Josh Morgan: Whole Person Care, Data & Analytics for Providers and Social Determinants of Health

As SAS’ National Director of Behavioral Health and Whole Person Care, Dr. Josh Morgan helps public sector health agencies use data and analytics to support a person-centered approach to improving health outcomes. SAS is a company that develops and markets a suite of analytics software, which helps access, manage, analyze and report on data to aid in decision-making. 

A licensed psychologist, Dr. Morgan was previously San Bernardino County Department of Behavioral Health’s Chief of Behavioral Health Informatics. His clinical work includes adolescent self-injury, partial hospitalization, and intensive outpatient programs, psychiatric inpatient units, and university counseling centers.

Dr. Morgan earned his Bachelor of Arts in Religious Studies from the University of California, Berkeley, and a PsyD (Doctor of Psychology) in Clinical Psychology with an emphasis in Family Psychology from Azusa Pacific University, and is trained in Dialectical Behavior Therapy.

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Transcript

All right, Josh, welcome to the pod.


Thanks so much tripp, I'm so grateful to be able to be with you. And I love the name of the podcast even in and of itself, as that. So connects to why I became a psychologist and what I'm interested in doing in really promoting human flourishing and helping people be the best they can be not just the reduction of the bad stuff and symptoms.


Awesome. So you became a psychologist? Tell me about that. What your What was your undergrad in? And then did you go straight into getting your ID? Yeah, you

know, it's been an interesting career path, probably not a typical one. In many cases. I did not know I wanted to be a psychologist early on actually, in high school. My plan was to go into film, I wanted to be a director. So very different directions in many cases, but I love the creativity and arts and a theme through all of it had been I want to positively impact people's lives and distilled into one word, it would be hope, even through film, can you give people hope? in undergrad I ended up actually being a religious studies major at UC Berkeley. Yes, Berkeley has a religious studies major, as part of undergraduate and Interdisciplinary Studies really expose me to a wide range of perspectives and ways of understanding the world, which really is critical to any form of religion and spirituality. Very long story short, ended up then coming to psychology and saying, this is the way that I think I want to be able to help people ultimately best. And again, I think that there's something unique about psychology, just like religion and spirituality, that's different than some fields is that psychology intersects with every part of the world and humanity. I did my psyche, as you noted, Doctor of psychology at Azusa Pacific University in Southern California, California, born and raised. And one of the unique parts of our program was that very only probably about half of my cohort were psychology majors. The other half of us came from other disciplines. And there was a big emphasis on an interdisciplinary, really holistic perspective that I think is so valuable, because even from a clinician perspective, or from an academic perspective, if you get too settled in one discipline, you start only thinking in those terms, and we can miss so much. And that I think is actually a problem in many cases is something I'm very grateful for in a lot of my training.


So from from being a practicing psychologist, first job out of grad school, or when you finish your side Tell me a little bit about the early days. And because it's very surprising, I feel like I don't know many I know a lot of psychologists most are, stick on a pretty, you know, linear trajectory, like sure. You start practicing. And maybe I'm really good friends with a couple testing psychologists and I think they've done the same thing for the last 30 or 40 years, you know, and I think it's really cool work. But you have to clearly not done the same thing.

That's right. It's it is not what my intended path was. And yet in hindsight, it almost looks like it wasn't the plans path. Funnily enough, you're absolutely right. I mean, my plan, my thought was, I'll just have a private practice, I just, I just want to help people I want to bring hope. I graduated and ended up working as the therapist on a child inpatient unit, actually, the only child inpatient psychiatric unit in two of our very large counties that serve close to 5 million people. Between the two of us, we'd have kids coming from four or five hours away, I didn't really want to work in a hospital. And it was one of the most valuable learning experiences I had. So very much tied to Yeah, I want to, I want to be a clinician, and also starting to really realize that that private practice world is not where we are today in the field. There are people who can be, it's very difficult to maintain a livelihood that way. In today's business model, that's just the way it is right now. Some of us joke, it's kind of true, you know, if you're in Beverly Hills, and can have a cash pay client base only Sure, you can do a lot of it. But that also connects very quickly to my career transition. And I think some of what we're talking about today, even with human flourishing, working on an inpatient unit, and then I moved to partial hospitalization and intensive outpatient programs. One of the programs I oversaw was focused on adolescent self injury. It's where I got exposed then to dialectical behavior therapy, and I should notice what may be implied based on some of my background, for the other clinicians out there, my heart and soul is in the existential humanistic traditions. I will My Viktor Frankl and Mago therapy and meaning making and DBT, I really have to say helped, frankly, with our theme of holistic and whole person perspectives helped give me a more integrated view where I appreciate and value behaviorism. Far more than I did previously, I see a very valuable place in it, when, if I'm being honest, I kind of dismissed it previously.

This is so interesting, we actually have it at our team at Green Hill, there has historically been a split between kind of the behaviorists and I actually don't know what the other poll is, but I would say the existentialists, eclectic practitioners who Yeah, but again, I actually not being a clinician, I found it very interesting to try and integrate those two, and see that it's not really two different things are two sides of the same coin. And,


you know, and honestly, it was my intensive training and DBT and running a DBT based program that really helped me seeing I think, exactly what you're saying, When, in the way Marsha Linehan, the founder of DBT, framed it in terms of stages of treatment, and focusing on different levels. If you look at the eye, while she frames things, totally in behavioral terms, which as a side note, I think is very practical, because it makes it more concrete and understandable, I think there are some very solid benefits. But if you look at the stages of treatment, it's actually highly integrative. I believe, not even just eclectic, is intentionally integrating a wide range of orientations, where at different stages of need, different orientations are more or frankly, less effective, and meet needs differently. And if you get to some of the later stages, I mean, that's where she explicitly talks about really kind of that existential humanistic side and meaning making is, even in our stage one of treatment where we're talking about just stay alive. meaning making was one of the skills formal DBT skills we taught. So it's, it's not an either or, and I think that's the benefit and beauty of the philosophical idea of a dialectic of two things that appear to not coexist, that actually can coexist. And there's more value about that. meaning making, you know, what drives me personally, going back to some of your earlier question is still the higher level, I mean, you go to that idea of hope. But even at a stage one, if I'm actively suicidal, and our number one goal is just stay alive. Some glimmer of hope, is incredibly vital in doing that, that's actually what also helped make my transition into that the data analytics, research evaluation, whatever term we want to throw out there on this into that career path, because in these highly acute settings, I got frustrated by the fact that we couldn't do what we often call person centered, strengths based care, focusing on a system, even working with kids and our lessons, yes, we bring family members and sometimes siblings, but that was the core of all of my training. And yet, the way payment is structured, you have to identify a quote unquote, patient, that person always has to be in the room, if you're going to get paid, we have to focus on symptom reduction. And it just does not jive with what we know even based on research to be the most effective. And so that's when I really started seeing the value of data as an advocacy tool to be able to help move our systems benefits packages policies forward and say, maybe we can do things differently.

So that's really cool. And that's how I mean, in a previous episode of this podcast, I was talking to my partner, and, you know, when we started our first, you know, behavioral health company, I mean, we really just wanted to help kind of young guys who had gone through some of the same struggles we had. And then as you get into the field, and you start to see the limitations as a, you know, you mentioned being in a kind of small private practice setting unless you're gonna cater to the 1% it's very hard to sustain it. And then as you start trying so we started out in a cash pay kind of model like we were private pay people were coming from around the country. And then when we opened up a community outpatient program, I mean, man, did that change the game, like we were, in a totally different world, we had to learn a lot of new lessons. And then all of a sudden, we realize the limitations that we face as a healthcare system because in a private pay model, you can really do what you want sure, that wasn't gonna fill my cup forever. Like I feel like I hope I would, you know, reached a level of, you know, security, that now it's about passing that on to other people. So if we're not making healthcare more accessible, it's it's not that interesting. You know, like, I don't want to just okay, those people absolutely And really being able to spread that kind of care to a broader audience who needs it not just those who can pay out of pocket for it, which, as you noted, that's a very, very small popular, I mean, even our intensive outpatient program, we had a grant funded program to cover the Medicaid kids, because Medicaid, at least at the time in our area, would not cover intensive outpatient treatment. And yet those kids needed it just as much.

Right. And, well, one of my rants that I go on a lot is about, you know, if we just provide better outpatient treatment if we in and inpatient doesn't matter, but if we provide better treatment, we're going to dramatically reduce the cost on the on the healthcare system. But it's really hard to make the case for that, if you don't have good data, if you don't have data. That's exactly right. That's right. That's where you know why why we got connected in the first place, is because my aim is to address policy change. Like that's what ultimately I want to do. And I want to advocate for policies that make sense. And I do, you know, I want higher quality care, but I also want it to be, you know, I don't want you know, the healthcare system to be so expensive, but we end up paying a lot for these stabilizations or emergency room visits that if we could just do you know, Person Centered Care probably wouldn't happen. So why don't you give us a little bit on your kind of your title is a is director of whole person care, right? Is that's part of it. So yeah, person care is, according to Josh, and how I think, tell me about whole person care, and then how Person Centered Care relates to data and analytics, because I often feel like from a clinician talking to clinicians, everyone wants to be person centered, everyone says that shaping like collecting data is almost the opposite.

And to be fair, with my clinician head on, sometimes it is, let's just be honest about about all of this. So to your first question about what is whole person care, it's a phrase I'm seeing popping up more and more commonly. And I think we all have a rough idea and sense of what it is, to me my short definition, I actually have a slide I will use that's fairly complicated because it can have so many diverse definitions. It incorporates so many aspects of as you're talking about healthcare reform and policy. Ultimately, much of our efforts are moving us towards whole person care. Sometimes we'll talk about whole person care as kind of our traditional integration of physical and behavioral health. And those are terms I don't like, but we'll use them because people understand that I don't have a great alternative. And I would say that's included in whole person care. But that's not a description of all of it. whole person care is to me, it really is about addressing people in a person centered strengths based, again, holistic way using the definition in there. But outside of the healthcare system, as well, yes, physical health and behavioral health. But beyond that, I mean, I'll throw it again Religious Studies is a big part of was my was my major. So religion, spirituality. If we go to samsa, the Substance Abuse and Mental Health Services Administration, they're eight dimensions of wellness, that's actually a component of that. Employment, homelessness, social services criminal justice system. So we stop looking at somebody as just saying healthcare util utilization, symptoms of suicidality, since we referenced that before self injury, hospitalization needs excetera. That's when we focus on you or don't know, let's let's examine things from a broader perspective. I mean, in some ways this even taps in some of the motivational interviewing type approaches for those familiar with it is, what is your personal priority, an area of interest, that will make a big difference? So as a psychologist, I think our field has long done that in many cases, not always, there's definitely exceptions to it at least, but my training was that 100% of the way. Our health systems are not that they are set up for the comfort of the healthcare system, and of the provider. And having been part of that, like, get right, this is not easy. That's why we haven't just transitioned but whole person care really is let's look at all of the systemic influences of a person, really, to your earlier to your next part of the question at an individual level. And more broadly, I think a lot of my area and career has shifted from I did want to help people at an individual level I wanted to see, am I making a difference in Tripps life? directly. And now I'm more interested in kind of where you are of let's impact policy and systems. Because that will then facilitate that individual level care that I was not allowed to do, frankly, at or at other points. So being able to open that up for additional clinicians and people in need to be able to seek that. So let's get help. before you're at the point of let's just help you stay alive to the stages of treatment, when I start saying, Hey, you know what, maybe I need some help, because I'm not feeling fulfilled enough. Can we make that an acceptable reason, and an encouraged reason to be able to seek some level of assistance, whatever that may look like, there is extra cost to your point before if we are going to cover that as a benefit. That is a new expense. Will that save us money in the long run? Yeah, I bet it will. And that's another aspect of whole person care is how are we talking about the savings funds? Are we just talking about expenses within the behavioral health system within the healthcare system? Let's broaden it out more and more. I work a lot with public sector agencies. Now, let's not just look at those. What about impacts on the criminal justice system, homelessness, education, social services, etc. If we can start looking at expenses and potential savings more holistically, now, I can guarantee we're going to see an even greater impact and financial ROI, let alone the minor thing of human outcomes, improving people's lives.

Why we all got into this work in the first place, but but we have to make the economic case. And I think that's really important. So I'm actually my undergrad was in economics, but I gravitated towards behavioral economics and kind of the psychology piece. And I've always I feel like I have an interesting background coming from a small kind of conservative town, getting going into the army, and then getting into yoga and meditation, like my Facebook Timeline looks like it's two different people, sometimes based on where I made my friends and their, their beliefs. But I've found really, you know, what's really interesting to me is, is numbers are the great equalizer, right? And if we can pull all of that, and you didn't use the term, use the eight dimensions of wellness, which kind of goes hand in hand, some with the social determinants of health. Yes, it's something like I am adamant about affordable housing, because I believe we're spending so much more money in the health care system, because we're not addressing housing, like that kind of stuff. So that's really cool. Tell me some about the work you're doing at SAS or what SAS is helping, you know, behavioral health organizations or public sector companies do because, you know, I'm hoping that we're gonna, we're going to be doing something at a scale that we can engage with SAS in the future. So tell us a little bit about your actual work now.

Yeah, I've been with SAS coming up on four years now. And prior to that, I actually was a sass customer. When I worked at the San Bernardino County Department of Behavioral Health, I oversaw research and evaluation as the chief of behavioral health informatics. And I give a lot of credit to my predecessors who had the foresight and vision to establish a data warehouse and an analytic system, even though we had a 26 year old billing system. I mean, it truly It was like dos based green screen, no backspace. It was entertaining and maddening at the same time, you know, electronic health record. And yet we were able to tell a lot of stories. So a lot of that is my background. And and for folks listening to if you're not familiar with California counties, you know, a lot of in California is big, although we have some counties, less than 1000 people. But San Bernardino County is over 20,000 square miles. It's geographically the largest county in the US, I think, like the fourth smallest states can all fit in it simultaneously. So talking about geographical diversity and highly rural areas. And we have about 2.2 million residents and about 900,000 Medicaid beneficiaries. Again, our counting population is larger than several states. So it's a different level of scale and scope that I saw, and it's a unique place to also an answering some of the earlier question that I didn't fully answer of looking at individual level treatment, and being close to services, while influencing up to policy is a benefit I think of county. And some of our work there i think is illustrative of the other question of what are we doing? I'll say my agenda and interest and what my work was in San Bernardino and now I get to be able to help share nationally and even globally at times. Is my goal based on my clinical work is not asked for new data collection, because that's just maddening most of the times, and not usually terribly helpful on the front line, there is rich information, including with progress notes, assessments, for instance. So let's tap into our natural language processing. My dissertation was qualitative. So I love that richness there. So we know that's already a standard. One of the core aspects that Sasa does is to be able to bring data together that already exists. We don't usually ask for new data collection, that's not our Mo, we usually tap into existing systems. So again, you know, our billing system, electronic health records, homeless management information systems, we can start going down the list, we work in every industry. And that, I think, is the big value, especially in behavioral health, where, frankly, we're behind the game, when it comes to data and even trusting data. So let's take what already exists. Let's bring it together, we do what we call entity resolution, is this the same Josh Morgan across these different data sets? And then what insights can we bring? So in San Bernardino, a lot of the work that I did focused on outcomes, what story can we tell of the impact of services, not just within behavioral health, but like Sheriff and probation, those were very close departments of ours? What criminal justice outcomes are there. In California, we have the Mental Health Services Act, which is a 1% tax on people with a personal income of a million dollars or more, in my mind, really to help fund the gap in public mental health services. And as part of that, at the state level, we have the mental health services Oversight and Accountability Commission, Say that three times fast. We you know, welcome to public sector, we have a really long names, my title, notwithstanding that, either, but I mean, one of the great projects with them recently, actually, they use SAS to do something similar where they integrated mental health services data with statewide arrest data, Criminal Justice data, to be able to really systematically assess, do mental health services, especially wraparound intensive services, make a difference on criminal justice outcomes. That's a powerful policy story. And going back to that can reinforce individual level treatment. To your earlier question, being able to have some level of statistics of this works, I would regularly have teens and parents go, does your program work? Well, I see any benefit? Well, that's one place data can be helpful. In a concrete fashion.

Yeah, I'm, I'm working some with, there's a program out of UNC Chapel Hill, it's called UNC horizons. And they're incredible model of care. They are Medicaid based every and what they do is they work with pregnant and nursing women and children with substance use disorders. So it's a super, really cool work, and now they're even working, you know, in the in the prison system helping transitions out. And we were talking about a lot of this, because, again, all that it's really interesting. So I didn't really think about it, I think I get siloed into thinking and healthcare, like it's all about outcomes, right? It's outcomes. And it's how do we, you know, decrease our spending as an organization or increase our billables. But you just mentioned that some of the work that SAS is doing actually pulls in a bunch of data from, you know, all these kind of disparate providers to help generate some of those insights. And that's exactly what we need to make the case for expanding like in North Carolina, we need to expand Medicaid. And we haven't done it, I think we we have an unprecedented budget surplus, but we're not going to get too political here. But shouldn't we need to expand Medicaid, but it's probably the most cost effective thing to do for the state. But if we can't capture that, and really present that insight to the legislature, then you know, they're not they're not gonna care.

Well, and it's a perfect example. I mean, even just to your prior point about housing, and there's lots of questions of should health care, should Medicaid fund housing? Well, it's not a health care thing in and of itself. But the reason it's been asked is because some initial research is showing, if I spend X dollars on housing, I'm actually saving my healthcare dollars. That's where we need to start breaking down the silos of even our industries. I mean, going back to looking at criminal justice outcomes, I mean, the amount of money we spend on the criminal justice system, and all of the questions, you know, right, wrong or otherwise, I mean, I don't even have to get into that. Nobody wants criminal justice recidivism, right. I mean, generally that nobody really wins. for profit prisons. There's my cynical side, you Right, exactly the for profit prisons when beyond that, nobody wins. Right? Nobody wants that. So if we can demonstrate funneling some of the funds into behavioral health as one of the many examples, and that that does cause a reduction in criminal justice recidivism, not only are we saving money, but we're actually improving our community. That's powerful. That's significant. inspiration.

Oh, go ahead. Sorry,

I was gonna, you know, even as individual clinicians, one of the things I got frustrated with working at an acute level, and there's some folks who love working in acute settings, and we need that blessings on them. Not my that is not my fuel, in part because I just you just keep seeing the significant problems and you don't get the end of the story. When you start being able to see some of these outcomes and say, well, you may not directly get to see each life, and what difference it makes your program causes and 50% 80% 90% reduction of homelessness, criminal justice, recidivism, unemployment, Child and Family Services, engagement, you know, go down the list of things, right, that's motivating for individual clinicians, and can help keep us motivated and prevent burnout, which then leads to poor access to care, because we don't have enough providers. So again, you know, looking at things holistically, sorry, you were gonna say something?

No, I just love it, it got me really excited, because I'm a huge, you know, we lean a lot on kind of community reinforcement approach, which takes a pretty holistic approach, as well, as, you know, just thinking about social determinants of health. And I mean, I have always argued that, that how housing is healthcare or, or that this is just an arbitrary distinction, you know, everyone needs these things, how are they going to be provided. And just a quick kind of side note, so all of my, my kind of parent company is called VEDA health ventures. And it VEDA is a Sanskrit word meaning non dual. And I, that's one of the biggest frustrations I have. And I feel like I just got really excited because I was thinking, Oh, my goodness, like, it truly is, like, collecting the right data, and really not collecting the data, but having the insights to argue that we should, you know, these should be the policies. I mean, that's incredibly important. And that's, that's really the only way forward. But what are your thoughts on breaking down some of those silos? Because I think you and I are both seeing how connected all of these facets are, but for other people who want to put healthcare as an industry and, you know, right, housing as an industry, whatever. Yeah, how you guys?

Absolutely. And I like what you said about not necessarily even collecting the new data, there were good reasons and to collect new data. Oftentimes, that would help tell a better story, right? So I'm not going to say don't do it. And yet, a lot of this data exists somewhere, if we can access it, I mean, again, even the work that we did in San Bernardino that I often felt was, in the moment, it didn't feel hugely advanced. And then I realized we're doing something that was billing data, it was claims data only. And we could look at things creatively. And through proxies sometimes. So I think curiosity, one is a theme and a bit of an answer to your question, a big barrier to integrating data, our confidentiality and privacy laws, and more specifically, people's interpretations of that's, that's more than the laws themselves, because there are reasons for and I've shared even recently, I'm a big proponent of the confidentiality and privacy laws, especially in even care coordination. That's where a lot of the discussion Can I share and between for providing homelessness services to your point there is more facilitation now to be able to share with housing providers some healthcare data, because we know what's important. The piece that I think is missing in that part of it is there is stigma and discrimination within the healthcare system. Right? We assume that if I share healthcare data with a new provider, they know what to do with that. That is a really big and frankly, false assumption. Just that's a whole nother rabbit hole, I think we could go down. So I there are times we need to do more data sharing. I mean that that is true. We need to do it in the right way. And to your point, we need to give people insights in what to do with it. So data sharing for care coordination is what most people think about. I think it's also important to talk about data sharing for in my world what I call analytics that could include research, evaluation, quality improvement, and there are different pieces of the laws and regulations. that govern that kind of data sharing that people forget about. So going back to the interpretation of confidentiality, and privacy laws, if we're going to do a prior conversation around outcomes, for instance, we want the individual level data connected. So we can tell an accurate story of what outcomes are, but you're not resurfacing individual level data, what we are surfacing our aggregate information about what's working, or what's not working. So that provides nuance that I think people need to recognize. Another piece of this is and, and frankly, we then create a feedback loop of the more we demonstrate holistic outcomes, the more people want to participate in that I mean, that stuff I've seen personally, the other aspect that I think we both help in, and where we can see this is in the realm of what I kind of called risk stratification or identification of community need, where let's try to proactively identify folks based on we can use our buzzwords, social determinants strengths based list or whatever you want to say, of who is likely at greatest need. So going back to individual providers, if I can be given a list, and this is work, frankly, I did in San Bernardino, and we've got it in other places, where let's identify a list of folks who we need to proactively do outreach and engagement to even then we can bring data together, I may surface a, you know, trip, go talk to Josh Morgan. And maybe I can't tell you why, because of the confidentiality and privacy laws. But I still provided you an insight, we have done data integration and data sharing, we've broken down silos, and we've now facilitated a provider to connect to someone in need proactively. Right? That's beneficial. And I believe we can do that today.

Yeah, that's great. I were I want to be cognizant of time. So I've got a few few more questions. And then a couple quick hits, but speak to speak to us as provider organizations, if you wanted to give advice to two different types of organizations, what would it be, say we've got, you know, anywhere from 20 to 50. providers, what can we be doing, because I believe that we've really got to all start pulling our weight on this and pulling some of these kind of resources and the data to actually get some of the insights. And I always kind of sell our clinicians and people who are going to work here, it's like, we're trying to build a better model of care. And, you know, data collection to you doesn't seem fun, maybe in the moment, but this is how we're going to get better at what we do. So how I mean, how would you as a, as a practitioner, actually make help make this argument for me, because I, again, it's not just about sending out surveys and outcomes, measuring but I think like if we want to improve the system, this is where it starts.

You're absolutely right trip. When I was in a clinical role, that's when we started getting into the value based outcomes kinds of things, we had administrator saying, Do this survey, do that survey integrated into this mat. And a lot of my colleagues were like, this is dumb, it doesn't provide me any insights, I'm not doing it. And I'm like, if I'm being told to do this, as part of my job, I'm going to do it, I'm going to figure it out. I don't disagree with some of it's done, it's not telling me a great story. But my view was, while some of them are like, this is dumb, I'm not engaging. My view as this is dumb. And so I want a seat at the table to help advocate for, yes, different. And so to me, that's that's the, for the providers who don't see value in it, you're the one who needs to be most involved, let's get it to be valuable. So outcome measures, I mean, in short to, if you want to survive and continue in business, you have to do this. There's just no other way around it. That is how funding is going to go with the exception of completely cash only and you can do what you want. But even there, people want to know their outcomes. So you know, and if we want to always do improved work, that quality improvement side that you touched on, too, we need to have the internal feedback loop. So yeah, you have to do it. One, if you have to do it, do things that are meaningful. So increasingly, we're getting closer to standardized models and outcomes. Most of them I really dislike because they're highly symptom focused and don't give us credit for what we're doing. So can you suggest things that demonstrate the outcomes that you all are really trying to achieve in your practice? I go back to what drives me hope. Can I demonstrate not just hospitalization reduction, symptom reduction, but also increases in hope and help increase Courage telling a different story. Hmm. Now, that's a way to inform backup to policy, etc, and say, Okay, we'll include that now as a metric. So you get paid not only for reducing hospitalizations, but for increasing hope. Now that can change your treatment plans, as well, right? Ultimately,

what, uh, what what kind of, so I mentioned community reinforcement approach Are you that's really more of a substance use disorder kind of treatment, it's more of a model, either kind of eight, eight areas of focus. And one of the things you do one of the tools they use actually call it the happiness scale, which isn't, doesn't sound all that scientific, but they look at kind of eight dimensions of your life. And then you're just reporting on a Likert, scale one to 10. Over time, like where you, you know, your happiness and each domain. And something as simple as that actually produces for that person centered care. It's like, hey, like, you just got back into school, you you're doing really well, and all this, but you're reporting less happiness, like, what's what's going on? And sometimes it's, you know, creates a little dissonance or the person like, Oh, wait, this is good. I mean, I, myself all the time, I'm, I have a, I kind of give myself some scores throughout the day. And I'm like, wait, I have a good life, you know, I'm doing pretty well. But if I don't, sometimes I need that data to tell me I am doing a

loop. You know, you're absolutely right. And going back to my clinical work, where I all I was one, absolutely, where I'm like, the scale we're using, I'll leave it unnamed. It's a good scale, it's just symptom focused. And that drives, as you can hear, I'm beating a dead horse here, it drives me nuts. And my view was, I know all of this already, I'm talking to the person and I'm doing a good clinical assessment, I should know, the piece where I found it really helpful was a feedback loop back to, in my case, the team and the family in two places in particular, one, if they were stuck, and we weren't having progress, I could show them back. Look, this is what you're saying. You are saying you are making no progress, what's going on? Now I can have that quote unquote, confrontation without being confrontational. If this is what you're saying, on the other hand, when it was time for them to discharge and move to a lower level of care, regularly, folks would be very nervous and go, I'm not ready. I haven't made enough progress. And like, look at the progress you have said you have made. Let's build up some confidence here. Is there still progress to be done? Of course there is. But those are places that I have found to be very, very helpful.

That's awesome. So last thing for kind of provider organizations, I mean, what if you had to give kind of your three quick hits on what we should be doing? You know, from a data and analytics perspective? You know, what would they be?

Number one is don't have data and analytics be an afterthought. That's what I usually see. It's just an afterthought. creatively, and Curiously, look at the data that you have already, to proactively tell a more complete story that gives you credit for things that you're doing, like strengths based work, like increases in social connectedness, because that's a way we can start being able to collectively advocate that we should get paid for that kind of work, ultimately, and continue to use it, I would say, in quality improvement, which could include, let's revise what data collection we have, maybe we do need to collect it differently, to be able to tell our story. Think of it as even self advocacy to be able to tell your own story, not just have someone else tell the story for you.

And one, one follow up to that because we didn't touch on the other term, I like to talk about standardized, interoperable data. So what do we owe? Because that's one of those things like as a small provider organization, sometimes I'm like, you know, this is great, but I hope we're collecting stuff that feeds into the greater good, yeah. Um, standardized, interoperable, are often used together, they are not the same thing in my mind. interoperable is really can you make connections between this, can you and it depends in context, if you're talking care coordination, can you share this information across systems? So providers will see the same thing? That's one set of technical requirements? It's not hugely hard, actually. It's doable. The other pieces then for analytics, can we connect this so what would facilitate entity resolution in my mind to be able to connect Joshua's data element in system a with Josh data element and system B, that's something for you all to think about, too is as you collect data in different places, is there some sort of identifier we can keep to facilitate that as you aggregate it up over time threat systems standardized, we are moving more and more towards where everybody's Collecting the same type of information in the same way, there are huge benefits to that to you to your point, if you want a nationwide or even, you know, California we struggle with a statewide story a lot of times to some extent you need the same data. The downside is the things that we have moved towards in standardization. Again, go back to it symptom reduction, it's utilization reduction, it doesn't tell the right story in my perspective. So that's where I think we need provider organizations to say, it's not that those are unimportant, we also need x to be able to tell them more complete story. And I think it also feeds right into stigma and discrimination reduction too. Because if we only end up talking about symptom reduction, utilization, reduction, criminal justice, recidivism, homelessness, then we also end up implying that it's the behavioral health folks that are filling up our streets, our jails, our hospitals, etc. which frankly, isn't true when you look at the data, all that interesting. Well, a couple of rapid fire questions, what advice would you give to a new maybe a new clinician or a clinician has been, you know, practicing for a while, but is feeling burnt out? Because this is the business of human flourishing and I think I like to end each episode talking a little bit at the personal level, what advice would you have for someone you know, in that that position?

It's an it's an important one because it's so common to and I've experienced that. reflect back on why you came into this field. What gives you meaning? What gives you purpose? What gives you hope? Can you see that still occurring? It may mean you need you may need a career change, you may need a setting change for me working in an inpatient setting burned me out so quick, other people thrive in it. What drives you? 

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