Episode 5 - Part 2: Community-Based Access to Behavioral Health Care

Host: Shakita LaGrant-McClain

Guests: Ken Ginlack, CEO of Serenity Inns and Milwaukee County Mental Health Board Member; Jennifer Wittwer, Director of Community Access to Recovery Services (CARS); Brian McBride, Director of Wraparound Milwaukee-Children’s Community Mental Health Services

DHHS Executive Director Shakita LaGrant-McClain is joined by Ken Ginlack of Serenity Inns, Jennifer Wittwer of Community Access to Recovery Services (CARS), and Brian McBride of Wraparound Milwaukee for a conversation about how behavioral health services for children and adultsare evolving across Milwaukee County. Together, they discuss the redesign of the behavioral healthcare system from institutional to community-based care and how new access points, partnerships, and prevention efforts are making it easier for residents to get the mental health and substance use disorder support they need.

Transcript

SPEAKER_02 0:03

Welcome back to part two of Conversations to Creating a Healthy Community, focusing on community-based behavioral health services. So, Brian, um wraparound um Milwaukee Children's Community Mental Health Services has created a new level of care to problem solve the complex needs of youth. Tell us about the new collaborative approach that you all are moving towards.

SPEAKER_00 0:25

You know, I think it's it's been years in the making in a lot of ways, and years of collaboration amongst our system partners. So um in really identifying where there are complex needs of youth and families, and how are we able to uh reach out to get identified uh youth who are are struggling, but then also how are we supporting them when a system uh can be siloed and a system can um not necessarily be as responsive in in times of need. So, what we were able to do is really take the uh youth behavioral redesign um framework that was has been uh operationalizing for um many years now and really kind of look at it as where is our where is our piece to this and how what can we do and really spearhead something um and and see if it if it if it's gonna meet a need in in the community. And what we're seeing right now is that uh we're we're doing that. We're we're able to have a um uh a service and a program designed at really embracing some of the most complex youth in in our um in our community. And when I say complex, I mean multiple systems. We're talking about kids that may uh be placed out of home, that may have mental health diagnoses, that may be in crisis, that may not be to grade level in school and may be involved in our youth justice, our child welfare systems, and have spent time in in uh hospital settings. And all of them would will be supportive and serve that youth in their own ways, but how do we how do we wrap that care around a youth um that is in those settings on a daily basis? And how are we coordinating that care and showing up? So, really what we did is we used the coordinated uh service model and we we wrapped a team of individuals around uh that youth and and family because it really is not only about the youth, it's about the family. Yeah, and um we know that through history and through um data and just and just being uh a part of the fabric of the community that you have to support the family if you want to see real positive growth for not only that youth but the family and showing up. So, what we were able to do is is get a team of individuals together. Uh it really centers around coordination, around uh clinical therapy, um, but also crisis intervention and and community outreach and somebody who's going to be able to uh really respond in that moment. Um, so we're we started this now, it's it's oh geez, five months ago. Um, and we've really uh been you know selective in how we're trying to treat to to create another layer of of support in in our community and really kind of embrace a model that allows um youth to get support across the pendulum of what their needs may be, um, from the most complex to just needing kind of uh uh maybe every couple of weeks of an intervention or a support. Uh so it really has been embraced by not only our system but our our uh community and our and our providers uh as well. So more to come. We hope to be able to expand to a uh to a second team here in the coming weeks. I'm sorry, the coming months. Oh, you said weeks. I was like, what is going on?

SPEAKER_02 3:58

Good, great work, uh Brian. Just you know, and if we start younger, right? If we do more of the prevention intervention younger, we know that it prevents some of those youth from ending up in the deeper end of the system, right? Well, I so that that really is our our goal, right? The more we can work with them, the the better.

SPEAKER_00 4:15

And and it's been it's been a I would say a model, but that's almost cliche. Uh we love to work ourselves out of a job.

SPEAKER_04 4:22

Yeah.

SPEAKER_00 4:22

I mean, and that's what the goal is. From the day one of you meeting with somebody, your your job should be to really work yourself out of working with that family because they have successfully gotten somewhere.

SPEAKER_02 4:33

Absolutely. I love that. So I'm gonna put this question out there, and whoever wants to take it, if everyone wants to, that's great. Um, so I want to know what impact has the mental health emergency center, now that it's more centrally located, has had on our community members across Milwaukee County. So, what do you think that impact has been? That now it's centrally located.

SPEAKER_03 4:51

Um, again, you know, how we started the conversation again is access to services, right? Um being centrally located, um, not having to travel out. Um again, Watertown Plank Road was it truly was like outside of the community, like a silo. It was almost like um, I believe history say it was some type of um institution where they kept individuals that were diagnosed with mental health. Um but the mental health emergency center allows people to go there, get them stable, they take a strain off of the emergency rooms. Um, and and that's very important, right? Because a lot of times when people go to the emergency department, they can't be seen, um, or they don't, they're not equipped to deal with their mental health at that point. Right. Um and so just having a space that they can go in and get seen right away, um, having that emergency center and then determining what services they they may need if they need a higher level of care, if they need to be stabilized, or if they can return back home or to the community. Maybe they just um out of medication and need that as well. So um it's it's been great. Um I wish more utilize it, more people utilize it and use it um exactly for what it is. What it's for. Right. Yeah. Because we still see a lot of mental health show up in emergency departments and hospitals around the community. Um, so just letting them know like this is a space that's that was specially made for you.

SPEAKER_02 6:26

Exactly.

SPEAKER_03 6:27

And so, you know, um, but it's been good.

SPEAKER_02 6:30

Okay.

SPEAKER_03 6:30

Um I I continue to watch, you know. Um, I've never been a data statistics guy, but I'm turning into that. And so I'm always watching now to just see, like, okay, how many people are really accessing this services.

SPEAKER_02 6:43

I mean, are accessing and then what is what are the outcomes, right? Absolutely. Yeah, I think that's really important that we keep an eye on. I mean, we see that the numbers are pretty similar to what we had at the hospital, like how many involuntary people who go involuntary versus voluntary. I think they're serving approximately 8,000 every single year. So those numbers are still pretty high, right? But it's easier for them to access it, right? And we just want to make sure, as you stated, that people know it's there and the reason that it's there. And right, and so when they go there, evaluating them, helping to stabilize them, and then getting them connected to whether that's inpatient or back home or to one of the access points or clinics, wherever that is, what in our community, and putting that plan together so we can truly wrap services around them, right? And get them the needs that you know that meets their needs and also support their family too. So any other thoughts about it being centrally located?

SPEAKER_01 7:29

Yeah, I mean, I think it's been fantastic. Then we have them right next door to us. Really, we have many examples of people who have showed up here at the CODIX building reaching out for help and support in a lot of distress. They might be suffering that day. And we've been able to literally just walk them away. It's not even half a block away, right? So that's been an incredible experience, and they are a resource for our community. I'm so happy that we were able to sustain an emergency room that has that specialization. I think that's really important. I think they're doing fantastic work. So we're having them right next door.

SPEAKER_02 8:05

I agree, I agree. So there are uh tremendous prevention efforts underway through Better Ways to Cope and harm reduction. You brought this up earlier, Jen, and about better ways to cope and the harm reduction MKE. And recently, County Executive uh Crowley and Dr. Van Weston, um, they recently announced a year-over-year decrease in open dose deaths. So there's been a decrease. Now we want to get to zero, right? That's the goal, but what we're seeing is that the work that, and this is collective work. When we talk about we, we're not just saying DHHMS are one program with service, but like the collective we, we really are helping to have an impact on bringing those numbers down. So, what are the upcoming plans to continue to advance prevention work in Milwaukee County? And I'll I'll start with you, and then if you all have thoughts, please add.

SPEAKER_01 8:46

We're always so proud of the prevention and harm reduction work that we're doing in Milwaukee County. And and I've said this many times in many venues, but I'm so grateful to work for progressive leadership like you, thank you, like our county executive, um, because I've been able to be part of some work across the country, and not every community is like ours, I'll just be honest. So the investment that we've had and the embrace that we've had, especially around harm reduction, believe it or not, we talk about it like it's very, a very normal thing. And in really, I've seen over the last four years, it has become just part of our vernacular. And we accept, oh, we have 19 vending machines giving out free harm reduction supplies in our community. That's great. There are other communities where even in their own DHHS department, they're not allowed to hand out harm reduction supplies. That's seen as something that's very controversial. We know that it saves lives. We want to keep people safe and healthy until such time they're willing to go to a Serenians or another partner to get the help that they need. Um, so I'm just grateful that we live in a community where that um is embraced and celebrated and invested in. So that's great. Um, but yeah, you talked a little about prevention with the youth. Prevention is not just for youth, it's for adults as well. And so we focus on population health measures that can keep our community healthy and safe and have really big investments in prevention. Better Ways to Cope has been one mechanism, not the only mechanism where we invest in prevention, but it's one of them. And again, um, when we got our opioid settlement dollars, you know, we were thinking of all the different strategies where we could invest and make an impact and bring those overdose numbers down, which we have. Year over year, we're down almost 50% from where we started, where it was at its peak during COVID. There are some communities where it's not down as much and where it even continues to climb. And so we know that we need to invest, especially in our black and brown communities, and we are making those investments. Um, but going back to the Better Ways to Cope framework, that was really a way for us to do some community regranting. Yes. And and having the recognition that we have a lot of good ideas at Milwaukee County, but we have not cornered the market on all the good ideas, right? I agree. And our providers out there, they're incredible. They are, they're energized. And this has been a coming together of an entire community to solve a terrible problem. And so we talk about when we come together, um, we're focused and we're passionate, um, we're joyful, but in a way it's not disrespectful. We we are always aware that there's this terrible problem we're trying to solve, but we're we're in it together. And just to share our resources and to get those resources out of the community to providers who they have come back to up us with brilliant ideas. Right. They've executed things that we never could have thought of or we never would have been able to do, quite honestly. Um, and it's been just it it's been an incredible thing to to witness that and to see um how much it's mobilized our community um to tackle this problem that we're facing.

SPEAKER_02 11:59

It truly is that vision of together creating healthy communities, right? Not just DHHS alone, but it is hand in hand with our partners. Because you're right, they have some amazing ideas and doing amazing work.

SPEAKER_03 12:10

You wanted to add oh absolutely, because the the biggest difference is that um we see the bigger agencies um get opportunities to work and so better ways to cope allow grassroots organizations. Like it was the the the um the individuals that was already boots on the ground, right? It was organizations that was already in the community doing the work, and then given that opportunity to have the OPUA settlement money be utilized for grassroot organizations made a really big difference. Um when it came to better ways to cope. I was like, okay, how do I be creative? Right? And and so I knew about the vending machines and I thought the vending machines are great. So I really designed the drop-in clinic as a human vending machine. I was like, what how can I enhance on the the vending machines? And I'm like, hey, well, what if I show up and I can actually talk to a person, right? And still get the same products that I get out of the vending machine.

SPEAKER_04 13:11

Yeah.

SPEAKER_03 13:12

Right? And so it made a a big difference, and that's really how the ideal expanded for the drop-in clinic. It's like, oh, you don't have to show ID, you don't have, you just walk up and you say, Hey, can I have some Narcan? Right? You don't have to give their name or anything. And so we really met like two different categories when it came to Better Ways to Cope. We could have gone in the prevention and the treatment category. But I'm like, how do we combine that? Yeah. And and again, the the outreach, the outreach we are able to do um within the clinic, right? We walk around, we go to emergency rooms. If somebody had a recent overdose experience, then hey, give them this flight or they can come to the drop-in clinic. They can go to these vending machines. And so just being real intentional about the people that we serve. Um, I we have a really great relationship with um the fire department, with Maury. Um, they come to Serenity Ends. I mean, they have a list of their own that they want to get me and enrolled in the um in the treatment in the residential treatment.

SPEAKER_04 14:10

Right.

SPEAKER_03 14:10

Right? But they come and they check up on them and they make sure they're good. But these are people that recently overdose. And so again, being intentional about that, being in the emergency, meeting people where they are.

SPEAKER_02 14:21

Right?

SPEAKER_03 14:22

Yeah, yeah. So being community, yeah, right. And so I'm really grateful, like better ways to cope, and I'm really grateful to see the opioid settlement money utilized the way it's been utilized thus far. Yeah, yeah, because it makes a difference.

SPEAKER_01 14:36

And it's been great because uh we built that framework and then we were able to fold in some of our temporary assistance for needy families, money, and the state was like, it's it's catching wind out there. They're like, we love what you're doing. In fact, they implored us to do even more than what we had planned. And now we're reaching families. So fathers, mothers, pregnant women who are living with substance use issues. And you brought up a great point, Ken, that I forgot to mention. One of our um objectives with Better Ways to Cope was not just to make sure that prevention, harm reduction, treatment, and recovery services were being expanded in our community, but to invest and create equity uh in the ability to apply for the funds. That's been a criticism of Milwaukee County in the past, and rightly so, that it is hard to competitively apply for our funds because we have a rigorous, as we should, a rigorous uh request or proposal process. And so some of those bigger providers who do great work, but they're the only ones who could ever get the money. And the way that we handled it this time was we leveled the playing field. And so for some smaller organizations who just they have they might reach a population that we've never reached before or that we aren't doing our best work with, um, it brought new partners to the table. And I think this idea that we're sharing our resources and doing it in an equitable way is one of the most important things we've done in recent years.

SPEAKER_02 16:00

Yes, I love that. I love that. Brian, I have a question. If you could just talk uh really quickly, so wraparound Milwaukee, you have this new partnership with Uncome. Um if you don't mind just telling us a little bit about that, and it really is working with after school programs. Um, and and why have you decided to to have that new partnership? What do you believe that impact is gonna have in our community?

SPEAKER_00 16:19

Yeah, so um new as in in and really um we've been in two of the centers a few weeks now. Yeah. Um I think this is the third week actually. So we through some conversations with with UNCOM, um, which is the United Neighborhood Community Centers of Milwaukee, um really started to understand what they're seeing in their after school um sites and and across the um across the community they there are seven agencies that are a part of this um a part of UNCOM. And really what we we've seen and heard is that youth are are are coming in with really, really challenging, heartfelt um and and needs that they're really not in a place to be able to support and help. And when you look at it um from a well, we we have the opportunity to step in and be supportive for you. And when we when we went and toured some of the sites and when and were talking to the staff, we really started to understand the amount of trauma.

SPEAKER_04 17:29

Yeah.

SPEAKER_00 17:30

Um, and when you look at it from a large system standpoint, and you walk into one school and one after school um um facility, uh and you start talking to the staff, and then you start talking to the youth, and you and you're hearing and understanding, you know, some of their stories and some of their needs, you understand the magnitude of what the work is that we're really really trying to do here. And while it's not direct service and it's not the normal way that we historically provide um uh service and treatment, we said, you know, we can do we can do better and we can be supportive of them. So what we have right now is we go to Silver Spring um uh Silverson Community Center, and then we go to New Life uh Community Center, which are our two locations that are operated. And one is more high school, uh uh high school edge kid, and one is then grade school. And we're seeing different needs on both of them. And uh Lawrence Thomas, who is uh one of our our internal staff members, who is a wonderful soul and a very knowledgeable individual, is took this on and said, you know what, this is absolutely something that I feel um we can we can do and we can give back to. So he goes to each of those sites for a couple of hours, um, two times a week in in each of them, and then is responsive to the needs outside of it. So it really has shown a partnership that we we didn't have, but it really fits with our mental wellness and our in our really uh no wrong door uh approach, is that we can go out and be supportive of them, uh of not only the staff, but of the youth that they serve. And we can do it in ways that we really had never thought about doing. Um and we talk about prevention and earlier intervention. Um this isn't necessarily and I say this, and sometimes all of all of my team looks at me and goes, Well, yeah, it it is. It's not about a referral for service, it's about doing something that is right, and we will get a a referral for a program or we something out of it, but we're not showing up in that regard. We're showing up because we know that there's a need and that we can be helpful in it. And um, I hope to be able to expand to all the locations by the end of this year.

SPEAKER_02 19:50

You are meeting youth where they are, and they may not necess necessarily uh have a diagnosis or even want to enroll in a program or get a service, but once you build that trust, right? Once you build that trust with that youth, they begin to talk a little bit more and they'll go tell their family, hey, I think I want to, you know, this is something I need. They begin to talk about. We talk about uh again, we talk about mental wellness and mental health, and how do we really normalize those discussions? That's what you all are doing. You're going in there and building relationships with youth who maybe have have never, you know, been in our system or had any connections to services or resources, but building that trust and letting them know that we're there. And if you need us, right, here's what's available. And if not, we're still here. So I love that. So thank you for that partnership. You all have get, I mean, so much amazing work that is happening um in this area. And so we just, you know, as we end and we think about, you know, all the initiatives, among the programs, among the things that are out there in our community, um, what would you point to as a highly effect that's highly effective in truly serving our community? What would what would be that initiative, service, program, resource? What thing would you point to to say, this is it? And if there's a call to action, right? We're talking about normalizing people talking about mental wellness and mental health. In Milwaukee County, we won't do everything. We can't do everything. That's why we have more than 300 providers. Because what we want to do is have people in the community who are actually doing this work. That's what better ways to cope is, right? Making sure that we have folks out there. So, what do you all believe? What would you point to to say, hey, I recommend this? What are your thoughts?

SPEAKER_03 21:27

Um, it's a it's a couple things. Um, and and I don't even for Serenity Inns, when our treatment facility, like we accept individuals that do not have insurance.

SPEAKER_04 21:39

Yeah.

SPEAKER_03 21:39

And I I don't know too many treatment centers that do that, right? The first thing you do is when you call, they say, Hey, what's your insurance? What it that's like on the back burner for us, right? We want to know how you do you really want to want this service, right? And we br we bring individuals in. And that's something that's important that I I'm hoping that we can continue to do, right? Um But, and then I also got a call yesterday. I actually went to a place on 15th and Keith a church. And it's like, hey, Ken, can you implement services in here? I'm like, hey, I would love to, right? But I don't even know if I have the bandwidth to do that. But I I would say, you know, and I encourage the community and myself to just continue to be intentional. You know, if I can't um provide this service for you, I can provide a conversation or a place where you can get the services at. And so I just think it's great that what Milwaukee County is doing when it comes to mental health, substance use disorder, the better ways to cope, and being a provider as well as being a board member. Give me some leverage where I can say, hey, I'm intentional on both sides. So, you know, I'm gonna be intentional as a provider, I'm gonna be intentional as a policymaker. And so, um, which I'm grateful for. I'm extremely happy, and and I believe it is working, and the overdose continue to drop. Um, I would love to see better ways to cope continue. Yes, continue. I I'll tell you this, and it's we were able to start the drop-in clinic, but then you know, we always have to look at sustainability. Yes, how do we can sit sustain, right? And so we started out to say, hey, just walk in, everything's free. You can see anybody, you know, and then it's like, okay, kid, how long can you sustain that where everybody just walk in for free services? Um, but it works, right? And so far we're still able to do that. And so I'm proud of that. I'm happy about that. And I want everybody to listen to say, you know what? If I don't have insurance right now, and I need to see a mental health therapist, I need to see a case manager, I want to talk to a peer support specialist, I can go to Serenity Ends Drop-in clinic Monday through Friday, 8 to 4 and see someone. Absolutely. And so I'm extremely proud of that.

SPEAKER_02 24:00

Thank you.

SPEAKER_03 24:01

Thank you so much.

SPEAKER_00 24:02

Yeah, I I think as as we're looking at the at the question you asked and really about the initiatives that are are happening in the community. I'm really looking about the collaboration that that has really started. And you really look at, you know, we have you know things internally to DHHS around children's system of care, adult system of care, bringing people together, really talking about and centering the work that we do. But it's in a way that it's about partnership. And it's not necessarily about us having to lead the way, but being at the table, um, and really kind of in a lot of spaces we do lead the way, and that that's um because we we choose to do that and we believe that it's best for us. But in a many other ways, we are also a partner. So that gets to um in it, it gets to us the work going in a different direction in a lot of times, and in spaces that aren't traditional to what we uh have historically done in in programs and service areas. Um, you know, and Jen alluded to it, you know, the progressive way of being able to be out there and do things uh differently, you know, not to keep talking about better ways to cope, but it truly has what I've seen in some of the grassroots root grassroots efforts that you talked about is it's enhancing a change in in youth that I've seen over the last 20 years. It really is about their voice, and we talk about stigma, and stigma is a true thing. But today's kids and youth aren't really afraid to talk about and tell you what's on their mind. Right. And we have to frame that in a manner that is positive and that is is put in a direction that they can use it, but that adults can listen. And I've seen better ways to cope, do that and teaching ways to look at things differently through the organizations that were funded in the next round that's out there. I hope we'll continually do that. Yeah, but to me, that is is um what really is catching uh in our community is the power of togetherness.

SPEAKER_02 26:05

Well, that really shows the leadership of Jen, right? A lot of people are bringing up better ways to cope. And I just want to call you out. You mean talk you talk about the leadership, but you have been an amazing leader here too. Every staff person that I know that works with you alongside you, they talk about how you lift them up, how you empower them. And all of these are your ideas if you kind of like whisper to them and then they go out there and they just do the work, right? Just do it and you trust them to do that work. So, are there anything else that you want to add to things you want to share in the community that you want to do?

SPEAKER_01 26:33

Yeah, you know, it's interesting. We spent a lot of time talking about some of the newer things that we're doing, and innovation is a cornerstone of who we are. I love innovation, I love new exciting things, but we have to still focus on like the foundation of who we are as well. So Ken referenced earlier what's keeping you up at night. I have things that are keeping me up at night. Uh, funding streams are changing, and we are having to shift how how we focus on our business and where we invest. That's not the fun part of what we do in leadership. It's the hard part. And we are in a hard space right now. Um it would be easy for things to get fractured during times like this. So, my call to action is remember all the other important things we have to do. Our treatment system, whether it's substance use or mental health, that is the cornerstone of who we are. We can't lose that. Um, and sometimes we can't invest in all the things that we want to, and we still have to focus on those basics that still matter. Um, and we have to have patience and understanding for one another when we go through times like what we're going through right now. Um, I always think that my call to action for everyone who's interfacing in our system is just kindness. Um, with our uh, we do a lot of work around continuous quality improvement and and we use a model for that called Niatex. Uh the gentleman who started that had a great saying that I always remember, and he said, No one should suffer twice. Meaning they're already suffering when they come to our door. That's right. Don't let them suffer at our hands as well. And during these difficult times, we have to make an extra commitment to stick together. Um, whether, you know, we need our providers, we need our community partners, we need the people who are coming to us for services, and we have to always remember we are all in this together. We cannot lose sight of that.

SPEAKER_02 28:31

What an amazing call to action. I would like to thank each and every one of you for joining me today and truly talking about mental wellness and behavioral health and all the things that we're doing together, not just the new things, but the things that really have given us that foundation. It truly is together that we create a healthy community. And so I want to thank each and every one of you for your leadership, for your dedication, and for being kind when people show up here. Thank you all so much.

unknown 28:58

Thank you.

SPEAKER_04 28:58

Appreciate it.