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

President Obama included mental health parity in his constantly under fire Affordable Care Act and has suggested “Change doesn’t happen top down, but bottom up.”  On January 15th the Los Angeles County Board of Supervisors issued a motion to integrate the departments of mental health, public health, and health services into a single agency.  My initial response is the title of this article.   Integration of the three multi-billion dollar systems will strengthen the non-existent safety-net of social services in low income communities of color.

As President/CEO of South LA based Inner City Industry established in 1999 and co-chair of LA County Department of Mental Health Cultural Competency Committee, without doubt integration will begin the much needed paradigm shift mentioned countless times in visits to local beauty and barbershops over the past decade.  It was Dr. Martin Luther King Jr. that envisioned “The nettlesome task of Black America is to bear the burden of redeeming the soul of America.”  We as Black people have slaved for others, walked for freedom, voted for hope and democracy, and now bear witness to our young men being callously murdered by individuals assigned to protect and serve our community.  Leading the integration of social services is our moment in history to transform the system and gain the respect well deserved.

The opportunity ahead rest in collective our ability to re-brand mental health services while trauma is being described as the issue of our time.  Underground Railroad conductor, Harriett Tubman said “I could have freed more slaves had they only known they we enslaved.”  The word mental health is paralyzing to Black people.  Near mention often triggers an “I ain’t crazy” verbal response.  Due to negative portrayal among the mentally ill and institutional bias, racism and discrimination, Black people have become hopeless having to cope with a “crazy system” that lacks equality, access and cultural and linguistic competency for Black Americans.  Therefore, a fully integrated system of care is essential to the soul of Black America.

Ours resilience is both our strength and weakness.  Fifteen years into the twenty-first century, Black Americans by population are disproportionately represented in nearly every adverse quality of life indicator.  When the race for equality began, Black people had just returned from building the track.  Matthew 19:20 proclaims “So those who are last now will be first then, and those who are first will be last.” Our resilience has led Black people to defy odds, often turning water into wine or making a dollar out of fifteen cent when our backs were pressed firmly against a wall.

The County of Los Angeles is as populated as forty-three states.  What we as Black Americans accomplish locally may have nationwide impact.  On March 30, 2015 the Board of Supervisors will receive their initial report from the County’s Chief Executives Office, Office of Health Care Integration including consolidated responses from stakeholders with intimate knowledge and involvement in each of the county departments.   Following review, the board will issues a 30-Day public hearing and comment period on the submitted draft beginning April 13. It is to our advantage to comment as a people to wait no longer for social justice. Don’t let it take so long for you to get involved.

If you’re like me and have at any time in your lifetime said, “The system doesn’t work for me” or “You’ve got to be the system to get ahead” of quiet simply “Phuck the system.” They you, like me, need to have input in how services are implemented into our community to begin a new conversation about how we changed the system.  Maya Angelou perfectly articulated our journey ahead with “And still I rise.”

As LA Clipper owner Donald Sterling was baited to express his feelings about African Americans, I was reminded of Presidential hopeful Mitt Romney’s private remarks about the 47% of the country he deems irrelevant as non tax paying citizens.  What stood out most profoundly is Sterling’s admission about his behavior being connected to the culture in which he was raised.  While this country, America I love so dearly was not developed on my back as it was my ancestors, I personally continue to carry the burden of witnessing the difficulty of changing the mindset of Black America who’s mentality is entrenched by such historical discrimination.
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Dammed if you do, dammed if you don’t…it’s the players who are put in an unfortunate compromising position. Will Black athletes  stand up for intolerance and boycott the sport they love or slightly turn their head in favor to continue collecting multi-million dollar pay checks to support their families.

What I strive to point out is African Americans are often pit against speaking out about injustice in favor of personal progress. This often involves simply providing for their family versus taking a stance and risk being cut off financially due to what both Sterling and Romney may consider disobedient behavior.

As of  this writing, who knows what will result from Sterling’s comments…will Black America boycott the LA Clippers or NBA? Or simply raise hell outside the arena for a day, go home, suck it up and chalk racism up to the game?

I believe it was Oprah who said it best…there will always be racism until the last bigot dies off. Until then, rest in peace because those that embrace a cultural of racism has kids.

 

In Honor of Pops: Charles “Chuck” Wheatley 12/22/13

Lil ol’ me as big as a pea rolling around aimlessly…

Oh where can I be headed, but down an endless road of misery…

Where I stop no one will know, I only hope I have time to think and grow.

As I settled comfortably the spirit inside of me rejoiced…

Be still and know son you will begin your growth…

As the moment ripened, I could feel a new breath of energy and excitement,

Before I knew it, I’d blossomed overnight under the moonlight an incredible sight for all to see Image

As the sun began to rise, I
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Since sharing my blog site, I’ve received a lot of interesting feedback about my conversations. The most memorable came from a friend who said…Big fella, you’re preaching to the choir…which my response was I understand, now grab your robe because we’re off rhythm. As the director of Inner City Industry, my concerns are likely your concerns. I share this information in an effort to bring to light the many and constant concerns that impede our community and culture.

We’re very much present but off rhythm. Off rhythm in the context of we’re facing one another with our backs turned. Understandably we constantly overlook our shoulders to protect property, relationships and peace of mind as we genuinely trust few. My objective is to point out what we already see and understand yet have little to no discussion about as it relates to our plight while culturally, holding on for dear life. Gentlemen, we’re two generations, some will say three, behind where we should be economically, academically and quite frankly socially. If our next generation comes of age under the hardship the last two generations have endured we will become further torn apart.

Our communities are suppressed by inequality which has resulted constant traumatic experiences that has affected our health and well-being. What I propose is uniting behind Behavioral Health.

Without being overly technical and certainly not wanting to compete against my own design (folk are watching, reading and listening…trust) as this opportunity is among us now, Behavioral Health will provide integrated health and wellness services to children and youth in K-12 education and adult support services at newly established comprehensive behavioral health and wellness centers. The end goal is to establish community wide systems for prevention to educate our young about the challenges that persistently impeded success, systems of early intervention to immediately begin supporting individuals whose needs have gone unmet for years and systems of care to help individuals requiring intensive treatment. Behavioral Health will support and advance all vulnerable communities delivering jobs and services simultaneously.

Despite the mismatch of circumstances we dare to become Champions arriving mentally prepared and motivational ready to compete every game as our journey from disparity to prosperity shall be no different. Therefore, I turn to you as athletes and professionals to stand united for Behavioral Health as we know how to win…yet more importantly, we know how to come from behind to win. In moving forward, we must harness our gift of “seeing the floor” in essence being aware of all moving parts combined with an ability to anticipate as timing is everything when our spirits align to inspire one another when the game is on the line…we become unstoppable.

Fellas, the game is on the line. We must square up shoulder to shoulder, heads high, unbiased, and game face ready. This once in a lifetime opportunity represents our World Cup, Super Bowl and NBA Championship post athletic careers. No one’s coming to advance us but us and oddly enough…we’re waiting on us….all we need is our collective rhythm. Can the Choir say…Amen?

See you on the wood in the hood. B.

I recently pinned this brief to the LA County Department of Mental Health’s Countywide Under-Represented Ethnic Population (UREP) committee when the discussion of disparity within the mental health system favored Asian Pacific Islanders and Latino’s.  The Countywide UREP members consists of department of mental health executives and community representatives.  Subcommittee UREPs are represented by American Indian (AI), African/African American (AAA), Asian/Pacific Islander (API), Eastern European/Middle Eastern and Latino.  I represent both AAA & Latino UREP subcommittees.   Critical to transform delivery of services to rebuild the no longer existent economic “safety-net” the following must be considered.

DISPARITY

In 1963 when Eugene “Bull” Connor, Birmingham, Alabama’s public safety commissioner, turned the fire hoses and attack dogs on its black citizens and children who were demonstrating against Jim Crow’s segregation and their second class citizenship, the nation woke up and realized that it could no longer tolerate the abuses that were being inflicted upon African Americans.  Today, the mental health system has become a symbol of the New Jim Crow as African Americans have become adversely represented across systems, i.e. mental health, health, education, prison, probation and foster care systems.  To that end, African Americans have the highest unemployment and poverty rates by population with several local and national foundations launching initiatives targeting Black Male Achievement.  As “the” root cause of disparity, the African American experience resulting from historical trauma perpetuated since slavery and further suppressed by no American system designed to support non-whites leaves little debate as to the underrepresented ethnic population at greatest risk during this profound opportunity for system restructuring.

CULTURAL COMPETENCE

I noticed agenda item in the Action Notes gathered from the Systems Leadership Team Ad Hoc Committee meeting on Thursday, Nov. 14, 2013.

II. Review – System Creation vs. Systems Improvement.

We are not creating a system like we did with CSS?

Prop 63 MHSA is specific: Transform delivery of services. Impossible if you don’t transform the system that distributes such services.  System Leadership Team members have expressed their displeasure with the Department of Mental Health which represents as much stigma as contracted service entities.

How does the CSS integration of physical health and substance abuse care in association with federally qualified health centers allow DMH to create and sustain mental parity per the Federal Affordable Care Act Law?   Strapping wings on a caterpillar doesn’t make it a butterfly any more than attempting to plug innovative PEI and ISM practices into a fragmented operating system going to revive or prepare the mental health system for parity.  The mental health system does not need improvements it requires whole-system transformation.  Any effort short of laser-like focus to develop a fully integrated and comprehensive culturally competent mental health system is critically short sighted and risk the legitimacy of DMH and its System Leadership Team.

ACCESS

Each UREP has identified three similar barriers to services cross cultures.

Stigma – Mental health stigma is a mindset, not process.  To date, I have seen no specific nor significant funding allocated to develop culturally competent outreach and engagement processes for individual UREP’s.  Stigma & Discrimination funding targets consumers and does little for individuals trauma exposed and/or in jeopardy of onset.  As long as DMH favors current services providers to deliver PEI practices despite the MHSA calling on new agencies, stigma will prevail.

Inability to serve children and transition aged youth – Every child must pass through K-12 education. Current school based mental health services reek of stigma are fragmented and inappropriately diagnose African American youth whom otherwise endure behavior issues.  The Early Start School Mental Health Initiative resulted nothing more than a process to police our youth.  The project consisted of teams of law enforcement and clinicians…This is not a PEI practice however, a screening process to justify billing requirements as school based mental health services has for over two decades under the current medical model to diagnose and treat.

Lack of a seamless integrated work process – It is inefficient and ineffective to place service providers under one roof “single-site” with multiple billing processes.  Without a process to effectively coordinate core support work process and internal social structure, integrated services will unlikely yield intended outcomes and decrease mental health sustainability.

QUALITY OF CARE

African Americans are constantly identified as overly aggressive, divisive, uncooperative, lazy and uninspired while controlled by unfavorable systems and its leadership that gives little to no account of the generational suppression that has creating such mindset.  Therefore, we lack faith and trust in system leaders and service providers who suggest they understand, yet continue to implement reactive processes that will never meet our community’s needs. Quality of care begins when the system is transformed though an open and transparent processes that intentionally engages the African Americans community in such transformation.

SUSTAINED MENTAL HEALTH OUTCOMES

Over the past decade African Americans fled South LA to Moreno Valley, Palmdale and Lancaster in search of employment at military bases that have since closed.  Sold on the idea of home ownership being the American Dream, African Americans yet again was manipulated by the financial system and its leadership losing its most valued asset.  Failure to simultaneously address systemic, culturally and economic needs in the African American community leave little doubt we will see ever see sustained mental health outcomes as the African American community is slowly but visually being eradicated post America’s worst economic downturn.

The following questions should be consideration by the System Leadership Team and Mental Health Oversight and Accountability Committee going forth.

QUESTIONS

  • Will operationalizing the 3 year program and expenditure planning process be placed for bid?  And, if so, what minimum mandatory requirements will the contracting agency be required to possess, given “systems transformation” has no relevance toward providing care?
  • How will integration of the 3 year plan be sustained for continuous improvements? May the ongoing 5% of innovation reserves be utilized to sustain transformation?
  • Given cultural competence is imperative, what population and/or community will DMH launch transformation of the 3year plan? Or is this decision one based on the logic of the contracted entity?

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Yo Fellas:

This outreach is to excite your support for Inner City INDUSTRY (ICI) of which I established nearly 15 years ago. I turn to you gentlemen first and foremost because you know me personally and my work ethic as an athlete.  With identical focus, intensity, energy and player camaraderie I bring to basketball my drive endures off the court in our South Los Angeles community working to transform delivery of services.  Based on my professional experiences and certainly no surprise to you, we gentlemen are the strongest Black men to remain standing at a time our young brethren are disappearing, our individual voices are powerless, financially strained and the powers that be look over our heads as if we do not exist.

Currently accumulating in California reserves due several recent voter approved propositions rest nearly $15 Billion dollars intended to support poor and disadvantaged residents. Additionally, as dysfunctional as the Affordable Care Act enrollment had become sits nearly $1 Trillion dollars with a significant portion of these dollars allocated to reduce disparity to close the health gap.  My research-study has provided me recognition as a whole system analysis. I possess extensive knowledge having developed several systemic program(s) processes that will utilize funding resources to transform the no longer existing “socio-economic/healthcare safety-net” in low income communities.

There are currently 47 million Americans in poverty and rising.  Another 30 million one paycheck or emergency crisis away from the hardship poverty presents. Among the 77 million poor or working poor, there are only 37million Black people in the United States. It’s safe yet unfortunate to say we’re heavily represented in these statistics.

Inner City INDUSTRY currently provide jobs and services simultaneously with intentional focus on the African American community and youth as our next generation comes of age.  The goal with your involvement is to ensure every child and their family has access to comprehensive health care, social-emotional learning, mental health and substance abuse care if necessary.  Therefore, Inner City INDUSTRY is launching its Behavioral Health Initiative of which my outreach to you today is for your consideration to join our movement.

In order to reduce disparity we must instill primary care services deeper into the community where citizens reside to proactively respond to their needs.  I believe restructuring K-12 education as research suggest is the only way to reduce poverty and improve the social determinants that increase disparity.   K-12 education must operate as an open system with focus on the whole child, flexible course schedules to re-enroll students who have dropped out for numerous reasons and of critical importance improve the students learning experience utilizing perhaps retired or downsized executives to provide professional instruction as electives to students interested in more than science, technology, engineer and mathematics.

Real Life Scenario: The Affordable Care Act is expected to enroll 1 million Californians over the next few years.  The current emergency room wait time at the dreaded County Hospitals is 10-12 hrs. minimum.  With 1 million new citizens becoming enrolled and seeking services wait times will increase dramatically without restructured access to behavioral health care.  Currently our “beloved” Kai$er hospital is opening a new site off Martin Luther King Jr. across from the “Jungle” as several other community clinics are popping up around South LA.  We have needed these services for decades and they have not come.  Now there’s new money on the table…do you think they’re here for our care or profit?  This is not to shame the entrepreneurial minded, it’s just that they’re in the game and we’re not!

Half of South LA is under 25 years of age representative of our next generation and Black folk are sprinkled throughout in small clusters.  If we as a population are united and intimately involved in leading the transformation of our health and education systems around Behavioral Health advocacy, we will all win and redeem the soul of America as Dr. Martin Luther King Jr. expressed is our nettlesome task to bear such the burden.

This means we must come together Now!

I plan to check on the availability of the multipurpose room at Washington Park to host Behavioral Health presentations on game days throughout December to bring those of you interested up to speed on Inner City INDUSTRY’s work, vision and advocacy timeline.  This will be a great time to answer any your questions during hopefully two separate hour long sessions.  

Immediate Involvement: Volunteer – Advocate – Donate.

  • Volunteer to become intimate with our program(s) and fundraising processes in so that as we prepare to expand the jobs and service program we have knowledgeable leadership identified.
  • Advocate for Behavioral Health by attending speaking engagements (City, County and Systems Leadership Meeting) to demonstrate unified support and/or call or write state policy makers to ensure their accountability to the process.
  • Donate for those who can spare a dollar or direct ICI to additional donors, financial support is vital to the organizations success to administer programs and host advocacy events as state funds are limited to service delivery.

Fellas, this call to action is not about whether or not you have kids, go to church, have a job or not, time currently spent mentoring a child or young professional, this is about our heritage as Black people.  What we do today will define our legacy throughout the 21st century.    

What I will present is a road map to prosperity, I hope you get on board with me. With all us together it’s going to be a lot of fun and celebration, but we need to walk unified.

Blessing to each of you, see you on the wood!

Big Bruce Wheatley.