Abby Burns (00:02):
From Advisory Board, we're bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns, grabbing the mic from Rae this week to talk about something I spent a lot of my time at Advisory Board talking about, and that's behavioral healthcare. There's no denying that among the other healthcare fires we are fighting, the US is in the middle of a behavioral health crisis. One thing I hear from leaders time and time again is that they feel powerless when it comes to addressing behavioral health. They tell me that their legacy approach can't stand up to the magnitude and the complexity of the need that they're seeing today.

(00:37):
And honestly, that makes sense. Unmet behavioral health need is affecting every single corner of our industry. This is something we've talked about before on the podcast, and I put those episodes in the show notes. In those conversations, we focused more on deconstructing the problems in behavioral healthcare. Today, I want to shine a light on an organization that's not only overcoming, but systematically dismantling those problems and improving the way they deliver behavioral healthcare for their patients and their communities. So I've invited Chief Bio-psychosocial officer for ChristianaCare, Erin Booker, to join me today. Erin, we have so much to talk about in a short period of time. Before we dive in, do you want to start by introducing yourself and your background a little bit?

Erin Booker, LPC (01:21):
Sure. My name's Erin Booker. I am the Chief Bio-psychosocial Officer at ChristianaCare. We're a large health system located in Delaware, Maryland, Pennsylvania, and New Jersey. My background is, actually, I'm an addiction and trauma therapist by background and spent my entire career, until joining Christiana, in the behavioral health world, either as a provider, a provider/administrator, and then an administrator. And my role here has really evolved from behavioral health to health equity to behavioral health growth, and then bringing all sorts of social care into the conversation and how do we look at psychological wellness, social care and medical care and create new models so that we are really doing whole person care, not just using the words.

Abby Burns (02:10):
What I'm hearing is you are perhaps uniquely qualified to help our Radio Advisory listeners make sense of what is happening in behavioral healthcare because there's a lot going on and people are seeing headlines every single day. When people ask you to describe the challenges in behavioral healthcare, what do you say?

Erin Booker, LPC (02:30):
Yeah, the challenges are, some of them are totally the same. They've been the same stigma. Biggest challenge we're up against always is people looking at behavioral health, mental health, substance use disorder with moral judgment, with vantage point of that's not really an illness, you're just making it up. It's all of those narratives. Culturally, a lot of people are kind of taught that that is not a appropriate thing to share outwardly about. So coming up against those barriers. And then we are in a crisis like a major behavioral health crisis and in the midst of a crisis, we are losing providers. We are losing access. We have stuck with traditional models and need to evolve. And that is hard. And you have to be willing to take risks and look at things differently and also make it not about you and what you bring to the table, but what the community needs. And I think that that is a change. And so as we are transitioning, I think those are the big things we struggle with.

Abby Burns (03:38):
Maybe bring this down to a local level for us and sort of paint the environment in Delaware right now in terms of behavioral healthcare.

Erin Booker, LPC (03:45):
So here in Delaware, we have pretty significant support from legislators who are very focused and build their platform around behavioral health and access and support. And we have some really great community partners that want to play a role, but I think we are still quite segmented and we lose some of those transitions of care just as we see most places. We have a significant lack of workforce in Delaware and that's a big issue. And I think the funding to support this work, we are seeing more and more people go to private practice and go to self-pay or commercial only. So some significant disparities in access.

Abby Burns (04:34):
Erin, I want to talk about every single thing that you just mentioned, which is an ambitious agenda for maybe 30 minutes, but I believe in us. I think we can do it.

Erin Booker, LPC (04:42):
Yes.

Abby Burns (04:44):
So you've sort of painted this picture of what is happening in Delaware that sounds reflective of what is happening nationally. You have a super maybe ambidextrous or diverse professional background. I've worked in the population health space for many years, worked with a lot of different types of leaders. I have never heard of another chief bio-psychosocial officer in my life. So can you tell what is a chief bio-psychosocial officer?

Erin Booker, LPC (05:12):
Yeah, you've never heard of it because I'm the only one. And I'm really hoping that that is a really short period of time that I'm the only one because I think it's so incredibly important. And so really the job, my job or the job of a bio-psychosocial officer is really around looking at how we deliver care and saying, "Okay, we do great medical care in the facilities." When you come into the walls of ChristianaCare, we are phenomenal at giving you excellent clinical care. But then you leave and there's this huge chunk of time that we don't see you. And in that chunk of time, you're struggling with food, you're struggling with transportation, how you're going to pay your heat bill or your light bill or a plethora of other things.

(05:57):
And we have no idea and we're not engaged around that. While all of that is happening, that level of stress, that toxic stress that you live under is then impacting your psychological wellness. And I talk very specifically about psychological wellness is not a behavioral health diagnosis because you don't have to have a diagnosis to need support around your psychological wellness. And everyone should be focused on that. So I think for me, my job is about how do I look at all of those different pieces and build new programs, new partnerships, new models of care that look and feel very different, but that we really then circle our community in everything that they need to thrive.

Abby Burns (06:40):
So I'm hearing it really important to take a holistic approach to be highly integrated with the rest of the system in order to wrap both hands around the challenges. Basically the work that you're doing supports ChristianaCare's very ambitious goal to end disparities. Is that right?

Erin Booker, LPC (07:01):
Correct. Yeah. We have six aspirations as an organization and they are our driving force. And what we focus on in one of those is end disparities. So hugely aspirational. And we believe in that. We believe in if we are not looking at that as our goal, then we are not working hard enough. And so yes, my work lives under that and I'm very focused around how do we change the disparate outcomes across every aspect of what we do.

Abby Burns (07:31):
Yeah. And just to kind of put a fine point on it, we know that, on the whole, folks with behavioral health conditions experience worse access and outcomes than folks without. So it makes sense that addressing behavioral health need is addressing health equity.

Erin Booker, LPC (07:48):
Absolutely. Absolutely.

Abby Burns (07:50):
I'm also mindful, and I imagine you would agree, by the end of 2020, just about every organization, every health system had health equity in their mission statement, written on paper, written on their website. Far fewer organizations made it to the point of integrating health equity actually into their strategies in the ways they allocate their dollars. Can you give us a sense for how is ChristianaCare making good on the commitment to end disparities through a behavioral health lens?

Erin Booker, LPC (08:23):
Yeah, I think that we were one of the very first organizations to have a chief health equity officer. We have stood behind that. When you talk to our CEO, Dr. Nevin stands on stages regularly and says depression, anxiety, those are no different than treating someone with diabetes or hypertension-

Abby Burns (08:41):
That's your CEO?

Erin Booker, LPC (08:42):
Yes. So it is top down for us here. That is the belief. The belief is that behavioral health is our responsibility just as much as primary care is our responsibility. And that doesn't mean we do it all. We don't provide all of the primary care for the entire state of Delaware, but we have to play a role. So I will say as a health system, we provide more behavioral health than anyone else that I know in this space. And we partner in very different and unique ways.

Abby Burns (09:15):
So when you're talking about behavioral health and primary care, I think you've had integrated behavioral health for eight years at this point.

Erin Booker, LPC (09:22):
Eight years, yeah.

Abby Burns (09:23):
But that's not the only place it is around the system. You also have it in your emergency department, on your inpatient floors, in your psych unit and also integrated into other medical floors.

Erin Booker, LPC (09:35):
We have done a lot of integration and we believe that there should be no wrong door to walk in if you have a behavioral health need or you have an underlying behavioral health driving factor in your medical. So one of the things that people don't really talk about, and one of the ways that you as health system organizations can push this forward is behavioral health untreated increases total cost of care, bottom line. Because we are not getting to the root that keeps people engaged in whole person care if we are not addressing their behavioral health.

(10:08):
So we believe in no wrong door. So if you walk into our cancer program, we have a full practice within the cancer program. If you walk into women's, I have a full practice in women's health to support pregnant postpartum women. And then I have therapists in our women's health program practices that is for any need of a woman at any age coming in the door. We are in heart and vascular neurology, sleep. I mean, really there is not a place that you come in that you do not have someone that you can talk to if you need to, and then they're going to connect you in. So they might not be your final destination. And I think that's part of what we've changed is that the door in doesn't mean it's the final door. It's just the door in.

Abby Burns (10:54):
Yeah. That is something we hear a lot of, honestly, provider fear in even screening for behavioral health conditions is, well, what happens if it's positive? What happens if someone actually needs the support? I don't have time maybe as a primary care provider to also be someone's primary behavioral health provider.

Erin Booker, LPC (11:13):
Yeah, you're not supposed to, right? You're not supposed to be the primary provider. You're supposed to be the access point. You're supposed to be the identifier. And we tell people that all the time. So we screen everywhere. You come into endocrinology, you're getting screened and then there's a process to connect you in because everyone had that fear. And of course, if someone screens positive for suicidality and you don't know what to do, there is really nothing scarier than that as an individual. So we've created pathways to support so that that's not an issue for our providers. So you can come into any practice and we're screening.

Abby Burns (11:52):
So Erin, that's a lot to have behavioral health resources in primary care, in outpatient specialty care and inpatient medical floors, et cetera, et cetera. I'm channeling our CFO listeners, even our population health leaders that are thinking, "It's a lot of people, it's a lot of investment. My executive team would never go for that or it'd be really hard to convince them." How do you make the business case for these programs that we just talked about as well as your other population health programs that support behavioral health directly?

Erin Booker, LPC (12:27):
Yeah, so I will say my CFO has become a huge champion of the work that I lead.

Abby Burns (12:33):
Did they start out that way?

Erin Booker, LPC (12:35):
Absolutely not. Absolutely not. And he is a phenomenal person, but he didn't understand the business case and there is a really strong business case. So if I'm talking to my pop health leaders, I'm going to say to you, "I want you to pull your data and I want you to look at your top hospital utilization, if you have any at-risk contracts, I want you to look at those." We've done that. We looked out of five hospitals, four of them were behavioral health. When I looked at the five hospitals that were the most utilized in our highest cost individuals. When I look at our top 5% of individuals driving cost of care in my risk-based contracts or in my ACOs, all of them have complex social behavioral health underlying need.

Abby Burns (13:22):
Erin, can I ask you a practical question about that? One thing we hear a lot is because of the separation of behavioral health and physical health data, I can't necessarily see which of my patients have a behavioral health condition. So how could you map that data back?

Erin Booker, LPC (13:39):
Absolutely. So first of all, there's the new federal guidelines that have changed, take away a lot of that barrier. So if you haven't updated how you're doing workflows, it's really important to understand the changes in N42 CFR part two because there are changes and they do allow for better integration of data. So that's really important. Number two, you can't see if a psychiatrist has diagnosed or a behavioral health program, but you can see if someone comes into the emergency department and they identify that they have a behavioral health need. If you have risk contracts or you have relationship with your payers, you are able to see at certain levels, hospital utilization, type of provider utilization. So you have to get a little bit creative in how you're looking at your data. We have risk contracts. We can't go into all the detail and we certainly are blinded to some things, but we can see diagnosis or prevalence of diagnosis.

Abby Burns (14:40):
So that's the type of data that you would pull in to make that business case to your CFO. Are there other elements to the business case?

Erin Booker, LPC (14:48):
Yes. So you definitely want to look at social. If you look at behavioral health in isolation, that's what we're trying to get away from. We want people to stop looking at behavioral health as its own little carved out thing because it's not. It is completely involved. Let's say I'm diagnosed with major depression, guess when it gets way worse? When I don't know where I'm going to sleep or I don't know how I'm going to eat or I don't know how to pay a bill and that stress or I live in a violent community and I can't go outside and walk, there's not good walking pathways. All of those things impact our psychological wellness. Again, diagnosis or not, but if I have a diagnosis, I am far more likely to struggle with progress and having a really fulfilled life if I have all of these other social barriers in conjunction.

(15:42):
So if you look at behavioral health in isolation to social, you're not getting your full picture. If you look at it in isolation to chronic disease, you're not getting your full picture. And that's why we are really unique in our capabilities in a health system. I want to just kind of push on, you have an access as health systems and I probably am the loudest person ever about this, but if you do not use community benefit in a strategic way to support this work, you are doing it wrong. And I stand in front of anyone and everyone that will listen to me and I will say that. We're doing it wrong. You have an opportunity to build up external partners so it's not you, right? There's lots of things we do not do at ChristianaCare, but I help support other organizations and we do that through community benefit dollars.

Abby Burns (17:44):
I want to go into partnership a little bit because when we're talking about, you mentioned whole person care, taking an integrated approach, we're talking about trying to affect structural change. If we're looking at health equity, by definition, that means we have to work outside the health system. Erin, what I find when I ask leaders who else they're working with, for behavioral health, I hear one of two things usually. One, "I want to work with other organizations, I want to structure community partnerships, but there are no behavioral health resources in my community, so I can't." I'll pause there. What is your reaction to that? Is that something you hear too?

Erin Booker, LPC (18:21):
I've definitely heard it and my answer is you're limiting what's a behavioral health provider.

Abby Burns (18:28):
Say more.

Erin Booker, LPC (18:29):
So if I'm just looking for a traditional therapist, I am one. I believe in what we do wholeheartedly, but I am not the only person who has the ability to impact and support someone's behavioral health needs. A pastor can. Someone can go to a church and feel so supported and so connected. People can have that relationship in a community center with an individual, kids especially. So if you're looking to get to support youth mental health, that is not just a traditional behavioral health provider. So I think for me, part of this is deconstructing what behavioral health support is. Therapists are one important part. Psychiatrists are one important part, but we're just one. And so I think that sometimes we have to take our egos out of it, that our professional license or are professional degrees, they're really important, but they're not all of it.

Abby Burns (19:27):
Yeah. To the point you made earlier of the importance of addressing social determinants of health. Addressing social determinants of health is addressing behavioral health. So that could be a different type of community partner. The other thing I hear is very similar types of organizations to traditional community partnerships, schools, libraries. One of the things that stood out to me when we were talking was this concept of you are casting a wider net to areas where behavioral health need is high, but where health systems haven't necessarily traditionally reached in your communities. One thing that comes to mind for me is the work you're doing around police co-response. So can you talk a little bit about that?

Erin Booker, LPC (20:08):
Yeah. So for me, anyone who's willing to partner, then I'm willing to partner and we're going to figure it out. We're going to figure it out because no's just not an option because our community needs that. So police departments, we are actually about to launch our second police department.

Abby Burns (20:25):
Congratulations.

Erin Booker, LPC (20:26):
Go live. Thank you. I'm very excited. But we currently support the largest county in Delaware and we are their partner for co-responding.

Abby Burns (20:36):
What does that mean?

Erin Booker, LPC (20:37):
So I have therapists that live there. They are part of the police department. Their office is in the police department, and they go out. They have a police officer that's their partner, they go out together. It's a very unique situation. So if there is a 911 call that comes in and it is a mental health identified need or a behavioral health identified need, this team is getting dispatched. Or if it's after the fact, what I love so much is actually the after the fact ones, and that's when other officers have identified this person really is in need of behavioral health and they will send out that team. They will alert the team and say, "Hey, can you go check in with this individual? They've called 911 three times. I really think this is a behavioral health need that's driving it. Can you go see if we can provide some support?" That shift in mindset in law enforcement is a direct outcome to putting behavioral health providers in their space.

Abby Burns (21:32):
Amazing, amazing.

Erin Booker, LPC (21:34):
I also think it's important, they're not just therapists going out there, and I think that's the other piece of it. If we stop-

Abby Burns (21:40):
What types of people are going out?

Erin Booker, LPC (21:42):
I have therapists, I have case managers, I have peers. I have what we call child victim advocates to support kids. And if they are on scene during something, then I have someone who engages with them specifically and supports them in a different way. I have the distinct honor because I do think it's an honor, but I chair our overdose fatality review commission for the state. And one of the things that we know is that children who have a higher level of trauma in their life have a higher likelihood of substance use disorder. And so by putting things like child victim advocates in, we are helping to engage around trauma immediately instead of allowing it to kind of grow and create. So part of the partnership is how do we do early intervention and people need to bring us in so that we can do that and not us, ChristianaCare, but ud behavioral health in general.

Abby Burns (22:36):
Yeah. Back to the idea of casting a wider net of who is working on these problems together. And Erin, I'm glad you brought that up because one of the biggest challenges that we hear is I don't have the people to do this work. Maybe you get the green light from finance to make the investments in addressing behavioral health, but nationally, half the country lives in a designated psychiatrist shortage area. I don't think Delaware and New Jersey and Pennsylvania are different. I think last time I checked same problems there as nationally. How do you contend with the workforce shortage?

Erin Booker, LPC (23:12):
I'm going to say a sentence that I think for me has been ... I hate it and I love it. Using people at the top of their license is really important.

Abby Burns (23:21):
Why do you hate it?

Erin Booker, LPC (23:22):
I hate it because it makes it sound like we're saying, "If you have this license and you're a higher level," and that's not what it is, it's just you bring a different part of the service. And so I say that a lot. A psychiatrist is incredible. We need them. They are not more important than the therapist. And the therapist is not more important than the community health worker or the peer. Everyone is part of the team that creates health for people. So top of license is just what does your piece of the puzzle bring and how do we make sure we can use that at the maximum level?

(23:58):
So it's how do we bring care differently? That's a huge part of this. Do I need a psychiatrist to see every single person? No. No. But can I train people at different levels to identify when it is really important to bring that psychiatrist in and then use them in that way? Yes. Can I do psychological first aid training for our community members, our deacons in the church, our camp counselors at summer camps? How do we provide this level of training and understanding and education in multiple environments so that people are identified early? Because early intervention is also the way we deal with workforce shortage.

Abby Burns (24:41):
Erin, what I love about that is you're talking about equipping your people at ChristianaCare. You're talking about serving your patients that come into your health system, but you're also talking about serving the broader communities where you live and work and all three of those levels of addressing health equity or advancing health equity.

Erin Booker, LPC (24:59):
Yeah, I mean, listen, if I only cared about the people who walked in the doors, then I'm not really living true to my word because that means I only care if you impact me. You might never walk in the door. But your health and your behavioral health, if you're the neighbor of a patient, matters. And it's going to impact. It's all connected. And I think we forget that sometimes.

Abby Burns (25:22):
So Erin, we have talked about making the case for these investments. We have talked about overcoming workforce shortage challenges. We've talked about partnerships including all sorts of different community partners. Beyond the community partners we typically think of. Maybe the ultimate partner or the largest external partner you could work with is government. And I know that at least part of your role revolves around getting involved in policy. That can feel really uncomfortable or really opaque for a lot of people. But policy obviously plays a huge role in shaping your operating environment. So how do you approach policy work? What does that look like?

Erin Booker, LPC (26:05):
So it's incredibly uncomfortable and it took a lot of getting used to, to go into that world and to respect that world. And I think that's really important. If we walk into meeting with legislators and we walk in an adversarial, you are not doing what we need you to do way we've lost before we even said hello. But if we walk in and say, help me understand what your policy plan is and here's what we're experiencing out in the community and how do we bring those together. Creating a real human connection with your legislators is also really important. And that doesn't mean being friends, but it means ... I mean, you might be, I am with some, but it might be just like I know how you've been impacted in your world and I want to be able to help that another family doesn't have to be impacted in the way you were. So how do we come together and look at this differently? Again, I think so much of this comes down to I don't need credit.

(27:08):
I don't care if my name's ever mentioned. I care about the outcome. And so if more people could kind of strip away from, let the legislator have their moment in the sun, let them get all the highlight and spotlight for that piece of legislation. They've worked really hard for it, but be that quiet, silent partner in the background that they can build a trusting relationship with that you can help guide them because that is how you influence. Influence is not about power. It is about relationships. And that is what we need to do to further the strategic plans around policy infrastructure for behavioral health.

Abby Burns (27:47):
What stands out to me about that is I think a lot of times in behavioral health, people look at policy and they have the reaction of, "I need to figure out how to navigate within this difficult or this unsupportive policy environment." What I hear from what you're saying is rather than, or maybe in addition to that, you're also saying, "Let me reshape the policy environment in a way that lets my people provide the best services, the best care for our community."

Erin Booker, LPC (28:18):
Yes.

Abby Burns (28:20):
Three part question for you.

Erin Booker, LPC (28:22):
Great.

Abby Burns (28:24):
What are some examples of policy work that you've done, that you're doing now, that you have on your plate now and that you are looking forward to or anticipating that you feel like will have a meaningful impact on your patients? So look back, look down at your plate and look up ahead.

Erin Booker, LPC (28:44):
Yeah. Goodness. So I think some of the legislation that we've done and we've worked really hard around is around access to behavioral health and requiring behavioral health in schools. That's one. Another one that we've worked really hard on and I'm very proud to say that Delaware is the first, and I still believe only state that we have passed legislation that requires that there are psychological well checks that are free of charge, just like an annual wellness visit for physical health that insurance companies are required to fund and that providers have to provide. And so we're working to put that into operational action now. But that is a legislative win, that is saying out loud, there is a parity between physical health and behavioral health and you need to do a wellness check on both, not just one.

Abby Burns (29:35):
And I can see how that, to go back to what we were saying toward the beginning of our conversation of is it on the provider to say, "Okay, I guess I'm going to screen because I think it's the right thing to do, but what happens if it's a positive screen?" And this is instead taking away that guesswork saying annual psych visit required.

Erin Booker, LPC (29:55):
Yeah. So you're doing an annual annual psychological wellness check-in. And part of that is as a state, we have to provide the support. We're saying you have to do it. So legislatively, how are we building support into different areas so that there's somewhere to get that patient if they are in need? So how do we do that? So that all has to go hand in hand. And I think that for me, legislatively is what we have to push is that you can't just do one piece and then be like, "We fixed it. We're so great." Right? So pushing on parity of access, got to do that.

Abby Burns (30:30):
And what does pushing on parity mean? I know this is a big thing legislatively right now as well. I think the Senate Finance committee just passed a bill on this or approved a bill on this. What does pushing on parity mean to you?

Erin Booker, LPC (30:42):
So pushing on parity for me means that if I walk in and say, "I need help," one, I'm trusted enough to know that I need help. I can get into help because it is funded properly, so there's people there to provide it. So funding and parity, those are hand in hand to me. You have to have both. If I can't sustain a business, there is a reason everyone's going to private pay. And if we don't create parity around funding and payment models, then we are in for a very, very huge equity crisis, far worse than what we're already seeing, which is already bad. But so for me, that is the number one way parity is impacted right now. The other piece of that is parity on length. So these ideas of carving out, and I can only have a certain number of behavioral health visits a year.

(31:40):
I have a lot of unkind words to say to that. If I have cancer, no one's telling me how many chemo treatments I'm allowed to have, but if I have depression, all of a sudden you get to decide I only get 20 sessions with a therapist in a year. Those types of carve outs and limits to access, those have no evidence behind them. It is just truly an archaic belief that behavioral health is not really as important and you can just kind of get through that. Why do we need to invest there? So those types of things I think for parity are really important. And then I think as we push forward legislatively and we look at different things that we need to do, we have to stop just looking at "behavioral health," putting quotation marks around that behavioral health legislation because it's not just around actual behavioral health intervention, it's around things around community violence.

Abby Burns (32:35):
So it gets back to, Erin, the idea that one, behavioral health is just health and two, behavioral health and social health go hand in hand. And addressing one means addressing the other, and you can't only look at one in isolation.

Erin Booker, LPC (32:49):
No. I think we have consistently failed because we always try to look at things just in our little bucket. But to me, if we don't change legislation that allows for places like the food bank to get incentives and be paid for screening, identifying and connecting, how great would that be? They have access to people that won't come to me.

Abby Burns (33:14):
Yeah.

Erin Booker, LPC (33:14):
So if they were screening and they said, "Oh my gosh, I have this," and then there's a pathway for them, but they could create revenue for their community-based organization that allows them to do the great work that they're doing, that is where we need to go, and that's the legislation that we need to push.

Abby Burns (33:33):
Erin, we have covered a lot of ground and we could probably keep talking for days on end about all the work that you and ChristianaCare are doing, but as we wind down, I'm actually going to quote something that you said to me when we were talking in a research conversation a few months ago. Do you know what I'm going to say?

Erin Booker, LPC (33:53):
I don't. But I'm very intrigued.

Abby Burns (33:57):
You said, "Yes, we are doing a ton of work and I am super proud of it. But Abby, I don't want people to think that this happened overnight." And you told me, "Ee have clawed our way to where we are today."

Erin Booker, LPC (34:14):
Yeah.

Abby Burns (34:15):
Erin, why was it so important to make that caveat to me, to convey that to me?

Erin Booker, LPC (34:21):
Because I don't want people to be afraid to start because they can't be where we are because I've been doing this at ChristianaCare for eight years. I've been growing this work. Our teams have been growing, our leadership has been supporting. We've had to change legislation. There's so much that we've done and it's taken time and commitment. And so I don't want anyone to think, "If I can't do what they're doing, then oh, well for us." Start somewhere. You have to start. You can't get anywhere if you never get in the game.

Abby Burns (34:58):
So I imagine you know what I'm going to ask you next, which is what is the one thing ... You said you have to start somewhere. What is the something that people can do tomorrow to advance or to work toward providing holistic, integrated behavioral healthcare? What do they need to know or think about in order to do that?

Erin Booker, LPC (35:20):
The top thing I would say is recognizing and saying out loud that behavioral health does not happen in isolation, and it doesn't have to happen in a behavioral health practice. That's just one place. And so how do you improve your access? Can you provide education from resources you already have? Can you educate resources you already have to be able to do more and increase your reach? That is the best way to start is optimize and capitalize on what you already have existing in your system. If I can, Abby, I'm going to cheat and just add one more to that.

(35:57):
And I think the other thing is as health systems and organizations, it's incredibly important as we think about our workforce to understand that we, post-COVID, have really, or whatever this phase of COVID is, we have continued to see people exit this work and they're exiting because of their own mental health and their own wellbeing. That's a huge component. And so I want to remind people that it's important to support your own wellbeing and to access care. Because as providers of care, we often don't want to take up resource. So we don't get care for ourselves. And if we don't do that, then we end up limiting access by taking ourselves out of the equation. So it's really important to do self-care and to get help and support as you need it.

Abby Burns (36:52):
Well, Erin, thank you for coming on Radio Advisory.

Erin Booker, LPC (36:55):
Thank you for having me.

Abby Burns (37:02):
What stands out to me about the work that Erin and ChristianaCare are doing is they are taking a truly holistic, integrated approach to addressing behavioral health. They're recognizes that behavioral health is just health, and that to provide behavioral health care, you have to account for whole person care, looking at social needs, medical needs, and behavioral health needs. Now, ChristianaCare is doing a lot of work, but I don't want you to leave this conversation feeling like you have to do everything ChristianaCare is doing in order to provide care at all. The most important thing is getting started. Figure out how to optimize the services you have at your organization and make the case or partner for the ones that you don't.

(37:47):
And remember, as always, we're here to help. If you like Radio Advisory, please share it with your networks, subscribe wherever you got your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Abby Burns, as well as Rae Woods, Kristin Myers, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Daniel Tayag, Chris Phelps and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston and Erin Collins. Thanks for listening.