Angie Fiedler Sutton
Welcome to Destination Change, a podcast where we talk recovery treatment and more. I'm your host, Angie Fiedler Sutton with the national Behavioral Health Association of Providers.

Today's guest is Jen Carvalho. Jen is a proven leader in the behavioral health industry --adeptly leading in times of crisis and calm. As a facility and system CEO for much of her career, she has developed a leadership style that supports professional and system development, transparency and global thinking. To that end, Jen has served on the birds of CCAPP, NBHAP, and NAATP.

Currently, the President/CEO of Your Behavioral Health, Jen is focused on providing dynamic leadership to multi-disciplinary teams with converting goals. Despite a significant focus on the worker providing access to care, Jen is granted by your family and a long practice of adventure running. Thank you for joining us today, Jen.

Jen Carvalho
Thanks, Angie, I appreciate you having me.

Angie Fiedler Sutton
Awesome. First question is usually the same for everybody, just how you got into the recovery space. Why that versus all the other possible job options that are available out there?

Jen Carvalho
There are so many possible jobs. But no, I chose this because it chose me. I have no problem sharing that I'm a woman in long-term recovery, and was given the opportunity to go to treatment 25 years ago, and I came away from that experience wanting to make sure that everyone has the same access to care that I had. Never in my wildest dreams did I see myself stepping into leadership in a behavioral healthcare setting. My education is in a different realm. My experience had been in a different realm. But the uniting factor was leadership. And I came to the work that I do now via a board of directors seat on a little nonprofit in northern California. And being in that position, I felt a great sense of responsibility, fiduciary, spiritually, emotionally for the patients that were being served, and therefore learn the business kind of from the outside in, and really have built my experience on that foundation.

Angie Fiedler Sutton
Awesome. In terms of you said, you're in long term recovery, what does it mean for you to go through treatment and recovery? How do you define recovery?

Jen Carvalho
Well, treatment for me and recovery are two different things. So recovery is the day to day journey of healing, and self improvement and self awareness. And for me, that manifested in -- I had alcoholism, I was struggling with alcoholism, addiction issues. And I needed a reset from my day-to-day practice. And I needed an opportunity to gain tools and understanding of my disease in order to make change in my life. And so treatment was my entry to recovery. Treatment is the six months I spent in a residential facility. Treatment was aftercare programming.

But recovery has been my journey all along. And that's what I'm engaged in on a daily basis. You know, today, I have an option whether to drink or use. And on a daily basis, I choose a healthy healing path for myself. That's what I consider recovery. Treatment is what I help provide for individuals who need that same reset, and set of tools and skill to make the decision that I'm making on a daily basis. Treatment is the industry that we work in, and treatment is, you know, the organized delivery of behavioral healthcare that has, you know, gifted so many of us with the opportunity to be in recovery.

Angie Fiedler Sutton
Awesome. We talked about on this podcast that you know, recovery and going through treatment is a journey and that obviously, it's not ... like any journey, it's not a straight path. What are some of the barriers you see as being able to move forward in that?

Jen Carvalho
Oh, my goodness, it's such a great question. And as you were speaking, I couldn't help remember, when I was actually in residential treatment. My mom sent me that very famous poem about life being, you know, it's not about the destination, it's about the journey. And so, you know, much like life in general, recovery is that journey, right? We have ups, we have downs, we have challenges, we have celebrations, and I think one of the most powerful elements for me has been remembering that life happens to everybody. It is not a constant flow of goodness and delight; that there are ebbs and flows. And our success in recovery is really predicated by our fluidity and our ability to be nimble, and to course correct as necessary.

And so when those big barriers come up, or some of the challenges come up, you use those tools that you would adopt in treatment to help guide you through. I will give you a very small example. You know, challenges are just what life throws at you. It's everything from, you know, the loss of the job, or the loss of a loved one, we have to work with the tools that we have to move through that pain and disappointment. I lost my brother-in-law yesterday to this disease. And it was very upsetting and sad and somewhat predictable. And I come to that place of acceptance, because I've done my own work in recovery. And I recognize that he's probably at peace now, where he has not been for so many years. It's one of those moments where life shows up and being in recovery makes it a lot more bearable.

Angie Fiedler Sutton
Well, I'm sorry to hear about your brother-in-law, my heart goes out to you and your family. In terms of the resources that you use on a regular basis. Can you give us some examples as to some of those tools and resources that you use?

Jen Carvalho
Yeah, I mean, very early on in my recovery journey, I adopted a practice of prayer and meditation. It happens to be really closely wedded to physical activity for me. So when I run, I am praying and meditating. And that was described to me early on is, you know, praying is talking to a power greater than yourself; meditating is listening for the response. And so that has been my path for so many years. And I think that sometimes it's simply that quiet space that I allow in my life that is most healing and sustaining.

So, that has been a powerful tool for me. You know, I also surround myself with people who are healthy, and at least on a healthy path forward. You know, the old saying from the 12 Step programs are so relevant, you know, you have to surround yourself with winners. And I am pretty thoughtful about not putting myself in a slippery situation. So, I work in the treatment industry, I am fairly surrounded professionally by individuals who are in long term recovery. My friends are either in long term recovery, or certainly respect mine. My family is respectful of my journey. And so there aren't many options for me to step out of what is healthy and best practice for me. Those are two of the things that I would suggest have been most monumental for me.

Angie Fiedler Sutton
Awesome. Now, let's talk about your work as in leadership, you said you kind of stumbled into that. Tell me like that point where you realized, Hey, I'm actually good at this.

Jen Carvalho
Oh, my gosh, do we ever feel like we're really good at it? I feel like ... half the time I feel like an imposter. You know, like a lot of us. But the reality is, is that coming out of treatments, you know, residential treatment, I was fiercely committed to giving back, as so many people are, right? We're taught in our early recovery to extend our hands to the next suffering individual. And I really wanted to do that in a meaningful way. I was blessed to have had education and a bit of a career history behind me. And I could add a little bit of value on the board of directors of the treatment facility where I got sober.

And doing that for a couple of years, I started to recognize that my business experience outside this industry was certainly relevant in this industry. And being on that board of directors allowed me to get a sense of the inner workings of what delivery of treatment actually looked like as a business. You know, one thing that's very clear to me is that recovery is not a business. Recovery is a journey. But treatment is a business. And there are lot of people who are in recovery, who step into our industry, and then are disappointed to find that they're working for a business. And they're two totally divergent concepts. Yet, they can be harmonious when your heart and your mission are in the right place.

On that board of directors, I recognize that my mission, personally, to expand access to care was very wedded with the mission of that organization to provide community resources to those struggling with addiction. And so it seems like the next right step to apply myself in a more fundamental way to the leadership of that organization. And when there was a spot open to be the executive director, I applied for it. You know, it didn't hurt that I had had all those years on the board, learning the business. And so it was kind of a natural step.

And it was challenging and rewarding to the extremes. And I learned so much from that early experience. I certainly made a ton of mistakes. And I enjoyed a few successes. And every time I experienced a success, I learned from it. And every time I failed, I learned from it. And somehow the years just started stacking up, and I found myself, you know, more integrated into our industry, by way of, you know, CCAPP board membership; by way of volunteering for community action committees' by way of, you know, being out in the world supporting the development of this organization.

It occurred to me that this is more than a job, this is really my life's calling. It really is so meaningful for me. And there's not a day that goes by no matter how difficult or defeating things can feel sometimes, there is not a day that goes by that I don't recognize that someone somewhere has an opportunity to have a changed life because of the work that I and others do. And that's a pretty powerful thing to go to bed at night. As long as I can continue to make an impact and continue to feel that way, I continue to feel that this is my life's work.

Angie Fiedler Sutton
Well, that leads to what do you feel are the traits that make a good leader?

Jen Carvalho
Oh, my goodness. You know, you and I have worked together long enough to know I've given plenty of presentations on what leadership looks like, whether its innovative, engaged, pivotal leadership: there's a lot going on there. And for me, leadership is heart driven and science directed.

And so I have everything I've ever learned about leadership and everything that I bring to the table in my own organization as I lead it, is based on terrible leadership that I've had in the past. And I have had one powerful boss that I look up to, and have tried to emulate. With that exception, I have worked with some just awful leaders. And I certainly know that that wasn't intentional. But they were either ignorant, ill informed, you know, undisciplined, or, you know, kind of didn't care about being a leader. They cared about the business, but they didn't care about being a leader.

And I think there's a real difference between being a successful business person and being a successful leader. A leader is someone who has a vision, and then is able to inspire others to help create that vision. So inspiration is really fundamental to my style of leadership. It's about engaging people and helping them develop their professional skills to a point where they can achieve what they envision for themselves. And in doing so we then lead an organization to success.

And so, you know, the key for leaders in this industry or traits of a successful leader in this industry really are deep connection to the mission, a willingness to roll up your sleeves and get dirty. I know too many leaders in this industry who sit behind a desk or wear a three piece suit to work and you know that may work for them. For me it's all about like literally getting in with my team and doing the work with them. I think that we have to be smart and nimble and reflective. We have to have a personal connection with the people that we lead. We have to be visible and responsive to the needs of the teams that we serve. And I truly believe that we make a deeper commitment to our teams than we do to just about anything in our lives. My husband often reminds me that I may be the boss at work, but I'm not the boss at home. But I very much treat my team like my family. And I care about them, and I invest in them. And I know that that investment will, in turn, be in their investment in the patients that we serve. So it is a worthy investment indeed.

Angie Fiedler Sutton
Awesome. You had mentioned that, you know, like everybody, you had some wins and some losses. Can you share some of the things that you've learned that lessons learned that you have come across?

Jen Carvalho
I do believe you're referring to my failures, Angie. I think that my failures have been around. I come to the table with an open heart in my personal life and my business career. And I have made mistakes when I have invested in people who I believed would have a return on investment in the organization, and they have not. That has been very disappointing.

And I have probably gotten a little bit jaded over the years. I've learned to be more discerning. And I have learned to temper my very overly optimistic personality with a little bit of realism when making assessments. And I've certainly become a lot more shrewd in my decision-making. I recognize that I do not know the answers most of the time, which is why I surround myself with great people, and I seek counsel regularly: to make sure that I'm looking at all aspects of the situation, a person and opportunity before I make a decision. And so yeah, you can kind of you can kind of generally guess, you know, where my failures of life from that answer. Yeah. I try to remain humble around that stuff. I keep trying to be a better and better leader.

Angie Fiedler Sutton
Well, let's phrase it this way, then. If you could give some advice to someone who was wanting to become a leader, what would that advice be?

Jen Carvalho
That's a really great, great question. It should be so simple and just roll off my tongue. And yet, when I think about that, it's really powerful to give, if I wanted to share what I've learned, it would be that you have to do what you love. You have to be passionate and committed about the humans that are doing the work. And if you're not, then this is probably not the right role for you. I mean, those old adages about, you know, if you love what you do, you'll never work a day in your life. And, you know, I just can't be more clear that that is the truth. And I try to remind my team of that all the time.

If you're not in a position that you love, and you're excited to come to work every day, then you're probably in the wrong position. And the work that we do in behavioral health is far too challenging to consider it a job that is a grind. You have to be in this to win it, in this to help another human change their life. You have to be in this for the reasons that motivate you and propel you forward. So in terms of leadership, I would suggest that that's a primary consideration. And I think another bit of advice I would say is invest heavily. Invest every resource you have in your teams. They are your greatest resource, and they will be your greatest success. And so, you know, that's just been an abiding theme for me.

Angie Fiedler Sutton
Well, speaking of resources, that's a question I like to ask our regular interviews, just kind of some of the resources that you do use on a regular basis that you can maybe recommend.

Jen Carvalho
In terms of leadership?

Angie Fiedler Sutton
In terms of leadership or the industry. Either way,

Jen Carvalho
You and I are talking for a reason, and it's because we've developed a relationship through some of, you know, the advisory roles that we've been in, both with CCAPP, BHAP, you know, NAATP. We both have been very committed to advocacy in our industry. And so I am constantly seeking guidance from those organizations and the people within them. I think that together, we are so much stronger. And our industry has been fragmented and not united in our efforts in a lot of different ways through the development of the treatment industry. And I think, you know, here we are in this kind of newest phase, which is a lot of investment into behavioral health. And it feels like the treatment industry is shifting at a really rapid pace. And so just to remain centered and grounded in the community of treatment providers, it's been very helpful and beneficial for me to consistently seek counsel with those advisory organizations. So BHAP being one of them. It's been a really steadfast point of reference for me, and I'm very grateful for membership.

Angie Fiedler Sutton
Awesome. Well, speaking of shifts in the industry, you've been in the industry for 20 plus years. What are some of the things that have changed in terms of the industry? And what do you see maybe trends going forward?

Jen Carvalho
I'm chuckling because the better question would be what has not changed. I mean, I came from a social model, you know, really 12 Step focused treatment center, which, at the time was very normal. And again, this is 25 years ago, but it was very normal, it was very standard. It was the days of the 28 day, you know, rehab where people would dip away for a month, and get care. And I think that a lot of the treatment curriculum, a lot of the staffing structure and the program development was centered around 12 Step programs.

And as we have evolved, we have certainly seen medical necessity and a true medical component being integrated into addiction treatment. Certainly the integration of MAT: at one point, that was so controversial. I mean, I remember just, you know, having personal feelings about that. And that now just seems so archaic, and so far removed from today's reality. But it was part of our history. And so now, you know, we really are using a medical model to treat addiction, as we should be. And we are using evidence-based practices, and outcomes measurement to determine if the care that we're providing is actually effective.

I mean, 25 years ago, that was unheard of. And you know, and I remember talking to stakeholders in that very first role, and trying to explain what an outcomes measure look like for our industry. I would have parents or funders talk to me about, 'Well, tell us what success looks like to you.' And I remember trying to explain to them, 'Okay, well, if someone you know, is addicted to heroin, lives under a bridge, can't hold a job, and they come into treatment, and post treatment, they can hold a job, but they still not permanently housed, they drink once in a while, which we wouldn't consider abstinence, you know, that is some measure of success.' I mean, I remember having those kinds of conversations.

Now, we've become so much more scientific in the ways that we are treating, and I'm really happy for it. Also see great value in what has historically worked for so many millions of people around the world, which is the 12 Step program. And I myself am a product of that, and I wouldn't be here had it not been for working the steps. And so, you know, it's fundamental. However, as we evolve, today, we find ourselves at a crossroads where we have a lot of mom and pop social models for the most part, who simply don't have the resources to work within a commercial payer network effectively. You know, they need accreditation, and they need to provide outcomes measurement, and they need a lot of compliance.

And it makes it very challenging to do business under those requirements. And so we see a whole bunch of private equity investment in the industry, and that is changing how we're providing services. It's both applying resources that have heretofore not been available, but it's also requiring a return on that investment. And that is shifting and changing the face of our treatment industry right now. And I have long been aware of and working within those systems and I see great value in the investment. I recognize as a business, there needs to be a return. As long as our constant and enduring focus is on the patient and the best possible clinical care, then I believe it's a good investment in our industry.

Angie Fiedler Sutton
Awesome. Well, as I was doing research on you, I found that patient access to care, stigma reduction and workforce development are a particular focus for you and guide your advocacy efforts. Do you want to talk a little bit about that?

Jen Carvalho
Absolutely. So I've talked about access to care, it is literally an undying theme for me. Before I went to treatment, I literally knew of kind of the 28-day model of, of treatment. But it was just a complete random, you know, awareness. I had not any idea that resources were available to me who had struggled for many, many years with substance use disorder. I didn't know anybody else who had been to treatment. And so I recognized that there were many, many people in the world who also didn't recognize that they had treatment options available to them. That really felt wrong to me.

And so, as I started advocating for access to care, I recognized one of the greatest barriers to that access is the stigmatization of the disease of addiction, mental health. We in this country have had a major awakening with the pandemic. And nothing has made me more happy than seeing the focus on and, you know, kind of the acceptance of the need for behavioral healthcare: that mental health resources should be available to everyone, that addiction treatment services should be available to anyone seeking or needing care. And for me, that period has been the greatest eye opener, undoubtedly, one filled with pain and suffering, but the fact is that we've seen such a reduction in stigma in the last five years due simply to that greater awareness of the need.

And so I remember the first probably six or eight years of my recovery journey, I was anonymous -- 100% anonymous in my day-to-day life. People did not know that I was in recovery in my workplace or in my community. And I was very thoughtful about how I shared that information. And when I started working in this industry, I recognized that it's only by being boldly a woman in long term recovery, and sharing that, that I would help reduce that stigma. By being anonymous, I was by definition hiding the fact that I was in recovery. And so I am ... I can get in a room full of investors and talk about being in long term recovery. I can, you know, talk from a stage as you've seen me do about being in long term recovery. I come to a board meeting and talk about it. It's not that I wear it on my sleeve. And it's a priority for me to share with people. But I certainly am not keeping it a secret. And I'm very proud of the time that I spent wholly in my own body with a clear mind and an open heart due to the time that I spent in treatment.

Angie Fiedler Sutton
Awesome. We're getting close to the end, was there something that you thought I was going to ask that we haven't or something that you wanted to talk about that we didn't?

Jen Carvalho
No. I appreciate you asking it, you know, I never know what you're gonna throw at me. So I was ready for anything, Angie. But no: I mean, I'm so grateful to just have a conversation with you today, any opportunity to shed light. And I mean that in a really metaphorical sense: like literally to bring light to the areas of darkness in the world is is a really welcome opportunity. And I truly believe in recovery being a light in the world. And I believe that treatment is the place where that light turns on. And so it's just ... it's a really powerful opportunity, and I'm so grateful for you allowing me to talk about my own personal journey and how it kind of intersects with the business that we all do on a day to day.

Angie Fiedler Sutton
Well on this. I've already kind of already touched on this but to end before we get to go into it, how to get all you: Why do it? Why do this?

Jen Carvalho
Because you can't do anything else. I could not walk away from the need that exists in this world for substance use disorder and mental health treatment. I could not look away from the still suffering addict. I had to make an effort to make the world a better place, and that's why.

Angie Fiedler Sutton
awesome. Now for people who want to hear more about you or get in touch with you, how can they get a hold of you?

Jen Carvalho
So my email address is Jen.Carvalho@yourbehavioralhealth.com and I am often available at our conferences, CCAPP and BHAP and I am available. You can see my bio on the website, and I am just grateful for an opportunity to speak with you.

Angie Fiedler Sutton
Awesome. Well, you've been listening to Destination Change. Our guest today was Jen Carvalho, thanks for being here. Our theme song is "Sun Nation" by Ketsa and used to be a Creative Commons licensed by the Free Music Archive.

Angie Fiedler Sutton
Please consider rating and reviewing the podcast on Apple podcasts so we can get more listeners. In the meantime, you can want to see more about the podcast including show notes and where else to listen on our website www.nbhap.org. If you have any questions for the podcast, please email us at info@nbhap.org Thanks for listening.