1. Diversity, Equity, and Inclusion (DEI) question: DEI is a strategic and valued priority for CFHA Board of Directors. Please answer the following questions to the best of your ability.

Diversity, Equity, and Inclusion (DEI) is an incredibly complicated and nuanced set of priorities and points of focus.  The risk with DEI is that we become complacent, thinking we “solved it”; then the critical importance of DEI becomes diluted and ineffective, as more individuals and organizations are focusing on this as a priority, and content with “boxes checked”.  DEI is about representation, about a systemic and systematic focus on issues of equity and inclusion, about voices at the table not just adding information but as critical decision makers.  DEI needs to be fully embraced at every level, with visual representation of people, visual representation in practice (e.g., noting pronouns or preferred name on intake forms), representation in sponsored activities and didactic experiences, etc.  And perhaps most importantly, DEI is about those without personal experience listening more than talking, and starting to gain insight not just into their own personal prejudices, but into the historical systems that have fueled exclusion and prejudice for people of color, LGBTQ+, gender inequality, etc.

To truly move forward with DEI, it needs to be imbued throughout every activity in which we engage.  We might consider adding DEI as a required section to every presentation.  That is not to say that DEI needs to be a core component of the content, but that by requesting a thoughtful consideration of DEI issues, we would be reinforcing the importance through actions in addition to words.  We might also consider reaching out to minority owned organizations, and proactively work to expand diversity of membership with those who might not otherwise be aware of CFHA.

Finally, if we have not already, we should consider hiring paid consultants to partner in an extended approach to systemic changes to make DEI a core component of not just our mission and values, but also our identity as an organization.

2. Strategic priorities: CFHA Board of Directors has identified the following issues as key priorities for the coming year. Please select one of these issues and speak to your experience and expertise in the area and how you might help advance this key issue on behalf of CFHA.

Health equity in integrated care is almost impossible without cross-sector partnerships.  There is no doubt, both anecdotally and with supporting data, that integrated care is the key to the future of healthcare.  At the core of this is the need to meet individuals where, when, and how they are ready and able to be seen.  Integrated care engenders a truly person-first mentality, with a “no wrong door” approach.  That said, far less focus has been put on “reverse integration”, bringing medical services into behavioral health organizations.  Yet this form of integration is critically important, for two reasons in particular: 1. Individuals often think of their behavioral health treatment as their “health home”, coming to therapy, psychiatry, MAT, etc., while not attending medical appointments, and 2. Individuals with serious mental illness are often complicated and difficult medical patients to treat; embedding medical into a behavioral health organization provides a level of knowledge shared between both medical and behavioral health staff to most effectively treat shared patients.

In recent years at Merakey, we have recognized the need for reverse integration.  The clients that we serve are at an exponentially greater risk of various physical health diagnoses, including Sexually Transmitted Infections (STIs), in particular at our Methadone clinic.  Noting this need, our team engaged in partnership efforts, building relationships with the behavioral health MCO (CBH), physical health MCO (Keystone), and experts in STIs (Dr. Stacey Trooskin with a local FQHC).  We recognized the need for collaboration, for everything from training and medical knowledge, to sustainability through reimbursement, and streamlined clinical processes (e.g., as a result of the MCO partnership, Philadelphia now has a system whereby blood draws for HCV automatically include a reactive RNA test, a test that previously required a wait and an extra blood draw, often resulting in clients lost to care).  We have now successfully treated and cured many individual patients with Hepatitis C, providing screening, testing, and treatment in the same location and concurrently with the administration of their Methadone treatment.  We have been able to meet the needs of a client population that attends services on a daily basis, and bring testing and treatment to them, when and where they are able to be seen.

Prior to my work with Merakey, I worked at Cherokee Health Systems, bringing integrated care to a rural health clinic in Alcoa, TN, and as part of the startup team in an Obstetrics/GYN clinic in an urban setting in Knoxville, TN.  Following my work with Cherokee, I worked as the first Behavioral Health Consultant (BHC) for the Philadelphia Department of Public Health (PDPH), eventually becoming the first Director of Integrated Behavioral Health for PDPH. Under this new program, we rolled out Suboxone from within primary care, and hired full-time BHCs for all of the 8 PDPH clinics in the Philadelphia area.  Finally, I worked closely with The Health Federation of Philadelphia, as the lead clinician, providing training and support, both clinical and administrative, to the FQHCs throughout the greater Philadelphia area.

3. Engaging CFHA: Please describe unique ways you and your work will impact CFHA.

In addition to the above, I would love to see CFHA become even more involved in policy-level issues.  Integration is often difficult due to sustainability issues.  Reimbursement is often noted as the problem, though in reality, reimbursement issues often stem from outdated or inefficient regulations and guidelines.  In order to fully move forward with integration at every level (primary care, specialty clinics, behavioral health organizations, social services organizations, law enforcement, etc.), policy-level barriers need to be addressed on a wider scale.

What makes you uniquely suited to represent our membership on the Board of Directors?

My past experience and expertise provide me with insight into the importance of integrated care in primary care, unique locations such as GYN, reverse integration, training, and the critical importance of forming collaborative partnerships.  I believe that the diversity of integrated care experiences I have had uniquely positions me to consider the broad needs and “doors” through which patients might be served. Finally, my position as overseeing innovation means that I am always looking for ways to work “outside the box”.  The core of my job is finding processes that might be improved upon and collaboratively engaging with others to creatively problem-solve with novel and realistic solutions.  In essence, I thrive on identifying hurdles and working with others to develop creative solutions.

     My name is Jennifer Thomas, and I’m a family medicine physician at Morris Hospital in Morris, IL.  I started with Morris Hospital in 2010 right after finishing family medicine residency.  Over the years as a primary care provider, I often found myself feeling frustrated that my patients’ behavioral health needs were not being met, and numerous barriers stood in the way.  I often thought to myself, “There HAS TO be a better way of doing this.”

     In 2018, I joined a primary care psychiatry fellowship through UC Irvine, which was designed to give PCPs more training and comfort in diagnosing and treating BH conditions.  The fellowship gave me a whole new view on ways to incorporate BH care into the primary care space.   The fellowship leaders, many of them dual-trained psychiatrists/primary care physicians, embodied the philosophy that the primary care workforce is uniquely positioned to help address the behavioral health crisis facing many of our communities.  Rather than hiring more psychiatrists as a solution and hitting the “refer” button, we ourselves could BE the solution.  By re-tooling our primary care teams, we could deliver integrated BH in our current medical practices.  I also learned about the Collaborative Care Model and reached out to the UW AIMS Center.  With a bit of “right place-right time” luck, my health system got to participate in two of the UW AIMS Center’s CoCM research studies: the MInD-I project, which was a perinatal depression research study; and also the CHAMP study- Collaborating to Heal Addiction and Mental Health in Primary Care.

     Thanks to participating in the CHAMP study, I’ve learned a lot about treating patients with OUD and found this work extremely rewarding.  My newfound interest in learning about SUD led me to pursue addiction medicine board certification through the American Board of Preventative Medicine in the fall of 2021.  I work in a small, rural primary care practice in northern Illinois.  The opioid crisis has touched so many lives of the people in my community.  Many of my patients are grandparents raising their grandchildren, having an adult child who is incarcerated or has died of on opioid overdose.   I truly believe that empowering primary care providers to screen for and treat OUD will be a fundamental piece of healthcare delivery transformation that can help us overcome the opioid crisis.

     The Collaborative Care Model has been a true “game changer” in my practice and in my health system.  I now serve at Morris Hospital’s Medical Director of Integrated Behavioral Health.  By embracing the principles of whole person care, I do feel that Integrated Care is making great strides in helping heal some of the “brokenness” in the American healthcare system.  My passion for Integrated Care has also led to some exciting and surprising career paths I never would have thought possible just a few years ago.  This fall, I will be serving as a Clinical Advisor for the American Medical Association’s BHI Immersion Program.  I’ll have the great honor of coaching a cohort of physicians as they begin their own Integrated Care journeys.

     I would be honored to help spread the word about Integrated Care and CFHA to members of the healthcare provider community.  I am thrilled to see diversity, equity and inclusion as valued priorities for the CFHA.  To me, DEI means creating a culture where everyone feels welcome and empowered to bring their true self to the workplace every day, regardless of our sex, race, ethnicity or sexual orientation.  DEI means celebrating our rich variety of backgrounds and experiences that ultimately make us a better workforce and a stronger team.  CFHA embodies the values of diversity, equity and inclusion.  CFHA welcomes all members, regardless of our specialty or guild, and attempts to remove barriers that have prevented our groups from communicating and working together in the past. What better way to live the values of DEI than by creating a professional home for all those who are passionate about whole person care?  I would be honored to help carry on that mission of DEI at CFHA.

     I feel my personal Integrated Care journey is an example of the power of cross sector partnerships and the benefits of CFHA membership.  I myself reached out to CFHA as a new member in 2019, and received a warm welcome and encouraging emails from members like Neftali Serrano and Jodi Polaha.  Their kind words of encouragement helped push me on as a new Integrated Care leader.  The CHFA podcast was a calm and supportive voice during many dark days of working in primary care during the Covid pandemic.   There are many providers out there just like me.  Physicians, nurse practitioners, physician assistants, nurses, medical assistants and other frontline workers who are tasked every day with helping the person in front of them with behavioral health concerns.  And many of them feel overwhelmed and underprepared for this incredibly important task. So many of them are suffering from burnout, craving a sense of community and looking for that feeling of belonging to one another that got them interested in the caring professions in the first place.  I would be honored to serve on the CFHA board and help spread the mission of Integrated Care.  CFHA has helped me find a true community, and I would love the opportunity to help provide that connection for others.

1. DEI:

     I view Diversity, Equity, and Inclusion through the lens of power structures; I see the work of increasing Diversity, Equity, and Inclusion to involve understanding how the structures of an organization shape who is empowered within it and taking steps to change those structures when they lead to inequities. I pursue this work in my current role in UVA Family Medicine through my work on our departmental DEI committee as well as a system-wide committee on gender-affirming care.

     One fundamental challenge around DEI that faces CFHA is being able to prepare our members to push their institutions beyond any DEI efforts that have been ineffective, such as single-mindedly focusing on anti-bias training, and into the work of implementing more proven practices, such as increasing contact between people of different identities, as well as seeking to change the structural relations within the organization to better empower people at the institution who have been disempowered by design. This is a daunting task by definition, but I believe that CFHA has an imperative to ready its members to try to take it on.

     I see preparation as the key to making CFHA more agile in terms of DEI skills. We have the benefit of accumulated wisdom among our membership, from people who are doing the work of DEI in their institutions. If we are able to coalesce these valuable experiences and facilitate dissemination, through events, publications, and standing collections of resources, CFHA will move towards being nimble and responsive, and become an incubator of DEI efforts in healthcare.

2. Strategic priorities:

      My experiences in my current role as a behavioral health consultant and faculty member in the UVA Family Medicine Residency have prepared me to advance CFHA in building cross-sector partnerships to grow our membership, one of CFHA’s identified key priorities for the coming year. I’ve developed relationships across roles, disciplines, and training backgrounds through my work in operations leadership of our department’s largest primary care clinic, where my main responsibility is to help the various members of our clinic cross over the natural silos that can form between people with different roles. Through this work, I’ve found that encouraging perspective-taking across roles leads to each team member feeling more understood as well as empowers them to fully engage with each other. I hope to bring these experiences to the Board and help CFHA plan outreach that seeks to empower potential members from sectors not fully represented in our membership, and positions CFHA as a welcoming place for their visions for integrated care.

3. Engaging CFHA:

     In addition to furthering CFHA’s work in their stated key priority areas, I would also hope to advocate for continuing CFHA’s efforts in building partnerships with residency training organizations that are also invested in integrated care, exemplified by the recent Community Conversation with the STFM president, as well as strengthening the voices of trainees and early career professionals, all to contribute to a stronger pipeline from training into integrated care. I would draw on my experiences as a residency faculty member that trains medical and behavioral health learners and a current early career professional (and relatively recent trainee) to advocate for this important constituency that will be the future of CFHA and integrated care more broadly. From interacting with trainees in both medical and behavioral health settings, I’ve seen a strong appetite for integrated care that is accompanied by some uncertainty about how to find opportunities to get involved, so I would seek to assist CFHA with developing initiatives that would channel this interest into engagement in the field and a more robust integrated care workforce in the future.