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Setting the Table for Collaboration Across Community Settings

December 5, 2013

As the proud mom of an adult son with schizophrenia and an addiction history, who has received fragmented services in the Contra Costa Public Health System for 14 years, I have dreamed of a health system that will provide continuous, compassionate, integrated medical and recovery care for my son. Because of my son’s co-occurring illnesses he is at risk of dying 25 years younger than the healthy population. A whole health system is what he needs to save his life.

My dream is to help build our public system into a seamless continuum of health services that will improve the health and care experience for my son, my family and my community. I have found that to be a common dream shared by many who live and work in Contra Costa. However, I have often found that adversarial stances and territorialism interfere with improvement opportunities.

Though intentions are honorable, personal agendas and system-focused agendas prevent authentic dialogue about what it is like to experience care and provide care in a very broken system. The fear of retaliation is real for patients, families and providers of health services. Thus, we don’t often hear the negative experiences expressed in meetings. Fear and anger creates distrust. All of these tensions have been present in stakeholder meetings in Contra Costa County. They have often locked us in competitive battles that stop us from realizing our vision and mission.

In the summer of 2012 I joined a small group of consumers, family members and providers who were determined to create a process that would allow for diverse perspectives to be heard in a safe, protected environment where we could discuss system gaps and barriers with the intent to create action plans for change. A Community Planning Partnership was created with a goal for driving change from the front line perspective of receiving and providing care.

The hypothesis of the Living Room Conversation Project of Contra Costa County is that we can change from a fear and anger based relationship to an empowered, respectful dialogue as partners in community health if we provide an opportunity for safe and respectful, learning about the patient and family experience. The intent was to outreach across the system from the hospital to the health centers to the community. We included psychiatric, mental health, homeless, Alcohol and Other Drugs, several community based organizations and consumer and family members with lived experience.
The planning partners used the Living Room Conversations model, adapting the structure to better fit the needs of this community. We called it a Community Living Room Conversation. (Living Room Conversations are an open source project that welcome this kind of use. )
Recognizing that the access and care experiences will vary based on racial, ethnic, language and socio economic disparities, our planning team felt that it was critical to go into each unique region of our county ‘s culture to engage in a community, human, gut level sharing.

The first conversation occurred in March of 2013 in the central part of our county at Mental Health Consumer Concerns. On October 17th we held the second test of the Community Living Room Conversation pilot project in Richmond, California at Rubicon, a long time community provider. This second conversation included the leaders of our CCC Health system, Dr. William Walker, Health Services Director, Anna Roth, CEO of Contra Costa Regional Medical Center, Health Centers and Detention Health and Cynthia Belon, Director Behavioral Health.

These health leaders were asked to just introduce themselves as Bill, Anna and Cynthia. They joined the circles but just to listen. Their experiences were communicated to the group during the partnership building after session. They described the profound privilege to “listen and learn” and the difference in “listening and hearing.” It was discussed how hearing is a physical sensation but listening touches the heart.

The community partners will review the evaluations from these first two Community Living Room Conversation tests and continue to make improvements to the model. We plan to host a third Community Living Room Conversation in East Contra Costa County in early 2014. We are also adapting the tools to Spanish and will consider adding law enforcement partners to our team.

The Community Living Room Conversation model allows for deep hearing of the human experience. It strips away titles and allows for a level community playing field to serve as an innovative lab for system improvements. These conversations are an opportunity to get real, build trust and bust silos. If we want to transform healthcare in America we have to get comfortable with being uncomfortable and learn from other perspectives. We are doing that in Contra Costa.

“For those who have no home or living room, we will create a Community Living Room to welcome all to share and learn. For those who have no family or a mom who still dreams of recovery, we will create a Community Living Room to build community dreams, hope and health.” Teresa Pasquini, mom

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