Latino Leadership

1
Latino Leadership WorkforceDevelopment for
Behavioral Health Prevention Early Intervention

• 14th Annual Latino Behavioral Health
• Conference
• Addressing Latino Behavioral Health
• Requirements in Workforce,
• Prevention and Early Intervention
• September 16, 17, 18, 2008
• Los Angeles, CA

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Latino Leadership Workforce Development for
Behavioral Health Prevention Early
Intervention

• Manuel J. Jimenez Jr., MA, MFT
• Mental Health Services Manager Sr.
• Solano County Mental Heath
• Rudy Cordero Arrieta, MSW
• Quality Manager Data Administrator
• Yolo County Alcohol, Drug, Mental Health

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Goals of workshop

• Address critical issues facing Latinos who aspire
  to become program mangers, deputy directors and
  mental health directors.
• Leadership development.
• History of the Mental Health funding system in
  California.
• Personal journey.
• Management and Leadership Challenges

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California Mental Health Planning Council

• There is a current crisis in the number of
  mental health professionals trained and able to
  provide appropriate services to the most severely
  disabled public mental health client, with
  projections for significant increased needs as we
  move into the 21st century. These acute
  shortages include staff serving clients who are
  bilingual/bicultural and those who live in both
  inner cities and in rural areas.

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Mental Health System Leadership

• At the State level and this regard California
  is not alone Many top Administrators have not
  had the program-level experience to understand
  how bureaucracies truly work, let alone how to
  make them work better.

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Mental Health System Leadership

• At the county level, the majority of mental
  health directors are experienced clinicians who
  have advanced through the ranks to lead their
  departments. Few of them have formal training in
  managing people, administering programs or
  championing organization changes.

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Little Hoover Commission

• Second, we need to fortify institutional
  leadership at the Department of Mental Health
  and in communities to create a system where
  barriers to improvement are identified and
  lowered, where the best strategies are replicated
  and improved, and where the public and state and
  local leaders are confident to invest additional
  resources.

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Leadership/managerial roles in the MHS

• Administration of public programs is very
  difficult.
• Personnel systems are defined by a complicated
  and often conflicting combination of civil
  service and collective bargaining rules.
• Funding requirements designed to prevent the
  misuse of public funds, are complex and
  restrictive.

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Our Journey

• Where have we been and where are we going.
• Rudy
• Manuel

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Who are the Current Leaders/Administrations of
MHS CA?

• Demographic Breakdown
• Training Education Psychology, Social Work,
  Nursing, Medicine
• Career Pathway Majority are Clinicians
• Tenure Average of 5 years

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Demographics

• 29 Men and 28 Women
• Ethnicity/Race Not Reported to CMHDA
• Language Proficiency Not Reported to CMHDA
• 24 (41.4) No Initials or Professional
  Designations Listed
• 13 (22.4) LCSWs
• 8 (13.8) MFTs

• 8 (13.8) DSW/PhD
• 2 (3.4) MSWs
• 2 (3.4) M.D.
• 1 (1.7) R.N.

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Requirements for MH Directors

• W I Code, Section 5751
• CCR, Title 9, Division 1, Article 8., Section
  620 Professional and Technical Personnel
  Standards.
• County Civil Service Commission Rules
  Regulations
• Mental Health Boards

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Key Funding Elements

• Realignment In 1991, a major change occurred in
  the funding of human services programs in the
  State of California with enactment of the Bronzan
  - McCorquodale Act, (chapter 89, Statutes of
  1991), referred to as realignment.

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Key Funding Elements

• Realignment transferred financial responsibility
  for most of the states mental health and public
  health programs, and some of the social service
  programs, from the state to local governments and
  provided counties with a dedicated revenue
  source to pay for these changes.

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Realignment

• For mental health, realignment transferred the
  amounts associated with pre realignment
  categorical program, general community mental
  health funding, state hospital civil commitment
  funding, and Institutions for Mental Disease
  funding.

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Two Tax Increases

• In order to fund the program transfers and shifts
  in cost-sharing ratios, the Legislature enacted
  two tax increases in 1991, with the increased
  revenues deposited into a state Local Revenue
  Fund and dedicated to funding the realigned
  programs.

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Realignment

• Each county created three program accounts, one
  each for mental health, social services, and
  health. Through a series of accounts and
  sub-accounts at the state level, counties receive
  deposits into their three accounts for spending
  on programs in the respective policy areas.

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The basic formula, which determines the amount to
each county, was included in the statute.

• State Tax in 1991, the statewide sales tax rate
  was increased by a 1/2 cent. The 1/2 cent sales
  tax generated 1.3 billion in 1991-92. And was
  expected to generate approximately 2.4 billion
  in FY 2001-2.
• Vehicle License Fee the VLF, an annual fee on
  the ownership of registered vehicles in
  California, is based on the estimated current
  value of the vehicle.

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Realignment

• Annually, realignment revenues are distributed to
  counties until each county receives funds equal
  to the previous years total. Funds received
  above that amount are placed into a growth
  account. The distribution of growth funds is
  complex. However, it is a fixed amount annually
  and the first claim on the Sales Tax Growth
  account goes to caseload-driven social services
  programs.

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Realignment has generally provided counties with
many advantages, including

• A stable and growing funding source for programs.
• Greater fiscal flexibility, discretion and
  control.
• The ability to use funds to reduce high-cost
  restrictive placements, and to place consumers
  appropriately.
• The ability to streamline bureaucracy and reduce
  overhead costs.

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Continued

• Financial incentives for counties to properly
  manage mental health resources, including the
  ability to roll-over funds from one year to the
  next, which enables long-term planning and
  multi-year funding of projects.

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Continued

• The emphasis on a clear mission and defined
  target populations under realignment has allowed
  counties to develop comprehensive community-based
  systems of care for individuals with severe
  mental illness and serious emotional disorders.
  Increased county flexibility has further allowed
  counties to institute best practice, and to focus
  on the recovery of individuals.

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Medi-Cal

• The second largest revenue source for county
  mental health programs is federal Medicaid
  dollars.
• The Medi-Cal program originally consisted of
  physical health care benefits, with mental health
  treatment making up only a small part of the
  program.

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Medi-Cal

• In 1971Short-Doyle/Medi-Cal started a pilot
  project and counties were able to obtain federal
  funds to match their own funding to provide
  certain mental health services to Medi-Cal
  eligible individuals.
• A Medicaid State Plan Amendment implemented in
  July of 1993 added services available under the
  Rehabilitation Option to the SD/MC scope of
  benefits.

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Leadership Development

• Defining leadership
• Describing Leadership Development
• How do you sharpen Leadership skills
• Who delivers Leadership development

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The Leadership Dilemma
Should Moses have Brought a Committee from All
the Tribes of Israel with him to Mount Sanai?
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Defining Management and Leadership

• Management is the process of planning,
  organizing, leading, and controlling the
  resources of an organization in order to achieve
  stated goals.

• Leadership is the process of directly or
  indirectly influencing others, by means of formal
  authority or personal attributes, to act in
  accordance with ones intent or shared purpose
  and vision.

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Who are the Managers?

• Persons who are appointed and/or hired to
  positions of authority
• Persons who enable others to do their work
  effectively
• Persons who are responsible for resource
  allocation and utilization
• Persons who are accountable for work results and
  outcomes of the organization

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Classification of Managers

• By level in the organization senior, middle, or
  first line
• By overall nature of the position policy, human
  resources (HR), operations, ..
• By extent of use of certain skills (e.g.,
  Accounting/Fiscal, Logistics, Engineering, IS,
  Clinical, Research )
• By nature of activities

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What Managers Do?

• 1. Assume responsibility
• 2. Balance competing goals (prioritize)
• 3. Think conceptually
• 4. Work through or with other people
• 5. Act as mediators, serving as arbitors and
  judges
• 6. Act as politicians to build alliances,
  coalitions, and mutual obligations using
  persuasion and compromise to achieve
  organizational goals..
• 7. Represent their work unit and organization
• 8. Make difficult decisions

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What Leaders do?

• Create and sustain a shared vision
• Provide purpose (Mission)
• Generate and sustain Trust (Win/Win
  Relationships)
• Foster Hope
• Get Results

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Ken BlanchardThe Secret

• See the Future
• Engage and Develop Others
• Reinvent Continuously
• Value Results and Relationships
• Embody the Values

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Bibliography

• Empowerment takes more then a minute, Ken
  Blanchard, John P Carlos, Alan Randolph.
• Monday morning leadership, David Cottrell.
• The Secret, Ken Blanchard, Mark Miller.
• The Serving Leader, Ken Jennings, John Stahl-Wert

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Leadership Qualities

• Technical competence business/public sector
  literacy and grasp of ones field.
• Conceptual Skills a facility for abstract or
  strategic thinking
• Track record a history of achieving
  results/outcomes
• People skills an ability to communicate,
  motivate, and delegate
• Taste an ability to identify and cultivate
  talent
• Judgment making difficult decisions in a short
  time frame with imperfect data
• Character the qualities that define who we are.

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To satisfy followers needs and achieve positive
outcomes, leaders must provide
Leaders Provide Sense and Purpose Authentic
Relationships Hardiness (confidence that things
will work out) Bias toward action, risk,
curiosity, and courage
To Help Create Goals and objectives Reliabilit
y and consistency Energy and Commitment Confiden
ce and Creativity
IN Service of Constituent Needs for Meaning and
Direction Trust Hope and Optimism Results
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System Transformation

• The passing of the MHSA provides an opportunity
  to increase funding, personnel and other
  resources to support county mental health
  programs.

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MHSA Funding

• Paid for by 1 on taxable personal income over 1
  million (Prop. 63).
• Deposited into a MHS fund in State Treasury
• Used to expand, not supplant services, or, the
  money cannot be used in place of money now spent
  on MHS.

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MHSA is Intended to

• Support a redesign of the public MHS.
• Introduce effective new services models that
  promote well-being, recovery and self-help.
• Introduce prevention and early intervention
  strategies in decrease the long term impact of
  serious mental illness.

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MHSA is Intended to

• Enhance staff development, computer technology,
  buildings and living space.
• Reduce stigma and discrimination.

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MHSA Vision Statement

• As a designated partner in this critical and
  historic undertaking, the California Department
  of Mental Health (DMH) will dedicate its
  resources and energies to work with stakeholders
  to create a state of the art, culturally
  competent system that promotes recovery/wellness
  for adults and older adults with severe mental
  illness and resiliency for children with serious
  emotional disorders and their families.

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Was the Shared Vision?

• Simple and Idealistic
• Appeals to Values
• Emphasis on Distant ideological objectives
• Challenging, but realistic
• Can be communicated in lt 5 minutes

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MHSA DMH Mission

• In its implementation responsibilities under the
  MHSA, DMH pledges to look beyond business as
  usual to help build a system where access will be
  easier, services are more effective, out-of-home
  and institutional care are reduced and stigma
  toward those with severe mental illness or
  serious emotional disturbance no longer exists.

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Mission Components

• Mission Statement what will be achieved? Why it
  is worthwhile? How can it benefit? Who will
  benefit?
• Strategic/Performance Objectives What are the
  milestones that must be passed to meet the
  ideological objectives?
• Slogan Summarize values in simple terms Note
  that overemphasis on slogans can trivialize the
  vision

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Guidelines to Formulate a Vision

• Involve Key Stakeholders director, senior
  managers, peers, senior enlisted, subordinates,
  consumers
• Identify strategic objectives with wide appeal
  looking for shared values and ideals
• Identify relevant elements in the old ideology
  that may be worthy of preservation in the
  foreseeable future.
• Link the vision to core competencies
• Evaluate the credibility of the vision
• Continually assess and refine the vision,
  including looking for ways to make the vision
  more appealing and credible

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Writing a vision/mission statement for your
organization

• Why you do what you do?
• The organizations reason for being/existence,
  its purpose
• Says what, in the end, you want to be remembered
  for

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Characteristics of Managers and Leaders
(Synthesis)

• The manager administers
• The manager is a copy
• The manager maintains
• The manager focuses on systems structure
• The manager relies on Control

• The leader innovates
• The leader is an original
• The leader develops
• The leader focuses on people
• The leader inspires trust

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Continued

• The manager asks how and when
• The manager has his eye on the bottom line
• The manager has a short-range view
• The manager accepts the status qou
• The manager is the good soldier

• The leader asks what and why
• The leader has his eye on the horizon
• The leader has long-range perspective
• The leader challenges it
• The leader is his/her own person

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A Contrarian View of Leadership

• The following leaders defy both a common traits
  and characteristics definition of leadership, as
  well as the great person view.
• Leaders are neither born nor made. Leaders
  emerge. And they emerge because of one critical,
  driving factor PURPOSE.
• That critical factor of Purpose then meets two
  other key factors, circumstance and opportunity
  and that union gives birth to leaders.

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Manager or Leader?

• Nelson Mandella, Spent 27 years in a prison cell
  in apartheid-torn South Africa Obtain freedom
  for both the oppressed and their oppressors who
  are trapped in a terribly limiting mindset.
• Abraham Lincoln, underestimated by even his own
  cabinet, amid the civil war-torn U.S. Preserve
  the Union despite the considerable opposition and
  agonizingly terrible costs.

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Manager or Leader

• Mother Teresa, Very small quite and shy, from a
  wealthy family, for 15 years a teacher of
  daughters of Indias wealthy, who encountered
  that nations demoralizing poverty while on a
  journey to a retreat Purpose, I heard the call
  to give up all and follow Christ into the slums
  to serve him among the poorest of the poor.

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Manager or Leader?

• Winston Churchill, a not well-liked critic of his
  government Purpose, I resolved absolutely to
  defend Britain against the brutal assault of and
  potential domination by the Nazis.
• Jack Welch, an abrasive corporate maverick
  Purpose, reform with tough love, a tired, stodgy
  old corporate conglomerate to assure its future
  as a model, leading company.

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Leadership development begins with an
organizational self-assessment

• An organizations commitment demonstrates a real
  commitment to leadership development
• Outcome is the basis of a Leadership Action
  Requirements
• Gauge to objectively assess an organizations
  readiness for change

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A Short Exercise in Leadership Development

• Mission
• Environmental Scan
• Vision
• Supporting Consumers
• Appraisal
• Results

• Budget
• Customer Value
• Primary Consumers
• Goals
• Objectives
• Action Steps

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Defining Leadership Development

• The expansion of a persons capacity to be
  effective in leadership roles and processes,
  these roles and processes being those that enable
  groups of people to work together in productive
  and meaningful ways to achieve common goals.

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Definition Implies that

• Leadership development is the development of
  capacities within the individual
• What constitutes effectiveness should be derived
  from studying what makes people effective in a
  variety of leadership roles and processes.
• Leadership roles may be formal positions infused
  by authority to take action and make decisions,
  or they may be informal roles with little or no
  formal authority

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Roles of Leadership Development

• It prepares people for leadership roles and
  contributes to the improvement of the
  effectiveness of those already in leadership
  positions.
• It serves to promote acceptance of the vision,
  values, and mission of a collective by those
  occupying positions in which leadership is
  exercised, and seeks to ensure that they will be
  committed to their realization.
• It is used as a strategic intervention through
  the use of action learning (Senges Learning
  Organization) that ensures that learning is
  utilized in order to help the organization adapt
  to change.
• It distributes leadership skills throughout the
  organization to create a community of leaders.

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Leadership Development Programs Must

• Build awareness of external challenges, emerging
  strategies, organizational needs and how to meet
  those needs.
• Employ learning tools that helps to recognize
  potential external change, envision the
  organizations future, and focus on actions their
  organizations can take to create its envisioned
  future.
• Link leadership development programs to solving
  important public policy and business issues.
• Align leadership development with performance
  assessment, feedback, coaching and succession
  planning.
• Assess impact of the leadership development
  process on individual behavioral changes and
  organizational success.

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Leadership Development Activities
Education Capacity to think critically about
complex issues requiring judgment.
Personal Growth
Training Capacity to apply knowledge and skills
to specific situations
Leadership Effectiveness
Experience Opportunities to carry out Tasks
Develop relationships in pursuit Of goals to
produce results.
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Leadership of Transformation

• A transformative leader is defined as a person
  who can guide, direct, and influence others to
  bring about fundamental change, change not only
  to the external world but also of the internal
  processes. Jahan, 2000 p. 1

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Why does one organization thrive on change while
another sulks like a teenager?

• Leadership creates and sustains an organizational
  culture that thrives on change
• Leadership creates a cohesive organizational
  culture instead of professional staff that seeks
  to function relatively autonomously leading to
  burnout and divisions of power
• Leadership ensures financial/job security,
  strategic alliances, harmonious relationships,
  and a high sense of social responsibility

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Major Reasons for Why Change does not take Place

• Employee Resistance
• Dysfunctional Organizational Culture
• Change Readiness
• Leadership

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What must transformational leadership do?

• Motivating changes in behavior and overcoming
  resistance
• Managing the transition to ensure control and,
• Supporting the political dynamics so that power
  centers develop that support change

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Complex Change Grid
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Leadership Resources

• CIMH Leadership Institute
• UCSF Health Professional Leadership/Cultural
  Competent Leadership Development Program
• Parks Leadership Fellows Program-Cornell
  University
• Andrew Young School of Policy Studies-Georgia
  State University
• Georgia University-Institute for Leadership
  Advancement at the Terry College of Business
• Center for Creative Leadership
• Gonzaga University Doctoral Program on
  Leadership

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Summary and Conclusions

• We need both effective leadership and management
  in our organizations
• Qualitative and Quantitative differences between
  leaders and managers as archetypes is not
  supported by empirical data.
• Leadership based on formal authority may be a
  minimal kind of leadership, characterized as
  rigid command which results in mere compliance
  rather than commitment
• Leadership and authority are always combined in
  some manner.
• Leadership plays a fundamental role in
  transformation by creating a vision of the future
  and inspiring people regarding their place in the
  future

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MHSA Workforce (Leadership) Development

• Education and Training funds are available to
  develop leaders of a transformed MHS from MHSA.
• Opportunities for Latinos at all levels to
  bridge gap between workforce composition and
  population served.

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How can we be included in the Planning Process?

• Decisions on the allocation of the MHSA Education
  and Training Funds.
• Dissemination of Opportunities to Latinos
• Submission of Specific Proposals to fund Latino
  Leadership Development to DMH
• Becoming members of advisory groups and
  committees that provide input/influence funding
  allocations.

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Mental Health Planning Council

• May 22, 2002, Latino Focus Group, Modesto
• The group identified several strategies for
  improving the pipeline to the profession such
  as mentoring and graduate school professors
  taking students under their wing.

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California MH Planning Council

• Economic incentives like career-ladder programs.
• Opportunity for growth
• Providing personal and academic support
  throughout
• Bilingual pay

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A word from the Wise

• There is nothing more difficult to take in hand,
  more perilous to conduct, or more uncertain in
  its success than to take the lead in the
  introduction of a new order of things.

Niccolo Machiavelli