Voices in Health and Wellness

From Clinic To Strategy: Building Trauma-Informed Systems That Actually Work with Valeria Lerma

• Dr Andrew Greenland • Season 1 • Episode 77

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Ever watched a great training fall apart in a real crisis? We sat down with Valeria Lerma, a licensed clinical social worker and strategic leader, to unpack a practitioner-centred approach that keeps skills online when stress is high and time is short. Instead of piling on theory, Valeria starts with self-awareness, nervous system regulation, and values-based decision-making—so nurses, techs, teachers, and officers can actually use what they know in the heat of the moment.

We trace how acceptance and commitment therapy, internal family systems, somatic practices, and the neurosequential model converge into simple tools that shift behaviour on the floor: breathwork to drop out of high beta, quick resourcing to re-open the frontal lobe, and “padded boundaries” that hold limits while preserving safety and rapport. The results in her hospital are striking—fewer restraints, seclusions, and injuries, alongside better retention—because staff can recognise activation, calm their own system, and respond with clarity and care.

Then we take it wider. In classrooms, behaviour becomes communication, not defiance—letting teachers restart learning without shame. For police, non-hierarchical, empathic communication reduces escalation while maintaining safety. Valeria also shares a telehealth crisis model that lets schools consult clinicians on the spot, increasing voluntary admissions and reducing traumatic emergency detentions for youth. We get honest about barriers too: why funding paths often exclude mission-driven for-profit providers, and how a citywide pilot could generate data for sustainable policy change.

If you care about trauma-informed care that actually works—in hospitals, schools, and public safety—you’ll find practical frameworks and field-tested steps you can use right now. Subscribe, share with a colleague, and leave a review with one change you’ll try this week.

Biography

Valeria Lerma, LCSW‑S is a Licensed Clinical Social Worker and Director of Strategic Business Initiatives at San Antonio Behavioral Healthcare Hospital. With over 15 years in the field, she leads trauma-informed, employee-centered training initiatives that improve outcomes for both staff and patients.

Her work extends into schools and law enforcement, and she’s pioneering a telehealth model to reduce unnecessary emergency detentions for youth. Valeria’s long-term mission is to reform mental health systems through compassionate, practical change.

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About Dr Andrew Greenland

Dr Andrew Greenland is a UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. With dual training in conventional and root-cause approaches, he helps individuals optimise health, performance, and longevity — with a focus on cognitive resilience and healthy ageing.

Voices in Health and Wellness features meaningful conversations at the intersection of medicine, lifestyle, and human potential — with clinicians, scientists, and thinkers shaping the future of care.

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Dr Andrew Greenland:

So, welcome to Voices in Health and Wellness. This is the podcast where we connect with practitioners, innovators, and leaders who are reshaping what care looks like from the inside out. Today I'm joined by someone whose work sits at the intersection of strategic leadership and deeply compassionate care. Valeria Lerma is a licensed clinical social worker and supervisor with over 15 years of experience and currently serves as director of strategic business initiatives at San Antonio Behavioral Health Healthcare Hospital. Valeria, thank you so much for joining us today and welcome to the show.

Valeria Lerma:

Hi, thank you for having me.

Dr Andrew Greenland:

So we had a brief conversation before, and I know you have a rich clinical background, but now you're leading strategic um initiatives. Can you tell us a little bit more about that transition and what it's looked like for you?

Valeria Lerma:

Absolutely, yes. So I have been a clinical social worker for for a while and in the behavioral health field for about 15 years. And um my original plan, my original goal when I got into social work was to eventually contribute to mental health policy reform. Um, because there's a lot of gaps in that. And um, but I knew that I needed to really, really get to work what I call in the trenches, you know, just really get in there and be exposed to different populations, to different needs, to different social issues, work in multiple sectors, um, which I have. And so over the course of those 15 years, I've done a lot of direct practice. I'm still in direct practice, aside from what I do at SABH, um, because I like to stay in the flow of clinical work. And um, and you know, in doing that, um, I have been really able to come up with some practical uh strategies to address um mental health issues on a macro and meso level. And um that is essentially what my goal was because what I did not want is to graduate, go straight into public policy, and you know, contribute to policy that sounds amazing in theory, but it's not quite practical once you have your boots on the ground. And that has been my life's work. Um, in the process of that, I have also gained a lot of clinical knowledge, not only for my clients, but also for myself, personally, for my own healing. And um, I have been able to kind of mold all of that together. And when I started at San Antonio Behavioral Health Care Hospital, I am very lucky to have a CEO that truly shares my vision, which is to be a servant leader and to really go out there as a subject matter expert on mental health and start helping the community to address our behavioral health crisis that we are currently in. And so that's how it came about.

Dr Andrew Greenland:

Amazing. Always good to hear the journey and how people have arrived at what they do. So, what does your um day-to-day involve right now, and how do you stay connected to the clinical side of the work? Because you slightly shifted direction. So, just curious to know what absolutely.

Valeria Lerma:

So, you know, my day-to-day at San Antonio Behavioral Health, um, you know, I oversee certain operations and making sure that our overall strategies are being met for the hospital goals. But I also directly oversee two departments, which is the training department and the business development department. And so as I was working in the training department to overhaul that and to really be able to train our employees to have some really good tools to be able to help our patients, I was able to come up with a model that is a little bit different from traditional models, which is very centered on the actual person providing the service, our nurses, our techs who are with our patients all the time. And, you know, one of the things that I that I saw is that there was some difficulty in applying trauma-informed care strategies and applying our milieu management strategies. And it wasn't because of a lack of effort, and it wasn't because of lack of knowledge, because they had the training. So I got to thinking, what is the barrier there? And I realized that the barrier there is the practitioner, uh, their own ability to access the information that they have and their own ability to move towards the values that brought them into this work to begin with. And so I completely changed the training model and I made it more employee-centered in teaching them how to raise their level of consciousness, which essentially is their self-awareness, and teaching them how all of those trauma-informed care uh techniques and knowledge that they have also apply to them because everybody has experienced a defining moment at some point in their life that shifts their perspective and that really kind of influences their behavior. And helping them to understand that when they themselves are activated, which happens often if you are in a crisis with a patient, um, that they lose access to that part of their brain, the frontal lobe, that has that abstract thought and has that ability to choose which way to go. And so just really starting to educate them about their own triggers and have some more self-awareness and helping them connect to the values that brought them there to begin with, and teaching them strategies to elevate that awareness and that consciousness through meditation, holistic huddles, et cetera. We saw a pretty dramatic increase in our retention of our providers. And we also saw quite a dramatic decrease in uh behavioral incidents, uh, seclusions, restraints, employee injuries, things that typically happen in a mental health hospital. And that was all due to uh the employees being able to actually apply the strategies that they had been taught through self-regulation. And when I saw that, I decided to um bring that into the community. And because I have a CEO that shares my mission and shares our vision of servant leadership, she allowed me to really get out there and present myself in school systems, um, police departments, and pretty much anyone that works with children or with adults, that works with people that interacts with them and propose this training model that is educator focused or officer focused, depending on the population. And so I have, that's what I've been doing. Um we've been going out into the schools, um, going to the police departments, training our crisis intervention team officers, and um, and the response has really been overwhelming. Um, time and time again, um, the the people that receive the trainings feel like this is something so different than what they've ever had, because it's not just didactic teaching of what you should do. It is experiential learning that helps facilitate their ability to do it. And because of these um outcomes that we have received, I am now on a much bigger mission and I've been meeting with uh political figures and CEOs of major hospitals, et cetera, really trying to help them shift their understanding of what trauma-informed care teaching and training really should look like. And so it was a combination of the training strategies that I was applying internally, shifting into our business development model. And it is quite amazing. You know, we are a hospital right now that a lot of people seek out for this type of training. So I'm very excited to get this out into the community and hopefully on a much larger scale.

Dr Andrew Greenland:

Amazing. So you've really achieved a local impact for your own institution and you're able to spread the word. Has anybody else been able to implement what you're doing? And are we getting some sense of how this wider impact is happening, or is this still kind of work in progress for you and your team?

Valeria Lerma:

This is absolutely a work in progress. It is it is new. Um, it has come, you know, I've I've really been out in the community probably over the past year. Um, none of the things that I currently teach are are self-created. It is a combination of various evidence-based models that address the different parts of the brain. So our thinking brain and our emotional brain and our reflexive fight or flight kind of reptilian brain. Um and there's a lot of amazing models that address each one of those, such as acceptance and commitment therapy. And then you've got somatic experiencing, internal family systems, um, the neurosequential model, the biology of trauma. These are all very, very known strategies that address different parts of the brain. And so what I essentially did was combine all of that knowledge and really turned it into very practical trainings that last about an hour and a half to two hours that just introduce those concepts and then through experience help them to learn how that comes up in their own body so that they can shift their perspective. Because at the end of the day, that's really what I'm trying to do. I find that kindness, compassion, and empathy really truly are the emphasis and the foundation of trauma-informed care. I don't think kindness needs to be taught. Kindness is a choice. If you choose to be kind to someone, your actions are naturally going to follow. Um, it's difficult to be kind to somebody who is difficult to work with, right? And so my whole strategy is to help them shift their perspective through self-awareness. If they can understand that how they themselves are reactive, then they're they'll be able to understand when other people are reactive. And when you can relate to others, you can empathize with them. And then the the kindness and compassion just naturally follows, and that's what trauma-informed care truly is about.

Dr Andrew Greenland:

It's really, really impressive work. And you also mentioned about um widening this, not necessarily to patient-facing situations, but also to um schools and law enforcement. What does it look like in that sort of setting?

Valeria Lerma:

Sure. So, in that sort of setting, it's really about teaching um educators, first of all, helping them connect with their values. Why did you, why did you choose to be a teacher to begin with? And when did that get lost? What has gotten in the way? There's a lot of frustration right now because teachers are having to manage classroom behaviors over teaching, and they are not licensed counselors, they are not licensed professionals. And so they find themselves in a situation where they resent their job, um, they feel powerless over their job. And sometimes they feel like the students don't want to learn or they don't want to comply. They have this idea that the behavior is a choice. And so once I'm able to get in there and really teach them that neurosequential model and the state-dependent functioning and how, you know, our abstract and our concrete thinking abilities start going away once we're in a state of alarm, fear, and terror. And they all understand the impact of trauma or even the impact of having stressors at home for these children. Um, when I can teach them that behavior is a communication and that all they have to do is help provide a sense of safety so that the child can return to their to their calm and alert state where they can actually process and think, then they understand why it's important to respond in a trauma-informed way, which is kind and is empathetic. A lot of times they feel like the children don't deserve that or that they are being permissive or letting them get away with things. And so what I teach them is that it's not about not setting boundaries. You absolutely have to set boundaries, but it's about setting padded boundaries. So, for example, if you run into a wall and it stops you, it's gonna hurt. If you run into a wall that is padded and it stops you, it will still stop you, but it's not gonna hurt as much. So I teach them how to set those types of padded boundaries where they can continue to have the rapport with the student so that they can feel more empowered as they teach. Um, and also how to notice themselves when they are shifting into an alarm state or a fear state and understand that at that moment they are not going to be able to make that conscious decision or even access the information of the strategies that need to apply to the children. And so teaching them that self-awareness, teaching them how to resource in the moment and come back to calm, how to reconnect with their values and their sense of purpose and choose a different response. So that's what it looks like for educators. It's very, again, it's very educator-focused. And how do you regulate yourself enough to be able to do what you already want to do? Because these are values they already have. They're there for a reason, and that's all they want to do is to be able to teach. So just kind of shifting that mindset. Um, and the same with police officers, um, training them how to communicate in a in a way that is, you know, accepting and curious and empathetic, while maintaining safety, of course, but helping them to see that when somebody is already in a state of crisis or argumentative, um, challenging and disputing with them in that moment is going to escalate the situation and put everyone in more danger. So for them, especially them, because they are very activated when they have to answer to certain calls to help teach them the self-regulation skills that they need to be able to really provide a safe space for that person to be able to come down from their crisis and comply. Because a lot of times that non-compliance uh is it comes from those hind parts of the brain. Um, it's probably not something they would choose if they were thinking clearly, right? And so, how to help them talk to them and approach them in a way that is non-threatening and non-hierarchical so that they don't feel afraid and they feel a sense of safety because people should feel safe when they're with a police officer instead of feeling afraid, um, and how to facilitate that sense of safety so that there could be more compliance and less injuries.

Dr Andrew Greenland:

Brilliant. Any any kind of new training, not just to your own staff, your own institution, but to others. Um, there must always be some skepticism, I suppose, when you're bringing something new in. How did you bring this in in a way that got buy-in from the people that you've been working with?

Valeria Lerma:

Yeah, so uh that's a great, great question. And you're absolutely right. There has been a lot of skepticism, and and uh more than anything, because I work for San Antonio Behavioral Health Care Hospital, which is a for-profit institution. So when I approached to offer originally when I was approaching to offer these kinds of services and these kinds of trainings, um, it, you know, you're looked at as a vendor, right? So, okay, you're trying to get referrals, you know, you want to, um, but it wasn't about that at all. I would never mention, hey, send your people to us. Um, the way that I that I brought it was, I would love to teach you some strategies so that you don't have these major behavioral health crises, so that you're able to manage these things on your own. And should you have a crisis, we are here if you need us. And then it started with some um short trainings here and there. The word started getting around to other school districts and other precincts. Um, and then we had people actually start um looking to us to be able to provide that. And our schedule is quite booked with um with multiple uh community agencies.

Dr Andrew Greenland:

Thank you. Um, and you've obviously had a long career and you've generated a huge amount of personal clinical experience along the way. But are there any particular tools or frameworks or philosophies that you found that you've drawn from in your approach to trauma-informed leadership?

Valeria Lerma:

Oh, yes, absolutely. Um, acceptance and commitment therapy, I would say, was my the very first framework that really started all of this. And um, what that teaches is it it teaches you how to separate your true self from the content of the mind. And there's this beautiful concept there called the choice point. And it says that in any situation, we have a choice to either move towards our values or away from our values. And it really teaches how often we move away from our values to avoid discomfort. And that discomfort is the thoughts and the emotions that we're having. So we are very identified with those thoughts and those emotions, and naturally we're going to try to avoid experiencing them. But acceptance and commitment therapy kind of teaches you how to step into that observing self, the consciousness that kind of organizes all of it. And when you're able to step into that, you realize that you have a choice. And that's when you can connect to your values, even in the in the midst of discomfort for long-term satisfaction. And so that really was the catalyst for me. That's what introduced me to this concept of self-awareness and the consciousness that contains everything. And we are not our mind. Um, and then there's a internal family systems, which really helps us to understand that that content that we have is not really random at all. It is actually, you know, different parts of us that were created based on lived experiences and or trauma exposure. So ACT helped me notice it, and IFS helped me understand it. And so though that was like purely the framework there. Um, and and after that, you know, I started going into somatic experiencing to understand how trauma is stored in the body, the trauma imprint that it leaves. And then getting into the biology, the neuroscience behind it, um, and how that our nervous system is wired in such a way that it can be activated even without conscious awareness. And when that nervous system is activated, then like I mentioned earlier, our ability to think um and to stay present is significantly compromised. And so there's all of those three uh facets, you know, you've got our mind, uh, you've got our body, and then you've got the biology and the nervous, the neuroscience behind it. And I would like to add the consciousness piece, I keep saying that, um, but there's there's a lot of information out there, um, you know, uh based on quantum physics and the different brain wave states that also correspond with trauma activation. So when you are activated and you're in that fight or flight, or you're in Alarm, you're in a high beta thinking state. And so through mindfulness and meditation, and even just some breath work and some resourcing, you are able to kind of get into that lower beta or even alpha state, at which point you are much better able to regulate your emotions. And so when I'm teaching these things, I also teach a lot of mindful breath work and meditation strategies that are aimed at lowering our brainwave state so that we could be more have more self-control.

Dr Andrew Greenland:

Thank you. So you obviously had a big vision about what you wanted to achieve when you moved more from the clinical to the strategic role. But what were some of the biggest mindset, mindset shifts you had to make in making that transition?

Valeria Lerma:

Let me share. Can you repeat the question?

Dr Andrew Greenland:

I was just gonna say, in when you moved from the more clinical work to the strategic role that you now have, what kind of personal mindset shifts did you have to make to kind of adjust to that new role?

Valeria Lerma:

Oh, sure. So my mind shift there was that I was ready to really get into more macro and meso-level social work, you know, so community-based, and then eventually, you know, getting into policy, et cetera. I felt that I had gained enough knowledge, um, having been in direct practice for about 10 years before stepping into my leadership roles. Um and also I never really truly got away from the clinical work. Um, like I mentioned, I still am still in direct practice. You know, I have some clients that I work with. I supervise clinicians so that they can obtain their high licensure. So those supervision groups, uh, there's their consultation groups, so it helps keep me in the loop of the clinical work. Um and I also provide immigration psychological um evaluations for immigration waivers. Um, and those are pretty intense. You know, they're very long evaluations with some pretty you know strict um clinical uh impressions for the court. And so to be honest with you, I'm still kind of I still have my my feet in both worlds. I haven't truly kind of moved away. But my uh my main focus right now really truly is in getting into that more strategic role because I feel like you know there's a there's a lot that I want to share, there's a lot that I want to do, and luckily I have a platform right now that I've been able to do that.

Dr Andrew Greenland:

Brilliant. What would a um fully informed, sorry, fully trauma-informed school or police department look like in your mind? Obviously, you've done a lot of good work already, but what's left still to do?

Valeria Lerma:

Oh gosh. There's still a lot of work uh left to do, I think. Um first of all, I, you know, I've I'm in a few districts, right? But I but I really feel like this this shift or this this paradigm shift in the way that trauma-informed care is taught in the schools really needs to be beefed up a bit, um, because there's millions and millions of dollars being spent on um trainings and teaching educators trauma-informed care strategy, but there is really nothing there to help them to be able to provide that strategy. And so I feel like without us really addressing the fundamental issue, which is the perspectives and the burnout that we currently have, and the burnout comes from feeling powerless, feeling like you're showing up to work to do one thing and you're not able to do it, and it's happening over and over and over again. Um, and so if we cannot really address those aspects, then all of the training in the world is not really going to be as effective as it can be. And so I really think that in the school systems, it needs to be more educator focused. There needs to be more support that doesn't just come in the form of you know traditional trainings that they have been receiving. And um, and it is the same with with the police force. You know, I um there's been times where we go and we and we train, and within that training, because the trainings are always very experiential. Um, a lot of things come up for the officers, and then after the trainings, they will come up to me or my colleague and ask us, you know, if they could be our client. They've realized that they need therapy. They didn't, they didn't realize that they had so much stuff carrying with them every single day. And so there's just there's not enough out there. There's, you know, not a lot of people seek mental health support. And so not a lot of people even think that they need it. And so until they're exposed to this type of experiential learning and realize, hmm, I didn't realize that that moment that occurred to me in seventh grade still influences my behavior today. What else influences my behavior? And wow, I have disconnected from my values. How do I connect back to my values? These are things that people normally learn in counseling, but nobody really, you know, not most of them, most people don't attend mental health counseling unless there's a crisis that they're trying to overcome. So, really, it's just a matter of giving them a little taste of self-awareness, and that's all people need. They want more, and they want more. So, yeah.

Dr Andrew Greenland:

Thank you. Um, if you could design a cross-sector pilot tomorrow, sort of combining health, education, and public safety, what would be the first step from a sort of strategic point of view?

Valeria Lerma:

Oh, from a strategic point of view, um, it would be uh obviously developing the training framework and you know what that would look like. Um, and really having something that is for me ideally, it would be kind of like a week, a week of intense professional development training that would start off with a two-day workshop that is purely experiential, that has nothing to do with training about the job, um, and everything to do with gaining self-awareness skills, understanding yourself, understanding your defining moments. Um there's this incredible program called Story of Self, um, and uh that really teaches people how defining moments in their life shift their perspectives and their behaviors, and something like that to so that they can gain that self-awareness. And then we would move into the education, um, the education on the different the different uh state-dependent functioning, um, the neuroscience behind trauma to eliminate this concept of choice. Um there, yes, we always have a choice, but that choice is very, very limited as we move into the hind portions of our brain. And so if we could eliminate this stigma of, oh, people are choosing to behave this way, they are choosing based on the limited access that they have, right? And so that can eliminate the perspective of um of blaming the person and really facilitating empathy. This nervous system is dysregulated and it needs help. Once we walk it back to safety, then we can have those conversations and correct those irrational thoughts, but not right now. So facilitating that empathy. Um, so some training for another two days and then finally ending with um emotional intelligence. And in that emotional intelligence, teaching them how to uh make values-based responses and also how to um shift their brainwave states through meditation and mindfulness strategies. So just kind of really combining everything from self-awareness to trauma-informed knowledge, neuroscience-based, into emotional intelligence. Um, that would be my kind of pilot model that I would ideally love to share with the world. Thank you.

Dr Andrew Greenland:

I was really fascinated by your telehealth model designed to prevent emergency detentions for use. Could you share a little bit about how that program works and what outcomes you've been aiming for?

Valeria Lerma:

Yes. So one of the things that I noticed when I, you know, being at San Antonio Behavioral Health and the other uh hospitals that I've kind of been at, um, is that a lot, about 60% of referrals that come from schools for inpatient admission come through an emergency detention. And what that means is that the child makes an outcry at the school, um, either a major behavioral outburst where they're a danger to someone else, or a suicidal outcry of sort. Um, and the the counselors um uh then try to communicate that to the parent to recommend the parent bring them for an assessment to the hospital. And many times the parents um don't feel that there's a need. Um, you know, they can still say, I'll pick them up and I'll make sure that I will watch them and that they don't have access to lethal means, et cetera. Um uh but the outcries may be very severe or there may have been an attempt. And so the um what ends up happening is they call law enforcement. Law enforcement goes and picks up the child. A lot of times the child is sitting in the back seat, handcuffed after during a behavioral health crisis, and it's transported to the hospital where they now have to be there for a minimum of 48 hours. It is considered an emergency detention. And parents, of course, can't wait to get their child out of there. And so, even though treatment is five to seven days, maybe even 10, depending on the severity of the case, all the parents hear is that you can get your child within 48 hours. So they end up getting their child within 48 hours, they don't complete the course of treatment, and now you have a child that keeps coming back and coming back and never really getting the treatment that they need while continuously being exposed and potentially institutionalized at that point, depending on how much they come back. So, what we did was we developed a telehealth crisis assessment model where our count the counselors in the schools can actually give us a call right there while the student is there, so that we could provide a full-blown crisis assessment while they are in the school. So now they don't have to come in handcuffed, they can do it there. And depending on the disposition, if they do need inpatient care, we have the ability to talk to the parent as the behavioral health expert, because I know our schools and our counselors try to do that, but it doesn't quite carry as much weight as a hospital that has just assessed your child and is saying, hey, this is a dangerous situation. And at that point, we're really able to encourage the parent to bring the child in voluntarily, in a safe way, of course. So maybe through a courtesy transport of sort to ensure that the child is safe on the commute to the hospital. And so what that does is once a parent is voluntarily admitting their child, they're more than they're more likely to keep the child in care until they finish their treatment versus the child being emergency detained. And not to mention the biggest goal, which is to preserve the dignity of the child. You know, they're already in crisis, then having to be handcuffed in the back of a police car and taken to a mental health institution forced for 48 hours, that doesn't set them off on the right course for treatment. Um, they feel like their rights have been violated, like they have no say, they trust no one, and it makes it incredibly difficult for us as a treatment team to be able to treat them because it requires compliance with the group therapy, with the therapy that they get individually, with their psychiatry visits. And so just really trying to reduce the amount of emergency detentions has been our goal. And um, and so far we've been we've been quite successful. There are times um where the parent just continues to refuse and it is a crisis situation, and we do have to mobilize emergency detentions. Those are very needed. Um, and so it's not my intent to take them away completely, but the goal there is to for it to be the last resort. And so we're starting to see that schools are starting to uh rely on that assessment because it also eases the administrative burden and um from the counselors to have to try to do those assessments alone and try to convince parents to do the right thing.

Dr Andrew Greenland:

Got it. So lots of success, lots of innovation. What are some of the challenges though in doing this work? And is there anything that you're sort of currently having to overcome or you've recently overcome in doing your work and moving things forward?

Valeria Lerma:

Yeah, the the I'm telling you, the biggest challenge really truly, I mean, we've been we've been very welcome in in the community, and I'm very grateful for that. Um, if I can be honest, the greatest challenge right now is our resources within the hospital because nothing that we do, uh, we don't charge for any of it. So the crisis assessments are free. Um, any trainings that we do in the community are free. Um, so we don't, we do not collect payment for that in any way, shape, or form. And so what you know, any time that I have to go and and train a police team or you know, present at a professional development for educators, I have to step away from my role in the hospital. And and it's a pretty significant role. Um, and we've got you know three amazing clinical trainers, and they're in charge of our new higher orientation and our in-staff trainings. And so when we go out into the community, um, I, you know, I have to pull one of them, or we have incredible talent within our clinical directing, uh, clinical team, and our senior clinical director is also quite amazing. So I borrow leaders sometimes to be able to go out into the community. And the biggest challenge is that, you know, because we are a for-profit hospital, we do not have access to grant funding. Um, so even though we have this amazing model, um, we are not able to uh obtain funding to be able to expand our training department and our team to really get out there. Um, but we're working on that. And um, you know, I'm hoping that a solution will come very soon. Um I'm I like I said, I've been meeting with uh legislators and political figures, you know, really talking about this situation. And um, they've been able to give me some guidance and some pointers to to ways to kind of hopefully work around that or obtain some kind of funding to be able to maybe create a crew a community training team so that we could have the actual resources to really scale this. So that would be our challenge right now.

Dr Andrew Greenland:

Thank you. I was going to give you a magic wand and say, is there if there's one particular thing you could fix in the system tomorrow, what would it be? I guess it's something around what you've just said, but what would be the ask exactly if you had your magic wand?

Valeria Lerma:

Yeah, it it would be that, you know, it would be to um to not be so black and white in terms of, you know, from a legislative standpoint, in terms of the provision of services that are really needed in the community, uh, because, you know, traditionally it's nonprofit agencies that are doing this work, but it's also nonprofit agencies that are the most taxed. You know, they have an incredible demand for services and they are very short-staffed. Um, and so if anyone has the ability to be able to really provide these um these more um sophisticated per se, you know, services, sometimes it is the for-profit institutions, you know, the ones that have that higher training and and and have um that ability to be more flexible in what they do. And so um not not to exclude us completely, of course, put us through the process of submitting the proposal, right? And having evidence-based practices, et cetera, et cetera. Um, but but not to discard um for-profit institutions because we too are mission-driven and we too are in it for a purpose, and we too also want to help and can come up with innovative solutions. And so that would be my magic wand.

Dr Andrew Greenland:

Great. Um, obviously, you must be a huge demand for the work that you do. And if referrals suddenly surged overnight, what um process or team would struggle to keep up with it? Would there anything break in your system if you had a massive influx next week?

Valeria Lerma:

Um no, not at all. Because one thing that I have uh spoken to to my team about is uh or to my CEO about is hey, you know, we we it would be amazing if we could really expand this. Like, is that something that you would be willing to do? You know, just talk to our corporate structure and really explain, you know, what we're doing and and uh staff up the department to meet the need. And and the answer was yes. So um, you know, we're ready, we are ready, and and I am also ready myself. Um, you know, I mentioned that I practice independently and I, you know, I do organizational consulting, et cetera, et cetera. I have a huge network. I've supervised over 40 clinicians to full licensure. So basically they've all been trained in the stuff that I teach. And so I have a team of people that that I am I'm ready to to use should the uh demand occur.

Dr Andrew Greenland:

And finally, what's next for you or San Antonio Behavioral Hospital or your work? What's it what's coming what's on the cards for the next sort of 12 months?

Valeria Lerma:

To scale, because we have seen really amazing outcomes in our hospital. And in the data that we have received from the school, one of the districts that we have worked with very closely, they've provided some data that really supports the effectiveness of this model that I am proposing. And um that that really truly is the next step is for us to really be out there and make a much bigger impact. And hopefully, um, you know, we're we're working uh to hopefully have a citywide pilot for this in our education systems. Um it was, it was um, it was it was approved and um and really um championed by uh by a political figure lately. And like I said, he was able to point me in the right direction. So the goal would be to launch a citywide pilot, collect a lot of data, and then uh and then take it to Austin, and uh that is our capital, and hopefully um be able to have some mental health reform, which was my original goal 15 years ago.

Dr Andrew Greenland:

Well, with that, I'd like to thank you so much, Valeria, for such a powerful and thoughtful conversation. Really interesting to hear your insights, you know, from coming from the clinical side and your vision for improving uh trauma informed care, you know, in the more wider community across different sectors. It's been really fascinating. I'm so grateful that you spent the time talking to. about it on this podcast. Thank you very much.

Valeria Lerma:

Thank you as well for having me.