 one who's here today. I think your dedication to this work really demonstrates your commitment. I know how precious everyone's time is, so the time that you're taking to be here today is deeply needed for us, the Department of Mental Health, and to the work that we're going to embark on here together today. Vermont's important charge when it comes to our Vermont system of care. And one of the things that we all need to remember in our work is that we convey our work and do our work with your partnerships. So that's partnerships through our designated community mental health agencies, our designated hospitals, and other community partners. And I think we'd all look at some of the challenges and opportunities before us as a system of care that no single group or approach is going to solve this, that we really need a collective answer. And I think that we can really focus on building a system that not only meets the needs of today in Vermont, but also thinking about what our families and people are going to need in 2030 and how are we thinking long term about our future Vermont mental health system of care. And I think if we can do that and align around a common vision, then we can really create a system of care that will benefit generations of Vermonters to come. And that is exactly the work that we're here to embark on together today. So before we go too much further, let's take a moment and just introduce ourselves very quickly. We'll just go around the room and where you're from. So you want to get started? Sure. Hi everybody, I'm still leading the committee and I work for the Department of Mental Health. I work for the Department of Mental Health. Don, I work for the Department of Mental Health. I'm from HTRS. Carol, I'm from the Department of Mental Health. Deming grade from the Hospital Association. I'm Jim, from the Department of Mental Health. Kathy Detsy, from the Department of Mental Health. I'd like to ask one more question? Sure. I'm from the Department of Mental Health. Great. We got everybody? Wonderful. Well, thank you all for taking a moment to do that. Some of you might be aware that our convening here today really builds off some existing work that the Vermont Department of Mental Health did and that the legislature charged us with, which was our Act 200, Section 9 report, And if you haven't read it yet, now that we have your email address you'll be sure to send it to you. But essentially the Department of Mental Health responded to that legislative charge and really to articulate what is kind of the overarching system structure of our system of care. And there are a lot of ideas and data in that report that I think we can really build on. Data related to quality, access, person-centered care, parity, coercion, and payment reform. It was also the charge of the legislature that this process was inclusive, that broadened the voices of broad stakeholders. That's inclusive of those who identify as psychiatric survivors, consumers, or peers, family members, providers of mental health services, and of course providers of our overall broader healthcare system. And the charge that we are responding to today to kind of build off the great information in that report is to work towards the articulation of a common long-term vision of integration of mental health services within a comprehensive and holistic healthcare system. And that is the work that we're doing today, building out of that report, tapping into the wisdom of communities to ensure that as we move forward with something more detailed and concrete that your voices are heard. In terms of some of the action that we're taking on, we think that now is really the time that we can strategically align around a common 10-year vision for our remontmental health system of care. And we need to articulate what that end state looks like. Because if we don't know our end state, then it's hard to know what our first step should be to get there. And then we might end up inadvertently falling into the trap of implementing band-aids and quick fixes, and those can actually get in the way of achieving some of the long-term solutions that we really hope for in our mental health system of care. So essentially, we know what we should do, but we never really feel like we get there. And I think that if we can come together around that long-term vision, articulate that end state, what are the short-term, mid-term, long-term actions and strategies that it's going to take to get there, then we really can achieve a system for remontors that will really meet their needs and advance our system forward. One of the next steps after our work is done, after we have conducted all of these listening tours, this is number four in a series of five. Again, wanting to ensure that the voice of community members and our partners is really infused in this work. We'll be pulling together a think tank that will have the daunting job of kind of synthesizing all of the data from the report, the themes and ideas that are generated in the listening tour, and then synthesizing that into an actionable blueprint for the future of our mental health system in Vermont. This is just a little bit of a visual timeline of the work that we're embarking on, the community forums that we're conducting right now across the state. The think tank will be convening between September and December, and then we'll be presenting the report and blueprint to the legislature in January of 2020. When we were embarking on this journey at the department, we knew that it would take an innovative framework to really hold this work, particularly as we're thinking about broader systems change. And we found what I think is the perfect framework for this work, which is appreciative inquiry. So forget everything you learned in Change Management 101. People and systems is problems to be solved. That kind of can get us on an exhausting treadmill of deficit based thinking and get in the way of real innovation and opportunity. Appreciative inquiry really focuses on leveraging our core system strengths. Our strengths as a community where we've had periods of excellence in the system of care and how do we build on those and create opportunities for innovation. That doesn't mean we can't acknowledge what hasn't worked. Whether you're an individual who has had a very challenging, difficult experience in the system, a family member who has watched your loved one fall through the cracks of the system, an agency leader who has stayed up late at night just trying to make the numbers work, we understand that there are many challenges in the system. The key is to articulate what hasn't worked and then allow us to understand what would have made it different. How can we take that experience from here to here? Because that's the real catalyst for change and that's what we can build on to move our system forward. The other thing to remember is that appreciative inquiry is not a top-down approach. It's a whole system in the room approach. Meaning that we want all stakeholders to be contributing their voices to this work. We know we can't create the future of our mental health system of Vermont in a vacuum, which is essentially why we've convened you all here today. And a little bit just about the appreciative inquiry process. There are five Ds, if you will, or domains of appreciative inquiry. The first one is really defining the topic of inquiry. What does the system want more of? And that was essentially defined by Act 200, Section 9, and the report that we did. And the discovery and dreaming is what we're focused on here today. From a discovery standpoint, it's a way of articulating what works, remembering our community successes, where we've excelled as a system and felt like there were periods of excellence. And then dreaming is imagining how we build on those experiences and strengths and then move them forward into a future system. The design will be the work of the think tank to try, as I said, to synthesize those facts and data and ideas and themes into that actionable blueprint, essentially taking the best of what is, bringing it together with the best of what could be to essentially create the ideal. And then delivery and deployment is really our implementation. So how do we take this blueprint and implement it in our state system and follow through? Now I put this slide up here. It says I'm sure that hole isn't in our end. Because I think at different times we've all felt this way in our system of care, depending on the seat that we sit in. But I think we all recognize that we are truly in the same boat. And sometimes I think we think that our best way to serve our system is to optimize our apartment. And that's important, but we also have to optimize the relationships between the parts to get the outcomes that we're after. And that requires us to work in a spirit of collaboration together, always recognizing that systems change truly moves at the speed of trust. So alternatively, we can think about a statement of common purpose where we're all pulling together as a system of care, playing to each other's strengths, and recognizing that it is truly the diversity of our perspectives that is our greatest strength. And we can't let grappling with these tough questions derail us from moving forward together. But it's going to take time, patience, trust, and iterative change to achieve the very best mental health system and that we're all responsible and accountable for the success of the future of our mental health system in Vermont. Just shifting a little bit to talk about our afternoon agenda, we'll be moving into our first activity, which we call inquiry, which is really getting at that discovery and dreaming and building on our strengths. And again, we also want to hear what are those challenge areas from your perspective and help us understand what would improve that experience to really drive that catalyst for change. We'll be taking a break. Then we'll be moving into the visioning activity and perhaps your groups might be getting into some thinking about implementation and then wrap up in next steps. And now I'm going to turn it over Kathy Hensie, who is our director of healthcare and mental health integration. So welcome, Kathy. Thank you. Yes. Good afternoon, everybody. Thank you for being here, especially at such a gorgeous day. So as Sarah mentioned, this is the fourth of five of these missed sessions. We started out June 18th in Rutland. Then July 23rd here in St. Johnsbury. Last week we were in Burlington. Today we're here. And next week we go to Brattleboro. At each place we're having an afternoon session and an evening session trying to make sure that people can come in if they can't get here during work in the evening around that. We've had some really, really good turnout. It's really exciting for us to hear the conversation at these gatherings. We're compiling a lot of notes as Sarah mentioned and we'll be going through those. It's been quite an experience. And I'm looking forward to today and next week as well. So this is our current vision. The Department of Mental Health's current vision, that mental health is a cornerstone of health, that Vermonters live in care of communities with compassion for and determination to respond effectively and respectfully to the mental health needs of all citizens. That Vermonters have access to effective prevention, early intervention and mental health treatment and supports as needed to live, work, learn and participate fully in their communities. Now I think unfortunately we can all agree we're not here. We don't have this. It is a vision for the future. And that's what we're really, that's what we want, your help. And the vision may well change. It probably will change as a result of this process, but we're aspects of it anyway. And this is what you're helping us to design. So this is a pretty old question I think. It's the glass half full or half empty. So this is, I wanted to say a little bit more about what Sarah talked about with appreciative inquiry and why we're using this framework. You could just feel like that's just so you don't have to hear about the challenges or problems that we've run into in the system. And that's not the pace. We want to hear those things. There will be many opportunities this afternoon for you to voice concerns and tell us about issues that you've had. We're also very open to after this if you want to send in written comments or how that might work for you. What we will ask you to do though today is when you name, if you name a concern or a problem we will ask you to then, as Sarah mentioned, say, how do you see, how could that be better? What could we do to make that better? And are there existing strengths that you can think of that we could build on that would help us solve that problem? It's really important that we do think about the existing strengths in the system today because that is, again, the science around change tells us that when you build on what's working it both builds energy and inspiration and you can get this working better and then you can still work on those problems to solve them but you get all the momentum here on what's working and on building on that. So the science behind this, creating the frame of mind really goes to a negative versus a positive frame of mind and the research shows that if you, like say you start your day out you either receive bad news or maybe you have a conflict with a partner or a child and you get into a negative frame of mind. The research tells us that it takes eight to nine hours on average to move out of that negative frame of mind. That we're trying, it's all about survival we want to ensure if there's a problem that we get that fixed so that it doesn't harm us. So you can see why we're really trying to get this in a positive frame so that we can move forward as a constructive way to build. So do feel free to tell us some concerns and problems and then if we can all talk about and how could we fix that going forward that will be really helpful. So to do this, what I'd like to do now is to ask you to think about an outstanding experience and maybe I'll just go back on this for a minute. So again, this is very transparently to get us all into a positive frame of mind. I'm going to ask you to think about a neutral non-mental health related experience. I mean if that's what comes to mind an outstanding experience that'd be great but it doesn't have to be just a neutral customer experience customer service experience so we're thinking about something relational. And what I think of whenever I think about an outstanding experience recently for an example is recently I stopped on my way to work at a place I'd never been in before for a cup of coffee so I didn't know anyone in there and I went in, it was self-serve I filled up my travel month with coffee and put half and half in it and I walked up to the counter to pay and I realized I didn't have my wallet. So of course immediately I was completely embarrassed and felt really flustered. The cashier said oh that's fine it's on the house, have a great day and you know I was very surprised but for me I really found that an outstanding experience. One, the cashier gave me the benefit of the doubt she assumed I'd made an honest mistake she could have assumed that I'd done it on purpose but that's not where she went she assumed I'd made an honest mistake she responded with generosity and kindness and then I left there just filled with this feeling of generosity and kindness you know it set up my day that way and I think many of you who work in the mental health field you may recognize those points as those are primary ingredients of a trauma-informed system you give people the benefit of the doubt to assume the best and then you treat them with generosity and kindness so we're going to work with that in a minute but first what I'd like to do is to ask you each to just take like 30 seconds and does an outstanding customer service experience jump to mine and then we'll just take a few minutes we're going to share that at your table so I'm really going to give you like 30 seconds to see if you can think of something your attention here and with an outstanding experience that's fine you can just share as a group if you're comfortable sharing your experience you can talk more about the example that I gave but if you've come up with an outstanding experience think about these questions what made it outstanding what wasn't about the person or persons who served you that made it outstanding what was your role in making it outstanding what was the result that you're having had that experience so we're asking these questions again thinking about we're going to translate this into mental health did it change your morning or your day did it change how you thought of those people in that place so go ahead and share your groups now I'll give you about five minutes to do that now this idea, this concept of an outstanding customer experience excuse me and points that could be brought over to the mental health system of care now I'd really like you to think about this and we're going to be asking you to do this the rest of this afternoon as you're going through these examples and discussing we'd like you to be as specific excuse me I've got a dry spot in my throat excuse me we'd like you to be as specific and some detail as possible so like with these outstanding customer experiences there's a whole realm of work that goes on around mental health everything, prevention, promotion treatment, recovery that you could say well that doesn't have to do customer experience it's what's happening in the office supporting that well that's a really excellent point how do you get excellent customer service how do you get frontline staff service providers anyone out in the field consistently providing outstanding service that doesn't happen by chance there's a whole lot of work that goes on behind in a system that provides outstanding service and it's everything from consistent and excellent training to a whole culture that is set by leadership that cashier who waited on me she knew that she could easily say take a cup of coffee on the house and there wasn't going to be any problem for her and her reaction was immediate she didn't have to think about that she really had support to treat customers really well so it goes way beyond that initial surface thing that you see and I'd really like you to think about that as we start to work in the small groups and your facilitators have worksheets we've got questions it's to guide it shouldn't limit you at all if that's not where you want to go with it and you've got other ideas that will be welcomed but as we dig into this if you can really just keep asking questions try to go deeper, try to go deeper this was this great experience well how, how does that happen what is behind that, how do you get to that and yes at some point you're going to come down to oh funding there's got to be you've got to have enough staff to have staff not be completely stressed out and getting angry with people they need to feel that they've got time to do their job and do it well well how do you get enough staff you have to have funds to support that staff so please as you talk about this really think about it in those terms to go further so what questions do you have as I say your facilitators can work with you if you think about that outstanding experience the points that you named how could that translate how does it translate into the mental health system of care and then your facilitators will help draw you along from there so we've got just about an hour that we're going to spend on this so really dive in and be specific please and please be thinking about current strengths in the system that we can build on thank you