Ebony Clarke, director of the Multnomah County Health Department, shared her thoughts on the job ahead shortly after she was announced as new head of the beleaguered behavioral health division of the Oregon Health Authority.
A priority for Gov.-elect Tina Kotek, the position will be charged with sorting out a fragmented and dysfunctional system that has generated report after report highlighting the need for major change. It's a problem tackled repeatedly by past administrations, only to have those efforts fizzle out or fail.
Clarke, a licensed clinical social worker, former served as the county's behavioral health director — and before that worked at the nonprofit behavioral health and addiction services provider, Lifeworks NW, working as service director of child and family services.
Her new challenge is one she's been thinking about. Clarke moderated an Oct. 31, 2022 panel discussion hosted by the Oregon Health Forum as the gubernatorial election neared, entitled “Advice to the Future Governor: Bringing Leadership to Behavioral Health Integration.” At the event, she stressed that reforms would need to be a joint effort with providers, and include diverse voices including the people receiving services.
Clarke stressed similar themes in her interview with The Lund Report. The following has been edited for clarity and brevity.
The Lund Report: How do you feel?
Ebony Clarke: I'm honored and humbled by the opportunity to step in and be a part of a solution that is urgent and critical and essential. Naturally there's anxiety and feelings of excitement and feeling overwhelmed. And at the same time, the time is now. We have people suffering. I don't hope to get it right — we have to get it right. And that's the mindset that I'm going in with this. There's a daunting task ahead. But we can achieve great things. And we will if we have to.
TLR: How do you think you're going to be able to put your experience into play in your new job?
Clarke: What I realized — especially working at Multnomah County, which is the largest and most diverse county across the state of Oregon — is that you can't take a one-size-fits-all approach in what you do. And you have to create solutions, strategies, and processes that allow for fluidity and flexibility for the local community and for the individual. Because as humans, we are unique. And we are complex. My past experiences have taught me the importance of really collaborating and partnering with the local community, with the individual to really partner in bringing forth solutions.
I believe that individuals, communities, and localities really do hold the solution to addressing what those needs are. And I believe that our job is to walk alongside and support and collaborate and partner in a transparent way, where there are strong lines of accountability and equity rooted in what we do.
TLR: As you know, there's been a lot of discussion of, and there's been report after report about the state's fragmented and dysfunctional behavioral health system. Governor after Governor have taken a run at trying to fix things, and it just hasn't worked. Will you be steering things in a different direction from where the state has been going in recent years? And can you give an idea of what that might be?
Clarke: In terms of the Governor's priorities specific to behavioral health. I'm thoroughly aligned. And for me, it's about accountability and it's about transparency. And I think that accountability is not one way. And so while we think about accountability specific to localities, or CCOs, or providers, accountability starts with the agency. Part of accountability is really getting some concrete, concise metrics and outcomes that are truly measurable. We are climbing out of a pandemic, so I think that we need to press the reset button: some things need to be recalibrated. And so while we work to do some long-term visioning, we need to get back to some of our basics around just really being able to get a clear understanding of where things are at — to right-size the shift, if you will, so that then we can start to innovate. And it's about accountability, accountability, accountability and then really working from an outcomes oriented perspective that also is informed and rooted in the consumer and peer voice, and also rooted in equity. And when I say equity, I think about not only racial equity but geographic equity and health equity.
TLR: You may have seen the recent Willamette week piece that quoted Ed Blackburn and talked about whether the state and Oregon Health Plan contractors should require providers to communicate and work together and do handoffs of clients and patients to ensure care. Is that consistent with your vision?
Clarke: From my perspective, warm handoffs and coordination is a basic tenet of what local mental health authorities and CCOs are to do. Again, we're climbing out of a pandemic. And so I think it's how do you get back to some of the basics in terms of roles and scopes. Quite frankly, coordination is not a new concept, so it gets back to how do we all hold ourselves accountable in a transparent way around some of those basic tenets of, you know, what our lanes are, what our roles and scopes are. I think that there's a number of issues and challenges that are playing out, that just make it the perfect storm that we're trying to find some feasible solutions to.
We know that when someone has a place to lay their head, it increases the likelihood of them being willing to consider treatment, engage in treatment, and complete treatment — and then have success with sustaining recovery. And there's some basic gaps within our continuum. I think that one of our core gaps, which is not surprising, along with behavioral health is our housing crisis. I think that it's important to remember that we have to be intentional and targeted when we think about real solutions for individuals that utilize and rely on our public behavioral health system, understanding that there's various kinds of categories of needs — from those who are at the top here, who are impacted by severe and persistent mental illness, versus a young person who is stepping into independence and out of wraparound services, and looking to find their footing.
You can reach Nick Budnick at [email protected] or at @NickBudnick on Twitter.