community right so getting involved and Brandon knew this was going to happen getting involved on that level locally of of where your tax dollar is being invested and advocating for that and also advocating to the payer you know your your commercial insurance whether you’re going in network or out to say what’s available to me as a family member and taking advantage of every inch of that because there are services that are available reaching out to the community and educating yourself about who are the resources even if you’re not experiencing it or a family member isn’t experiencing that just understanding what your resources and how do I get involved how do I support my community in its health because no Community is without impact of Behavioral Health need it absolutely you know I always love talking with you because I have thought bubble questions and you just answer them in real time and I think you know the the takeaway for me and the family systems out there is it’s these decisions aren’t as simple as Medicaid and network out of network make a choice right it’s a very complex system that we’re engaged with not only as providers but it’s a complex system that the family you know through better questions and uh insights and knowing the community and the resources around them can be best supported when these trials and tribulations reach those family systems uh in that regard so you know reaching out uh and uh you know asking those good questions is imperative understanding the complexities of the systems as well too I think helps inform good care in what you’re looking for and at the same time you know when you talk about those Medicaid systems and what’s holding up the network Contracting the tax dollars matter you know and as a country it matters where we put those dollars and you know historically to lightly bring up the drug we’ve put it into police and you know probation and the systems and jails and prisons and so forth and uh have left little consideration for this other side of impact around assessments and these types of things that might um you know bring about greater healing not just for the individual but for communities in general and so our ability as family systems to support in network Contracting probably it’s not unreasonably low it’s probably lower than our ability as political Advocates to get out there in the community and say we demand these Services be present for my loved one or just in general for my community absolutely I think if people are able to on the most local level and again not just State your community your town your municipality to understand what are the resources that are publicly funded and how do those get decisions those decisions really get made because your votes in those cast ballots at various times through the years and through the the political Cycles have tremendous impact and if you ignore those and many people do they just focus on the ones that hit their wallet and their pocketbook or their political interests and then they skip by the rest of them and say somebody else will take care of that and and that is to me quite frankly irresponsible in that citizenship but that’s again another podcast which is something you know reintegration recoveries about citizenship but to the to the point of it really is about being active and aware and and taking the time to read those booklets I know I got mine in the mail for Colorado recently and line by line reading those those uh you know those different propositions proposition 122 I believe is one we were talking about not that long ago right things that are really important because that’s how it gets made but also understanding you’re paying these taxes and where do you want these dollars to go so talking with your community leadership groups talking with your action you know your local action committees uh you know whether it’s a municipality a town or a city or a county and an understanding because that’s where those decisions are going to get made there’s always public opinion referendum opportunity at every point and so becoming an active participant that is how you change the health of your community to say where are these are these tax dollars really being spent well in behavioral health or they just you know flowing and I have no idea where because you as a citizen as a taxpayer actually have a right to know and they do what they can in the bureaucratic systems to educate you but educated providers know that and so oftentimes call your your local Peaks call Brandon yeah because he will know the answer he’ll say actually here’s the person you want to call all you know here in Colorado Springs here’s the person you know that I know as a contact in Denver here’s the person I know in California that I I collaborate with as a provider Network that’s involved in this because you know we as providers interact with those parts of the community Through offices of Behavioral Health and City Zoning commissions and you know we build those relationships because that’s how we’re good providers but as as you know citizens in our communities and active community members public health is not someone else’s responsibility takes all of us and so being educated being invested and making a choice and not waiting until you have a need but recognizing that the needs already impacting your community yeah today and saying where do I want that to go I don’t want yes I want more safety officers in my community but I want those safety officers to be trained on deflection right to be able to have Behavioral Health assessment capacity or resources so yep I’m all about that tax dollar going to local law enforcement but I want some of that tax dollar to actually be used for training for for law enforcement to collaborate with treatment providers you know there are groups like the police treatment and Community collaborative that focus on deflection rather than diversion programming which involves connecting directly to providers so rather than arresting someone it’s actually assessing and calling a behavioral health provider in the community to say I think they actually need assessment and treatment first we’ll get to the legal impact where it makes sense but like let’s get them help now because this is where this is coming from it’s coming from a behavioral health need right and there are not just movements but there are large tax dollars being deployed for that at the federal level to to resolve some of those huge challenges the recognition of the you know billions of dollars that were wasted on the War on Drugs yeah that didn’t provide safety for a community that didn’t do anything to impact change in a community and and didn’t really produce any you know better Wellness in the community fundamentally yeah absolutely love that um always well stated I you know for the sake of time I think I want to uh just do a not a slight left here but I think you know kind of recapitulating kind of how we’ve gotten you know to this moment is that you know just understanding the the systems that are you know associated with all of these Services how they impact the services where the resources are coming from what is what we are capable of as an organization outside of those uh resources um and then I think from there a big component of this and why we’re advocating for taxpayer dollars in any direction is the community you know here at Peaks right Jason we only have so much opportunities we only have so much we can give to the family systems the individuals and so forth the community has incredible resources and if those are intact and true for the individual and then we have a place to send those individuals to Greater support to the family systems and so Port uh healing um is much more likely as an outcome in that regard or at least much more supportive of the services we’re running in the absence of those communal Services where World continues to be scary and frustrating for the individual families communities and so forth you know the outcomes are going to drop you know in that regard respectively so appreciate how just you know how we’ve gotten here and where we’ve come from and with that I think you know one of the things that I would love to talk about without talking through all of the issues maybe you experienced you know when a company calls you for Consulting Services I think one of the ones we’ve talked about is Staffing priorities and how to do that well because even if I have the resources to pay you know our staff really well and provide benefits and all of those things that are nurturing at the end of the day um if I just Brute Force say work harder you know in that regard it’s going to come at a cost and I imagine that you know allocating those resources and really understanding how to manage teams and systems is a big part of the Consulting gig and just uh hopeful for the viewers out there that we can kind of walk through that together and what that looks like within your Consulting operations absolutely a lot of the work of our engagements involves helping operations refine where they’re deploying their resources to best serve the people serving the people we all know in the provider world and some families know this that the number one thing that happens it’s people serving people it’s called Human Service for a reason right right and I’d say that not globally but to really out of tremendous humility and respect that it’s people treating people and that for an operator that their biggest expense is staff and treating them on making sure that the staff is is you know not just well trained but maintains competence and grows skill level and and continues to evolve and grow their ability to be healthy to meet the needs of the people they serve the healthier the organization’s staff the higher quality services are possible for an organization and so the investment of any wise organization is their staff um the challenges with that is it’s not very attractive when the pay rates are significantly lower in Behavioral Health across the board compared to other Healthcare Enterprises and other jobs you know when it pays as much to be a manager at McDonald’s as it does uh you know when it really pays three times as much to manage a McDonald’s drive-through as it does to to be a front line technician on a second shift at a treatment center that’s sad when you can get better benefits because Workforce is so challenged working at Starbucks um and not have to deal with as much stress so but you’re still dealing with the public right and some probably people who need treatment as your consumers the reality is that that’s really challenging to recruit highly trained staff so our education systems have been challenged for years to make it attractive to become trained to become not just clinicians because that’s the the glory I want to be the therapist the Healer but every level of Behavioral Health or different Workforce Pathways and so being able to think of it as human capital investment in human Capital Management uh you know is the modern day for human resources and really being able to see the people as the primary value of Service delivery the challenge is when rates are low businesses can’t afford to pay Beyond a certain point so it becomes harder to attract and retain people let alone this work does come with a compassion cost you know compassion fatigue empathy fatigue lead to burnout and and every job class has their capacity for that in different types but the helping profession of helping people who were under duress and sick who are challenged who are behaviorally outwardly struggling and asking for help by acting out as their primary mechanism does come at an investment so developing Workforce is a tremendous need and there is a humongous Workforce challenge that’s been building for decades and this stems back to prior to Managed Care organizations coming together and trying fixing costs and Behavioral Health Care it really stems back to the early 80s really the 70s at some level with that where the bar has been set incredibly low and it’s harder for employers to push that bar up to be able to adequately compensate people to invest in their staff health and to do the best that they can to to address the workforce challenge when people can you know really get to a place in their pathway of again making more managing a warehouse than they can working in a treatment center serving someone in their community and as a participant program it’s really sad and extremely challenging so being able to have more dollars available invested in Education and Training outside of the treatment centers you know for highly trained staff to be available as one one part so those efforts uh you know by decision makers at different levels federal state local uh you know about you know tuition remission and reimbursement are really important because it does allow people to then you know save money and keep growing individually but for the workforce challenge really encouraging people to look at the helping professions and and to look at them honestly and not to to make them more attractive requires again pushing back on your tax dollars and where they’re spent pushing back on the payers to say well how are we supposed to provide highly you know highly reimbursable care when you won’t negotiate values based rates for us to be able to produce quality outcomes at increasing levels over time they’re all interconnected so again to your to your point in question the workforce challenges are real and and very difficult so those of you who have an interest in Behavioral Health call your local treatment provider and say are there opportunities for me to volunteer to find out if I might like to do this because most organizations have some volunteer capacity and you can get exposed and see is this something that I actually would enjoy because the compassion satisfaction is the part we also measure in our work of being able to say why do I do this work and what do I get out of it besides a paycheck it’s saving people’s lives seeing people grow it’s being able to you know almost 31 years later you know have a guy who was a real challenge for his community causing all kinds of trouble go through a treatment process and then years later be invited to a podcast like this to share how we serve the community together you know the reality of of That’s The Passion of the work that we do we get into this because we want to help people individuals families ourselves we want to make the world a better place so you know again being an advocate of the concept of citizenship it really is getting getting involved and exposing yourself and say where can I volunteer and it’s not the local Treatment Center is there a local Council on Behavioral Health that I can get involved in maybe it’s not substance use maybe a challenge you’ve had is depression and maybe there’s you know volunteer opportunity somewhere in there where it’s Manning a phone to be a resource when a family member calls says how do I find treatment right the communities have these resources you know and so getting involved and not just giving of yourself but getting involved and exposing yourself as part of that yeah absolutely and you know with that you know it is it is election season it is uh proposition season all these things coming up here on November 8th that you know here in Colorado and certainly across the country in that regard and and I was reading something the other day on an article on psychiatrists I think it was something like some absurd number like 60 of psychiatrists are 55 years and older I mean we have a massive psychiatric Gap you know coming in the background in that regard and you know I I’m hopeful for the voters to hear me clearly on this it’s it’s it’s there’s many challenges but if we don’t start today and keep pushing into the Health Care system not just meant the medical side but certainly the Behavioral Healthcare side we are going to be in a a terrible Jam here in the next five to ten years and you know your vote matters and your interest in where the taxable dollars goes and it doesn’t matter what side of the political coin you sit in on site you know in America it’s about your community at the end of the day and like you’re City and I thought it was eloquently stated we support local law enforcement we also support training around that to nurture the potential issues to you know talk to create deflection motivations versus you know the other possibilities within the system and the Divergence programs that have historically existed so no absolutely it’s it’s you know it’s now more than ever and there will be more press and there’ll be more impact and the the traumatic stress that the world has experienced in the last several years is bringing what was already a rising tsunami of Behavioral Health need as we continue to progress as communities through the coveted pandemic and to towards recovery States because we’re still in the disastrous phase technically yeah you know as we get into the recovery phases the the mental health need and the impact is going to continue to rise across you know the world and so communities so to your point it takes 12 years to train a psychiatrist that takes that four years of pre-med that four years additional after for medical school and then another four of residency and training to be to be a psychiatrist out there serving communities you know we have to do this it takes you know four and a half to six years to get an initially trained Master’s level clinician uh not fully licensed that’s another couple years on top of it right right of supervision and and guidance and mentoring um you know and and there are Pathways there are communities where you know peer advocacy movements and and various levels of opportunity Food Service uh on LinkedIn the other day in a a a culinary expert that worked in an organization that we served years ago um really he left a very lucrative corporate culinary training job to work in a treatment center because he wanted to do this work with people and serve a team that was helping people in his community and it wasn’t about money and he got paid well but you know he makes you know made five times what he was making in the corporate world and said ah I want to do something meaningful that that has that compassion satisfaction right that I can’t get from a dollar that really is about that connection yeah you know so to that that connection back to it’s all about relationships yeah you know it’s all about our connectedness in the world uh and to those things and so you know that political motivation and that Workforce Challenge and meeting that is something we need to invest in now and I know that there will be a generation of epidemiologists that will come as a result of the last two years right and as much my hope is and although it’ll be a long ways out there’s going to be a generation of people willing to to participate in Behavioral Health as well but the need gap is actually very real for organizations today we can’t increase access to Services if we don’t have staff to serve Beyond a certain point and the community needs going to keep Rising um so being able to do that now so those of you who are listening to this podcast or family members who are considering Human Service Double Down level down now double down let’s triple down I’ve got a sake of it and see where it takes us and you know I think you know kind of coming to the end of the time here and want to be cognizant of time as as you know the kiddos on the Facebooks and so forth and everybody watching you know do three seconds at a time and we’ve given them thousands of seconds at this moment so uh but with that I think it’s you know it’s easy sometimes to sit back wax political talk about the problems that exist you know move through some solutions with it and then kind of put our hands up and say well that’s all we’re going to do you know we’ve talked about how big the community part of this journey is for Behavioral Health Providers for re-emerging into the community from the person who’s suffering from you know mental health episodes behavioral issues substance use disorder and so forth and um you know the thing that I really admire about you Jonathan is is your ethics around all of this you’re not only talking the talk but you’re walking the the walk at the same time too and you know I know I recently learned this about you know you uh today actually you know around the foster care you know being a foster care family in a setting and contributing to your community in that sort of way and I would just love to for the viewers to hear more about that advocacy at the community level from a foster care standpoint um you know kind of maybe what led you to this uh as a contribution to the community and what you’re seeing um of value in your service and maybe call on you know some viewers out there to maybe take these similar steps that you’ve taken as well I really appreciate that so as Brandon uh acknowledge and thank you for that uh my my wife and I are our foster care providers in our community uh and uh open our home to uh children of a certain age and opportunity to really serve them to help bridge their need gaps to be restored to their families and their communities uh you know part of the motivation for us as a family to do that is our belief in that that every child deserves an opportunity for a loving home uh and that if we’re going to heal communities you know for me personally I grew up in a neighborhood that had several Foster Care Homes and and I you know through my own circumstances almost faced a similar challenge due to health challenges in my family system where you know that was a real possibility for my brothers and I uh and so very young I had decided earlier that that was going to be a pathway that I would pursue for me as a behavioral health care provider you know working in substance use Mental Health and and you know through the last 27 years of my life and ongoing for the next number of decades part of the satisfaction for me is the work that I get to do as a therapist as a consultant as a provider but part of the satisfaction for me is being able to serve in my community locally to really make a difference in in someone’s lives to give back in a different way for all of those people who contributed to my life no matter how small that contribution was to to focus that effort and share that unconditional love and positive regard and give someone else an opportunity as well so for for me you know and my wife that’s part of that motivation is to really give you know not just a child the children an opportunity to have a different experience you know we’re trained to have a healthcare providers my wife is a a licensed marriage a family clinician an addiction therapist as well and and Trauma trained and is a trauma therapist and so our our background in training as providers is one part but our commitment to it was really about you know giving people an opportunity to have a different experience to know that something else is possible and not just hope but to really share that relationship and build a lifelong relationship with them um you know so in the children that we’ve been privileged to serve and in our process as foster care providers that’s that’s been really the greatest reward is to to sow seeds and to fertilize the soil of their future growth uh you know within the community to give them an opportunity that they weren’t able to have for whatever reason um and you know to to do our best to show them something different something possible uh we’re human beings we’re far from perfect I tend to curse quite a bit you know which our kiddos sometimes get along as we serve teenagers most often and uh you know I’m a human being but to show them that you can have a meaningful life and that it comes from you know self-care and comes from you know balanced mental health and behavioral health and wellness and that that it’s possible and fun and it isn’t just nonsense and that you know somewhat because of the work that I get to do they’re exposed to therapy probably more often than they want to be whenever they’re providers but in that sense you know we’re we use the term aunt and uncle uh you know they have parents whether they’re a part of their lives or not and so we’re part of their lives in that capacity the the community service aspect for us and for me and for others is that you know there are tremendous opportunities within Foster Care Systems and tremendous need for even volunteer opportunities you know to you know explore providing you know being a foster care provider such as my wife and I are but even at less intensive levels of being a volunteer in an organization uh you know that has me being willing to you know if you love baseball uh you know go coach you know some foster care kids on how to play baseball you know if you love golf go do that if you you know if you love macrame and sewing you know sew some blankets sew some clothes like you know it sounds silly and it sounds hokey but the reality is that organizations need more than money they need people that the healing that that these you know children in these families deserve a need comes from other human beings as we said so there are lots of ways to volunteer you know they’re I was giving an example before uh you know we kicked off this discussion of you know there are tremendous needs ruining kids age out of Foster Care Systems when they become 18 and they’re not 21 yet they’re still have resources but to to volunteer to open your home to volunteer to to be a respite provider to you know volunteer to be a coach um you know to to become somewhat trained and be able to say yeah you know we’ll have kids who don’t have a home to go to at the holidays we’ll welcome them into our home and and share that with them because there are those kids that age out in the system that that don’t have families or their friends families aren’t healthy and they they need to step away from them but they still don’t have resources to be able to do that so to be a part of a community for us a big belief is that we want our lives to be better and we want our future to be better for our children and the children of others is to to invest in healing those communities who are through you know impact and for us this is a way to do that so I you know certainly encourage you to to Google your local foster care organizations and find out where there’s some volunteer opportunities to explore it to consider it you know to to look at training to look at you know what some of those opportunities are and if that’s you know uh not something that’s attractive to to think about rather than donate just a good will to donate those clothes your kids have outgrown or no longer wear to a Foster Care Organization because there’s a child somewhere in need beautiful well I greatly appreciate that before I take us out on this road we got this camera here that’s been staring at you the whole time hopefully you can look into it to the you know the viewers out there and support of the organizations who made me in need of C4 consulting services and uh you know let them know how to find you guys where to look for you and uh yeah take us out there absolutely so uh best way to get a hold of us is our website www dot the letter c the number four dash consulting.com lots of ways to reach out requests of information blogs all kinds of things team profiles but even if it’s you’re not a provider and you’re just a person in a community looking for a resource part of the four C’s you know our four C’s from the foundation through the Consulting organization are convening collaborating Consulting and conferencing and and convening and collaborating you know lead us to Consulting and so Consulting isn’t just about organizations it’s about resources in the community our our Consultants are across the country in 19 States and have resources so pleas