Interview with Jennifer Wills (BRAVE)

In this episode, Chris interviews Jennifer Wills, Network Partner and Expansion Lead for with Care Connect+ BRAVE (Be Resilient And Voice Emotions).

Learn more about the program: www.careconnectplus.com/programs/brave/

Watch a video about the BRAVE program and some of the impacts they have made since they started in 2019:  https://youtu.be/Vk_V1fFeydg

The 2023  BRAVE Summit is scheduled for March 29, 2023.

For the Zoom link to join the information session on November 15 at 10:00 a.m. Eastern, email jennifer.wills@flaglerhealth.org. 

Transcript

Pinwheel Podcast – BRAVE Episode Transcript

Hello, my name is Chris Lolley. I’m the Executive Director for Prevent Child Abuse Florida. In working with children and families for over thirty years in the field of child welfare, I find one truth stands out: every person can play a role in protecting children and supporting families. Join me on The Pinwheel Podcast, as I talk with other experts around the state about policies, practices, and programs that are making a difference right now for families in Florida. 

Chris:

Hello everyone, thank you for joining us on our Pinwheel Podcast today. I’m so please to have with us today Jennifer Wills of the BRAVE program. And we’re gonna talk about what BRAVE is and where it comes from. Jennifer is the network partner and expansion lead for the BRAVE program, and she has some really exciting things to talk to us about today. Jennifer, can you just start by telling us: how did the BRAVE program originate?

Jennifer:

Thank you for having me on the show! I’m really excited to spread the word about all we’re doing in the BRAVE program and to give you some background. So, it’s very prevalent as well because we know that last week there was the sentencing requirements for the Parkland shooter and that is really all where BRAVE came from. BRAVE came about as a result of the Marjory Stoneman Douglas Public Safety Act, which the Florida senate passed that bill in March of 2018, which was almost exactly three weeks after the Marjory Stoneman Douglas Highschool shooting. That really unfortunate event, which all of our school shootings are incredibly unfortunate, but this is one that for some reason kinda captured the public’s interest. There were 17 unfortunately killed and 17 injured, but the magnitude and the gaps in the system, it really bought it to the surface, and that is where the BRAVE program came from. 

Chris:

Thank you, Jennifer. Yeah, can you tell us: what does BRAVE stand for?

Jennifer:

Absolutely! So, BRAVE is Be Resilient And Voice Emotions. BRAVE is a house bill, it’s 3517, that is a special project from the Florida Legislature, that we have been given the greenlight to expand our services state-wide, and we are so excited to bring our successes across the state and help more people and families get connected to the resources they need. 

Chris:

Yeah. I know you and I have known each other for a few years now, and when you got that news, I knew that we had to make sure we connected and start telling people about this. Because what a difference resilience makes in children’s lives, families’ lives. We have a lot of experience in using that word in different ways including after natural disasters like what we just had. But let’s talk more about the specifics of this BRAVE program. What happened to make people think that this was necessary? 

Jennifer:

Well, after the Marjory Stoneman Douglas unfortunate incident, it really pushed youth behavioral health concerns and needs to the surface of people’s minds, it brought it to the forefront. And we can all agree, I don’t even need to say, how horrific that event was, but to pull some good out of it. So, what we do with the BRAVE program is reduce stigma – to tackle stigma – to engage families that have been historically unengaged, and I don’t just mean a lower income family or an affluent family, this is for all families. Unfortunately, we have a very difficult system of care that is daunting to families, not only, you know, if you think of a family that has a youth that is displaying some behavioral health concerns. First off, the family wants to take it upon themselves, right? They take it upon themselves that it's their fault, that they did something wrong. But then when they go and try to find a therapist, and if there’s any stigma that is existing in these family systems, that is the first thing that they’re gonna – “we don’t need to do this, that means that my youth is going to go into a room and have to lay on a couch with a therapist, like how we used to see in those old cartoons.” It definitely is not like this, so, one of the good things, like I said, that came out of the Marjory Stoneman Douglas Public Safety Act is that the Florida legislature designated mental health allocation dollars to each school district, and they asked each school district to come up with a plan for what they were going to do to address mental health concerns with their students and their schools. And, you know, part of it was the Guardian program, that there would be armed guardians on each campus. But another part was that the school districts had to come up with some kind of plan. Either they hired additional clinicians based on their school population, but they had to figure out how they were engaged, or how they would engage with community partners as well. 

Our outside youth behavioral providers, because what was going on in the past, was at the quarantine meetings, or the multi-tier support system meetings within the school, it would be brought forward that, say, Johnny, was having some behavioral health concerns. And the social worker and the school administration, they would recommend that Johnny be referred to some youth behavioral health help out in the community, while the parent would get a card with, like, five different numbers on it to call, not knowing which provider accepted their insurance or which provider actually had capacity, which provider didn’t have a waitlist. Then thinking about how the parent was going to implement another appointment that they have to take their youth to within their day already, you know. I don’t need to talk about the current state of the economy, where we know that families are working two, three, maybe four jobs to try to keep their families afloat and try to keep everybody healthy, and that this was just one more thing. 

So, the St. John’s County school district approached Flagler Health in 2018 and said “hey, can we come up with a plan? You already have the Care Connect referral process, well what can we do to help get our youth connected and support our families?” So, BRAVE was born. We were born from a generous gift from The PLAYERS, the Flagler Hospital Foundation funded some of our positions, and I’ll give you kind of an insight of how it works. 

So, in the MTSS process, the Multi-Tier Support System process, in the school, it’s identified that Johnny needs to be connected to youth behavioral health help. And, like I said, it used to be the family that would get five different numbers to call and they wouldn’t know, you know, who accepted their insurance, if there was a waitlist for that provider, or how were they going to get their youth to the appointments. So, what we do is, that referral comes through from the Multi-Tier Support System meeting – or the MTSS meeting – it populates on a BRAVE Navigator’s dashboard, so it’s an electronic referral. But there is also a warm handoff from the social worker to the family. So, the school social worker lets the family know “hey, you’re gonna be receiving a phone call from a BRAVE navigator.” And so when that referral would populate on a BRAVE Navigator’s dashboard, the clock would start ticking, and we would connect with the family within 24-38 hours to gather information, to identify what was going on, and then see if they were looking for outpatient, or in-school, or telehealth, any kind of specific modality. 

Part of the Marjory Stoneman Douglas Public Safety Act requirements is that school-based mental health services must be initiated within 15 days after identification and that assessment. So that’s where if the school district has hired clinicians with their mental health allocation dollars, they have 15 days from identification to when that youth needed to actually be seen by their in-house clinician, but there was also another part of that which stated that the referral had to be seen within 30 days if it was a community referral. So, we know our school districts are very stretched thin, our youth behavioral providers are stretched thin, and how does anyone have the capacity to track on that? Right, Chris? Like to track on that, that it’s been 15 days or it’s been 30 days. 

Chris:

Yeah, yeah. Yes, I know, Jennifer, that response time is amazing to me. I know that you and I have talked about this before. The stigma, this is where our missions really interface or intersect is around decreasing the stigma associated with asking for help. We want to encourage people to ask for help with any need that they have, but unfortunately there has been a stigma associated with seeking this type of help for many years and I know the school districts are really glad to have y’all and that really helps us understand what a benefit it will be and is to school districts to have y’all just exist. But it also, I think, would be really helpful, or is seen as helpful, and will be seen as helpful as y’all expand, it’ll be helpful to families, of course, but I’m guessing also to physicians and other treatment providers in the area. Can you talk a little about that?

Jennifer:

Yeah, absolutely, and you know, touching on the stigma piece, Chris, you’re absolutely right how it helps both of our missions intersect. I mean, I can’t tell you how many phone calls. I was the first BRAVE Navigator, and I can honestly say that there would be some phone calls that I would call the families and right away I would get “I’m not putting my kid on medication,” “my kid doesn’t need this,” “I don’t understand what you mean.” Because parents take it personally, right? They think they are doing a bad job, and it’s very scary, especially with how the media portrays mental illness, and everything. I mean, that old adage of that if you have two people standing beside each other and one is wearing a sign that says “I have cancer,” and the person next to them says “well, I have anxiety,” you know, are you going to make fun of the person who has cancer or say to them “can’t there be anything you can do for yourself? Just get over it, it’ll be fine! Tomorrow is a new day.” In these little, and I do call them little but they’re all making really great impacts with stigma, where BRAVE supports families, and I’m getting to your questions about physicians, is that we have the capacity to have those one-on-one conversations with families to de-mystify the process and to support them. Because, once we send the referral through to the youth behavioral health provider, that the family is eligible for, we actually don’t disengage then. We stay connected with that family all the way through the intake and up until six visits are had, with weekly communication. 

So, I’m talking to Mrs. Smith and it’s three weeks in, you know, waiting on that intake to be scheduled, and it’s like “Hey Mrs. Smith, how are you doing today? It’s Jennifer, your BRAVE Navigator.” And Mrs. Smith would say “well, you know, I’m really stressed, I can’t pay my light bill,” and I would say “you know, let me help you find a resource for that.” So, in addition to supporting the families throughout this process, we’re helping to support the families, as we get established in more counties, to address any and all social determinants of health, right? That are occurring within the household. Because we know that these things do not happen in silos, and when you have stressed out parents trying to make ends meet and, you know, so many adages run through my head. They’re trying to make ends meet, they’re stressed, this is another thing on their plate that they need to take care of because they’re concerned, so we also offer that support. So, not only do we get the referrals from the school district, but we realized we needed to reach Joe Q. public as well. And all these families that didn’t want to go through the school districts to get the help that they need. So, we created a “BRAVE in the Community” doorway, portal, if you will, and people can find that on the Care Connect Plus website, with the “plus” spelled out. And what BRAVE in the Community does is it allows everyone to get that same encouragement, support, throughout that process, and we have seen our pediatricians, community members, non-profit agency providers, that don’t have anything to do with youth behavioral health help, they’re putting the referrals into BRAVE in the Community. Because they know that we’re gonna pick those families up and we’re gonna give them the same encouragement, the same support, all the way through the process. 

Chris:

That’s awesome! You mentioned that warm hand-off? That’s important, of course, and I really am glad to hear that. Of course, you know, the other part of it that you said is not just closing them down during that bridge time. So, I think that’s a critical time too, and when you were talking about families and the stress that we face, I thought of a lot of different analogies, myself. One that comes to my mind is, we all probably know what it’s like to move, and a lot of people move with a pick-up truck or with one truck, and you pack it full with all your worldly possessions, and then you add one more thing to it. And you may or may not be able to make it that one more thing, and to me, that just illustrates how much stress families are under. And as you said, this being one more thing that adds to their plate and that can really cause them some problems. We know that stress can impact us physically and mentally. So, the resilience film that we show talks a lot about exactly what you just said. But, I want to change gears a little bit, Jennifer, and just get you to tell me a little bit about what are some of the concerns that the youth that y’all work with are telling you are critical for them and important to them. 

Jennifer:

Well, that’s another really good point, too, Chris, yeah, with the concerns. We were able to survey St. John’s County schools’ youth anonymously and what we found out was that their main concerns are: stress, anxiety, how to help a friend, and time management, if you will. I mean, you know, going back to Chris, what you said, that was a really good point about packing up your family, and a lot of families are packing all their worldly belongings in a truck because we’re seeing so many families being pushed out of areas, not only throughout the state of Florida, but throughout the nation! Because of the cost of living going up. And I know that the county we were established in, we were born in, per se, the median rent is over $2,000 for a one-bedroom apartment. I mean, how does anyone survive on that? And then thinking about when you need that youth behavioral health help, and you’re still just getting by, and then you might have a co-pay of like $30 or $40 for each visit. So, I do want to touch on that for a second because the first year that BRAVE was in existence, the school district divided their mental health allocation dollars between two providers, and what we were seeing on the Navigator part, and remember now our role is to disseminate information and encourage and support families and individuals through the process, what we were seeing in the first year was that a lot of those appointments weren’t being scheduled into the system. So, what we did the next year was we said to the school district, “let’s try something different, here. Let us hold a portion of your mental health allocation dollars, none of it is going towards any services we do or anything at all, we’re just going to be the fiscal manager.” And then what we do is our youth behavioral health providers that are within our network, they have to put the appointments attended in our system, because then they get invoiced by our BRAVE Regional Manager. 

So, what we saw was an extraordinary increase in engagement, and we took the St. John’s County school districts’ rate of engagement from 30% to over 90% in the first year that we were in existence, and we’ve been able to repeat that for St. John’s, Clay, Nassau, and Putnam, the school districts we’re established in now, currently. And with the state-wide expansion, I am speaking to all counties all throughout the state of Florida, and I always get “are you sure this is free for us? Are you sure that this is real?” and I’m like, “yes! The legislature granted us funding for special projects, this is what we’re doing.” because it almost is, and I don’t want to say “too good to be true,” but it almost is. Because we are that missing component that as population has increased, especially in the state of Florida, and school districts have been spread so thin, youth behavioral health providers have been spread so thin, we’re that piece that addresses it. 

And there’s one more carrot: bi-monthly, we are having meetings with our youth behavioral health providers that are within our network, and we are able to determine who is getting close to capacity that’s going to have a waitlist, but, also, which agency just hired a new clinician. So, because we are hands-on with those referrals and with those families, we are able to pivot the referral to make sure that when the school district reports to the FLDOE at the end of the year that they have adhered to those senate requirements. So, that is the magic that we are able to provide. As well, in recognizing that we are seeing an increase of anxiety, an increase of depression, with our youth, our youth are having a hard time coming back from the pandemic, and the virtual learning, when they were kind of making their own schedules, and now we’ve put them back into a regimented, in-school, in-person arena. So, talking about what’s going on over in the Ukraine, that weighs heavily on our youth. Environmental anxieties, with climate changes and everything, and like we said earlier, our youth are watching our parents being stressed out, which is like that snowball effect, now the whole family is stressed! With BRAVE coming into play and supporting the family, even if that referral comes through for that one child, what if there are two children in the family? But yet, Johnny’s little brother isn’t on the radar yet. BRAVE is around and saying “hey, so we know that Johnny is being referred to a youth behavioral health provider, how’s Johnny’s little brother doing? Do you need us to submit a referral for him as well? Because he’s being exposed to all this.” 

Chris:

It’s just amazing, Jennifer, and the first thing I gotta say based on what you’ve just said, and you said a lot, but the first thing I gotta say is we have to have you back for an update really soon, because there is so much to unpack about what you just said. I’ll just touch on a couple things. You mentioned how housing is one of the leading causes of stress, and we know that the cost of housing, even just trying to find a two-bedroom apartment that you can rent, and then couple that with the recent storm that came in and the damage that it did and the housing, in general, shortage that we have. So, I know that the Department of Children and Families through their Child and Family Wellbeing Council is looking at that issue, too, so I know a lot of people are paying attention to it, so I won’t go into that anymore. 

I am so glad to hear you say one thing though, and you beat me to the punch, you’re reading my mind, because of course one of the main things people want to know about is “how much is this gonna cost me?” So, to know that y’all are gonna be there with and for the family, and especially that you’re conscious of siblings. I think, we know, socially and emotionally, the sibling relationship is the longest relationship most of us will ever have. Longer than with our parents, longer than with our spouses. So, those relationships are just critical to our social and emotional health, and our mental health, of course. But I have one more question for you, and this is a big question right here, Jennifer, so: I heard what you said, leading up to this, but what I wanna know is how can I get BRAVE in my community? 

Jennifer:

Thank you for asking, Chris! All it is, is a simple email to me, and my email is Jennifer.Wills@FlaglerHealth.org. You could also visit our website at CareConnectPlus.com, with the “plus” spelled out, and click under the “BRAVE Referral,” and there is all of my information in there as well. I am also hosting an open Zoom, the next one is November 15th at 10am in St. Augustine time. That’s one thing that’s been really interesting that we see state-wide is that I’m having to do a lot of math! With the time zones, and everything. You know me, Chris, I’m allergic to math, but I’m so passionate about this and all that we’re doing with the help of Flagler Health and the community that I will math all day long for this to get through. 

So those are some options to get in touch with me, I definitely would love to come back because, I’ll just give a little teaser about this one: we have secured the date for the third annual BRAVE Summit, which is the Coachella for mental health for youth, that Chris was at last year. He knows the vibe was kicking! That’s all I will say about it, save the date: 3/29/2023. And Chris, we can reconnect to talk more about the BRAVE summit as more of the plans are being finalized, but I just can’t tell you how much I appreciate this, for helping us get the word out. We are stronger together, and we are truly making a difference in the families lives that need us, and it is just so good for the soul.

Chris:

 Yeah, it’s so good to hear you say that, Jennifer. It’s great to hear about all this. You’re learning now, you know you’re not the only person who might not have been aware that Florida actually does have two time zones. Growing up in central time, or as we say, “slow time,” you get to know that pretty quick when crossing the bridge over the Chattahoochee rivers. So, yeah, it’s interesting and I know what you mean, we share that allergy to math, for sure. I’m also glad you brought up the BRAVE Summit, though, because I think that’s an innovative approach to being able to reach you, being able to reach children of all ages, and being able to reach families. So, of course I appreciate the invite to that, I really enjoyed it last year, had a lot of fun interacting with the youth that were there, and I know y’all have big plans for this coming year, so I’m already looking forward to that, too. And you can bet that we’re gonna reconnect very soon, sooner rather than later. But I want to give you a chance, Jennifer, as we close: is there anything that I haven’t asked you or that we haven’t gotten to talk about that you want to say about this wonderful program?

Jennifer:

One thing, that if I could impress upon school districts, anyone from a school district that’s listening to this podcast, anyone that works with a youth behavioral health agency in this podcast is that we’re not coming in to reinvent the wheel. We’re not coming in to take over. We want to come in and enhance what school districts are already doing because we know that they are doing the best that they can. We want to come in and help youth behavioral health agencies with their capacity and enhance the services that they are already providing. So, if there is one thing that I could impress upon everyone is that we are coming in to help, the service is free, and to please reach out to me for further information. I feel like everyone would be very, very pleased at connecting and getting this service in their community, and working together, we can help more families. 

Chris:

Thank you, Jennifer. We’re really glad that you could join us, and I look forward, very much forward, to talking with y’all more, and hearing more about, as you’re able to, expand across the state. I know we’ve had some discussions about that already, and the connections that we’re making through these podcasts are really cool. So, thank you for giving a shoutout to everybody and you can bet that we’re gonna be in touch. So, we appreciate having you with us today, Jennifer, thank you very much!

Jennifer:

Thank you very much, Chris!

Thank you for listening to The Pinwheel Podcast, hope for Florida’s families. To contact us or learn more, visit PreventChildAbuseFL.org.