Valley Behavioral HealthValley Behavioral Health

By Gary Larcenaire

Feel that? It’s Your Culture: Synchronous Resonance

Gary Larcenaire, CEO Valley Behavioral Health

I found two definitions of “resonance” with a simple Google search that reveal the secret of cultural
transformation. Musicians are trained early to recognize rhythm, tempo, and reverberation. As a
musician, I have come to understand corporate cultures in these terms. Listen closely when you
experience your favorite business. You will sense a tempo, a beat, a rhythm that resonates with
you favorably.

res·o·nance/noun 1. the quality in a
sound of being deep, full, and
reverberating.”the resonance of voice”

The first definition points to something critical in the establishment of corporate resonance and
that is: “voice”. Voice, to me is the internal narrative that finds its tempo and rhythm only in a
genuine establishment of non-negotiable core values.

2. PHYSICS the reinforcement or prolongation of sound by reflection from a surface or by the
synchronous vibration of a neighboring object.

The second definition contains three key words:”reinforcement, prolongation, and synchronous”.

These are essential ingredients for resonance to occur. Core values must be reinforced through the
referendum of hiring, training, promotion and termination daily over a prolonged period. Only then
will the echo effect begin to take hold and once resonance begins, it is hard to stop.

Synchronous resonance begins to take on an effect and power all its own which transcends the
personalities and efforts of literally anyone in an organization. And then, the magic occurs. Nearly
unstoppable. Goals are met with minimal effort and metrics seem to align themselves.

Have you experienced synchronous resonance in a company you worked for? Frequented?
Tell me about it.

I look forward to discussing this more in person soon.


By Gary Larcenaire

Results-Oriented Behavioral Health

Gary Larcenaire, CEO Valley Behavioral Health


Public behavioral health is a poorly understood and complicated field; every aspect really. The way
we communicate about the benefits of investing in our service array can’t be. There is too much at
Effective behavioral health service systems prevent very expensive things from happening.
Our systems of care keep behavioral health patients out of expensive places where the benefits to
patient and society are questionable: emergency rooms, jails, court rooms, inpatient hospitals.
Of course we ease suffering and improve peoples lives, but those things are very difficult to quantify
and may hurt our credibility when negotiating, if emphasized too heavily.
The reduction of strain on those resources listed, IS the ultimate measure of our value when it comes
to appropriations, and managed-care contracting.
A clinical dash board that ignores the relative strain of those resources is incomplete and weakens
our ability to quantify our value.
I look forward to meeting and discussing the ways that we can improve the marketing of our
cost-savings outcomes together at our next meeting!
Gary Larcenaire

By Gary Larcenaire

Five Reasons Your Company Won’t Survive Significant Change

Gary Larcenaire, CEO Valley Behavioral Health

1. Message transmit speed and saturation not measured

If your executive management team designated Tuesdays as “green t-shirt day” how many Tuesdays would pass before employee participation reached 100%?

This example seems simple enough but one very critical assumption is built into this example: That you have a process of tracking “T-shirt Tuesday participation” over time.

In order for a group to evidence that communication occurred, a specified change in behavior must be observed and measured.

Organizations fail when they fail to adapt. Positive adaptation is a product of clean and efficient communication. Without a formal process to measure and improve message transmission efficiency, your company will be at a significant disadvantage, will inevitably fall behind and may gradually fail.

I recommend you establish a process whereby message saturation and duration can be tested a few times annually. Make it fun! At Valley, we recently challenged Program Directors to disseminate a survey link to all staff in their units. We set up a process and informed Directors that once an employee completed their three-question survey, a set of warm clothes would be donated to our homeless services unit on their behalf.

We then tracked how long it took each unit to reach 100% survey completion. Sure, many of the larger units never did reach 100%, but it did establish a baseline. A baseline each Director has vowed to beat next time.

At Valley, we are developing innovative ways to empirically track communication efficiency and are developing organizational designs which minimize message attenuation.

The attenuation graph is an example of a visual representation of percent loss of message as time or layers of bureaucracy are added. Developing and sharing this visualization of message loss can be a powerful educational tool.

2. Message distortion levels not measured

If your executive management team designated Tuesdays as “green t-shirt day” how many employees would show up wearing blue, black, or sea foam (a shade of green, but not “true” green) shirts? 

Message saturation and duration testing, as we have learned, is critical, but how many times are messages transmitted, only to be received in a distorted form?

Inflection adjustment, sarcasm use, or simple lack of clarity in message transmission can result in the wrong behavioral change. This distortion can be more damaging than a team not getting a message at all. We borrowed again from the science of sound, and refer to this as the signal to noise ratio.

The science of sound has developed methods of measuring sound absorption and dissipation and distortion. We are borrowing heavily from this science as we adapt their learning to our organizational learning and adaptation.

We are borrowing heavily from the “science of sound” as we measure and redesign our communication systems.

3. Staff training curriculum and processes not dynamic

Staff training curriculum not “dynamically” influenced by the most recent set of performance metrics will inevitably become stale and useless. Whether training on compliance, clinical outcomes, customer satisfaction, or budget performance, the foundation of effective training, organizational learning and adaptation is the incorporation of current performance metrics. Incorporation of most recent performance data into training materials, combined with experiential learning methods can produce the Holy Grail of training: dynamic knowledge.

Dynamic knowledge steps beyond just “know about” and steps into performance. It is actually doing something with the information, working with it, building skills and understanding on a deeper level.

Dynamic knowledge is to gain a feel for something, to internalize information and have it become real and active in the learner’s world.

Minimizing attenuation and signal to noise ratio isn’t enough. New and existing staff must be trained routinely as new information is discovered or process requirements change. Training must result in dynamic knowledge and the existence of dynamic knowledge must be measured.

4. Lack of prompt “business critical” feedback loops 

Feedback loops are a critical component for organizational learning and adaptation to occur. Single loop learning processes at a minimum must be established so that dynamic training and knowledge acquisition can develop and spread.

Double loop learning and even triple loop processes can be developed over time as team sophistication grows.

Failure to institutionalize learning will compromise organizational agility and adaptation.

By combining the sciences of sound, cutting edge education and organizational theory, a company can move a long way toward becoming a force of adaptation and innovation. But without developing a common language, the true realization of synergy from these concepts will remain elusive.

5. Failure to establish a common performance language

The concepts touched on in this blog must be uniformly defined shared and understood. Leadership must make certain that words and concepts like:

  • Attenuation
  • Message Saturation and Duration Testing
  • Signal to Noise Ratio
  • Dynamic Knowledge
  • Dynamic Curriculum
  • Experiential Learning
  • Loop Learning

are taught at New Employee Orientation and leadership training to ensure that they become routine nomenclature within the culture of the company.


Use the five points listed above as the baseline of an assessment for your company or department. Work to develop your understanding of what is in place and what isn’t. Then act.

You could even start with using your traditional communication channels to launch and monitor a message push similar to “T-Shirt Tuesday”. Let me know what you come up with! I hope this has been helpful. I look forward to our next meeting together.

By Gary Larcenaire

We were active in 2016!

Gary Larcenaire, CEO Valley Behavioral Health

Our Information Technology infrastructure is undergoing a complete refresh which will be completed in the summer of 2017. With the collaboration and support of our many community partners, we have strengthened and expanded services. We added several participating schools to our “on site” counseling program bringing us to 54 schools in 3 counties and we added Tooele as a partner as well! We co-sponsored a community needs assessment with Summit County and were named “Community Partner of the Year” by Canyon’s School District. We have rebuilt our Billing Department to ensure a much more sophisticated commercial insurance collections design. We implemented a community-based treatment program for children and families challenged with the learning barriers that accompany an autism diagnosis. Our marketing and social media initiatives are “on fleek” (look it up or ask a millennial). We fully launched “Slack” an internal communication software that has enhanced communication significantly. After extensive need analysis, we launched a major, state of the art clinic in West Valley. We started a dual executive coaching series to improve the managerial skills across all programs. Our “inspired by helping others” culture donated thousands of dollars in food and school supplies to needy families and cold weather gear to 700 homeless individuals. Valley’s Wellness Program “ValleyFit” is one of the most innovative in the industry and still getting better. We are getting stronger every day and every year. We have changed the way we hire and are reinforcing the culture with every new hire we onboard. Our “communication saturation” initiative and expansive leadership development series will enhance the speed of adaptation and will ensure that Valley and its affiliated brands not only survive, but thrive in the years ahead.

We could not have done all of this without our stakeholders, community partners, our engaged Board of Trustees and our amazing dedicated employees! We thank you all for a great year.

If you want to keep up with what’s happening at Valley, check it out our Facebook, ValleyCares.Com and


By Dr. Todd Thatcher

Living With Anxiety

B. Todd Thatcher, DO, CMRO Chief Medical Officer

Worry, worry, worry. Fear, fear, fear. Panic, panic, panic. Dread, dread, dread. Got your attention? Hard to say all those words three times quickly? Try living with those emotions on a daily basis. Along with them go physical symptoms like chest pain, shortness of breath, sweating, rapid pulse, nausea, diarrhea, and dry mouth. People suffering from anxiety problems often feel like their mind and body are out of control. Like they’re stuck on an unpleasant amusement park ride from which there is no escape.

According to the National Institute of Mental Health, approximately 18% of adults in the United States suffer from an anxiety disorder. That’s 40 million Americans. Adolescents ages 13 to 18 have a 25% rate for anxiety, and 5% for severe anxiety. As many as 80% of adolescents, and 33% of adults either don’t know they have an anxiety problem or don’t get help. That is not acceptable because behavioral health has good treatments for anxiety.

You may be asking yourself, “How is it possible for someone to have an anxiety disorder and not know it?” That’s a great question with a very reasonable answer…they think the symptoms are either a normal part of being a human being or caused by some other medical problem. The Anxiety and Depression Association of America and Journal of Clinical Psychiatry reported in 1999 that people with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. The Journal of the American Medical Association recently reported that about 8% of all ER visits are because of mental health problems, and about 60% of those are because of anxiety and depression. Just start asking around. You’ll be surprised how many people in your social circle have been to the ER with chest pain later diagnosed as anxiety, or know someone who has. If you know someone who works in an emergency room they’ll have lots of stories.

It important to understand that anxiety disorders are extreme forms of normal brain-body-behavior when faced with threatening situations. Your brain constantly scans your environment for threats and quickly acts if a threat is perceived. You feel fear, which heightens your senses and makes you want to fight or flee to escape the danger. There is no logical thought with this part of the brain, only emotions. To think through your feelings, the front part of your brain kicks in. It will either confirm the emotions as real, or help you fight or escape, or decide the threat is not real and start calming you down. It really is a wonderful system.

However, like any complicated system, things can go wrong. Remember, that the anxiety disorders are extreme versions of normal anxiety responses. For example, when you go to bed at night, checking to make sure the door is locked is a good thing. You feel a little anxiety and fear that someone might come in and invade your home. Double checking the lock helps you to logically deal with the fear and you soon calm down and go to sleep. Now imagine if you couldn’t’ make that fear of home invasion go away. No matter how many times you checked the lock it didn’t help.

We all know how good it feels to wash our hands, especially after shaking the hand of someone who was just coughing a lot. We know that warm water and soap, kill and wash away the dangerous germs the other person coughed into their hand. Now imagine you can’t make the fear of getting sick go away no matter how many times you wash your hands.

Hopefully, you’re starting to see the problem from the perspective of people who suffer from anxiety. Maybe you are starting to think about your own anxiety feelings for the first time. If you think you have anxiety problems, or know someone who might get help. With all the treatment options available today, it’s unnecessary to suffer.

By Dr. Todd Thatcher

Attention Deficit Hyperactivity Disorder

B. Todd Thatcher, DO, CMRO Chief Medical Officer


October is National Attention Deficit Hyperactivity Disorder (ADHD) Month. As with any disorder, if we stop and consider SQUIRREL!!!! Now where was I? Most of you probably recognized this reference about distractibility from the movie UP. It may be funny on a movie screen, but it’s no laughing matter when it’s happening to you or someone your care about.

ADHD is a legitimate medical problem recognized by all national professional organizations, including the American Medical Association, and the American Psychiatric Association. Treatment is reimbursed by insurance companies and Medicaid. There are more than ten FDA-approved medications to reduce ADHD symptoms. Colleges and universities have well-established policies to accommodate students with ADHD so they can be successful in school. In short, ADHD is real and needs to be taken seriously.

According to Centers for Disease Control, approximately 8% of children ages 4-17 are currently diagnosed with ADHD. That’s 5.1 million children. Most (69%) are taking prescribed medications for the problem. However, ADHD doesn’t suddenly disappear when a child becomes an adult on their 18th birthday. The Anxiety and Depression Association of America reports that about 60% of children with ADHD become adults with ADHD. More striking is the estimation that only a small portion (20%) of adults with ADHD actually get a diagnosis and treatment.

Uncontrolled ADHD is devastating. Some striking outcomes found in various studies are:

· They are far less likely to enroll in a 4-year college.
· They are 11 times more likely to not enroll in any school vs. enrolling in a 4-year college.
· 50% attend vocational or junior colleges vs. 18% of the non-ADHD comparison group.
· 15% hold a 4-year degree compared to 48% of the control group.
· 0.06% held a graduate degree compared to 5.4% of the control group.· They are 11 times more likely to be unemployed and not in school.
· They are 4 times more likely to be in unskilled vs. clerical occupation, and 6 times more likely to be in unskilled vs. professional occupations.
· 61% more likely to have ever been fired, compared to 43% of the comparison group.
· 33% more likely to have ever been laid off, compared to 13% of the comparison group.
· 53% more likely to have ever quit a job due to dislike, compared to 36% of the comparison group.
· They earned close to $2 per hour less in wages than the comparison group.

Car accidents, criminal behavior, substance abuse, and divorces all carry higher rates for people with ADHD. The cumulative effect of the inability to pay attention and control impulses is remarkable.

What is ADHD? The front part of the brain helps us to focus and concentrate and control impulses. Dopamine, a brain chemical, helps this part of the brain to work properly. In some people, there isn’t enough dopamine and they are unable to focus and concentrate as well as other people.

Medications increase the amount of dopamine and stop the problem as long as they are taken. There are also effective treatments that don’t involve medications. These treatments primarily involve skill building like using notebooks, structured study times, and other regimented schedules. Career counseling can also be helpful to avoid choosing the wrong professions. For example, accounting typically requires focus and attention for hours at a time (probably not an optimal choice). People with ADHD are often bright and outgoing, so working in sales may be a great choice as scenery and work environment change a lot.

As with any other medical problem, there are do’s and don’ts when managing ADHD symptoms. Don’t use substances to “self-medicate.” Your problems will only get worse. Do get professional help and assistance. At Valley Behavioral Health we have specially trained therapists and prescribers ready to assist you or your loved ones. Don’t wait any longer. Get help today, let’s deal with it together.

By Dr. Todd Thatcher

Recovery Awareness Month

B. Todd Thatcher, DO, CMRO, Chief Medical Officer

“It is what it is.” How many times have we heard or used that phrase? It is baked into the American language. In a few short words, we accept that we can’t always control what happens to us, and that is a fact of life. However, we can finish by saying, “…but what it becomes is up to me.” Nobody wakes up in the morning wanting to have mental illness. It just happens, but what you do with it, is up to you.

Can you recover from mental illness? The resounding answer is yes. September is National Recovery Month, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). It has been a time to stop and consider the resilience of the human body, mind, and spirit. Mental illness may happen to you, but it doesn’t have to rule your life. You can make steps today towards recovery.

There is hope.

Many people with mental illness feel like they are broken human beings.”

They lose sight of the fact that they are more than their mental illness. As a psychiatrist, I practice and teach that even in the most severe cases, people with mental illness are more than 99% normal. They are just like everybody else. Voices may cause you to fear the world, but your eyes, ears and mouth work normally. Depression may sap your energy and zest for life, but your heart and lungs are normal. Anxiety may make you feel out of control of your emotions, but your legs, muscles, and bones are normal. I have never met someone with mental illness that didn’t have longings for comfort, love, acceptance, and companionship. You are more like the people around than you are different. Don’t let mental illness tell you otherwise. It will rob you of the motivation you need to recover.

Like any journey, you usually get farther faster if you have a good plan. Here are four important building blocks of recovery, courtesy of the United States Department of Health and Human Services

Health: Make informed, healthy choices that support physical and emotional wellbeing.
Identify and reduce sources of stress where possible.
Avoid drugs and alcohol. Many people “self-medicate” with these substances, but they will not help you recover. They will make things worse. There are many evidence-based treatment options available today to help you recover from substance abuse. Recovery is hard by yourself. Join with us to help you.

Home: Have a stable and safe place to live.
Home should be a place of refuge, support, and rest. If your home life causes problems for you, talk with mental health professionals. We can help you.

Purpose: Engage in meaningful daily activities, such as a job or school, volunteering, caring for your family, or being creative. Work for independence, income, and resources to participate in society.
I often ask my patients, “Why do you get up in the morning?” We humans are happiest when we have a purpose in life. If you are struggling to find one we can help. It is often a simple problem of not realizing all your options.

Community: Build relationships and social networks that provide support.
People are at greater risk for suicide when they feel detached from those around them. Good people often don’t know you need help. Take control of your recovery and reach out. You’ll be surprised how easy it can be to find a good friend. A professionally trained therapist can help you with how your brain thinks about things. A prescriber can help you with medications. Friends help you explore and share all the wonderful interests and aspects of yourself that are not part of your mental illness.

By Gary Larcenaire

Culture: Developing Modern Behavioral Health Leaders

Gary Larcenaire, CEO Valley Behavioral Health


The future of behavioral health is dynamic and full of opportunities to further improve quality of life and human health.  Machine learning, metadata availability, healthcare integration, and contracting challenges (to name a few) will require behavioral health companies to develop sophisticated, resilient leaders capable of positively leading change initiatives (while maintaining high levels of employee engagement and loyalty) at a pace we have never seen before.

“The future of behavioral health is dynamic and full of opportunities to further improve quality of life, and human health.”

Developing resilient leaders internally and rein
forcing our core values are crucial keys to our continued success. I am convinced that with the right leadership and culture, Valley Behavioral Health can more broadly lead and positively shape healthcare transformation and modernization for the next 30 years.

“changes underway will require behavioral health companies to produce sophisticated, resilient leaders, capable of positively leading change initiatives”

All of the behavioral health organizations I have worked for over 27 years have expressed value in “promoting from within” for leadership roles. However, none of these organizations had leadership development programs with curriculum founded upon a company-wide, formally adopted, unifying management philosophy. I am committed to changing that by taking some key steps in 2016-2017.

 “who you hire, fire, reward and promote provides the most visible referendum on adherence to core values”

In my experience, trying to influence a company culture, I had to always remember that who is hired, fired, rewarded and promoted provides the most visible referendum on your adherence to core values and strategic direction.
I also have learned that, as important as who stays, leaves, thrives and advances, is the management “feel” of the daily work environment. With culture in focus, once you have grounded  basic human resource practices to core values (completed! 2015-2016), next, we must ensure that leaders at all levels practice the same general management philosophy to gain a consistent work feel and brand experience.  We will work hard to reach this point over the next 12 months!

“next, make sure that leaders at all levels practice the same management philosophy.”

In my experience, if a standardized management philosophy is not formally incorporated into leadership-development tracks, and monitored, inconsistency will result and twist the most well-intentioned cultural initiatives into “tribal” variations ranging at worst from ‘nightmarish-toxic’ environments to at best ‘amazingly congruent’.  Of course, most departments will tend to fall somewhere
along that continuum.

Early in my career I found managers using the maladaptive “us vs administration” approach to produce what appears to be highly productive and cohesive teams, simultaneously fearful and resentful of administration.

Yes, creating a common enemy to rally a team around does work, but that common enemy needs to be “competitors, inefficiency, illness and poor outcomes”, not the senior leaders of the very company you work for!

I have seen these poorly trained leaders resist all efforts for central branding and congruence and want to be left alone to develop their tribe in isolation. Their teams do tend to be fiercely loyal to the local managers but will express extremely negative views about “leadership”. I have seen less of this at Valley, but we must remain vigilant that is doesn’t grow. It isn’t necessary and it creates damaging (gap widening) inconsistencies in the brand experience.

“Some (never trained) managers may use the maladaptive “us vs administration” to produce what appear to be highly productive and cohesive teams, simultaneously fearful and resentful of ‘administration'”


Anytime departments or programs develop a maladaptive cultural norm, it is attributable to leadership at the highest levels (C-Suite) because it is the result of a lack of a comprehensive leadership training and monitoring strategy I believe.

Frankly, I have found that more damage than improvement can result from the best intentions and investments of your executive team if inconsistent management styles are ignored to maintain “harmony” in the leadership ranks. Unifying philosophies are well-understood in the treatment world, this creates an opportunity!

Generally accepted practice guidelines and philosophies are not new to us in this industry.

In behavioral health we understand and embrace the concept of “philosophical underpinnings”  in the treatment realm.  We will use that “openness and familiarity to concept” to guide consistency in our leadership realm as well.

Imagine a highly-credentialed behavioral-health practitioner lacking a consistent approach to the therapeutic process, rooted in a credible philosophical orientation. Their treatment wouldn’t work very well and might even do more damage than good for clients in the end.

“Inconsistency can twist the most well-intentioned cultural initiatives into variations from ‘nightmarish toxic’ environments, to ‘amazingly congruent’.

Sure, a behavioral health leadership team may decide to select a “mall approach” by offering therapists with diverse philosophical orientations as a way to provide choices best aligned to patient preferences.

Conversely, that same practice could decide they were strictly a “Cognitive Behavioral Therapy” shop and only employ practitioners whose therapeutic approach is founded accordingly.  I suspect having several accepted treatment orientations within the same practice may not be ideal for many reasons, but it wouldn’t necessarily put the practice at risk of failure with the future we face, from a business perspective in my opinion.

I suspect having several accepted treatment orientations within the same practice may not be ideal for many reasons, but it wouldn’t necessarily put the practice at risk of failure from a business perspective in my view.

The same cannot be said of inconsistent management philosophies. I believe a “mall approach” to management philosophies (to each her own) within the same practice is anathema to creating a sustainable, healthy and productive work environment, congruent to core values and resilient to positive change.

If you are serious about reinforcing or adjusting your company culture, I suggest you join us in starting with the following steps:

1. Management team will review and choose a management theory and supplement it with authors and trainers whose views are congruent to our “philosophical underpinnings” and company core values.

2. A policy will be crafted, debated and approved expressing the philosophical orientation upon which management training, reward, promotion and evaluation will be founded. Leadership development curriculum will be adopted and deployed to shape current and future leaders toward the adopted approach.

3. Annual surveys and other processes (accountability partners, 360 reviews, stay interviews, etc) will be used regularly, and designed to measure any “congruence gap”.

4. Performance evaluations and training for leaders will be at least partially informed by “gap” feedback.

5. A “congruence gap analysis” will be reported to Board of Trustees annually and trended.

6. We will be patient, but not complacent, we will use data, deadlines and feedback loops to “course correct”.

I hope this has been helpful. Im excited with what we have already done (a lot!) and for this important initiative to kick off in September 2016.

Many thanks to the (too numerous to mention) authors and thought leaders that have influenced my views and approach to culture and leadership development.

Best, Gary

By Gary Larcenaire

Congruence in Behavioral Health: Core Values, and The Brand Experience “Two Step”

Gary Larcenaire, CEO Valley Behavioral Health



Enduring brands are those we trust, that fulfill a need, and resonate with us emotionally. In “behavioral health”–the umbrella term I use to include psychiatry, developmental disabilities, addiction, rehabilitation, counseling and social services–brand loyalty increases over time when “stakeholder” expectations and the brand experience are tightly aligned.

I use the word “stakeholders” here as opposed to “customers” because in not-for-profit behavioral health, there are so many individuals depending upon the service system, that the term “customer” is simply too narrow to do justice to the demands and expectations placed upon our (typically under-funded) service systems.

[Behavioral health practitioners, support staff, and administrators have to dance every bit as gracefully as everyone else, we just have to do it] “Backwards, and in [borrowed] heels”, Ginger Rogers
In behavioral health we certainly have “service recipients” or what other industries would call “customers”, but the broader range of “interested parties” in behavioral health may, at any time, include all three branches of government, a slew of payers and regulators, a host of family, friends, social and legal advocacy groups, and last but certainly not least: a highly-skilled, passionate, fiercely independent, (and scarce) work force.

Its one thing to mess up a fast food order. It is quite another to fall short when arranging thoughtful, collaboratively developed, patient-centered discharge planning.
I am not complaining about our broad stakeholder base; just stating a fact I have observed over nearly 30 years of service. Maybe I am minimizing the complexity of other fields, but I don’t think so.

I believe that behavioral health practitioners, support staff, and administrators have to dance every bit as gracefully as everyone else, we just have to do it in the famous words of Ginger Rogers: “Backwards, and in [borrowed] heels”. I, of course, added the bracketed content, but the quote fits the behavioral health field perfectly.

Congruence is very much possible to reach in the behavioral health field, but it is more challenging, and harder to measure than in other fields.
Marketing and branding serve to the provide visual and emotional reinforcement of what a brand stands for, and how we will all benefit from using those goods or services when we need them.

Study the picture above that I found online while researching this topic. We have all experienced the opposite of congruence. It is no fun. Few things are as disappointing as when a brand or product’s advertising campaign resonates with us, but the actual experience falls so short from the ideal, we are left feeling unfulfilled and slightly defrauded. Have you ever had this happen to you? If so, please describe your experience in the comment section below.

I do not intend to demean the fast food industry. Without it, I would have been penniless in high school, and likely would have starved in college, but admittedly, it is one thing to mess up a food experience; its another to fall short when discharge/transfer planning for a patient or client. I believe that the emotional (not to mention financial) consequences are far more substantial when behavioral health systems fall short.

Few things are as disappointing as when a brand or product advertisement resonates with us, but the actual experience leaves us feeling unfulfilled and even defrauded.
Broadly, there are two essential steps to establishing standards and measuring congruence:

Step One:

In step one, it is critical, especially in behavioral health, to budget time–and money–to develop a list of core, non-negotiable values, a concise mission statement, logo, a marketing plan and clear branding guidelines. Step one is not easy. Done properly it is arduous, emotionally draining work. The essential task of developing deeply empathic descriptions of the emotional states of every stakeholder, and how our service systems can, and should respond, is draining and takes hours (days) to complete.

Step one is challenging, but relatively easy compared to step two:

Step Two:

Developing a process of ensuring that the stakeholder experience, is tightly aligned with the developed and approved brand model.

“Congruence” Is the compliance between ideal self and actual self -Carl Rogers
Author John Spence’s description of congruence, relative to the high-end automobile market isn’t something I can improve upon so I won’t try, but I did add the bracketed content to align with behavioral health processes:

“At the heart of this concept [congruence] is the strong belief that every single aspect of the brand experience must be uncompromisingly consistent throughout all touch points with the consumer [stakeholder].

From first exposure,[crisis call, web site inquiry, ad exposure] to pre-purchase, [intake assessment, prescreening] to the buying event, [co-pay collection and billing, service provision and follow-up, solid performance in contract and regulatory compliance, and of course, measurable clinical improvement] to product decline and eventual obsolescence [discharge planning, referral, post acute care monitoring] and finally to re-purchase [referral or relapse]— every interaction must fully support the brand promise.”


What Mr. Spence describes is an ideal to strive for at all times. This should be made clear to every employee in behavioral health. We must make it clear to all new hires and veterans that falling short of our carefully-crafted brand expectations, represents a “gap” and obligation to learn and improve. We have made a promise, and intend to keep it!

I see no more pressing challenge for leaders in behavioral health than to establish a marketed “ideal”, and then to work tirelessly to close the gap between that ideal and the experienced “actual” for our stakeholders.

Let me underscore, that by definition here, “brand congruence” and “gap management” applies as much to the employee experience as external stakeholders.
If employees feel that they were “sold” one company at interview and on-boarding and are then disappointed, the problems of turnover and low employee morale will certainly render more difficult if not impossible “gap closure” in other areas.

Accordingly, do not fail to establish and measure employee congruence with the same vigor and accountability!

Metrics should be centered around measuring congruence and made a routine topic in staff communication, training, on-boarding, compensation and performance review.

Do not fail to understand and measure employee congruence with the same vigor and accountability
The essential ingredients necessary for brand congruence include: Non-negotiable core values, brand congruent, well sourced and-supported (superior training and paid for performance) employees, brand-congruent, well maintained infrastructure, constant measurement and broadly-shared feedback.

Here is a good checklist to get started:

Step One Steps:

Budgeting for congruence.
Core Value Development: A multi level, externally facilitated “gut check” about what a brand stands for: aka non negotiable “core values”.
Stakeholder Identification and description of their likely emotional state.
Broad release of branding guidelines and strict adherence at all levels.
Development of 12-month marketing calendar
Step Two Steps:

Incorporation of core values into applicant screening, employee evaluation and compensation design.
Routine stakeholder survey process. (Daily, weekly, monthly quarterly, semi-annually, annually; judgement is required here to avoid stakeholder saturation and fatigue, but also to maintain value)
Broadly shared, prompt, constructive feedback and training processes at all levels regarding survey findings. Prompt feedback and training means prompt. At ALL levels of the service system.
Compensation alignment which is substantially based upon the closing of the “Congruence Gap” (Stakeholders and Infrastructure)
I hope this has been helpful. Valley Behavioral Health has solidly completed step one tasks. I would like opinions on where you think we are on the second step tasks!

Disclosure: The number of exceptional authors and consultants who have shaped my thinking on this subject over the years are simply too numerous to mention. If you are one: I am eternally grateful to pass on my experience, influenced by your original works.


NOTE: Valley Behavioral Health Directors: I hope this has been a helpful starting point. I look forward to further discussion here, and at our leadership sessions Fall 2016.

By Gary Larcenaire

Just say “NO!” to Co-Location Cop Out: How to Integrate Healthcare for Real!

Gary Larcenaire, CEO Valley Behavioral Health


I have been working to find effective ways to integrate behavioral healthcare and primary care for over ten years. My goal has been to demonstrate improved health outcomes and care efficiency for patients challenged with chronic behavioral health and primary care conditions.

My teams have led collaborative efforts that included a co-location design whereby we invited a Federally Qualified Health Care entity into an outpatient behavioral health clinic renovated to include traditional exam rooms and equipment. The problems we were trying to solve remained. Question: “did the co-location design improve health outcomes and access to care?” Answer: emphatically, “No.” And it wasn’t for lack of trying either! Both teams were VERY committed. But we did learn from our failure!

Simply co-locating health care specialists into a common work setting isn’t the whole answer. (If you have observed otherwise, please produce the data!)

If an integrated health delivery system is to result in improved outcomes and efficiency, two elements must be present:

1. The contents of the Electronic Health Records (EHR) MUST be dynamically (electronically) shared between behavioral and traditional medical providers in a common data warehouse, or preferably, the same EHR.

Health outcome metrics must be established at baseline and reviewed routinely.
2. Payers MUST be on board to:

Provide data to integrated health coalitions on health outcomes routinely to improve care.
Get creative with payment to incentivize and encourage iterative learning and periodic failure.
Demand and pay for the routine staffing of complex cases.
Incentivize accountability and creativity.
We CAN and MUST integrate care, improve outcomes and reduce costs for our patients and for society. Let’s get started by demanding that experiments include passionate partners, integrated technology AND payer creativity.

Let’s Deal With Health Care Integration Together!


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