InTouch - Five Stars for Our Work on Mental Health

It’s one thing for me to tell you we do excellent work. But there’s nothing like hearing it right from our customers. Like this message from a grateful parent:

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Yes, that’s a Yelp review, a place it may surprise you to see feedback on such a serious matter. Take it as one more sign of the changing environment we find ourselves in as we work on mental health and substance use issues, which we refer to together as behavioral health. The changes, the challenges, and the opportunities we’re seeing in this realm are as dramatic as any we’re grappling with. Maybe most noteworthy for you as employees is that our efforts are affecting more of you than ever before.

It is an enormous challenge. Nearly one in ten adult San Diegans suffers a psychiatric crisis in any given year. About the same number has a substance use disorder. The rise in opioid misuse and overdose deaths has made national headlines, and it’s a troubling trend here as well. Suicides have increased. Behavioral health is a major factor in homelessness.

And as with homelessness, we can’t deal with behavioral health in isolation. It’s become increasingly clear that the issues we see are interwoven with an incredibly complex set of social factors, in addition to each person’s unique needs. Complex issues will take complex, multidimensional approaches to address.

At the same time, the hospital industry is undergoing shifts of its own. It’s typically been designed to set a broken arm rather than tend to the less straightforward care of a broken psyche.

People like our Yelp reviewer will attest to the quality of care we offer. But the County has always been just one part of a health care system that includes hospitals, treatment facilities, and a variety of medical providers. And while collaboration is not new, we are really stepping up the ways we coordinate care, both internally across our departments and with the whole medical community. Let me give a few examples of things we’re doing and areas for future focus.

The availability of psychiatric beds in the region has recently jumped up our list of priorities. The County’s expansion plan will add roughly 150 long-term care and step-down beds, the latter helping people transition out of acute care. We’ll also build the ability to serve 300 people through Assertive Community Treatment, an array of services paired with housing for those in that step-down phase.

The number of staffed beds at the County Psychiatric Hospital will increase to 82. We’re having conversations with health care providers throughout San Diego County on ways we might collaborate to offer treatment.

No Place Like Home is a state initiative voters approved last November to help people with serious mental illness who are, or at risk of becoming, homeless. We’ve requested $125 million from the program to help develop supportive housing, which is a place to live combined with behavioral health services. That’s in addition to several other supportive housing efforts targeting the nexus of homelessness, housing affordability and ongoing care, such as Project One For All and several hundred units made possible through Mental Health Services Act funds. Our Children, Youth and Family System of Care is working with a contractor and the City of San Diego to develop the first family-oriented supportive housing program.

We’re looking at taking currently unused County property and creating a behavioral health services hub. An initial site in Hillcrest would take advantage of nearby hospitals to create integrated, whole person care. But we may eye other County property for critically needed behavioral health services.

That potential expansion is important, because in a region as large as ours, and a population as spread out as it is, we need to make sure resources are distributed broadly. That includes those proposed hubs, but any of the behavioral health services we’ve been talking about.

This past year has seen a dramatic increase in the availability of care through what’s called Drug Medi-Cal, which makes it possible for the state insurance to cover substance use treatment programs. As part of that, the providers of those programs are now paid by services delivered, rather than simply reimbursing their costs, making them more effective for the client.

One area we’ll strengthen even more is the coordination between behavioral health and the justice system. That includes expanding PERT: psychiatric emergency response teams, which pair mental health clinicians with law enforcement officers. Not just more teams, but more follow-up with the people they help. Again, moving from cases in isolation to a more comprehensive approach.

We will be focusing on the development of community-based crisis stabilization centers, where people can easily access trauma-informed care and law enforcement can efficiently transport people for care close to their homes.

As we are with many County operations, we’re ramping up our use of data to drive our efforts. With something so big and complex, that number-crunching is invaluable to getting our resources focused in the right direction.

As a department, Behavioral Health Services is second only to our Sheriff’s Department in levels of funding you’ll see in the County budget. It’s getting $658 million this year and added more than 100 positions. Final details are being hammered out for the coming year’s budget, out in a few days, but expect more dollars and staff. The total we devote to these services shows it is now a top priority. Credit to our Board of Supervisors for showing their commitment to addressing these needs by bringing many of the ideas forward and then backing them up with resources.

I can’t mention this topic without a reminder to be aware of the behavioral health needs of our employees and their families. Please remember our Employee Assistance Program is there for you. It offers counseling, free and anonymous. Don’t hesitate to bring up concerns with your primary care doctor. Our Access and Crisis Line is not just for the public. Anyone can use it, 24/7, at 888-724-7240.

May is Mental Health Month, a time to raise awareness about this essential aspect of our well-being. It’s also a good time to spread awareness about some of what the County is doing. Often in my columns, I’m barely scratching the surface. If tackling behavioral health is not an audacious goal, I don’t know what is. Thank all of you who have a hand in, and will continue to be involved with, helping us serve these vulnerable residents.

InTouch - Who We Are

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It’s important to know our customers. And since we need to serve our fellow employees every bit as well as we do the public, we also need to know our colleagues. You know many individually. But as a group, who are we, what do we look like?

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Our County team is around 17,000 strong, and as you’d expect with that many people, we’re a varied bunch.

Sometimes it might seem like a lot of employees have been here a long time, and of course, many have. But the numbers show that’s not the whole story. Last year, 1,451 employees joined the County from the outside (welcome!). Everything is new to them – from their daily duties to understanding our culture.

Roughly another 2,000 existing employees were promoted (congratulations!). That’s almost 3,500 people in new positions. That’s a lot of learning, a lot of people who need help getting into their roles so they can be successful. 

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In fact, nearly 6,000 of us have been here under five years! If you’ve been around for a while and are ever tempted to think something is common knowledge, remind yourself how new many of our colleagues are. Help them along. If you’re new, don’t be afraid to ask about things. We know there’s a lot to pick up. 

A handful are really in it for the long haul. Fourteen employees have been here 40 years or more, with our longest-serving worker at 47 years!

Our workers range from 20 to 83 years old, with an average age of 44. The average for the national workforce is about 42. So we’re a touch older, but not much.  

You can expect some of the next generation to come from those who are now student workers. We had 391 last year. Our District Attorney’s Office had the highest number of any department: 93.

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We tilt pretty heavily female. Our workforce is 59 percent women, and it’s been that way for a while. County jobs don’t mirror those of society at large. We have a lot of positions in fields that tend to disproportionately draw women.

Our largest age group is 27-40 years old, approximately the range we know as millennials, aka Gen Y. They make up about 41 percent of our workforce. They’ve nosed ahead of the next group, those 41-56, roughly Gen Xers, who are just over 39 percent. Then Boomers, 57-73, still make up about 15 percent. The incoming Gen Z, people up to age 26, are already 5 percent. We still have a few Silent Generation members, 74 years old and up, on the job. We’ve talked pretty extensively about some of the differences, but it’s really exciting to get to work with people across five generations. We can learn so much from each other.

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Racial/ethnic identities can get quite complex, but at a high level, here’s how we break down and how that compares to the San Diego region at the last census: 0.6 percent American Indian/Native American (compared to 0.5 percent in San Diego overall). Nearly 19 percent Asian or Pacific Islander (vs. 12 percent locally). Almost 8 percent black/African American (to 4.6 percent of San Diegans). 32.6 percent Hispanic/Latino (vs. 28.3 percent of residents). And just over 40 percent are white (vs. 54.5 percent regionally).  

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Almost 2,000 of our County employees are sworn officers. That includes Sheriff’s personnel, Probation officers, District Attorney investigators.

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In recent years we’ve worked harder to get veterans of the armed forces to join us, and they now make up 6.6 percent of our employees. We thank them for their service and for continuing to serve the public with us.

That’s a quick snapshot of our employees as a whole and some indication of the diversity within our County team. But only some indication. We’re diverse in all kinds of ways we don’t gather statistics for: where we’re from, the culture our families shared with us, our beliefs, our challenges, our passions, and the whole gamut of life experiences. We fall into many different categories that make each of us unique and interesting. And when we bring our individual talents and backgrounds together, it makes exciting teams!

Looking at these numbers is fun but also has a purpose. I share them to help us better understand our fellow employees, so we might serve each other, and in turn the public, better. Because regardless of all these other groups we may be a part of, it’s the qualities we bring to our jobs that really define us at the County. Respectful, attentive, compassionate, hardworking public servants – that's who we are. 

InTouch – How Engaged Are You? Results from Our Survey

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This month I want to talk about the results of our recent Employee Engagement Survey. But before I do, I want to acknowledge Employee Appreciation Day and offer all of you my sincere thanks for the work you do.

Though we’re singling out today to make a big display of gratitude for your efforts, please know I feel it in my heart every day. We could not be a successful organization without YOU. I’m always humbled by your dedication and proud of your desire to make life better for our residents. And, like many people, I need to be better about saying it more often! Thank you! You are amazing, and I’m truly grateful you have chosen to work here at the County.

I think it’s timely that the results of our recent engagement survey coincide with Employee Appreciation Day. The survey is a look into how we feel in our County jobs. “Employee engagement” can be kind of a fuzzy concept. It describes your emotional relationship with the organization.

I want each of you to feel engaged, one, because I hope on a personal level that you have a sense of connection and fulfillment in a place you spend so much of your life. But two, as the one tasked with overseeing this operation, I have a strong interest in performance. Research shows an engaged workforce has higher goal achievement and higher retention rates. An engaged employee is a happy employee, and a happy employee is more productive. A happier workforce is also a healthier workforce, and that’s one more way we make Live Well a reality.

We emailed the survey out in December and about 22 percent of you responded. Not bad, but definitely the first area of improvement to work on. It’s important to hear from as many of you as possible, so we want to get the number of responses up.

I won’t go through every question, but here are a few results.      

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Seventy-four percent of you say you feel motivated to work for the County, and 78 percent get a feeling of personal accomplishment. A solid majority of you feel you’re making a difference in the lives of those you serve. That’s pretty good but an area where maybe we can do a little better.

Ninety percent of you understand how your job contributes to the success of your department. I’m encouraged by that. We spend a lot of time on aligning efforts to strategic goals. It’s easy to get caught up in details and lose sight of the big picture, but the number tells me we’re on the right track there. 

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Seventy-three percent say your skills are being used effectively. Pretty good, but it also sounds like a fair amount of untapped potential, so that’s an area we’ll need to work on.

Are we getting along? Eighty-nine percent say you have a good relationship with co-workers, while 82 percent say you have a good relationship with your supervisor. Not hard to see how that makes employees happier, and in turn, more productive and again, healthier.

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About three-quarters of you feel your department values diversity and inclusion, and that you can be your authentic self at work. We made D&I one of our priorities a few years ago, so I’m heartened by these results and will continue to focus on ways to further our D&I efforts as they go directly to employees’ comfort level at work and our ability to meet the needs of all our customers.

OK, our biggest Needs Improvement grade: recognition. We know how important this is. It’s part of our General Management System. It’s part of our Journey to a Positive Customer Experience. But only 43 percent of you feel you’re frequently rewarded or recognized for good work. We’ve got to do better than that.

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Putting in hard work feels so much different when you know someone sees it, appreciates it, and most of all, shares it with others. More formal recognition and awards are great. But don’t forget the day-to-day thank-yous and acknowledgments. Research shows the more immediate the recognition, the greater impact it has. We should be maximizing impact in anything we do.

A lot of that message I’m directing at supervisors. Let’s really work on it. But no one should overlook peer-to-peer recognition, either. It can mean a lot to a co-worker to hear from someone who understands exactly what their job takes. 

This is where we need your help, too.  As I’ve mentioned, recognition can mean different things to different people. If there’s a specific way you like to be acknowledged for good work, make sure to talk with your supervisor about it. We want to make it meaningful to you!

This is the first year we’ve done the Employee Engagement Survey, so this let us set our benchmarks. Here’s an overview of results for all the questions. We’re sharing it with our leadership across the organization, and they’ll be working out how we boost that engagement.

This all brings us back to Employee Appreciation Day. I hope we can make it not just an opportunity to show our thanks, but a day we commit to building habits of gratitude, as individuals and as an organization. That will have a big part to play in how engaged everyone feels.

Only one way to end this: Thanks again, so much, today and every day, for all you do.   

InTouch – Happy New Era!

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Happy New Year!  Are you ready to roll?

I hope so, because this new year kicks off a new era at the County. On January 7, two new members will be sworn in to our Board of Supervisors. Welcoming two at one time is a first for me and all but the most veteran County employees. It’s been 24 years since two new board members were sworn in!

When I say a new era, I’m talking not only about the current board transition, but the practice of regular turnover in elected leadership since term limits are in place. The maximum time an elected official can serve as a supervisor is two terms. So our culture must adapt to continuous change.

New elected leadership means new policies and more dynamic shifts in priorities. Our successes of the past will be the foundation for the successes of the future. Old ways of doing things may be reviewed, tweaked or maybe even discarded.  And new ideas and initiatives will be implemented. 

Where we direct our energies might shift. But who we are won’t. We’ll remain dedicated to exceptional public service and the principles of HEART. We’ll demand the highest ethical standards. We’ll encourage innovation and continuous improvement in all areas of our operations.  We’ll be outcome driven and expect excellence in all that we do. 

Over the past several decades, we’ve never stood still, and we’ve shown great flexibility in responding to new demands. Now we’ll need to step it up and be even more nimble than we’ve ever been, as individuals and as an organization.

Our new supervisors and their staffs have an adjustment to make as well. Think back to the learning curve you faced when you got to the County. It’s a big, complex operation. All those acronyms! They’ll need our help in showing them how we function and how the fresh ideas they bring to the table can make their way into what we do.  

The familiar is comforting – but change is exciting. Invigorating, even. Embrace it! And as you do, reflect on some new year’s resolutions of your own. As I’ve talked to employees over the past couple weeks here are a few they’ve shared:

  • Solve problems, don’t just share them.

  • Be a positive force in our residents’ lives.

  • Listen more.

  • Appreciate and help co-workers.

  • Become more tech savvy.

  • Use social media to help, not to criticize.

  • Take a daily walk or run to enjoy the beauty of San Diego (exercise is a side benefit!).

  • Turn off the TV, set the phone aside and have a face-to-face conversation.

  • Smile more.

  • Relax – everything isn’t a crisis.

  • Make at least one unexpected good thing happen every day for someone.

As we close 2018, let me reiterate how grateful I am to each of you for your hard work and dedication this past year. Your commitment was extraordinary. Now, let’s ring in the new era together. We have many exciting achievements ahead. Let’s get going! 

InTouch – Look at What You’ve Done!

InTouch – Look at What You’ve Done!

Each of us stays so busy with the day-to-day demands of our own jobs that it can be hard to get a sense of how all our work adds up. And the County does such a vast variety of things, any one of us won’t be aware of much of what our colleagues are up to.

When you get a big picture look at a full year’s worth of accomplishments and services delivered, it’s pretty darn amazing.

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InTouch – Use It or Not, Social Media is Changing Us

InTouch – Use It or Not, Social Media is Changing Us

Love it or hate it? With social media, it’s easy to be torn between the two.

It’s a great way to keep up with friends, share pictures of the kids, get recommendations, and be entertained. In the wrong hands, it can be manipulative and a weapon.

You can use it to expand your horizons or build a bubble. You can efficiently keep tabs on news and professional topics or get sucked into hours of mindless nonsense.

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