Chief Executive Officer
David serves as CEO of Integral Care, which serves as the Austin/Travis County Local Mental Health and Intellectual and Developmental Disability Authority. Integral Care strengthens our community by supporting our most important asset, our people, to achieve well-being. Integral Care provides individuals with high quality mental health care, collaborates with community partners to strengthen programs and systems, and works to raise awareness of mental health issues in our community.
HTA - Tell us about your personal/professional background?
I’ve had the extraordinary opportunity to be part of the Community Mental Health development in the country from nearly its inception after the landmark 1963 Federal Legislation establishing community centers. Integral Care opened the doors in 1967 in Travis County and I began my career in 1973 in Oakland County Michigan with Residential Treatment Services. I’ve served on national level association officer positions, court settlement consultations to implement consent orders, State Commissioner appointments in two states, chaired City and County task forces, and have been a speaker at National, State and Local Conferences. In short over time, I have been engaged in innovation and change management as the field of Mental Health Services has evolved. Fortunately, I have also had the opportunity to serve as adjunct faculty at the University of Nebraska, University of Texas and St. Edwards University.
HTA - What experiences prepared you for leading Integral Care?
The most informing opportunities to prepare for leadership challenges took place in the intense periods of new patterns of care. This mix includes new models of program design, new effective medications, electronic health records and data exchange, while working across systems of health care, youth and family and criminal justice.
To navigate these choppy waters I had a supportive Board, mentors and effective advocacy relationships in the field. I’ve grown to believe networking is the most critical competency for executive leadership success.
HTA - During your career, you’ve held statewide leadership roles in Georgia and Nebraska, how do those states compare to Texas in delivering care for mental health services?
State Mental Health Systems, while having some commonality in service delivery like evidence based best practices, are significantly different across the Country. Most differences lie in the state/local relationships. Nebraska has six local regions with local Boards, Georgia has six field offices with a private Administrative Services Organization (ASO) partner, and Texas has 39 local authorities that operate under Boards appointed by local government agencies.
By far, Texas is unique in the multiple funding sources, braided together at the local level, to finance services. Also local Boards in Texas, like Integral Care, contract a portion of services out through other quality providers. The strength in Texas is the locally planned and delivered services in collaborative partnerships.
HTA - How do you integrate behavioral healthcare and physical healthcare at Integral Care?
Integrating behavioral health care and physical health care is a strategic direction for Integral Care. Currently we have embedded Mental Health Clinicians in primary care community clinics, mental health assessments and social workers in the new Dell Medical School Integrated Practice Units and clinical staff corresponding to EMS calls at the point of service. Also we have “reverse integration” where partner primary care doctors and nurse practitioners are in several of our Mental Health Clinics supporting treatment for chronic illnesses. The next area for significant progress is the integrated treatment of Substance Use Disorders.
HTA - What is the biggest challenge facing Community Healthcare Centers (a.k.a. Local Mental Health Authorities) like Integral Care at this point in time?
Due to the mix of Federal, State and local funding, there is significant upheaval in health care financing. Value based payments, moving provisions of the ACA, equity in Mental Health coverage, Medicaid and Medicare coverage changes and local funding priorities that create a mosaic of funding patterns that are moving and often unstable.
HTA - How is your organization funded today and how do you anticipate CHCs (a.k.a. LMHAs) will be funded in the future?
So this current fiscal year, Integral Care funding can be understood in four large buckets compiling a $119,000,000 budget to serve nearly 30,000 Travis County Residents. First we are funded through State general fund contracts for nearly a quarter of our funding. Second, local sponsoring agencies, the City, County and Central Health make up a quarter. Third, Medicaid through MCO contract and the 1115 Medicaid Transformation Waiver makes up a quarter; and grants, contributions, fundraising and foundations comprise the remainder. In the near future, a new category of Certified Behavioral Health Clinics, Value based MCO payments and Accountable Care Organization partners will form as methods of finance shift. This will be in line with health care financing in general.
HTA - How are you using technology to improve patient's access to care and patient outcomes?
We are using technology to both improve the business functions and improve patient outcomes. Examples of recent improvements include, personnel and accounting software with Employee home pages and benefit management, Facility planning, maintenance and valuation programs, fiscal report generation, and online staff training and seminars. Point of service technology enhancement has included piloting hand held devices, hot line call center technology improvements, and we have a RFP out for a new electronic health record solution at this time.
HTA - How do you learn? What are you reading?
I strive to be an active learner beginning with listening. If I have 50 encounters a day with people in the work space, there are 50 opportunities to learn. I’m engaged in a national “master class” on new clinic development, I chair the state level “Health Opportunity Workgroup” with monthly outside presentations, a long list of favorite webcasts and blogs and news outlets including the BBC and NPR. I’m currently reading two books, An American Sickness by Elizabeth Rosenthal and Performing under Pressure by Hendrie Weisinger and J. P. Pawliw-Fry. I highly recommend the Rosenthal book that explores how health care became big business. I most frequent the Kaiser Family Foundation and Modern Healthcare websites as well.
HTA - Where do you want Integral Care to be in 5 years?
Integral Care is at the verge of a next level of effective health care delivery informed by science, an emerging Medical School and advances in what we will routinely reference as “Brain Health”. The new Mulva Neuroscience Center, the expert Departments of Psychiatry and Population Health, the redesign and rebuild of the Austin State Hospital and full partnership with Central Health can lift our local services with research, work force training and a valued embedding in the future health ecosystem.
A parallel opportunity exists in working as a full partner with the criminal justice system; the courts, local law enforcement, jails and probation/parole. The next five years will be the most exciting and disruptive in the history of Travis County Mental Health Services. Then Mental Health “sleeping giant” has woke up… The challenge this shifting patterns of payment for indigent care creates some uncertainty in access, volume and coverage that we can guarantee with our partners and new patients.
HTA - How can Mental Health Advocates help during times of Public Tragedy?
Here are some thoughts on a time of public tragedy and prevention
- Mental Health First Aid training and knowing the warning signs of Mental Health conditions
- Respond early with school based Mental Health services and first onset psychosis treatment available.
- Post-traumatic treatment for first responders’ families and the most affected.
- Remember the long term impact, often symptoms don’t occur for 6-9 month later.
- Take threats of violence and self-harm seriously and encourage the seeking of treatment.
- Understand that Mental Illness itself is not a cause for and should not be equated to violence.
- Because of the obvious – consider meaningful and progressive gun laws.
- Know and use the hotline number (512) 472-HELP