Supportive partnerships are essential to the “grow your own” approach to workforce development programs. In this episode, Meadow Hazelhoff, Director of Behavioral Health and Special Populations at the Oklahoma Primary Care Association, explains how strategic investments in partnerships and internal processes can help to support the recruitment, retention, and effective integration of the mental health workforce into community health centers.

Transcript by Rev.com

Sydney Axelrod:

Welcome to the STAR² Center Talks Workforce Success. I’m your host for this episode, Sydney Axelrod, Associate Director of Workforce Development at the STAR² Center at the Association of Clinicians for the Underserved or ACU. This season we’re focusing on mental health professions, pathways, and integration into community health centers. Today I am talking to Meadow Hazelhoff, Director of Behavioral Health and Special Populations at the Oklahoma Primary Care Association. Thank you so much for being here, Meadow.

Meadow Hazelhoff:

Thank you for having me.

Sydney Axelrod:

It’s our pleasure. So Meadow, can you tell me a little bit about yourself and your background? How was it that you got started in a career that supports community health centers?

Meadow Hazelhoff:

I’m an LCSW, a licensed clinical social worker, and my first job out of school was in a community health center. So I come by this very naturally. I have a deep passion for community health centers and the work that we do as well as behavioral health integrated into the primary care setting. So those two marry perfectly together. I got to experience this firsthand working in this environment and really seeing the positive outcomes for patients.

Sydney Axelrod:

It sounds like you had a really amazing opportunity, sort of, right at the beginning of your career to get invested in this community health center space. And clearly, it’s a good fit for you because you’re still here doing it, so that’s wonderful. I want to tease that out a little bit further. In your opinion, why is it that mental health is such an important component of the services provided by community health centers and why are the mental health providers and staff so critical to the overall operations of a community health center?

Meadow Hazelhoff:

So I think that’s a multifactorial issue. I think first of all, health centers are in areas that often have no other services available or services that are available are incredibly limited to people that have insurance. Community health centers treat people who are uninsured, underinsured, and insured, and disallow barriers to treatment. So health centers already live in areas that are greatly underserved, both medically but also in other realms such as behavioral health.

Meadow Hazelhoff:

Secondarily, when going to your medical provider and if you are screened and screen positive for a mental health issue, when you go back for treatment, there’s much less stigma. So you’re just going to your doctor’s office, you’re not going to your local behavioral health provider that everyone in town knows is there and knows that you might be going too. So it decreases stigma.

Meadow Hazelhoff:

The third component of this is that it’s very preventative. When we’re screening a population, we can screen and find people who may not have serious concerns yet, but they might in the future. But when we meet them in that space where they haven’t really gotten to the point of needing high levels of care. We can actually care for them prior to that and it prevents them from having to go inpatient or having to suffer for long periods of time. So there’s that preventative aspect as well.

Sydney Axelrod:

Thank you so much for sharing that perspective. I really like this sort of big picture view that you’re taking of it and really thinking about addressing those barriers to access and getting services to people who need them the most and might not otherwise be able to access them. So I think that’s a really great perspective on it. As you just laid out, there’s a lot of reasons we know that these mental health services are such a critical component of a community health center. But we also know that folks across the country are really struggling with recruiting and retaining their mental health workforces. So, can you share a little bit about some pathway programs that you’ve developed or maybe are aware of that support the expansion and recruitment and retention of that mental health workforce?

Meadow Hazelhoff:

Absolutely. We had a program that we started out, affectionately calling, Grow Your Own, but ended up turning into the Community Health Center Professional Educational Program. That really focused on finding folks embedded already, living in their communities who might be ideal to return to school, get their masters and in this instance, in social work. And then be able to take those skills back to their communities and potentially their community health centers. So that they weren’t moving around, they were going to go back within their community and serve their community. That is something that we identified early, would be really helpful in incredibly rural places. There’s not a lot of people across the country that have a strong hankering for living in rural Oklahoma. There are not a lot of exciting things to do in rural Oklahoma. There’s not necessarily a big draw. So we wanted to find people who were already deeply in love with their community and then allow for them to have a greater skill set, a degree, and the ability to then give back to their community in a way that really served both them and their community.

Sydney Axelrod:

Wow, that sounds like such an interesting program. Thank you so much for sharing about that. I think that’s a really compelling approach to really tap into the resources that are already available within our communities, to then further support our communities. I just think that’s so beautiful.

Sydney Axelrod:

Obviously, this sounds wonderful, but it’s not an easy thing to do. So are there any sort of strategies that you might recommend that health centers can use to support that mental health workforce? And not only to find that mental health workforce, but really then to make sure that they’re integrated into the overall organization?

Meadow Hazelhoff:

I think that’s kind of a two part question. One part is really finding the people, and I think that that really takes a deep look into both an organization. So a community health center might look at some of the employees that are already employed in that health center and see if those folks might be appropriate to push through a master’s program, but also, to expand that into the community. Also, I would say it is rather ideal in some ways to recruit folks who are within a reasonable drive but maybe don’t live directly in their communities. That gives a little bit of distance between the people being served and the person that’s serving them. It sometimes can be a little bit sticky if the person that is offering these services also goes to church with you or teaches your children or is your grocer. Those things might get a little bit sticky. But if you can find folks who are within a reasonable drive but that are just maybe adjacent, that is another wealth of folks to pull from, another population we can pull from.

Meadow Hazelhoff:

Finding those people within the community or communities nearby is ideal. And then once that person has gone through school, having truly integrated behavioral health is also just as important. So rather than having co-located behavioral health and medical, it is ideal to have very highly trained, highly skilled clinicians who know what integrated behavioral health looks like, as well as leadership who understand what that is and condone it and endorse it and seek it out. So having both of those components are really important.

Sydney Axelrod:

Thank you for sharing all of that, Meadow. I think some really important insights in there. Number one, that the needs of rural communities look very different than the needs of more urban communities. I think that’s such an interesting consideration around that piece around stigma you were talking about earlier and someone’s position within the community and how that might interplay with their role as a provider at the community health center. So I think that’s a really interesting part to pay attention to here. I also love when you’re talking about integration, really thinking about the health center as a whole. From a leadership perspective, from a policy procedure perspective, from an individual practitioner perspective, and really leveraging that knowledge that exists within our providers themselves. I think there’s something very important there about looking at this kind of concept of integration from a number of different perspectives. Are there any other sort of tools, resources, or final thoughts that you would like to share with our audience about some effective ways that you have learned to train and integrate the mental health workforce into health centers?

Meadow Hazelhoff:

So I think there’s a couple of pieces here as well. I think from a statewide policy perspective, there are a few things that we learned as a state at the PCA here, which was, making sure that if you were to have a program like ours, which pipelines people within communities into school and then brings them back into their communities or really ideally having never left their communities and learning from a distance, making sure that the folks that are coming back into the health centers are actually going to be reimbursable. And that’s a situation that we found here, in our state, that if you are under supervision or in candidacy, which refers to that first two years or so, 3000 hours working under someone else’s license, in the state of Oklahoma, that is not something that health centers can be reimbursed for when providing services. So that means that the health centers had to essentially take on the salary for two years of their new hire without being able to be compensated for their services.

Meadow Hazelhoff:

So having hindsight, it would’ve been preferable had we been able to fix that problem first and then have our program run. There were still health centers that were able to figure out other ways of making it work, but it was not ideal. It can be preventative for health centers because they might see it as another detriment to keeping our doors open. So there is that piece of really wanting to make sure that the health center is going to be supported to the best that we could know to do. And then training is really ideal.

Meadow Hazelhoff:

In a perfect scenario at a state level, one of the things that we might be able to incorporate is having a statewide clinical network. That would look like having highly trained clinicians in specific areas. All clinicians are generally trained, but it is ideal to have, in each health center, clinicians who are specifically trained in certain areas. For example, maternal grief and loss and postpartum depression. Or diagnostics of ADHD and autism, the geriatric population, infant mental health. These are areas that… And there are many more, of course, I’m really only speaking of a few. Another one that comes to mind is emergency management and crisis. Someone presents to a clinic who is irate or who is suicidal or who is psychotic or a number of other things that you have someone who is highly trained to handle that person or help someone who is in the clinic who is highly trained.

Meadow Hazelhoff:

So having the statewide network knowing that we can be incredibly responsive. Health centers tend to be across most states, they tend to be in the places that are least served and in most need. So if we could have these highly trained clinicians in each health center. And ideally, in almost every clinic, that’s a big ask, then we would really have a safety net for those who need it the most.

Meadow Hazelhoff:

Really, being well-trained is very appropriate. Having workforce to be well-trained is also very appropriate. And that is, I think, where we’re at right now is we are in a space where we have a huge need for mental health services and not as many clinicians to meet the need as we would like to have. First getting clinicians, ideally, by growing our own, which is the name of our original program, but then also having them be specifically trained in the areas. And I would just say every area also is unique. So there may be specific trainings to each given clinic area or health center or a region of the state. So, given that set of circumstances, just having folks who are able to know what each community needs and then facilitate that, would be absolutely ideal. But first comes first, we need the workforce, and that’s where finding the folks that would be appropriate to be part of the workforce is where it’s at.

Sydney Axelrod:

Yeah, that makes a lot of sense. So thank you for sharing all that. I think there’s a lot of really helpful considerations in there when we’re thinking about this challenge of recruiting and retaining and supporting and integrating our mental health workforce. There’s really a lot to consider and I think you lift it up some really important things that folks can maybe pay attention to. And I think at the end of the day, you’re exactly right. There’s no one cookie cutter solution that’s going to work for every community, for every state, for every health center. So thank you so much for just lifting up all of those different things that we should keep in mind.

Meadow Hazelhoff:

I would say one other thing, and that is just I think that it is time for leadership and really, in any given situation, it is time to recognize that our staff, our employees are human beings and we often have our own lives that are going on. So having flexibility, being allowed to flex in or flex out in various ways may really be the key. Having various types of work settings. I think that just recognizing that we’re all human is really important. We all have lives that are going on, and so being able to have a workforce that feels that, that is appreciated, that feels like they have the opportunity to live their lives as well as their work lives, their home lives. I think that is a big piece of this as well.

Sydney Axelrod:

Absolutely. It’s really that wellbeing piece that is such a critical component of retention and really, as you said, acknowledging people as humans with complex lives outside of the four walls of the health center. I think that’s so important. So thank you for lifting that up for us.

Meadow Hazelhoff:

Absolutely. Thank you for having me.

Sydney Axelrod:

Yeah, Meadow, thank you so much for joining us today. And listeners, thank you for tuning in. We hope that today’s conversation provided you with some ideas, suggestions, and insights into ways that you can approach mental health professions, pathways, and integration into your community health centers. Be sure to check out all of our free workforce tools and resources found at chcworkforce.org and check out all the wonderful things that the Oklahoma Primary Care Association are doing at www.okpca.org. Thank you again so much, Meadow, and have a wonderful rest of your day.

Meadow Hazelhoff:

Thank you.