Taking the LEAD in empowering staff to act locally

Randy Stith, PhD, executive director of the Aurora Mental Health Center, is shown at the Colorado State Capitol with (l to r) state Rep. Nancy Todd; Heather Dolan-Jackson, executive director of Providers' Resource Clearinghouse; and Sarah Poffel, coordinator of child medical services at Aurora Mental Health Center. Photographer: Povy Kendal Atchison
Retaining staff is one of the greatest challenges for any community mental health center (CMHC). Stressful cases, emotional burnout, and an increasing number of cases per caregiver have led to an alarmingly high employee turnover rate. For the Aurora Mental Health Center in Aurora, Colorado, the attrition rate has been as high as 30% for one year (and many CMHCs have rates much higher than this). Add to this challenge the aging workforce, the large number of executives poised to retire in the near future, and a shortage of funds for expensive employee-training programs—it's hard to see how this situation can change anytime soon.

Yet overcoming this hurdle is critical to providing successful treatment for clients suffering from all types of mental illness. A lack of caregiver continuity can significantly impact outcomes, as it is difficult to establish the client/caregiver trust and respect necessary to achieve long-term results. Positive outcomes heavily rely on relationships that cannot be easily replaced or transferred to another practitioner, making the need to resolve staff attrition even more critical.

Our Response

To combat staff turnover, CMHCs have to be creative in providing aspiring opportunities for their staff. Much like we do with our clients, we have to instill hope, the realization of dreams, and a sense of achievement and self-worth or self-actualization among employees at all levels. This was Aurora Mental Health Center's mission when we developed the Leadership, Entrepreneurship, And Development (LEAD) program in 2001.

We created LEAD to improve employee satisfaction, enhance continuity of care, and provide opportunities for staff at all levels to develop their leadership and entrepreneurial skills. We intended to develop community mental healthcare leaders by helping employees develop their entrepreneurial spirit and thus take ownership of improving the Center, enhancing our care, and better serving our community.

LEAD was inspired partially by leadership programs developed by Quinco Behavioral Health Systems in Indiana and the Aurora, Colorado, Chamber of Commerce. LEAD gives people the opportunity to “stretch” and aims to:

• empower and educate employees through experiential learning;

• enhance retention of valued employees;

• facilitate the promotion of qualified individuals committed to the organization's success;

• train staff to be future leaders;

• give employees a closer perspective of the Center's mission, values, and goals;

• enable employees to better understand the Center's role in the community and how it shapes healthcare policy throughout Colorado; and

• increase internal communication and collaboration.

How LEAD Works

For each LEAD class we have a long list of applicants from all areas of our business: psychologists, psychiatrists, nurses, social workers, case managers, administrative support staff, insurance specialists, facility and maintenance employees, and so on. Participants are selected through an application and interviewing process conducted by LEAD graduates, and about 12 people are selected for each class.

The program starts with a three-day retreat at a hotel that focuses on team building. During the next five months the team learns to identify challenges, solve problems, and collaborate across service lines. The LEAD class meets twice a month to complete the various training modules, which include:

• personality type and lead-ership skills assessments;

• conflict negotiation;

• change management;

• project planning and management;

• financial management;

• building and maintaining good team morale;

• supervisory skills;

• negotiation skills; and

• volunteerism.

Each session is run by a volunteer committee, which consists primarily of LEAD graduates. LEAD program participants complete a required reading assignment and attend statewide meetings of organizations that have a significant impact on mental healthcare and related issues. For example, Sarah Poffel, coordinator of child medical services, and other members of the 2008 LEAD class recently attended the Colorado Behavioral Healthcare Council's annual Day at the Capitol and met with Rep. Nancy Todd, who represents our area in the state legislature. They were joined by Heather Dolan-Jackson, executive director of Providers' Resource Clearinghouse and the original LEAD Development Committee chair. Each LEAD class also completes a capstone project (see sidebar for examples).

Because one of the program's goals is to develop community leaders from the Center as well as other organizations, much of our curriculum involves the community. For example, for our leadership training component we bring in community leaders (such as police officers, city council members, state senators and representatives, and successful business leaders) to share insights, techniques, and experiences.

Results

So far 68 staff members have graduated from LEAD. The program's main expense is employee time, which is easily justified by the capstone projects' results.

In just a few years the LEAD program has become the core of our culture. The program is a fulfilling and rewarding experience for our employees that keeps their passion and commitment to mental healthcare strong. Since we have implemented LEAD, our turnover rate has declined to 18% in 2007, and we feel that the change in culture LEAD promotes has contributed to an increase in staff retention.

The LEAD program has many intrinsic benefits that one can't put a price on, including increased employee satisfaction, higher morale, more staff innovation (among both clinical and administrative positions), and the increased ability to develop strong leaders. With all the challenges we face (such as managed care, limited resources, the stigma clients face), it can be difficult to stay focused, yet the LEAD program reaffirms our decisions to pursue careers in mental healthcare.

The LEAD program has received praise from both national and local organizations (see sidebar). Once all of our approximately 400 employees have had the opportunity to attend the LEAD program, we intend to open it up to employees of other community organizations, including CMHCs.

The LEAD program is not just another staff training or leadership program for other CMHCs to follow. It is the type of program CMHCs must implement for our organizations to survive into the future and, thankfully, others are creating similar programs (for example, see Behavioral Healthcare, January 2008, page 14). CMHCs nationwide must lead their staffs forward, providing them the inspiration, personal fulfillment, and realization of dreams to allow them to better serve their clients and communities. In doing so we can recapture the energy, spirit, and passion that was associated with the beginning of the community mental health center movement in the 1960s.

Sidebar

Praise for LEAD

The Colorado Behavioral Healthcare Council awarded Aurora Mental Health Center its 2007 Golden Abacus Award for the LEAD program. In congratulating the Center, Colorado First Lady Jeannie Ritter said, “Coloradoans should be very proud that we have one of the most forward thinking, effective community mental health centers in the United States. We are facing some very real challenges in Colorado, but with all of our centers working together and continuously improving their services, and with the leadership and innovation shown by the Aurora Mental Health Center, we are making the strides we need for continued excellence and recovery.”

In September 2007, the Annapolis Coalition on the Behavioral Health Workforce also praised the LEAD program. “Our coalition reviewed numerous employee training programs nationwide for best practices that can be shared to benefit mental health centers everywhere,” said Gail Stuart, PhD, chair of the Annapolis Coalition's Board of Directors. “The Aurora Mental Health Center's LEAD program excelled in all areas and truly sets a new standard for our profession. We congratulate them on this superior accomplishment and for the care they provide their community.”

Sidebar

Comments From LEAD Graduates

Frances Grant, Grant/Contract Administrator

“I attended the LEAD class in 2004. Originally it was just to understand the agency better. What I got out of the class was so much more. I really got a better understanding of my own leadership style, how to better communicate with people whose styles are very different from my own.

“One of the biggest things I took away from the experience was a willingness to get involved. Prior to LEAD I did not believe I had the skills or courage to get out of my own comfort zone. Since attending this program I have been promoted to a position that I basically had to create from the bottom up. I have chaired the LEAD program for two years. I am involved with a few of our other committees now (Inclusiveness Committee, Faith-Based, etc.). I am not afraid to try something new.

“It also gave me the courage to reach out within my own community. I have become a leader both in my community as well as my job. Even though I don't hold a management position I learned how to be a leader within my team from my experience with LEAD.”

Mike Tapp, Program Manager, Emergency Services

“As a participant in the first Aurora Mental Health LEAD class in 2002, I experienced both professional and personal insight like no other time in my career. The LEAD program was instrumental in forming working relationships and a model of collaborative sharing across teams, cultures, and divisions in our agency. Likewise, the curriculum was a unique opportunity to learn the ‘back story,’ the dreams and the ultimate history forged by those who served our clients before us.”

Photographer: Povy Kendal Atchison. The 2008 LEAD class

Sheryl Stefaniak, MD, Associate Medical Director, Children's Division

“I graduated from the LEAD class in 2006. LEAD taught me how to more effectively manage people with different personality types. There are always certain folks who one can use more practice managing! It allowed me to meet people from other departments of the Center who I would not have met otherwise, and I have still maintained these friendships to this day. The program also helped me to understand how the various parts of our company interrelate, as each of us tends to get somewhat isolated in our specific, daily jobs and can easily lose sight of the BIG picture of the whole company. This overall view is quite useful in knowing who I should talk to when something in particular needs to get done, which saves time and serves our clients better. I am very glad to have participated in the LEAD program, and it has served as a springboard for me to other leadership opportunities.”

Sidebar

Examples of LEAD Capstone Projects

Child Trauma Assessment

This project created a simple acute trauma assessment tool for children under 18 years old to be used by first responders, including fire departments, police departments, and the Red Cross. The Aurora Police Department will start using this tool this year.

Measuring Recovery

This project was developed to create guidelines for determining clients' progress in their recovery efforts. Program managers studied a client population to identify common attributes resulting in recovery, which became the basis for measurement tools that the research and statistics department are adopting this year.

Capacity and Revenue

This project was created to increase capacity while continuing to drive down costs to allow the Center to serve more members of the community. The team interviewed each program manager and summarized how each program could make an impact. This project began as a cultural shift within the organization, empowering each program manager to take responsibility at a program level to have a Center-wide impact.

Programs continue to improve clients' options and constantly look for potential revenue sources, such as grants and community contracts. Goals have been established for the next four years for each program. This project has allowed the Center to increase the number of people it serves: 4% more clients were helped in the most recently completed fiscal year than in the year prior, but the operations budget increased by only 1.5%.

Randy Stith, PhD, has been the Executive Director of the Aurora Mental Health Center for the past 30 years. Under his leadership the Center has grown from one small office in Aurora, Colorado, to eight large offices and five residential facilities, with 400 staff and a $20 million budget. The Center is a member of the National Council for Community Behavioral Healthcare and the Mental Health Corporations of America. Dr. Stith was awarded the National Council's Lifetime Achievement Award in 2003 and the Distinguished Service Award from the National Council's Region VIII in 2001. He was named the Aurora Chamber of Commerce's Man of the Year in 1993. He has participated in international mental health conferences in Canada, China, Egypt, England, New Zealand, and South Africa. For more information, contact Dr. Stith at randystith@aumhc.org or visit https://www.aumhc.org.