Jason Dana Costa 0:00

Welcome to Worth the Work with Jason Dana Costa. Today's guest is Lisa James. She's the vice president of behavioral health and social work at Chase Brexton Healthcare. She's a clinical social worker, healthcare leader, and has spent her career improving behavioral health systems in communities. And I just found out we share Columbia, Maryland in common. So very exciting to meet you, Lisa. Welcome to the program. Thank you. It's good to see you, Jason. Excellent. I love it. So here at Worth the Work, I try to connect upbringing and family stories with things that we learned and how it impacts your career. So the first question I wanted to ask is how did your growing up and learning to take care of people still show up for you and how you lead today?

Lisa James 0:42

I love that question so much. I think because it takes this back to like, why do you do this? You're making the work worth it. I grew up in community. And so to me, taking care of people is a community effort. My mom and dad, and being raised in my home with my brother and my sister, like that primary unit. But there is no Lisa without going to my grandmother's house every day and being able to eat what she made that was just for me. And then taking a walk to the store with my uncle, who taught me my left from my right and how to look at the sun and be able to tell east from west. And spending time with my cousins and my auntie who taught me how to dance and watching Soul Train with me and songs that I hear today that automatically take me into her living room. And both of my parents worked. And so I got dropped off at my auntie's house, who lives seven blocks from my private school. So got dropped off there in the morning and then walked to school. But it was everybody. Everybody was there to take care, provide care. And that's what that means to me. I think it's why I love working on multidisciplinary teams.

Jason Dana Costa 2:02

Oh, excellent. So what's some of those lessons your grandmother might have taught you that sort of show up in how you lead today? And it doesn't have to be a grandmark, of course, but Yeah.

Lisa James 2:12

The folks who talk to you, I would love to say one of the lessons that definitely sticks with me is actually not a biological family member, but part of the village was my track coach. And I remember running track and for AAU. So lots of traveling, lots of fun. But I ran on a team and ran an event that two people on my team were faster than me. And I remember being so discouraged. Like, I'm getting ready to go out of town just to be beat by the two people who are already on my team. Like, what type of I want and I wanted to quit. And my coach pulled me aside and he was like, Lisa, you have to understand, like, we're coming here and we want to sweep this event. So you are committed. Like, you got to make sure we nail third. And that was so meaningful to me that I was committed to coming in third because I still wanted to be Pam and Kim. But it was so meaningful that Lisa, here's your role. And we need you to do that role to the best of your ability so that the whole team will win. And that's stuck with me. And it also made me get really comfortable with being around people who were smarter than me, faster than me, and better in different ways. And got really good around being around excellence because I have something to offer too. And I've I found that a really wonderful life lesson that helped me in many different arenas: school and college and graduate school and moving from different cities. And just that lesson of you can be around great people and have something to offer that is also great.

Jason Dana Costa 3:59

That's fantastic. Boy, I hope you sent a thank you note to that coach.

Lisa James 4:03

Many times. Many times.

Jason Dana Costa 4:06

Excellent. That's a really great story. I love hearing that. So you spend more than a decade crowing Chase Brexton. I'm pronounced that right. Correct? Chase Brexton. Yep. So you got it. What's made that organization continue to be something worth investing in for yourself?

Lisa James 4:19

Chase Brexton has given me the opportunity to grow and be creative. And I have the painting brush. It wasn't this is what we see you doing. Oh, actually. And now mirror this. And I think having that freedom has been incredibly wonderful. But also what when I can't underestimate the amount of time that I spend with other disciplines and working on a common goal with folks who are seeing it from a different angle and learning and seeing their perspective, and then connecting the dots of how we can all work together to get to this best end. And being on the clinical side, where I get to work with dentists and clinical pharmacists and physicians and OBGYN to the leadership side of folks in marketing and operations and finance, it really has been a wonderful investment of time and energy and creativity over this past decade plus.

Jason Dana Costa 5:25

Yeah, excellent. Sure Baltimore is blessed to have you in doing this work, no doubt about it. So for me, the other thing I was curious about with your career, clearly you've worked a lot with children and families. And I've always found that sometimes the best lessons come from unexpected voices. So is there something that one of those children of families might have taught you that maybe no leadership program you've taken so far has really rung true for you?

Lisa James 5:54

Right, Jason. Children, right? They will tell you the truth. Regardless of there's no, we're not about to make this socially appropriate. Here's what it is. And but it that authenticity comes through. Ah, there's the word. It just comes through and they call it. Like, and there was a time when I was working in residential treatment for four to 12-year-olds, and there was a four-year-old who wanted a bedtime story, but was triggered by you being in their room. But everyone else had stories at night, and they were able to share with me. They're like, I trust you, but I want to tell you something. And I'm like, okay. And I was like, I want a story, but I don't want you to sit next to me. And I was like, that's okay. I'm gonna let you sit on this side of the doorway, and I'm gonna sit on this side of the doorway, and I'll show you the book and the pictures this way. And I'll read a story to you anytime you want. We can do it this way. And the way their eyes lit up, and that I could get something I want, but in the way that I need it was a game changer for me in terms of engagement with children. Being able to make sure that we're meeting needs was so often we're setting the parameters of how it has to be done. Well, if you want me to do this, then you have to sit right here. Or if you want to have this, then you have to. And being able to give them that autonomy to share the need and then giving it to them in a way that felt safe was really a game changer for me moving forward and how I wanted to be able to create atmosphere and meet needs for kids in different ways. And when I think about families, the families that I've worked with, there's some have made life really great, some have made life really hard. I've learned from I've learned from both of them. But I think sometimes our families that are doing their best to meet our basic needs, right? I'm working two jobs so that we can live in Howard County. But I can't take off work to come to your meeting, your parent-teacher meeting, because I'm at work and I'm not less of a parent because I can't come to this meeting. But being able to understand the capacity that families have, that they love their kids too, and they're doing the best they can with what they've got. And doing that same thing that I did with the child in residential, it's like, then what how does the system need to shift to be able to support you in your capacity? And so everyone can't come to the meeting at five. That's okay. We could send this to you in this format to be able to get your feedback because your feedback is still really important to us. And so seeing that in mental health, seeing it in school, seeing it in residential treatment, it's really helped me think about how we need to be more flexible and adaptable in our delivery.

Jason Dana Costa 9:15

Oh, wow. That leads to one of the questions I was hoping to ask you. It's given that you have worked cross-behavioral health, which I share with you. I worked in behavioral health myself, primary care and social work, and I have so much respect for social workers now. You know, and even community outreach. Where do you think the healthcare system is still failing to connect the dots for people?

Lisa James 9:34

I think we still have opportunity in the system in two arenas. One would be reimbursement, right? Like we pay sometimes, we pay and reimburse and inadvertently incentivize the wrong things. So if we're incentivizing that the visit is actually happening, then people get the system becomes very hyper-vigilant on ensuring that people show up for the appointments. But then we ignore that the people who actually do show up for the appointments, how well are we tracking their progress, their health advancement as a whole health person, not just you came today, we're glad you're here, and we have to talk about this because they're reimbursing this during this visit right now. And so I think our reimbursement model has some opportunity to adapt to whole health person care. And Jason, I know I'm a social worker at heart, but data is truly my love language. And if I yes, I love some data, but if we could get the data to talk to one another, like that interoperability, I think we could serve people so much better that when you go to the specialist and I have to beg the specialist for the information or rely on the parent or the child or the actual patient to bring the information when it's sitting in a system that if we could just access it, we could all see it and really connect the dots for your health. Yeah, I think the payers and the data are our system opportunities to adapt in the way that people do and allow us to serve them better.

Jason Dana Costa 11:24

Interesting. When I've asked this question previously, a lot of people bring up the social determinants of health. I was just curious if that's like your number three out of any chance or tracking those sort of activities and issues.

Lisa James 11:37

I think it is, but oftentimes when I hear that, and when I've had those conversations, I feel like then it leans those social drivers, then lean towards the people versus the system.

Jason Dana Costa 11:53

Got it. So it puts the onus on the wrong spot. Is that a fair way to say that? Yeah, all right. I can see that definitely.

Lisa James 12:01

When we have a diabetes management program and the nutritionist tells you you need to walk more, does where I live have a sidewalk? Is it walkable? Do I have a car to get to the park the way you want me to walk? Is it like and so now walking and making these improvements, when I come back and I tell you I haven't done it, now looks like a me problem. And systemically, I think we have bigger things in those drivers that the system would have more power to solve.

Jason Dana Costa 12:33

I agree. So that's a great lean question because you've clearly been a leader in these sort of health systems, in the organizations you've been in. So when you see a team or a system that needs change, I personally believe it and worth the work. I've I really believe it all starts with trust. So I love to ask that question when you're joining new teams or systems that you need to earn the trust of those people before they ask them to do differently. What tactics is Lisa doing to make that sort of change happen and build trust?

Lisa James 13:03

Listen. I think the number one thing is to listen. And don't get me wrong, I have ideas, I have thoughts, but I hold them. I just, I'm like, Lisa, sit tight because you also need to listen. And the great thing about therapy is that you have an opportunity to formulate questions and to be curious and to leave things open. And so whether it's a new team or an established team, really taking time to listen. And then from listening, creating some questions. And most people, when you're working on a team, it's like, is this what you want it to be, or could you see this being something different? And sometimes people are just coming and doing what I'm told and doing what gets it done every day. But when you open up that vault that says, What if we had some magic and we could do it a little bit different? What would you want to do? And that spark comes back into their eye of like, well, I think, and getting, and then now this is your energy not only in building trust, but also building a new way forward. And now we're in it together and building this of what we're reimagining could come to fruition.

Jason Dana Costa 14:26

I love using the tool called a big tree and little tree. I say to colleagues, what's the three little things we could do that would just make your life easier? Like making it up for a minute. If the coffee bot was just a little bit closer to where my office is. I mean, I'm being silly about that, but there are often little little things that could just make life easier, that those are immediate wins. And then asking somebody like the well, what's the big three? The big three are like system-wide major changes that would significantly improve those components that they're dealing with. That's the tactic I tend to use from time to time. Big three and little three.

Lisa James 15:10

I love that. Big three, little three. In my world where we work in multidisciplinary teams, I say I love it. And there's also the challenge of it. I've learned, I was like, okay, guys, we have to learn to speak their language. And when I was working with our behavioral health team, they were like, the senior leaders, they just don't listen. And I'm like, I think they do. I don't think we're speaking their language. And how do we do this in their language? And each of our teams, we have folks. I have my BI language, my business intelligence person. I was like, okay, I want a dashboard. I want it to be pretty, and I wanted to have this six portions of information. And I would love it if we could have it by next month. And my business intelligence liaison, who is also a therapist, is like, love you. And yes, you're not getting that fast. That's unrealistic. Here's how I'll share your needs and wants in a way that they can listen and actually deliver. And being able to like speak those different languages across the industries has been top tier in terms of helping us get along, be effective, and work together as a team. But I love big three little three.

Jason Dana Costa 16:29

Oh, thank you. I appreciate that. It's it was just one of those things that came up during an employee review in a real difficult interaction with the individual. She was very challenged, had been with an organization for a long time. So it was a lot of institutional knowledge. And it was just an inspired part of that came out of the conversation with Carol. But it really made a pivotal difference because those little three were easy, actionable items and usually turn out to be. But it was also really insightful to find out what a 25-year employee really thought needed to be done. So I was curious, given that you've worked in both behavioral health and primary care, and even in the community, when you're asking that kind of question, you were just asking to speak their language and sort of understand that. What kind of differences have you seen in each one of those sectors where that translational work kind of came and blossomed for itself? Am I making sense of my question?

Lisa James 17:24

Yes. So I think probably our best example would be, dear gosh, COVID 2020, where behavioral health went from being a 100% in-person, especially in our environment with as a federally qualified health center, folks, all of it was in person. And then overnight it wasn't. But it became very common that for mental health you had to wait. There's a wait list, there's a wait list, there's a wait list, there's a wait list. To the point where our primary care docs were like, I see these folks, and they can't wait as long as you're making them wait. Our therapists were like, this is ridiculous. We can't do this. We can't make people wait. And of course, our community members, the folks who needed the service, were also, we can't wait like this. And so we adapted our model. And so we moved to what we call the third. And a third of every single therapist, when we heard that feedback of we can't wait for this reason, primary care is like, we can't wait because it's too long. We'll refer somewhere else. Other people were like, we like you, but we can't wait because the need is urgent. And our therapy teams were like, I don't, what else? We don't want people to wait, but what else could we do? And we came up with the third model where a third of every single therapist's caseload will include short-term. So there's always going to be two to 12, a third of your caseload that will do two to 12 sessions, which will maintain access at all times because you're moving and discharging folks, and they can come back in because inevitably people would come into care. And now I don't want to leave because I like working with you, Jason. But if I leave, it took me too long to get in. And if I leave, I won't be able to get back to you. I was like, we've kind of created our own problem. What if we create a way for you to get back in? Because a third of my caseload will always be revolving. And we leave room for moderate to long because there's trauma and more intense care that's needed, but holding ourselves and adapting to the model and to the need. And now we track our wait times, we send it to our primary care docs by center so they know who's waiting and how long it takes from referral to sitting in front of a therapist and being really transparent with the community. They can go to our website, it's posted all over the place. We share it with our docs and the rest of the organization. So that something that used to be a pain point is now something that we're really accountable, transparent, working on, and willing to share.

Jason Dana Costa 20:39

I have curiosity because I it just occurred to me while you're talking about your model there. Maryland recently became a CCBHC state, yes? Yes. Is is Chase Brexton Healthcare considering becoming approved for that?

Lisa James 20:53

So we because we're FQHC, our model probably would probably help us be better partners with the CCE.

Jason Dana Costa 21:01

Interesting. There's a couple of them here in Rhode Island, which is where I'm currently sitting, that at least one FQHC has chosen also be designated as a CCBHC. Really? Wonderful. It was the designation came in place for 2023. Oh, and for the listeners, CCBHC is certified community behavioral health center. It's a certification that the federal government's rolling out, I believe, to 18 to 25 states currently in the U.S. Rhode Island's been one for a while. Maryland, I think, just started the process this year.

Lisa James 21:33

Correct. Yes. Yes. And thank you for that. We're sorry for the acronyms. FQHC is Federally Qualified Health Center. There's nothing worse than listening, and people are using alphabets and it's like what does that even mean?

Jason Dana Costa 21:44

It's healthcare. It's all alphabets in my march. That's what happens. It does. So I just want to make sure I'm sensitive to your time and everything, too, that we're doing this. So a couple of the last questions. I always like to ask every leader has a difficult. Season in their career that potentially pivoted how they were leading. And I was curious of one of those experiences for you that changed you to become a different kind of leader.

Lisa James 22:11

To be completely authentic, it would be now. I think it would be now. Yeah. Yeah. If I've had a significant amount of grief and loss in the past year. And it was humbling to watch my team rise to the occasion and just go do what you need to do. We got this. And even coming back, like, okay, wait a minute, brain, I need you. Like come back. I and understanding that the work and the trust and the pieces that we put into place are sustainable and watching folks grow and expand. And it's been really humbling. I've been incredibly grateful. And it's also to be on the receiving side because I noticed I it's the way I've treated my team. If something happens, family is priority. This work will be here when you go back. Please take good care of yourself. And having that same message echoed back to me was like, yeah, it's okay. And someone who's been very driven and you know, very thoughtful. And I tell folks, I'm like, I really understand that this is a journey, but I prefer being a sprinter. So let's see how we can get this done. And the lesson I've learned is really at this season, too, moving slower perhaps can get us all there faster.

Jason Dana Costa 23:48

Ah Lisa, I love that. And my condolences if there was a challenge in your personal life. But you asked me before we started recording why I got into doing podcasting. It's in many respects a tribute to my middle name, Dana Costa, my father, who passed away just at the beginning of COVID, as you mentioned that. So it is those life lessons from him that has was the seed of this idea. And I fully appreciate how it changed my own personal leadership style. So that very much resonates with me. Thank you for sharing. I appreciate that.

Lisa James 24:20

Thank you. Thank you for your question. My condolences. Those losses are the love is deep and the loss is full. Yeah.

Jason Dana Costa 24:28

Absolutely. So one last question for you. After years of clinical and executive leadership in community service, the name of this thing is worth the work. So, what makes an organization in your mind truly worth the work to preserve or build into the future? What are those homework you look for?

Lisa James 24:45

I think the homeworks that are most important are being people centered, like really caring about the people, not just being in it, like we're in, but of it, and showing our presence in the community, at the parade, at the wellness event, at the back to school events, that we're not just sitting in the community, but we're of it. So many of our folks who work in our offices share the same zip codes in the offices that we're in and anchoring ourselves to that piece. And I think for me, when I think about it, what makes it worth it is the connection. Connection to community, connection to the multidisciplinary teams, connection to our clients. That's what makes it worth it.

Jason Dana Costa 25:37

So it gets into nonprofit work and community service. If we weren't doing that, we would have all gorked for fidelity somewhere or something.

Lisa James 25:44

There you go.

Jason Dana Costa 25:46

I may have had a yacht if I had done that, but hey, at least I feel more satisfied. So, Lisa, it's been great getting to know you, particularly someone who, again, lives in the area in the community. I love Tear League, Columbia, Maryland. Our guest today has been Lisa James. She is the vice president of Behavioral Health and Social Work with Chase Brexton Healthcare. Lisa, wonderful to meet you. Thank you so much for joining us here on Worth to Work with.

Lisa James 26:11

Thank you, Jason, for the opportunity.