Erika Clark Jones, the CEO of the Alcohol, Drug and Mental Health Board of Franklin County (ADAMH), leads a workforce that’s a highly demanded superpower: community behavioral health providers. She explains how ADAMH helps community agencies compete with the likes of hospitals, schools, insurance companies to hire and retain culturally competent employees. Among their tools: tapping into altruistic motives of giving back to the community; supporting paid internships or practicum placements; helping agencies provide a supportive work environment; providing workers with micro-credentials and leadership training for learning and career growth; and leveraging state resources and working to change public policy by lobbying at the statehouse. 

Trevor Brown 0:02

Welcome to the podcast Leadership Forum conversation with leaders who serve the public good. My name is Trevor Brown, and I'm privileged to serve as Dean of the John Glenn College of Public Affairs at The Ohio State University, where we aspire to fulfill a simple phrase that Senator John Glenn used to describe what we do, inspire citizenship and develop leadership. I also have the honor of serving as the host of this conversation series. So welcome to a thoughtful and reflective conversation about leadership and public service. I'm joined today by Erica Clark Jones, the CEO of the alcohol, drug and mental health board of Franklin County, better known as Adam H. Adam, he helps Franklin County residents find the right places to turn for affordable quality mental health and addiction services provided through its network of more than 30 non for profit contract agencies located in neighborhoods throughout the county. She previously served in nonprofit organizations in the social services and behavioral health arena. She also served as the city of Columbus's Director of Policy Director of the Office of homeless and social service advocacy, and Deputy Director for the community relations commissions. There are so many things we could talk about in the behavioral health, addiction services and social determinants of health arena. But we're going to focus our conversation on some of the labor force challenges, specifically how to grow, cultivate and nurture a pipeline of committed public service professionals in a highly turbulent labor market. Erica, thank you for joining me today for this conversation.

Erica Clark Jones 1:36

Trevor, it's my pleasure to be here.

Trevor Brown 1:38

So we're gonna jump around a little bit. But I want to just start by talking about what makes for a highly effective professional in behavioral health. What do you look for in talent?

Erica Clark Jones 1:50

What a great question. And I want to first say, at the alcohol, drug and mental health board, one of the things we care about most is the community based care that's available to any resident, regardless of their background, regardless of where they live, including their zip code, and regardless of their ability to pay. So at the alcohol, drug and mental health board of Franklin County, we don't do services, we do not provide direct services, what we do is support over 30, community based agencies that deliver services every single day, including weekends, and 24 hours a day, seven days a week. So when we talk about the behavioral health workforce, we're really talking about these folks that are on the front lines, and that are supporting this community based service to all of our residents. And so we get our information from our leaders and the workers that are in this space. Of course, we want someone that's committed to providing this type of care to the patients and the clients that seek out services are diverse. And so we absolutely want someone who is open minded, who can see across all barriers, including gender, background, race, ethnicity, and come to the work with their own authenticity, their own experience, can empathize, but at the same time deliver the professional services that an individual needs, particularly when they are in crisis, when they are trying to stabilize or when they're trying to support their child in the same endeavors. So we want someone that's credentialed, the behavioral health workforce or the workspace is heavily credentialed. When people talk about wellness, a lot of folks immediately when they when they talk about health and wellness, a lot of folks immediately think physical wellness, which is super important, right? And that kind of clinical care. But the mental wellness has also taken center stage these days, whereas, say 10, 15, 20 years ago, and even really few say a generation or two ago, there was heavy stigma around how one individual took care of their mental health, particularly if they suffered from mental illness. These days, it's much more common. Even my children are much more forthcoming with the support that they would like, and the fact that they've even sought out support and what else can we do to support them on their recovery journey, or just working through anxiety, depression. And so I love this new generation, I think it's Z and part of millennial they're all coming forward saying I need help. And we say at the Adam H. board, it is okay not to be okay. And so we want to make sure you have the support for doing that. So you've got the interest and the demand is now from our community for more community behavioral health Services. We need the professionals to deliver that service on a consistent and regular basis that are culturally competent, and well trained and credentialed.

Trevor Brown 4:56

So what in a nutshell, and we're going to unpack this over the I think next 20 minutes or so, what's the what's the primary challenge in hiring these types of people and keeping them in the in the field?

Erica Clark Jones 5:09

Yeah. So the first thing is, and I think you see it everywhere these days, finding the talent, and keeping the talent that you have is a primary challenge. So let's talk about retention first. The folks that work in public health, and I call it community behavioral health, I consider them to be salt of the earth. These are folks that show up every day, committed to the job committing to making the world a better place one client at a time, one patient at a time. They are in high demand, frankly. So I think and Trevor, I'm sure you see this a lot. The social determinants of health are these things that impact our health, that relate to employment, sense of safety, transportation, access to insurance, education, stable housing, all of these things contribute to our mental and physical well being. And so there's a recognition, I think, across the health industry, right, both behavioral health and physical health industry, that social determinants matter. And they're looking for individuals with some insight to that background, or that understand this and can work through this. And so behavioral health is no exception. So the individuals that train in the community behavioral health space, are highly sought after, by insurance companies, by hospitals there, because of this recognition that social determinants of health matter. And social work degrees in social work are have become very popular these days, licensed clinicians are wanted everywhere schools want licensed clinicians, a lot of people do, we're seeing an increased demand for for this talent. And so the folks that are in the community behavioral health space, are being heavily recruited in the community behavioral health space, you know, we've they've, they're nonprofit organizations, there's a traditional pay structure, and I guess a work environment that demands a different type of commitment. And those folks are being quite frankly, highly sought after. So the pipeline into community based behavioral health is really important. And that's where, at the from the Adam H. side, we've got to create pathways into the field, and then support individuals to stay in the field and work in this space and contribute to our community's well being.

Trevor Brown 7:41

Okay, so just this is great helping me understand this, this arena, you need culturally competent, mission driven, credentialed professionals and got it that's that's not something you just find walking around. Those are those are a unique or uncommon labor population. And now you got to increase competition for their their services.

Erica Clark Jones 8:04

That's correct.

Trevor Brown 8:04

So let's, unpack that a bit. And give us a you gave us a great background on Adam H.. I want to talk about the behavioral health social determinants of health space. What's the what's the behavioral health landscape look like right now? And how has it changed over the last 5, 10 years that you mentioned, the social determinants of health being a sort of philosophical underpinning of how people are approaching? Who are the new entrants into this space? And what do they do relative to what Adam H does?

Erica Clark Jones 8:36

Yeah, what a great question. And I may come at this a little differently than maybe someone else who's worked in the field a long time. So my background, I come from a public policy background, rooted in city government, as you mentioned earlier in the conversation, and then made the shift to public health, and was honored to work with just a team of professionals from the hospital association and hospitals, frankly, clinicians, community based care and clinics, as well as policymakers in this space that said, you know, the social determinants of health have an impact on lots of different things, including birth outcomes. So I came from that maternal child health space, where we were had a team of epidemiologists that helped, you know, identify and the metrics we would use to know if we were being successful. So we might attack certain areas, and then, you know, study them over time, study the impact and then double down on them if we were getting what we saw were positive results, and that's that public health approach. And I love that they're, they're such a disciplined group. So coming from that space into behavioral health, I expected the same and that's not what I saw. The behavioral health area is a little different from the from the public health space, at least traditionally, it has been in different from the physical health space, but they are shifting. And I love to see where the shift is. I recently got to see Thomas Insel who used to be the head of the NIH for several years, he wrote a book called "You are not alone," it really gives a high level overview of where the behavioral health discipline is right now and what services look like, where the gaps are. And there's a recognition for the need for more data, tracking of outcomes. And outcomes can be if an individual is living with mental illness, are they more stable, so that they can enjoy and be enjoy life differently, and be productive citizens? Right? These are the types of metrics, they are looking at quality metrics to say, is anyone better off as a result of receiving services in the community or with their clinician, that's the space I came from from maternal child health. And that is the space where behavioral health is moving towards. It's an awesome energy. But it's not it's not always, you know, it's messy, right? Change is messy. How it impacts the workforce, for example, there is a recognition that people with lived experience, either living with mental illness or have come through substance use disorder, and that still are committed to the work and want to help others should be credentialed, licensed and used as a part of the bedrock of the workforce, in the behavioral health space. And those are what they call peers, or peer clinicians if, if that's where that's possible. So many of our community based agencies, and quite frankly, it's happening all over the nation are relying on peers as an entry point into the workforce. The other thing they're doing, they're taking individuals that are already in the space, and starting to add and microcredentials really supporting their learning and their growth, one, they want to retain these folks. And two, they bring this level of experience and commitment that, you know, they're helping to essentially develop the commitment over time.

Forgive the interruption. Give me some examples of micro credentials that get added on to the sort of traditional.

Yeah, that's, that's a great, that's a great question. So licensed counselor, alcohol and drug counselor, right? These are credentials that can be achieved fairly soon, with with some focus and support from your employer, right. So they'll, they'll help underwrite. And at least, this is an initiative that several folks are working on. They'll help underwrite the cost of the program, so that you can add that additional credential to whatever you came in with. So if you're a licensed social worker, you can add these additional credentials while you're still working in the field. And I mean, one that's helpful in this space, that means a lot to folks. And employers are looking at different ways to keep people so that they are supporting that effort. The other thing, though, is what we're seeing. And we recently, and I credit, our Vice President of advocacy and engagement, Dr. Amina Kimofour, in our HR director, at Adam H., we are tasked with the planning, funding and evaluating of our community based system. And so we stepped back, we asked our providers, what is the biggest challenge you're facing, and one of them is workforce. And so we pulled maybe 30 Plus partners together from higher ed, from our community to say, what what is it that you need? What is it that we can do, and one of the things that came up was leadership development, we've gotten them as so it's not technically a micro credential. But it is a skill set that people want to lean into, you know, they want to stay in the field, but they've got to see the opportunity to stay in the field. And one of those ways is being able to support managerial experience, right? It's separate from a licensed social worker supervisor, right? But additional managerial experience and how to lean into the fiscal side of the business, the policy side, because that's where we need change, we need change in some of these spaces that allow us to share data so that we can track incomes better, so that the population is better off. Yep.

Yep. So who that's Thank you, that is a great background in the habit of changing dynamics of the workforce. What what uh, who are you are, who are the active people hiring in this space? You mentioned there are insurance companies, hospitals coming in. So when you first started this job, were you the only sort of your network really the only people buying these kinds of or hiring these kinds of folks or were, has that always been the case? You have a highly competitive environment for these these types of people?

That's a great question. So you know, our community based health agencies are always looking for a committed people to work with a population regardless of insurance, right? And that's it's a diverse population. I think the shift started and like I said, maybe 15, 10 years ago, now, it's really you see it? There's a lot of people hiring social workers. Yes, that's what I would, I would say, a lot. It's become a new superpower. I mean, those that are social workers know that it's a superpower. But now the rest of the world is saying, yes, it is indeed a superpower. So, I was really fortunate to work with Care Source, maybe eight years ago, when we started talking about infant mortality. And they were they at that time, they were really taking a look at social determinants of health, especially housing, to say, Okay, how do we learn more? And how can we change things, and they did a pilot program, which I understand is now they've had two papers from this program that said, if you, you know, they did a whole control group with pregnant women. And if you were able to provide for stable housing, was the pregnancy better with less complications, and did the baby you know, come out in a in a way that was strong enough to thrive well beyond their first birthday, and really start getting at some of these other challenges, right, the parent and and of the family. After that they wanted more, Care Source did, they wanted more inputs from social workers. So people that had that background, that could understand because they are one of our Medicaid managed care plans here in Ohio, one of the largest, they wanted people with that skill set that authenticity that lived experience, lived experience in that they've worked with individuals who they're ensuring to have a greater and deeper understanding of the type of products and how to be best responsive to the folks that they're serving, and can maybe serve in additional capacities to keep, frankly, their risks to really mitigate their risk and keep them lower, if you stabilize a certain part of the population, what kind of benefits can it have? So Care Source is just one example. I think hospitals absolutely are looking for what I would call the Swiss Army knives of, of personnel, we see that all the time. We love it, when we support it. But on the back end, I think it's our community based nonprofits all the time that cannot compete with the salaries and the benefits that are being offered in the marketplace. And that's where Adam H., has had to be creative to say, how can we be helpful? Do we need, for example, when we need to look at the system as a whole? What kind of incentive can we give to a community based agency that they can then pass on to their workforce to retain them now, it may be short lived. But if you layer that, with the support of credentials, leadership, training, exposure, you know, and of course tying it to that higher mission, then you may indeed have a stronger chance of keeping that pool of workers at that community base level.

But I'm gonna come back to that. But before we dive into what what a leader can do in either one of those nonprofits, or are you at the network level, I want to talk about the supply side, first of of these professionals, and make it about me in higher education. What what do you what what can we do in the higher ed space to produce more professionals that have that complement of skills that you mentioned earlier?

What a great question. Well, of course, one, we need lots of programs in this space. So maybe not limited to one university, but more universities being able to meet the needs of the employers at this time. I know there are several local colleges that are thinking about social worker track offering microcredentials, doing their licensure, for example, counseling. That's what we need more of, we need these related coursework, to be readily available in multiple forms. A lot of times the again, as I spoke earlier, there are peers in this conversation. These are adults that maybe have had a lived experience, and they're pivoting from another career, they need to be able to access this type of education so that they can serve in this way. So credential access in the coursework that comes with it needs to be accessible to working adults, and we're people that might take it in the evening. Your young social workers just coming out of high school, they're budding social workers, you name it, we need to make sure we have a diverse offering, and easy on ramps to the folks that want to do this program. I think the other thing and we talk a lot about this here at the board. We have we've got a show it model it underscore how important it is. You know, when we tap into those altruistic motives of giving back to the community, and making sure you're healthy, the good thing is and if Trevor we go right back, maybe to the beginning of where mental health used to be, you know the stigma associated with mental health mental illness and behavioral health challenges 10 years ago was much greater than it is today. I'm not saying stigma doesn't exist, it is, but we're chipping away at it. And the pandemic helped us kind of break that open. Consequently, there are so many individuals that have family members that are living with mental illness and substance use disorder, they're seeing it firsthand. So how do we appeal to those people to say, you can help, you can change this right, you can be a change maker in or you can force change in someone else's life, right? You can be a helpmate in many people's lives. So we've got to tap into the thing that they see in that they know, and can give them the tools to be to make a difference, right in their own community, and for other people in their families. So we've got to model it, we've got to make the credentials accessible. And then we've got to reward it, frankly, right, we are community based agencies need to be competitive, too, right? So we need to put them in spaces where folks have a choice. You know, you can go into the corporate culture, or you can, you know, you can take this other path. And we want to make sure we're standing that up as a choice and admirable choice. That that really taps into that commitment that folks want to want to provide.

So let's let's talk about that what you all on the demand side, can do particularly in that nonprofit space. So we'll do this in two parts. First, let's talk you got 30 nonprofits in your network. And I want to start with them. And then we'll talk about your sort of network organizer. You're the network hub, what what can a leader of one of those nonprofits do to attract and nurture and retain the kinds of people you've described, given that they have perhaps limited resources, they can pay less than then one of the hospitals or the the insurance? What are the key steps they can do to attract these people and retain them?

Yeah, it's a great question. And you know, this won't be an exhaustive list. But it's a start, I think the first thing that our nonprofit network partners can do is make their workplace an attractive place. Right? It's time to rethink the old ways of doing business. To make sure this, the work environment is positive, it's supportive, it's nurturing. And it leads to something better, and you can see your contribution in the lives of others. I think that's job one, actually, we heard that as well from our network partners, that said, give us the tools to assess our current workplace. And then the path are the lists the map for the modifications, right, show us how to make those modifications, coach us, give us some support to transform our workplace so that it becomes a place of choice for for an employee. So that's number one, create the environment that encourages people to stay and feel good about the contributions that they want to make. I think the second thing they can do is offer the incentives to achieve more credentials, and become a professional, not just think about this as a $17 an hour job for the next two years, right just to help pay off student loans. But really tap into what a model what a career looks like, show the pathway, kind of the bright spots along the way. And then frankly, tap into the incentives that Governor DeWine has made available through the Ohio Mental Health and Addiction Workforce Development Plan, and then take advantage, of course to anything we can do as a board to support that it this is not a time to go it alone. This is a time to look around and see what other incentives are out there that you can leverage to again, create that healthy positive work environment where your employees are empowered. And they're thinking career, you know, the long term taking the long term career path as opposed to the job path.

Educate us about what those incentives are that the governor has made available.

So there's a there's a couple of incentives that the governor has just rolled out as a matter of fact, Trevor, like in the last month, and this program is for existing mental health professionals, as well as those that want to become mental health professionals. And their priorities are increasing career awareness, supporting the recruitment, not just from community based agencies, but higher education, looking for individuals that want to go into this path. They are incentivizing and providing retention bonuses through the state dollars to your your local community based providers. And they're supporting contemporary practice. And I just want to touch on that just for a minute. This contemporary this notion of contemporary practices, is I don't know if it's the same in the, you know, kind of physical health and wellness space. But in the behavioral health and wellness space, it's really important because it gives confidence not only to the people who are coming to seek services there, but to the employees that are providing it, you know, gone are the days in the 1960s, where there were all these experimental trials and people, you know, it just added to the stigma of what was really happening in some of these in these behavioral health spaces. The governor has incentivized getting the training for contemporary practices, so that we are on the forefront of behavioral health service delivery, and not lagging behind. And that's exciting. If you're in the discipline, that's exciting. You get to learn new ways of delivering services either more efficiently, more effectively, you see the outcomes of your work, we're celebrating those outcomes, and you are a part of the change. So I do think the governor's office and the Ohio Mental Health and Addiction Services, get it right. We're supporting the workforce in that way. And at Adam H., we're happy to be able to be a conduit between what the governor, the governor's office and OMHAS is offering through and our network so we get to serve as the liaison between those two.

Well, let's let's use that as a great pivot into then what's what do you see as your your role? And you can answer this both you Erica Clark Jones and you Adam H.? You are you just said you're the conduit, you're this liaison organization, you're not the direct service provider, you try to coordinate and organize the direct service providers. What can you do at that system level to try and and again, make it easier for the nonprofits to be able to hire and retain the best talents? What if someone in one of those positions like yours do?

Yeah. So that's a great question. And I want to first answer it at a high level and define the why we're doing it. And simply though, what we're seeing, and you started this conversation off in this way, what what change has the behavioral health field experienced, because we talked about the lowering of the stigma, and people want more access to services. So record numbers of people coming in saying I need help. And I finally took the step to make the call to say I need help. And now I have to wait four to six weeks for an appointment. So the demand on the, you know, patient side or the client side has risen. But the behavioral health workforce and the people delivering those services have either stayed the same or been reduced, which is creating a backlog in a waitlist. For Adam H. board. That's not good. We want people to be able to get in and access services when they need them. It could mean the difference between life or death, right for someone who's in crisis really needs to talk to someone or stay in counseling or in treatment. This is our motivation for helping get our community behavioral health workforce stronger and retain these employees. So from the board side, we have our why. And so we want to work both short and long term about how to increase and strengthen our workforce. So what we can do number one is always look for these opportunities to assist the community based agencies with retention and recruitment. Now they do a really good job recruiting, you know, they have their methods going out finding people, and we don't do a lot of recruitment. However, we can support, for example, community based internships, and these play space internships, or practicum placements that happen from higher ed into our community based agencies, one of the things we said is, okay, if we can just get on that same list, that you know, some of our for profit partners are on to be able to attract some of these social work students or or counseling students in the community, we want to give them a choice, let them have the choice to do their internship at a community based agency, Adam H is willing, we're hoping to roll this out in 2024, to support several individuals who are in higher ed to be able to do their internship and we want to make it paid, we want to do all the things that make it attractive, because we want our community based agencies have a little more parity and be to be in competition with our private sector partners, when folks choose a place for an internship, so that's one of the things we can do. The other thing we can do is leverage that investment that the Ohio Mental Health and Addiction Services Office and the governor's office, they're putting, you know, incentives and and programs out into our local community. We can leverage that right. Is there something we can do to make it even more attractive? Those other things we're always looking for, to be able to assist our community based agencies. So we are motivated to do that. But we're also listening to them, Trevor, you know, this and, and public policy. You know, we can have our own ideas. But if we're not solving a real problem, what exactly you know, have have, have we achieved our goal. So we're listening to our agencies to say, this is what we need help with. So we want to one, support the assessments of workplace environments in the community, to make sure they become employers of choice. Two, we want to support the pipeline and help secure that pipeline from higher ed into our community based agencies again, so they can see it up close and personal and know if this is the kind of commitment they want to make for life? And if so, what can we do to incentivize that maybe we underwrite the cost of micro credentialing for certain things. And then we want to train the leaders, we want to make leaders. If you're already in the field, how do we increase your your skill sets in your tools to be leaders eventually, in this agency, we've had we, we were very fortunate to have a generation of leaders come through behavioral health and stay, there is so much knowledge in this space, we have leaders that have worked at the forefront of this and community based agencies for over three decades. And now they're retiring, they're moving on, who are we replacing them with? So we have to develop a strong bench, I think there and then, of course, we can always continue to advocate. We want to stand shoulder to shoulder with our clinician partners and our other business sector partners to say, hey, workforce matters to us, too. So we're always at the Statehouse talking with our legislators to say we can do more here and make sure they know, education of our future workforce credentialing and parity, frankly, and you're hearing a lot about that on the national level, the federal government is looking at how do we reimburse the care, behavioral health care, like we do physical health care. And so I think that's something there's always an advocacy point there. And my last thing is peers, peer workforce will become a dominant thought in the future. Because, again, we need more folks. Sometimes we need entry level, folks, how do we credential them better, that we have a strong system now, credential them better, and then pay for the services that they give. And sometimes what they can provide is an intangible, that relationship of being there, coming through the fire surviving, and then being able to assist someone else going through the same journey, irreplaceable. And that's, that's a key part of our workforce that we need to invest in.

So I perhaps should have thank you for all of that. I'm inspired. I should ask you this question, perhaps at the very beginning. But as we pull this conversation to a close, I can feel your your passion, your clear knowledge and expertise and commitment. So you mentioned though, we got to figure out the What's your why, what's your why, what, what drives you to both work in this space and be a leader in this space?

What a great question. You know, I was bought in from the very beginning, when you start college and you go to the like that first symposium and they say, you know, will you be the one that changes the world like I signed up? Okay, I said, What can I do, for my little for my little perch, to be able to help many others. And it has been the most rewarding career. I love serving I come from a family of public servants. I had a great uncle who organized the labor movement on the east side of Columbus that ultimately turned out to be the strong voting bloc, and the cornerstone of get out the vote efforts to mobilize union workers and their families to come out and vote for candidates that would support their issues. My mother, you know, my grandmother was work for the federal government, but did a ton of community service and volunteered at women's prisons all her life. My mother was a political organizer. And really, kind of once they she worked for Governor Celeste and, and others and fought for a seat at the table for community members. It wasn't just for herself, she got at the table and that she brought many others to come in and really trying to change how life is for African Americans in central Ohio. My grandfather integrated the pools in Logan County. So I come from a legacy of community servants. And I just want to do my part, frankly, and I'm honored. I love the public health discipline and I'm honored to be able to occupy this role at this time and bring on new services and increase access for people who are seeking services in the behavioral health space. It's awesome time to work here.

Well, thanks for sharing that that legacy of of public service. I'm sure if they're not still with us. I'm sure if they are still with us, their family members would be we be proud of the tremendous good work you're doing.

Thank you so much.

We are the beneficiaries here in central Ohio. All of your work and your organization's work. So thanks for this conversation. But more importantly, thanks for your commitment to behavioral health and, and the clients you serve.

Thanks. Thanks, Trevor. This is awesome. Appreciate the conversation