The first week of March, I attended the annual meeting of Grantmakers in Health (GIH), a national affinity group for foundations that fund health-related activities. Although I don't attend every year, I always come back from meetings with information that I can incorporate into my work. I thought that I would share what I learned this year with you.
• Many foundations approach prevention from an advocacy point of view: converting vacant lots to vegetable gardens, making sure a park is a safe place for walking and other activities, lobbying for better fluoridation of water, or smoke-free environments, etc. Here at the Health Foundation, we have developed the Assistance for Substance Abuse Prevention (ASAP) Center which approaches prevention from a different perspective. The ASAP Center is less about advocacy and more about teaching individuals and groups to use specific prevention practices. It was interesting for me to contemplate how we might use the other approach. One foundation shared a readiness assessment they use when working with communities that are trying to change their community environment or social norms. I wonder how this might be helpful for communities in the Health Foundation's region.
• One session was a breakfast meeting for the Behavioral Health Funders Network, a group of about 70 funders within GIH. John O'Brien, senior advisor on healthcare financing at the federal Substance Abuse and Mental Health Services Administration (SAMHSA), shared the SAMHSA strategic plan for 2011-2014. As a group, we discussed ways that the federal government might partner with foundations in behavioral health. Even though I had heard the SAMHSA strategic initiatives before, I recognized nuances of the SAMHSA strategic plan I had not seen before. This will hopefully turn into an improved ability to coach grantees attempting to get SAMHSA funds.
• In a session about "what keeps you up at night," I learned that many foundations are in the midst of transitions in leadership. Since we have just gone through a transition in leadership here, it was good to listen to others and offer some guidance from our experience. I was reminded of some transition practices that might be helpful for our grantees that are or soon will be going through transitions. These included developing a succession plan before the time for new leadership emerges, using both board and staff involvement in the search process for new leadership, and forming a transition team from all parts and levels of the organization to help guide the new leader in the first few months of the job. For new leaders, those present recommended taking at least a year to get situated before making major changes.
• In many of the sessions, I was reminded that as grantmakers it is important to start where our communities are. What works in Los Angeles or New York or a small rural community in Nebraska might not necessarily work here in Greater Cincinnati. It might sound great, but I can't push it on people here. I can share, but forcing people to do something "my way" rarely works.

Does any of this raise questions for you? What did you learn at your last conference that you want to share?

Healthcare reform is truly exciting for mental health. Finally, mental health is recognized as a health condition and is to be included in basic healthcare benefit packages.

Now that mental health is on the inside, what happens next? What healthcare reform means for mental health can be very difficult to decipher. I have found a couple of sources for excellent information - information about mental health and healthcare reform that is explained clearly and simply:

• The College for Behavioral Health Leadership offers free monthly webinars over the next year. The webinars are archived in case you miss one.
• The National Council of Community Behavioral Healthcare sponsors a regular blog on mental health and healthcare reform. The previous blogs are archived in case you want to go back and look at blogs you may have missed.

Let me know if you find other helpful sources of information about mental health and healthcare reform.

I regularly convene grantees with similar projects to share the lessons they have learned, to discuss common problems, and provide project updates. These grantee groups are interactive and interesting. I always learn important things at these meetings - things beyond the status of each project.

In a recent grantee meeting, we started discussing staff turnover and how quickly the loss of key staff can de-rail or delay projects. This led us to the importance of staff recognition. The group got very energized discussing the different ways employees are recognized.

The experiences of the grantees aligned with a book that I read: The Carrot Principle by Adrian Gostick and Chester Elton. The book details the results of a 10-year management study of 200,000 people. The key finding is that the most successful managers provide their employees with frequent and effective recognition, which in turn leads to better staff retention along with other positive outcomes such as high productivity, engaged employees, and customer satisfaction.

According to the study, recognition accelerates positive outcomes when it is based in management that sets clear goals, communicates openly, builds trust, and holds people accountable. The grantees gave examples of recognition in each of these areas:

• Set clear goals: one agency gives "on-the-spot" award certificates to recognize employees that show behavior that helps the organization meet its goals. The awardees are also treated to lunch.
• Communicate openly: one agency holds an annual recognition event where employees are recognized for specific contributions to the organization's work.
• Build trust: one agency has suggestion boxes where employees can make suggestions for improvement in the organization. These suggestions are taken seriously and often result in changes for the better. The management of this organization makes sure that they let employees know when changes happen as a result of their suggestions.
• Hold people accountable: one agency holds leadership classes for future leaders in the organization. This class imparts the organization's expectations as well as the value it places on skilled leadership.

In The Carrot Principle, there are 125 recognition ideas. Most cost nothing. One suggestion, #110, struck me: "Chances are that you have someone on your staff who always does solid work, always meets deadlines, is always there ... and is rarely recognized. Make a point to do it today."

I want to follow my own suggestion and recognize Lisa Myers, Financial Specialist at the Health Foundation. Lisa makes sure all of our grantees receive their grant checks, pays the vendors that Foundation uses, handles all of staff's expense reimbursement checks, and answers all sorts of questions. She does this quietly and flawlessly. So, I just want to say to Lisa - thanks for all of the work you do for the Foundation and our grantees.

I am always curious about what makes some places good places to work. I think that good workplaces tend to have stability within their staffs and good services--the kinds of things we all value in businesses we deal with.

I started thinking about this again when The Cincinnati Enquirer named Greater Cincinnati Behavioral (GCB) Health Services as a 2010 Top Workplace in Cincinnati. The Top Workplace is a program run in conjunction with the major newspaper in a region. Employees can nominate their company and an independent research company then conducts anonymous workplace surveys and selects the top workplaces.

First, I am pleased that a mental health center received a Top Workplace designation. Mental health centers are sometimes seen as, well, depressing places to work by the general public. Hopefully this honor will show people that mental health centers are good places to work.

Second, I found the comments that GCB staff members made on their surveys revealing. As I read these comments, I noticed common themes that give insight into what makes any workplace good:

Customer-focused

• Everyone is focused on the organization's mission to improve the lives of its customers
• From top to bottom, people care about the organization's customers

Positive culture

• Staff are valued and are seen as part of a team doing important work in the community
• Staff are encouraged to give feedback and suggestions for improved services
• Staff regularly receive positive feedback as well as constructive feedback for improvement
• The organization has good internal communications

Investment in human capital

• Staff are given leeway in how to do their jobs best
• Staff have competitive salaries and benefits
• Staff have opportunities to grow and career paths are in place
• Co-workers are energetic, caring, and dedicated
• The work is varied and interesting, not the same everyday

Being a community partner

• The organization is always looking ahead for ways to innovate and be leaders in the field
• The organization is not afraid to step up and help tackle tough community problems

This is an impressive list, but as I think about it, I have seen these same qualities in many of our grantee agencies who have been successful in implementing projects. How does your organization stack up? What steps can you take to make your workplace good--or even better?

"Ten years ago none of us would have been sitting together in a meeting."

This remark was made by someone at a roundtable discussion on integrated care hosted by Talbert House. The guest of honor was Cristal Thomas, Regional Director at the Region V Office of the U.S. Department of Health and Human Services (HHS). The topic was the integration of behavioral health and primary care. Attendees included mental health centers, federally qualified health centers, the health department, and others interested in integrated care.

Ten years ago, folks from behavioral health and primary care would probably never have even thought about meeting to discuss integrated care. Back then, the mind and body were seen as totally separate and treated in very different systems of care with little or no collaboration.

Early on, the Health Foundation recognized that people with severe mental illnesses had terrible health from anecdotal reports from grantees. Later, studies confirmed this and indicated that people with severe mental illnesses die 25 years sooner than the general population. There are many reasons for this disparity, but lack of access is one of the reasons.

The Foundation decided to promote integrated care and has been a pioneer in the field. Its first integrated care grant was in 1999 and the project started delivering primary care services on-site at mental health centers in 2000. In the last 10 years, there has been increasing interest in the way behavioral health and physical health affect each other. And, there is increasing realization that treating the whole person (behavioral and physical) leads to good overall health and more effective use of resources.

We have come a long way, but there is still a ways to go. There are many barriers to integrating behavioral health that need to be addressed. However, now there is interest in integration at many levels - local, state, and national. We are fortunate that we had the opportunity to share our work with Ms. Thomas who has a high-level position at HHS. We are also fortunate to have many people in our communities who recognize the importance of integrated care and are willing and eager to work together to implement integrated care programs, tackle barriers, and provide holistic care to some of our most vulnerable citizens. Thanks to all of you for your hard work!

There were many terrific sessions at this year's GAINS conference, but a particular one stands out - Top 10 Ways to Sustain Programming. The topic caught my eye since the Health Foundation is especially interested in the sustainability of the programs we help start. So, I got up early - this was a sunrise session - and attended this session on sustaining programs.

I was not disappointed. The speaker was Stephen Bush from the Shelby County Public Defenders System (Memphis, TN), who talked about a jail diversion program he is involved with. He had composed a Top 10 list on how to sustain a program.

I like Top 10 lists and I thought his had lots of relevance to Foundation grantees and others who are trying to sustain new programs. Here is Stephen Bush's Top 10 list:

1. Build a brand - create a easily recognizable brand for your program.
2. Exploit any and all technical assistance that is available to make your program strong.
3. Tell your story; make a video - client stories are compelling.
4. Amplify your program via advocates (such as NAMI).
5. Look smart - get published, be seen, use the media.
6. Use data effectively to show that you make a difference in the lives of your clients.
7. Cultivate patrons in the community.
8. Find your local relevance - show that you make a difference in your community by the work you do.
9. Be a key to something bigger - show how the program connects to the larger community.
10. Throw a party to celebrate your successes.

Stephen Bush's program produced a video to tell their story. You can see it at http://community.livefrommemphis.com/_Voices-of-Jericho-Stories-of-Jail-Diversion/video/316209/14881.html

The Health Foundation's Capacity Building Programs series helps you achieve item #2 and many of the other items on the Top 10 list. You can see the entire catalog at www.healthfoundation.org/events/by_topic.html. Some workshops connected to the Top 10 list include:

• The Art of Cause Storytelling (Top 10 item #3)
• Public Relations (Top 10 items #7 and 8)
• Meet the Press (Top 10 item #5)
• Making Data Work for You (Top 10 item #6)

Stephen Bush's list is a good place to start for sustaining a program. What has worked for you in sustaining your programs? What would you add to the list?

In March 2010, The Substance Abuse and Mental Health Services Administration (SAMHSA) announced their 10 Strategic Initiatives. As I read these over, I was reminded of how interwoven many of the problems that we face in our communities are. Employment and healthcare are linked, as we all know, but homelessness, addiction, returning military, trauma, and criminal justice are all connected to these issues as well. I have two reactions to all of this: despair and conviction. I am dismayed that all that we have done over the years seems to have had limited impact on these problems. But I am also convinced that we have the tools available to make an impact on the lives of individuals who have health and social concerns. Things can be different if we work together.

SAMHSA seems to be addressing some of these ills in a manner that makes sense...they are demanding collaboration across systems. A recently released request for applications for the Community Resilience and Recovery Initiative from SAMHSA requires the involvement of public leaders, behavioral health prevention and treatment providers, criminal justice systems, employment services, and veterans' services. Although it seems overwhelming to get everyone working together, I know that it can be done. I've seen it happen in some of the communities that we cover with our grants. And when everyone is working together, amazing things happen.

Think about what seems impossible in your community. Now, think about who has a stake in this problem. Start talking to them about what solutions might be. Share with them the strengths that you see in the community. Begin to gather a group. And if you need help getting started, call me.

Remember - "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." - Margaret Mead

I attended my first Grantmakers in Health (GIH) meeting in 2000 shortly after joining the staff at The Health Foundation of Greater Cincinnati. GIH is a membership organization of funders from across the country. Being new to philanthropy, I was very excited to hear from other grantmakers about their experiences in making grants in mental health. Much to my surprise, there was not one mention of mental health in the whole three-day conference that year.

I decided this was not acceptable. Over the next few years, I made informal contacts with other grantmakers interested in mental health. We started submitting session ideas for each GIH meeting. Many of these sessions were accepted. Last year, our core group of mental health grantmakers formally launched a Behavioral Health Funders Network at the GIH annual meeting. At the meeting, we held a preconference session and had three sessions focused on mental health/behavioral health.

Over the past year, we have had over 50 foundations join our Network. At this year's annual meeting, from which I just returned, mental health again was represented at a preconference session (I talked about our social enterprise initiative) and three sessions. We also held a special meeting of the Behavioral Health Funders Network which was well attended; we had a special guest, Dr. Eric Broderick, Deputy Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). We talked about how grantmakers and SAMHSA can collaborate together. In addition to the mental health sessions, mental health was frequently mentioned in other sessions including the plenary sessions.

GIH staff told the Behavioral Health Funders Network that we are the most active network in GIH. I expect our membership numbers to increase after this most recent meeting and we have webinars and other activities planned for 2010. I now have a strong network with other mental health grantmakers who see great opportunities to make significant impact in the field of mental health. We learn from one another and together we promote mental heath grantmaking across the country. We have come a long way since 2000.

Most people probably wonder what goes on behind the scenes at the Health Foundation. One thing the senior program officers do is write annual focus area reports that we present to our Board. My report on the Severe Mental Illness focus area always occurs in December. For me, these reports are difficult to do. It involves looking back over the past year's work and writing a concise summary for Board members, none of whom are professionally involved in the mental health field. My 2009 focus area report can be found on our web site at http://www.healthfoundation.org/publications/documents/Severe%20Mental%20Illness%20Dec%2008-Nov%2009.pdf

For part of my report this year, I compiled a list of all the mental health evidence-based practices that the Foundation has helped start in our region over the past 10 years. I was surprised to count 49. The most frequent evidence-based practices implemented were Assertive Community Treatment (ACT) teams (we helped start 10), Supported Employment programs (8), and Integrated Dual Disorder Treatment (IDDT) teams (7). Of the 49 projects, 41 no longer receive grant funds from us; i.e., these grants have closed. Of the 41 closed grants, 35 are sustained for a sustainability rate of 85%. To me, this is pretty impressive.

Evidence-based practices are not easy to implement. For one thing, current payment systems are often not adequate to support evidence-based practices. Additionally, it takes a huge commitment on the part of organizations to carry out the training and monitoring necessary to meet fidelity to the practices. I appreciate the efforts of the many organizations that have worked so hard to bring the many evidence-based practices to our region and worked hard to find ways to sustain these practices in difficult economic times. To me, the efforts are worth it because hundreds of people with severe mental illnesses now have increased access to proven, effective treatment.

I watched a PBS show in October called Minds on the Edge. The program explores mental illness in America. I highly recommend taking an hour of your time to view this show.

A moderator leads a discussion of two hypothetical scenarios among a diverse and distinguished panel. The panel includes physicians, family members, attorneys, judges, scientists, and government leaders. Some of the panelists live with mental illness. One of the scenarios focuses on a college student who develops mental illness while in school and does not welcome the concern of a professor and her family as they try to get her help. The other scenario focuses on an adult who has coped fairly well with his mental illness until his mother dies; without key support, he becomes entangled in the criminal justice system.

As the panelists grapple with what to do in these two scenarios, the viewer gets a sense of the many flaws in our country's mental health system - difficulty in accessing treatment, dilemmas of forced treatment, fragmented mental health care, disjointed mental health policy, and too few resources. The program raises lots of questions and offers few clear cut answers.

The intent of the program is to open minds about issues facing contemporary society. The program on mental illness is to be a starting point to engage communities in discussing mental illness and to share ideas about what to do.

I strongly encourage you to watch this note worthy show. You can view it online at www.mindsontheedge.org. Or, let me know if you would like to come to the Foundation for a viewing and discussion. I think you would find it worth your time.