Archives for category: Education Reform

incredible hulkI could not help but write having come to understand, I, Bruce Wheatley have been labeled as an Angry Black Man. While, I might be green in character, I realize this stereo type was headed my way due to the nature of my work to speak truth to power.  It’s not as if we have not heard this label used before. It appears typical coming from those intimated by intelligence, passion, courage, and god fearing Black Men.

I received an athletic scholarship from both the University of Arizona and Texas at San Antonio; I have traveled the world an ambassador of USA Basketball; I am the son of one of California’s most respected Prison Facility Captains (May The Captain rest in Peace) I have worked with hundreds of children, youth and young adults over 16 years here in LA County. Among all those individuals that have spent any significant amount of time with me, refer to me as a soft-spoken Gentle Giant.

So the notion, I Bruce Wheatley am all of a sudden an angry Black Man because I speak truth regarding the Department of Mental Health Executive’s biased and discrimination decision-making that adversely affects the health and well-being of African-Americans, confirms DMH Executives are up to no good and have something to hide in their attempt to discredit me.  Keep in mind…This is system executives speaking.

As the former Co-Chair of the DMH Cultural Competence Committee, this does not come as a surprise. DMH Executives assumed having me as the co-chair was being Culturally Competent. Among my population, we call it being a token.  In fact, DMH Executive William Arroyo contributed to a monograph: Toward a Culturally Competent System of Care which revealed tokenism as a process in which individuals are selected to essentially appear as change agents yet, given no authority to make any changes.

Now, I have every reason to be angry as a Black Man.  As does every Black man witnessing the challenges facing our population. However, I see this more as a teaching moment in how to destroy the labels that people put on you.  The kids benefiting from social emotional learning in ICI’s Peer Empowerment Program is taught how to respond appropriately or not based on the situation.

imagesMy kids understand, it’s not what’s on the outside and other people’s negative perception of you; it is how you on the inside perceive yourself and respond to negative stereotypes. My kids understand we use our Defense Mechanism to make either negative or positive decisions.  Will you validate a negative label given to you by another person envious of you?  Dumb, Looser, Lazy, Angry Black Man are simply a reflection of those that are unhappy with themselves and intimated by your good-natured character. The individuals attempt to provoke your character is to throw you off your game, to make their point. Not here, not today, not ever and certainly not with my kids!

To my staff, use real life situations to instruct our kids to make positive decisions. If people were perfect, there would be no reason for social emotional learning. As we continue to positively affect the behavior of future generations, those that attempt to belittle us for selfish gain will diminish.  I could on one and one but I’m busy today. You get my point. Peace.

We have a history of sitting, waiting and watching thinking someone is going to say…Oh yea, don’t forget about African Americans. During public comments related to the County’s Homelessness Initiative at the AT&T Theater in Downtown LA about twelve Black people among three hundred or so service providers and citizens convened to witness $100 million in public funding prepare for distribution to fund a“Family of System Partners.”  Absent from six areas of key focus was serving the chronically ill. Many of the County’s chronically ill are African American and located downtown Los Angeles where the public hearing took place.  Ironically, before entering the building next to Bank of America laid three African Americans homeless citizens rolled up in blankets. Such blatant oversight and disrespect is what weakens and further separates us as a community.  From personal experience if system administrators are not causing a rift between Blacks and Hispanics, they’re pitting Black people against Black people forcing us to compete for the reaming public funding crumbs.  

During the first round of public comments the project Director responded to questions yet completely dismissed articulately read questions from General Jeff and a Black woman who also represented downtown homeless.  As the second round of public comments began the same Black woman stood to speak and the Director commented “let’s hear from others that haven’t spoken”  The event by design was intend to present information on six key areas followed by public comment recommendations. Less than twelve Black people among over three hundred in the room and we’re not important enough to be heard more than once.

Pay attention to how we (the public) are being accommodated

First and foremost, these recommendation were discussed and developed among majority of white folk, perhaps they represent the Family of Systems?  The Director categorized the 47 recommendations into six key areas.  I attended the last of two meetings after learning they were taking place during an Empowerment Congress Meeting and recall two Black women pleading not to overlook African American families and homeless in Service Area Six. One gentlemen suggested, we can’t do this work without public involvement.

This is copy from the email notice sent 8 days before yesterday’s hearing:  Thank you for registering for the Homeless Initiative Community Meeting on January 13, 2016 at 1:30pm. Due to a high level of interest, we have reached capacity for the Community Meetingand have a waitlist.  If you are unable to attend, please advise us via a reply to this by January 11 at noon, so that we can accommodate those on the waitlist.

SO MUCH FOR NOT BEING ABLE TO DO THIS WORK WITHOUT PUBLIC COMMENT! It was already done and certain folk was clearly extended invite before notice went out.

This is the same biased process that will play out with the health agency as system administrators are currently deciding how to allocate $7 Billion annually behind closed doors. If we do not come together and learn how to engage this system…guess what?

Breakdown Priority strategy A-1.  Recommendation:  Homeless Prevention Program for Families.

Direct the Los Angeles Homeless Services Authority (LAHSA) and the Department of Public Social Services to convene a workgroup consisting of other relevant County departments and key community stakeholders  (Hopefully those two Black women have not been discouraged and get an invite to participate?) to develop an integrated, comprehensive homeless prevention program for families which draws on the Homeless Family Solutions System (HFSS) model and builds upon current available County homeless prevention funding sources to address rental/housing subsidies, case management and employment services, and legal services.

LAHSA should develop, in collaboration with County agencies and family system partners(please define this term and who are the family system partners?) a comprehensive strategy toeffectively identify, assess, and prevent families from becoming homeless, (How will we be ensured ensured African American families are appropriately identified to benefit?) and to divert families in a housing crisis from homelessness. The strategy should consist of a multi-faceted approach to maximize and leverage existing funding and resources, evaluate and potentially modify policies that govern existing prevention resources (under who’s authority?) to allow greater flexibility, prioritize resources for the most vulnerable populations (What data is being used to classify the most vulnerable populations?), and create an outreach and engagement strategy to identify access points for families at risk of homelessness. The major areas critical to developing a homeless prevention system in Los Angeles County involve identifying additional and targeting current resources from multiple systems to focus on homeless prevention.

There’s a category in which Chronically Ill will benefit. However don’t be misled into assuming it will serve downtown homeless. Grouped in the category are Disabled Vets. The Family of Systems I’m sure are looking out after their own.

Questions for consideration:  How will the County ensure the equitable distribution of Homeless dollars sever the County’s most vulnerable population?  Of the $100 million – What percentage will be allocated to African American lead providers? suggesting how many African Americans in homeless crisis will be served using public funding?

This is what’s happening:

Following the August 11, 2015 approval to integrate the Departments of Health Services, Mental Health, and Public Health, the Board of Supervisors instructed its three directors, Dr. Mitch Katz, now retired Dr. Marvin Southard and Interim Director Dr. Cynthia Harding to develop a strategic plan to guide integration of the Health Agency. 

Accompanying the three directors in this planning process was Dr. Christina Ghaly and a second gentlemen employed by DHS develop recommendations behind closed doors without African American representation.  Despite Supervisor Solis motion to includeCultural and Linguistic Competenceas a Board Priority during public comments, the operational framework which includes eight strategic priorities with multiple goals, outcome metrics and major organizational next steps are once again being discussed behind closed doors with no interest in public comment.

Here’s what you need to know:

Cultural and Linguistic Competence respectfully considers the thoughts, belief and perception in how best to serve specific underrepresented ethnic populations.

The Health Agency final report included stakeholder input on how best to develop the Health Agency clearly indicated “Bottom up”change.

The overarching goal of the Health Agency is to reduce health disparities. By population African Americans are disproportionately represented and disadvantaged across the quality of life spectrum

The Health Agency will manage and disburse $7 Billion (DHS $4 Billion, DMH $2Billion and DPS $1Billion) annually while nearly $3 Billion in tax payer resources is generated through several propositions.

For instance: Proposition 10 is generating nearly $1billion annually in cigarette tax which has been leveraged to provide Health Services for all specifically undocumented. First Five is the recipient of these resource have developed 14 Best Start Communities in predominately Hispanic neighborhoods.

For instance: Proposition 63 is generating a $1 billion annually to transform the delivery of mental health services in five key areas. Recent data suggest African American children have doubled its rate of suicide comparative to adult white males and Latina women. NOT $1 dollar address this crisis among Black children yet, DMH has allocated additional funding to address this issue among Latina’s as well as support agencies helping immigrate children who recently fled from South American countries. A proposal came from the African American Underrepresented Ethnic Population Committee charged with being liaison between DMH and the community proposed a project for funding to determine how best to engage Black men to access and benefit from services that has been on DMH desk for 16 months NOTHING.DMH pulled funding from a prevention early intervention program serving Black males that provided jobs to transition-aged youth with NO explanation why.

For instance: Proposition 30 is generating a $1 Billion annually to provide supplemental support for children and vulnerable communities. In vulnerable communities’ children, youth and families are engulfed by Trauma yet there is no strategy to address this issue in funding. And, African American have pretty much been absent from engaging in the process with exception to the recent convening hosted by the Advancement Project which brought roughly 25 Blacks together yet, LAUSD proposal overlook the real issues of poverty.

Whatever your agency mission if you provide Health and Human Services, resources will be procured through this Health Agency if developed correctly. If you are prospering from this blatant discrimination, help us out.  But for all others, why are we working separately with no voice or strategy for effective engagement with the system?

Several reason why African American desire substantive change:

Historically, no-American system was designed to support non-whites. Therefore most, particularly our youth have simply given up forcing focus solely on self.

African American life expectancy is decreasing while other population increase. South LA before the recession was identified as a vulnerable community, since the cost of living has increased significantly forcing focus solely on self.

According to data a majority of “middle class” African Americans are in deep credit card debt and one missed paycheck from experiencing hardship poverty presents forcing focus solely on self.

African American are innovators of many capital driven products and services that have made many men and this country wealthy, yet we have no connection to the local or global economy forcing focus solely on self.

African American have a deep sense of distrust among one another, often pit against having to compete for scares resources which has threatened the sharing of one’s knowledge freely forcing focus solely on self.

African American participate on multiple local Alliances, Task-force, Coalitions, Cadre’s, Collaborations, Community Partnerships, Hub’s, yet we as separated forcing focus solely on self.

We are all demonstrated great individual leaders protecting what’s left of our South LA population since it has dwindled from 78% in the 80’s to 8% today. We far too often look for what’s wrong as oppose to what right.  Some will say, HE forgot to add an exclamation point at the end of that sentence, that’s why I’m forced to focus solely on self!

These are core reasons why we fail to commit to uniting under a common agenda.  We’re all “too busy” funding and running our organizations in an attempt to survive and do public good simultaneously.    

Why the African American Behavioral Health Care Coalition was formed.

 “You can solve problems with the same thinking that created the problems.” –Albert Einstein.

WE NEED ANSWERS:  Top down approaches have demonstrated never to benefit society.  Where is the transparency? Accountability? Respect? Who was selected to participate in working groups and what is the requirement? Are other Blacks involved? Are they employees of DHS, DMH, and DPS forced to comply to keep from voicing their sincerest opinion to avoid being ostracized by their employer? If members of the public are participating, how were they selected?

As current and future service providers, we cannot lay in fear that our funding will be pulled. Not wanting to be associated out of worry our agency will not reap public resources.  As it is, we’re not able to appropriate benefiting our constituents or self.

WE ARE THE VOICE OF THE REMAINING 8% of our POPULATION.

Such blatant act of discrimination reminds me of the disheartening saga between the Los Angeles Clippers and Donald Sterling. Players were pit with doing the right thing (boycott) versus continuing to claim their paycheck to feed their families. As professionals they continued to play yet, with a halfhearted spirits. Wanted to win, but not for their disrespectful owner.  I don’t desire to reignite this incident but, to make a point.  Keep in mind Donald Sterling said his words come from culture. If one of ourcommunities most beloved, Erving “Magic” Johnson is a N!gga, what are you? 

We are not in the game or at the right table to be appropriately served.

As professionals charged with serving our community, I am requesting that each of you demonstrate your leadership, insightful intelligence and disapproval to encourage the Board of Supervisors to open these meetings to the general public for input immediately.  It is our collective ingenuity that will set us free from despair if we work United.

Knowledge is Power if Shared.

Please understand, this is not about scolding Supervisor Thomas for those of you who hesitant to speak up.  The Supervisor like President Obama can do no more than set policy. Our collective voice of advocacy is required to shape policy outcomes. We cannot only march passionately to the polls and vote for candidates and propositions to return home proud as if our work is completed. Nor are we against our Hispanic brethren, WE ARE FOR AFRICAN AMERICANS/BLACK AMERICAN’s what ever your preference. 

Our Work Has Just Begun.

I’m certain each of you have expertise in one of the following eight priority areas that can contribute to the discussion.

1. Consumer Access to and Experience with Clinical Services
2. Housing and Supportive Services for Homeless Consumers
3. Overcrowding of Emergency Departments by Individuals in Psychiatric Crisis
4. Access to Culturally and Linguistically Competent Programs and Services
5. Diversion of Corrections-Involved Individuals to Community-Based Programs and Services
6. Implementation of the Expanded Substance Use Disorder Benefit
7. Vulnerable Children and Transitional Age Youth
8. Chronic Disease and Injury Prevention

If you do not wish to speak, show your support and sign up forwarding your time to Bruce Wheatley. Each speaker is allowed two minutes. I would like 7 people to forward their time to effectively make the case for public involvement in the decision making process that effects our health and well-being as providers of the county’s most vulnerable.  

Health Integration Transformation Executive Summary.  As presented with my public comments regarding the steering committees Board Priorities and Operational Framework strategic plan. 

The Health Integration Mental Model Framework highlights theory, dynamics and multiple phases associated with large scale systems transformation.  Supported by relevant research the final report represent a systemic process to organize, prepare and implement a comprehensive integrated system of care and service reimbursement mechanism.

A mental model is an explanation of someone’s thought process about how something works in the real world. It is a representation of the surrounding world, the relationships between its various parts and a person’s intuitive perception about his or her own acts and their consequences.  Mental models can help shape behavior and set an approach to solving problems and doing tasks.  This mental model framework represents a non-threatening approach toward integration of Los Angeles County systems of care.  The framework embraces Institutional theory and social marketing technique to establish measurable benchmarks during health integration implementation.  The framework and its content lends itself to collaboration building, knowledge sharing and education to develop new partnerships to sustain community health and well-being.

Integration of the county mental health, public health and health systems will include developing a team of professionals to become familiar with whole-systems thinking, large group facilitation processes and social marketing communications.   Successful integration of the county’s system of care inclusive of board priorities require the expert team to gain understanding of each organizations structure, culture, funding streams, program categories and communication methods.  Equally important is maintaining exceptional community relations to engage and prepare contract providers with community-based organizations during implementation while embracing public opinion.

Sponsors of whole-system transformation understand integration requires one-third of stakeholders to embrace a conceptualized vision demonstrating how the emergent system will increase population health outcomes.  Stakeholders currently include county employees, commissioner oversight groups, contract providers, community activists and each agency Director contributing to the Health Integration, Strategic Priorities and Operational Framework final reports.  As a vision of what a community-based health and human services system of care resembles, the mental model framework becomes a living strategic plan guiding its organizational design, planning and coordinated implementation processes that link administrative, service and program functions of the county’s three systems. The following summary points shed additional insight into system change elements that enable restructuring of the county’s system of care.

System and Community Dynamics: System & Community Dynamics represent real examples of administrative issues and citizen concerns that justify model building, analysis and evaluation of joint solutions.  With as many constantly evolving dynamics related to institutional transformation, becoming an expert takes 10 years and requires the acquisition of 50,000 chunks of knowledge.    Differentiating stakeholder concerns will reveal gaps in services and policy leading to the integration of innovative practices that close systems and community gaps in pursuit to streamline services.

System and community dynamics often remain unmanaged until issues become extremely challenging to resolve without systemic change.  This Health Integration Transformation framework establishes protocols and processes that mitigate conflicting system and community dynamics that threaten the health and well-being of citizens within Los Angeles County.

Whole-System Transformation: Whole-System Transformation (WST) embraces the thoughts, opinions and interrelationship among the internal social structure of government agencies, external ecosystem of community-based organizations and providers in concert with general public opinion.  WST procedures facilitate multiple processes and phases that enable stakeholder readiness that develop holistic themes centered on vision-based leadership, collateral leadership, power sharing, and process-based leadership. WST methodology allows cross-sector collaboration to share information, resources, activities, and capabilities by organizations in two or more sectors to achieve jointly an outcome that could not be achieved by organizations in one sector.  By engaging diverse opinions, environments, influences and skills, individuals participating in WST processes may reach comprehensive and thoughtful resolutions that exceed the expectation of a few decision makers.

Cultural and Linguistic Competence: Imperative to reducing health, education and economic disparity is the institutionalization of cultural and linguistic competence. As a non-threating action to organizing the internal social structure for health integration is the sharing of culturally competent strategies implemented by each agency to inform continuity of care across the provider network.

Social Marketing: Social marketing should not be confused with traditional marketing considered strategic Social marketing is a promising method to assemble and engage the internal social structure with its external environment to initiate decision making about the system’s core support and work processes during the planning of social change.  Social marketing in essence represents the mental model’s Blue Print that incorporates vision, processes and change mechanism’s that will enable civic engagement during health integration transformation.  Social marketing toward social change is beneficial to gaining institutional legitimacy by influencing a renewed belief among citizens in their perceived value of health and human services delivered in historically underrepresented communities.

Open System Structure: The open systems structure will remove traditional barriers to services and shift public perception creating acceptance of a system of care co-designed by the community intended to serve.  The open systems approach to health integration establishes ideology in which the internal social structure intentionally engages the external social environment.  An open system structure allows for shared decision making and accountability among qualifying stakeholders providing system oversight and designating by consensus a Health Agency Director with the responsibility of reporting to the Board of Supervisors on behalf of his/her constituent delegates.

Evaluation: A dual evaluation approach using design and implementation feedback will analyze perspectives of different stakeholders evaluating the system from multiple levels of scale (Gregory 1996a).  Health Integration Transformation will emphasis evaluating Goal seeking and Systems-resources. As the system undergoes redesign with sustainability in mind, systems-resource evaluations adapt to internal and external system interactions as participants will have different views about how the system evolves and processes that govern the emergent structure.

Health Integration Transformation Implementation Phases:

  • Phase I – Pre-Planning for Health Integration Transformation (Gathering Stage) 3-4 Months
  • Phase II – Preparing Internal Social Structure & External Ecosystem (Envisioning Stage) 3-5 Months
  • Phase III – Community Integration & Reconstruction (Mastering Stage) 12-14 Months
  • Phase IV – Health Integration Implementation (Renewing Stage) 2-3 Months
  • Phase V – Evaluation & (Scale) Continuous Improvements

The effort of the Health Agency Steering Committee is commendable however, the proposed Operational Framework falls short of representing its mission and precludes implementation of the Board priorities. With respect to attempting such a challenging task, the Board of Supervisors now possess the consolidated thoughts and opinions of county employees, contract agencies, community activists and Directors that govern the county systems of care.

What’s missing is a live strategic plan that facilitates a fair and impartial organizational design, planning and coordinated implementation processes that link core functions of the county’s three systems. Such framework guided by social marketing communications will prepare and inform citizens of Los Angeles County to voice their opinion and concerns as to how best the health agency will advance individual and community well-being.

From a systems thinking approach it would be advantageous for the Board of Supervisors to immediately contract an external consultant suggested under Access to Clinical Services – Major organizational next steps as the appropriate course of action hence forth. Accordingly, such contractor should perform a details analysis of the Boards requested reports to create an objective assessment indicating how best to share information and operationalize identified Board priorities defined by community input while initiating cross-sectional discussions among the three Departments. The Directors strategic priorities and operational framework suggest development of an integrated system of care however, contradicting statements suggest otherwise preventing ecological changes that sustain comprehensive transformation.

Case in point, the mission of the LA County Health Agency is “To improve the health and well-being of LA County residents through provision of comprehensive, culturally appropriate services, programs and policies that promote healthy people living in health communities.” The strategic planning workgroup should have included the thoughts and opinion of diverse medical and mental health professionals given cultural competence is a board priority. Certainly, few understand the magnitude of each Director’s responsibilities, however taking into consideration increasing health and mental health disparity in LA County, closed door processes reinforce institutional bias and discrimination. Focus of Health Agency should be to appropriately serve Angelinos to reduce health disparities or we have missed the mark in favor of bureaucratic repositioning.

Another example, statement #7: “Departments shall maintain spectrum and level of current activities. Services, budget, and staffing for Department activities shall not be cut and financing streams shall not be redirected because of a transition to the Agency model.” This statement reinforces “medical model” thinking and will prevent county residents from developing sustainable, comprehensive and fully integrated health and human services system of care.
Question: Which Department or Agency will oversee the implementation of countywide prevention early intervention programs critical to bettering population health outcomes?

Example: Statement #8 suggest conflicting agreement; “Agency shall avoid unnecessary bureaucratic processes. The Agency shall operate in such a way as to ensure strategic alignment of operational and administrative activities with and between Departments in pursuit of Board-supported priorities.” While this statement supports the mission of the Health Agency in comparison statement #7 suggest “activities shall not be cut and financing streams shall not be redirected because of a transition to the Agency model”

Withstanding the significance of providing culturally proficient integrated care; equally significant is ensuring the county’s structure supports an integrated billing mechanism and information technology system. The risk associated with failing to redirect financing streams circumvents true integration and eliminates the opportunity of closing service gaps.

Example: Statement #14 “Departments shall maintain individual mechanisms to engage internal and external stakeholders.” Allowing each Department to maintain separate internal operating committees and external community stakeholder groups reinforce a biased and myopic approach to health integration. The sharing of cross cultural information is crucial to developing a culturally proficient system of care particularly acknowledging an emergent multi-cultural millennial generation. Provided each system has individual stakeholder processes attempting to communication within an integrated system, please describe a vision of what a complimentary mechanisms stakeholder committee structure and process will resemble?

The Board of Supervisors action lends credibility toward operationalizing mental health parity per the Patient Protection Affordable Care Act. The County current system of care requires transformation into the knowledge age paradigm to satisfy emergent culture and eliminate Departments working independently.

It is recommended, the Board of Supervisors include executive administration and front line staff from the Departments of Children and Family Services, Probation Department, Los Angeles County Office of Education and Department of Public Social Services in coordinated working group discussions to guide transforming the county’s health and human services infrastructure. Working groups shall also include contract providers and community stakeholders in the designing and planning process to legitimize the Health Agency operational structure and services delivered. Otherwise as presumed in the strategic priorities and operational framework, the Boards initiatives will fall exclusively on the Health Agency Director to manage, while business as usual continues with the remaining departments to the detriment of advancing individual and community well-being throughout Los Angeles County.

The attached executive summary frames whole system transformation dynamics and processes related to large scale systems change. I am hopeful the Board of Supervisors will continue to advance this important initiative under the guidance of an external consultant to bridge system mandates with community need. The end result will produce a culturally proficient system of care legitimized by residents intended to serve.

Morning Dennis,

Wanted to check in with you following yesterday’s EQRO meeting. I get the sense that you’re often caught between your role and responsibility to DMH and your genuine care and concern for humanity.  It would seem that DMH would be in alignment with both however, from my vantage point this may not be the case.

Following yesterday’s insightful EQRO meeting, I’m really looking forward to the release of the AAA capacity building project to better understand the thoughts and attitude among Black men in how they perceive trauma in relation to mental health. I have serious concern the current attitude and belief among Black people is not considered in the distribution of resources or delivery of services. And, that is withstanding your recent engagement with UREPs to discuss the equal distribution of nominal dollars to advance the Promotores model. Research suggest cultural destruction, when administrators reinforce a one size fits all model is best for all ethnic populations.

Therefore cultural competency is absent in terms of engagement with the AA community. This decision essentially demonstrates the clear bias in favoring one ethnic population over another, particularly with Black people being historically disenfranchised, should never be out of the focus of attention.  DMH’s decisions demonstrate an attempt to prioritize their work processes over the health of the community designated to serve. The notion that AA was not even mentioned in the 3yr program expenditure plan confirms such bias. The fact that ICI program engaging Black boys was defunded with no follow up, justification or question adds insult to injury.

Cultural competency takes into consideration the thoughts, beliefs and attitude of specific ethnic populations. The fact that AA are accessing services outside their community is due to the shame of being associated with mental health. Black people must be engaged using non-traditional means.  The fact that the Latino UREP is preparing for a mental health awareness media campaign to promote DMH’s latest Health Neighborhood Innovation to their community before projects are approved by MHOAC demonstrates favoritism, particularly when the AAA project is barely assessing Black men attitude.  I’m hopeful you see the disparity between these processes.

Individuals that may consider my comments an attack against the Latino community, reinforce bias and the racist and discriminatory views typical among those that claim they are not. When one champion’s for their community not to be left behind and others have a problem with such, either they are clearly biased or a prior plan is being disrupted. Which would mean transparency has evaded the process.

Therefore, it is becoming increasing difficult for me to represent as DMH CCC co-chair with such blatant bias and in action. My integrity is now being placed in jeopardy and I’m uncertain as to how long as I may continue as co-chair.  What you may not realize is other people see what’s not happening.  I’m hopeful this Black men’s capacity building project is released near immediately and that DMH does everything in its power to reinforce, fund and build upon the recommendation and/or strategies that result from the project expeditiously following receipt of the project report.  Appreciate your time, leadership and understanding the significance of this concern.

May 18, 2015

Presented by: Bruce Wheatley, President/CEO, Inner City Industry and Co-chair DMH Cultural Competency Committee (CCC).

As co-chair of the department of mental health cultural competency committee, today I am representing disadvantaged citizens throughout LA County whom otherwise are absent from this discussion. When endorsed as co-chair of the CCC, I was explicit in expressing “I supported community first”.  As an African American male who has resided 200% below the FPL for nearly a decade, I am the underrepresented, underserved and when possible the inappropriately served. I have carefully witnessed this stakeholder process with disappointment while system administrators and contract providers position for control, autonomy and authority over the emergent system of care. There has been no mention or focus on ensuring the needs of my constituents who reside in vulnerable communities are addressed.

I speak to the most viable opportunity present.  To lead the transformation of health and human services in America by strengthen the socioeconomic safety-net of services that no longer exist in LA County.  Health disparities are at its greatest fifteen years into the 21st century and our system of care clearly does not work for the people intended to serve given recent population report data. LA County is as populated as forty-three states, what happens here influences the county.  We must exhibit or Angelino pride and represent this country with courage in the face of many challenges while highlighting our responsiveness to work together to serve diverse populations and communities.  My understanding of large scale transformation spans over fifteen years, since discovering African American students in K-12 education being inappropriate diagnosed with mental illnesses who otherwise had behavior issues.  As co-chair of the CCC, I whole-heartedly support integration among the departments of mental health, public health and health services into a single unit agency.

While I understand much about each systems culture, structure and revenue streams, I make no claim of being a practitioner or administrator.  My expertise is as a systems architect which encompasses understanding system and community dynamics as they currently exists.  While the CCC and provider networks take a different position than I, there concerns are warranted, well-received and understood. Many of their identified risk and challenges can be mitigated through coordinated communication amongst influential system administrators, contract provider and community leadership.  There are multiple theories and practices applicable to restructuring core support and work processes to fully integrate the three departments.  The intent is to ensure mental health parity by law and to achieve positive population health outcomes which one system cannot accomplish alone.

I acknowledge Schumpeterian theory which suggest the creative destruction toward innovative reconstruction as a core principal for health integration.  Keep in mind, every agency will not receive all that they champion for residents included however, we must reach common ground ensuring a fair exchange while maintaining laser like focus on ensuring increased population health outcomes.

Such a proposed shift in thinking requires an upstream approach to social change guided by social marketing ideology.  Our country’s infrastructure has reset and so must our system of care. My recommendations are based on the latest research data contributing empirical and anecdotal observation over fifteen years. Therefore, it would be wise for the board of supervisors to:

  • Research Large System Transformation to understand the dynamics associated with integrating multiple systems. Before the public comment period ends, I will present a position paper framing several dynamics essential to large scale transformation.  Considering this process as whole-system transformation suggest changing one part of a system requires changing the whole system.  Piecemeal processes fail to have significant lasting impact toward social change and causes greater damage to the external environment.
  • Utilize research data from the State funded and produced California Reducing Disparities Project reports. This community profile report will aid in developing a culturally responsive system of care based on relevant community input. Case in point, the African American report essentially says’ if you don’t change the system, nothing else changes.  The Department of Mental Health 2008 population report clearly identified South Los Angeles and African Americans as a disadvantaged community and population. From my experience in dealing with the mental health, education and health care systems neither lend any consideration to African Americans as a focus population. If you deny begging where disparity is at its greatest there will always be a disparity gap. Therefore Black lives must matter here as much as beyond these four walls.
  • Investigate to incorporate local community placed-based initiatives. Many of these projects represent the voice of community-based organizations and key stakeholders who have developed practical ideology and processes to meet localized needs. Projects that have the ability to scale should be considered as viable change mechanisms to sustain health integration outcomes.
  • Convene each county department cultural competency committee, unit’s and processes to initiate dialogue to reach consensus supporting community integration and delivering services. As primary and essential to reducing racial/ethnic disparity cultural competency must be embedded and considered in all aspect of decision making and delivery of services to strengthen the quality of care.  This internal system process will prepare agency leadership to appropriately engage the external social structure.

This is a long-term project produced in multiple phases over several years. Begging with reaching common ground among all parties, developing policy, implementing recommendations, evaluating processes to scaling services and making continuous improvements.  Without an effective strategy for community integration, agency and contract provider recommendations gain no legitimacy among its external social structure and increase the risk of a social revolt.  Health integration presents an opportunity for learning and discovering a new process to motivate staff to work more efficiently and effectively allowing residence to be active participants in meeting their personal health needs.

I thank you for considering these recommendations and reviewing the forthcoming position paper to glean understanding how to transition LA County’s health system into a fully functionally integrated system of care.

Regards,

Bruce M. Wheatley