Well, welcome, everybody. My name is Art Woloszek. I'm Vice Chair for Education and Faculty Development at the University of Wisconsin-Madison. I'm also here in my capacity as Chair of the Council on Medical Education and Lifelong Learning. And so this today is a joint venture between two different components at APA, CAGER, or the Council for Advocacy and Government Relations, and CMAIL, the Council on Medical Education and Lifelong Learning. So I hope you enjoy our session. I'm going to introduce our outstanding presenters. So starting off first is Dr. Kiki Kennedy. She is Chair of the aforementioned Council on Advocacy and Government Relations and serves on the editorial boards for APA Publishing Books and the American Journal of Psychotherapy. She is a board-certified adult psychiatrist in private practice in Connecticut. Clinical professor, recently promoted to clinical professor, congratulations, Dr. Kennedy. Clinical professor in psychiatry at the Yale School of Medicine, where she leads the Yale Legislative Advocacy Program, co-leads the Social Justice Health Equity Curriculum's advocacy track, and supervises psychiatry residents in psychotherapy. These are her two passions, advocacy and psychotherapy, supervision, and she has books on both of those. So edited A Psychiatrist's Guide to Advocacy, and also edited Supervising Individual Psychotherapy, a guide to good enough, and you can buy those both at the APA Publishing Bookstore right upstairs. So that's Dr. Kennedy. And Dr. Fonseca. So Dr. Fonseca is a Senior Associate Consultant at Mayo. She's a newly minted attending at Mayo, having just completed the CL Fellowship at Mayo. They are a liaison between CMAIL and CAGER. So Fee has been a very active member of CMAIL and has helped foster this relationship between our two components. They work in an outpatient gender clinic and outpatient consultation clinic at Mayo. So great presenters. And here are our objectives for today. So hopefully by the end of this session, you'll be able to explain why advocating for patients in populations, especially those who are marginalized and minoritized, is in fact a physician's responsibility. In fact, we were just talking about this earlier, about the next wave of ACGME program requirement revisions will be coming up in the next two to three years. And so that's a potential opportunity to think about are we missing things in residency training and advocacy may be one of them. So keep an eye out for that. Again, by the end of this session, hopefully you'll be able to recognize different approaches for teaching advocacy skills to psychiatrists at different career stages. Consider how role models inform and advance any advocacy curriculum and identify ways to implement an advocacy curriculum at home institutions and organizations. So obviously our focus today is going to be on advocacy, in particular on the importance of mentorship in advocacy. So I will hand things over to Dr. Kennedy. Great. I don't know if I can see over this. All right. So I thought it would be helpful before we get into really the fun part of our session today, which is Dr. Fonseca collected some incredible videos of various different advocates and their journeys. But I thought it'd be helpful to just frame out what, how we define physician advocacy and just a few aspects about that. And then we'll be talking about the, how kind of I teach advocacy along with how it's enhanced by mentorship and role models. So basically physician advocacy, the definition, it involves the pursuit of strategies outside the provision of medical care to affect a desired positive change in the health of individuals or communities. It can also be seen as the public voicing of support for causes, policies, or opinions that advance patient and population health. And there are some other definitions. This is not necessarily it, but I, I think you get the idea. And just, just to elaborate on that in, in our minds, physician advocacy is for the primary gain and in the best interests of the patient community or population. And it respects the values of those patients and the communities and populations that we serve. It can be a wide variety of actions. I'll be talking a little bit about what those can be. What's important to note, this is not an opportunity for you as an individual here in US to have your own personal expression of political speech. Certainly you can do that under our first amendment rights, but that would not fall under the umbrella of physician advocacy. Why is physician advocacy necessary? I think all of you understand that the patients who come to see us come from different zip codes. They have, as a result of social determinants of health and various different structures, they come to us with, with health disparities that contribute to very different health situations and health outcomes. And certainly, and so addressing those social and structural determinants of health as a physician is, is, can be incredibly important. In addition, who pays for the care can make a big difference in the type of care that's received, whether it's managed care or in the VA system. And within that system itself, the healthcare system policies and procedures, like what is in the formulary can also make a difference in the quality of care. And we've only seen recently over the last couple of years how the state in which the care takes place can really make an incredible difference in, even if you can get certain types of care for gender affirming care or reproductive health and so on. And so if we want to be able to use our power and our privilege as physicians, we need to do that to advocate for whatever policies in those arenas can help to reduce health disparities and improve health and health outcomes for patients, especially those who come from marginalized or minoritized communities and populations. It's really important to know that physicians make highly effective advocates. And that's because hopefully you've been trained a little bit in what structures and systems may impact on our patients, but also more importantly, you do a lot of clinical work. So you have firsthand experience, you have memorable clinical vignettes that can be compelling and memorable and persuasive to those in power, like a legislator, your little story about what a potential bill that they might be introducing could mean for a patient, positive or negatively, will be sticky. And they'll recall it as they consider how they're going to advance a bill, let's say. In addition, as physicians, we are used to data, we're rooted in an evidence-based orientation, and so hopefully we've learned how to parse data and present it effectively. Before we start on our vignettes, I want to just go over the levels of advocacy, which can sometimes be helpful, because I think it's important, no matter what you're advocating for, to think and reflect about what level are you in, what are the structures that you're going to be working within. And so just briefly to go through these quickly, certainly self-advocacy, we need to advocate for our own wellness and to reduce burnout, whether that is due to a system or the electronic health record. Interpersonal advocacy, I'm guessing all of you are actually advocates right now, even if you might not think of yourself that way. If you've ever advocated to a family member to understand their loved one's mental health diagnosis or substance use diagnosis, you have been an advocate at this level. At the institutional level, if you've ever worked with your hospital formulary to add a non-formulary medication, you have been an institutional advocate. And certainly there's community advocacy, and I'm just demonstrating, and we'll actually hear from one of our video participants in a little bit about working with, in Connecticut, this is an example, where we've worked alongside the Husky for Immigrants Coalition, where we have tried to amplify their voices to legislators to pass bills that will expand state Medicaid to people who are undocumented. This is actually an effort that began several years ago, and each year we've made a little headway in 2021, from including pregnant people to under eight for people who are undocumented. We got Medicaid expansion the next year, up to age 12. Last year, age 15, so this year we're pushing to age 18. This is a photo from a rally that they organized. They actually asked us to wear our white coats. I didn't even have one, I had to buy one on Amazon, because I'm a psychiatrist. But we were following the lead of the community and what they needed from us, and doing what they wanted to help with what they thought would be helpful. You'll hear a little bit about this as well, state legislative advocacy. You'll hear from one of the residents who recognized it in Connecticut a couple of years ago. Fentanyl test strips were considered drug paraphernalia, suggested, let's decriminalize them so that people will carry them and test their substances, and it actually made them into an omnibus opioid bill and became state law. It would not have happened if residents working with patients recognizing this was a problem had not told the legislator. Federal advocacy, so much going on here, these are just a couple of samples, but one thing that happened this past year is for the first time in 20 years, the Consolidated Appropriations Act expanded GME slots, specifically for psychiatry, starting in 2026, 100 new ones. You can see how some of these efforts can really translate into great difference. Global advocacy, I have a colleague who goes to every COP28 or COP conference to address climate change. I'm almost ready to introduce, or not introduce, but welcome Dr. Fonseca, but just to share with you that the way we approach teaching physician advocacy at Yale is kind of threefold. One, we recognize that it is a professional responsibility. Some of you may not know that in 2001, the American Medical Association basically said that physicians had a duty to advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being, and this was affirmed a year later by our APA. We also believe that it's critical that learners choose whatever issues they advocate for. Advocacy is a very personal passion. We will never tell you what to advocate for, and so what we suggest is that people be informed by their own lived experience, their personal values, and certainly the clinical work that they do to help them decide what they want to advocate for. Finally, we look at physician advocacy as a skill set, a number of different skill sets, and like any skill set, just like your clinical training, it requires opportunities for experiential learning, like you work with patients in the hospitals, for role modeling and mentorship, which we're going to talk more about today, and then with that role modeling and mentorship for supported practice experiences. So without further ado, I'm going to turn it over to Dr. Fonseca for a bit. Good afternoon, everyone. So before we dive into some of the videos, I just wanted to put things into a little bit of context here. So we have many possibly overlapping roles listed up there. So role models, role models are people who have traits that you admire, that you wish to maybe emulate. You may or may not know them in person, but you definitely admire maybe skills, maybe attributes that they have, and then we move up to the next level, which is an advisor is someone who more provides advice or guidance on a certain topic from their expertise, their experience. And then you have coaches, and coaches, they generally work with you as you try to develop or enhance a very specific type of skill, generally instructing you in how to do something, how to build that competence, and oftentimes, this is on a paid basis too, unlike some of these other roles. Mentors, I have that one highlighted here because we'll be talking about mentorship quite a bit. So a mentor is someone who talks with you about maybe your career goals, your plans, aspirations, hopes, dreams, challenges. They share their knowledge, their experience, they're helping you kind of refine your plan. You know, they're suggesting who you need to talk to, opportunities that you need to be aware of and be involved with, and maybe obstacles to avoid and be aware of too. And they can also recommend other people that you should be maybe connecting with who could join your mentoring team. Oftentimes, it's not just one mentor that you're relying on. It's often like a team of mentors, different mentors for different things. Relationships can be long-term, short-term, sporadic, depending on what the issue is that you're being mentored through. And often, mentors will be role models as well, and sometimes mentorship can go both ways. There's also reverse mentorship. And that's when someone is maybe younger or less experienced than the actual mentor, but they have experience in a very specific particular area, and then their insights can provide valuable guidance to help the mentor learn new perspectives and skills. So it's kind of a back-and-forth learning process for everyone. And then a sponsor, very different from a mentor. So different from just talking with you and being there for you, they're taking that conversation out of the room. So when you're not around, they're bringing your name up, they're shining a spotlight on what you do, they're nominating you for positions, promotions, awards, and often it's within a specific organization or specific group, specific enterprise. And then you have advocates, which go the next step further, kind of championing whatever cause that you find important, really amplifying your voice in that way. They're using their own influence, their own privilege, their own social capital to create opportunities to remove barriers. They're leveraging their network, leveraging their resources, so they're really kind of putting a lot of power behind the support that they're giving you. So when we have that advocate up there, that's pretty different than advocacy when we're talking about that. So I just wanted to make that clarification and just operationalize some of these concepts. Some context for what you will see in the videos, I sent this list of questions out to our interviewees and I let them know, you know, hey, this is kind of a prompt, you don't have to tackle every single question, but I just didn't want to assign questions because everyone has such a unique perspective, unique experiences, unique intersectional identities that they're bringing to the table, and I wanted to kind of just have folks share as much of an authentic story as they could and leave it up to them what they felt would be most meaningful to kind of share with you all. So those are the questions we have up there, and I'll just quickly read them, so just telling us a bit about the work they've been involved with, how they've used brought in pieces of their identity, how they've been able to kind of lean on their mentors and sponsors in that, and some memories, some experiences that are particularly meaningful for them that they could share that, and how did they find their role models, mentors, sponsors, and kind of key lessons that really stuck with them that they're bringing along and then maybe sharing with their mentees as they kind of parse the torch past the torch along. So we'll start with Dr. Tanner Boomer's Bach who is currently a child and adolescent psychiatry fellow at the Mayo Clinic in Rochester Minnesota. He also serves as a policy fellow in the Center for Mental Health Services at SAMHSA and is originally from North Dakota. He completed adult psychiatry residency at Yale University with Kiki and next year he will be an assistant professor of psychiatry at the University of Wisconsin-Madison where he will also work as a psychiatric consultant for the state of Wisconsin's Bureau of Prevention Treatment and Recovery. So there's Tanner. Hi everyone I'm really excited today to be able to share a bit about my experience with advocacy and the ways I benefited from mentorship in developing this aspect of my professional identity. Even since before entering medical school I've long considered myself an advocate and the opportunity to advocate for my patients on both the individual and population level was one of the primary reasons I wanted to enter medicine. However I didn't actually learn how to be an effective and an impactful advocate until I started receiving mentorship on advocacy and for me this mentorship started in residency when I signed up to take Kiki Kennedy's legislative advocacy program at Yale. Through this program I not only received mentorship from Dr. Kennedy but also from several senior residents and fellows who had been involved in the program for a couple of years and who had taken on a leadership and a mentorship role for some of us more junior residents. During this first year of the program I joined a group of residents and fellows in a statewide coalition that was advocating to expand Medicaid to undocumented children throughout the state of Connecticut. Dr. Kennedy and the resident leaders taught me so many core skills and advocacy during this first year. They taught me how to build relationships with my legislators, how to think strategically about building an advocacy campaign, how to write op-eds and written testimony and how to deliver oral testimony and in the midst of the day-to-day grind of residency to be part of an effort that was positively impacting patients on a population level was empowering and especially to be around these incredible advocates who are also my peers was also really energized. And so during the next year of the program I was able to use what I had learned in that first year and lead a small group of residents who are interested in advocating for legislation to reduce opioid overdose deaths in the state of Connecticut. And at first I remember feeling intimidated and overwhelmed at the thought of trying to impact such a huge problem and Dr. Kennedy's mentorship and guidance was really instrumental in learning where to even start. I remember Dr. Kennedy reminding us of the knowledge and the skill set that we had and how legislators were not only interested but were seeking our ideas and expertise on this really difficult problem. So at her recommendation we put together a list of evidence-based policies to reduce opioid overdose deaths in Connecticut and we ended up submitting it to the Public Health Committee in the legislature and not necessarily expecting anything back. But to my surprise the chair of the committee called me several days later asking about several of the policies that we had proposed and in the end several of them ended up being included in an opioid bill that the legislature ended up passing later that session including legislation that operationalized methadone, legalized fentanyl test strips across the state and expanded access to Narcan. And so this experience really showed me how legislators are looking for our expertise and our ideas to help solve these complex problems and if we engage in this process we can have a positive impact. Another key lesson that I've learned about mentorship through these advocacy campaigns that I was a part of in residency is that often a key source of mentorship is our own patients and the lived experience community. In both of these campaigns that I was a part of we partnered with individuals with lived experience whether it was families of undocumented children in the state or parents who had lost children to drug overdose deaths. These families were ultimately the reason we were advocating and they had incredible knowledge about advocacy and had often been working on these issues in the state for several years. And so I think it's always important to remember important source of mentorship and advocacy as our own patients and folks with lived experience. And so as I'm wrapping up I just want to communicate how important mentorship has been for me in solidifying my professional identity as an advocate and like I said before I think many of us go into medicine and perhaps more so psychiatry with this inherent identity and passion to advocate for our patients but it is through mentorship that we can channel this interest and energy into really effective and impactful skills. Advocacy truly is a practice and a skill set I think that can be learned and honed over time and mentorship at least for me has been critical in feeling more effective in this practice. And so thank you for allowing me to share a bit of my experience with you today. So it was not my idea that Tannery interviewed. It's like a little embarrassing but anyway but he's wonderful. So I hope that gives starts to give you a flavor of that mentors and role models can be found in all different areas whether it's families our patients people with lived experience and we're going to see three more videos but I want to talk a little bit we're trying to make the videos relevant to thinking about how you will find mentors and role models perhaps but also contextualize it in in my thoughts about teaching advocacy at Yale. I'm not going to get into the weeds here too much but I teach in two very similar but different formats and one of them is the advocacy track which is part of the core curriculum in the Department of Psychiatry embedded in our social justice equity health equity curriculum and I teach that longitudinally over three years PG 2 3 & 4 and that's and basically there's not an expectation that residents really engage with too much work at the state capitol or writing op-eds although they are introduced to some of those topics simply because clinically they're so busy but I also lead the legislative advocacy program which is across the Yale School of Medicine and it's actually a wonderful way for people to get out of their silos and discipline so it's a mix of psychiatry certainly pediatric surgery internal medicine and so on and this is a one-year program from September to June and this is when this is the program that Dr. Brumers back was referring to where he really was working very closely with legislators well I'll just say basically when you teach advocacy I think it's important to have a mix of didactics and workshops a lot of times we will invite community members and advocates to attend actually this year we just had the director of Husky for immigrants come in person and speak to our class which was a wonderful experience and but basically for the program we really focus on the Connecticut General Assembly it's our laboratory and it's broken down into residents choosing their topics what they're passionate about and working together in resident led groups to identify bills or issues policy issues that they want to work on I really won't get into the weeds here but just a couple of mentions that that really advocacy is a combination of these different experiences that where it since it is skill based it's really important to bring not only didactics but to also bring in as I mentioned before experts like legislators we have legislators come we have other kinds of advocates we've even had journalists and op-ed writers come and share their best practices and so unlike a regular experience of education within let's say your Department of Psychiatry we really look outside of the department for experts in the community who are extremely willing to come in and share their ideas and best practices for what we can do as physicians and psychiatrists what I want to do now is just maybe talk about the number one advocacy tool that we highlight in both of the program and the core curriculum which is we tell everyone to use to vote and never miss a chance to vote in any election and basically as many people know if you are eligible to vote here in the United States there are elections every single year while the presidential election which will be held in November of this year is every four years most local and municipal elections are held more frequently sometimes in odd numbered years certainly in every two years and even numbered years we elect all of the members of the House of Representatives and Congress and so basically people should have it in their mind that every single year they need to vote and I think we're seeing how important it is to vote at our local level because the local level is who elects the school board and the school board is the are the people who decide what kinds of books are going to be in the schools are books going to be banned what are going to be in our town or city libraries so it's really important to never never miss a vote to vote in election in that kind of an election or here whoever you you know the American Psychiatric Association has vote an election every year and probably 10% of members vote so vote in that election it matters who is going to be on the board of trustees the best way to talk to other people about voting is to ask what their plan is to vote and to have them think through the schedule of their day make sure they know where their polling station is and have them figure out I'm gonna vote before work after work before I pick my kids up from school do I know what my vote at my polling place hours are and studies have shown that that's the best way to make sure that people will actually follow through on their their decision to vote certainly if people are not eligible to vote in the United States you can personally vote in your home country but certainly encourage people who can vote to vote here and talk to them about making a plan and why it's important to vote so with that in mind I want to turn it over to our next and you are here over my right hand shoulder to our next video person and you're gonna introduce absolutely so I'll just I'll just add one thing on to that which is this resource a resource called VOT dot ER where physicians can sign up and you get a little card with a QR code that helps folks vote and I don't have a vote I am and I'm on a work visa over here but I do have that in my office so that my patients can kind of they can scan it they can register to vote because this is an important aspect of their own health care to have a voice because people are going to be making decisions and you either you're a part of that or not use the little bit of a voice you have or you don't and this is one very important way to advocate for your patients and support them in that and our next video actually is from someone who also did a lot of advocacy work but in a very different way while she was living in the country as a non-citizen so dr. justly in chat well is a clinical assistant professor at the University of Arizona College of Medicine in Tucson Department of Psychiatry she's an IMG she received her medical degree from the Bharati Vidyapeeth University Medical College in India and is active in advocating for her patients and colleagues through the Arizona Psychiatric Society she also holds a position in the Executive Council with them and she's a member of the APA Council and advocacy and government relations I am just linked to the wall I'm a psychiatrist by training as you would expect now that you're attending the annual meeting here for the APA I wanted to share a little bit about my advocacy story I am a psychiatrist based out of Tucson Arizona I've been here about 12 years and currently a member of the Council of advocacy and government relations sorry we're just trying to get a little more volume here so definitely active in advocacy a lot at the state level and learning more about federal advocacy some of the topics that I've been involved in in terms of advocacy have been mental health parity scope of practice transgender health reproductive health physician health and well-being health professional well-being etc and so it's just a wide berth of things over the years now my true advocacy journey I want to say it may have started in childhood but my legislative advocacy journey started around 2018 here in the u.s. when I started to be more active and would say that I may have done things that really would count in that sphere what I found when I initially moved to the u.s. so I'm originally from India and was born and raised there completed my medical school when I came here I found that I didn't really know how the political process worked how overall those became law what the regulatory process was and I was here really learning clinical care and clinical psychiatry but in the first couple years of training I started to discover that things would be frustrating for me when I couldn't really get my patients resources that they needed as a lot of you would probably be able to also understand and this was a time for me when in Arizona we did not have Medicaid expansion there were a lot of people who were uninsured in our state and so starting to find a way to channel that frustration into some positive movement what I started to do was be part of the Arizona Psychiatric Society which is our district branch and initially just being part of a group was good I had some connection could see other people who face similar frustration in different parts of the state but gradually started to recognize that there was this legislative or government affairs group within the district branch that was active in trying to make changes to things that didn't feel right and so that was really my way of starting to find mentorship within advocacy started to join in some of those calls and see other physicians who really spoke up to issues that resonated with me and so we reaching out to them looking for a greater understanding of ways to be effective a couple of physicians who really helped me along my journey were Dr. Gretchen Alexander as well as Dr. Don Fowles they both had really diverse experiences within community mental health the peer space and so learning from both of them different ways of being effective I felt really helped me along my journey in growing another I think unique perspective that I can offer is that being an international medical graduate and coming from a system that was totally different. India has more of a British system. And so starting to understand how a bill becomes law and starting to really discover ways that I could have an impact became important. And so initially I used to think, oh, I don't have a vote, so what's the point of even being here? What's the point of trying? Nobody cares what you have to say. Especially when for legislators, most people say, write to them saying that you're a constituent. I'm like, well, yeah, I live in the district, but I don't have a vote. And what I started to discover as I worked with legislators and started to work with regulatory bodies is that maybe what really mattered is the fact that I had a voice, that I was a subject matter expert when it came to the experiences my patients had and the experience I had in not being able to get them the care they needed. And so being able to really come to terms with the fact that my voice was maybe more important even than my vote was a very empowering thing for me. And so I hope that you'll find topics and areas that you are really passionate about and start to speak up and speak about your unique perspective on it. We may not win every single battle we pick up, but hopefully we're moving the needle forward as well as sensitizing people to the issues that our patients as well as our professional colleagues face in the community. So again, thank you so much for joining. And I hope some of you, if you're looking for mentorship or looking for some guidance, can also reach out because I really enjoyed working with our trainees in the state as well as other people who are interested in learning about legislative advocacy throughout the APA and happy to be of assistance and hope you enjoyed the session. Bye-bye. Great. So, oh actually, so this was in a little bit. So you can see how Dr. Chotwal addressed her concern about not having a vote but discovering her voice. And she also mentioned, and this slide is a little bit out of order, that it was very overwhelming for her and it was a very unfamiliar system, the U.S. system. And so you saw those levels of advocacy and I alluded to the fact that it's important for you to figure out what level you're advocating in, but then to understand the system in which you are advocating. And so you need to understand, what is the history of your issue within that system? What is the system's organizational structure? If you're working within a hospital, look at the org chart, for example. Who is in power? Maybe there's someone who has a title but they're not really the one who makes the decisions. Do the best you can to identify who really does make the decisions, either at the top or in the background. What are the processes for change? She mentioned how a bill becomes a law. That's in the legislative system. And it's easy if you're working at the state level to look it up online and find out how your state operates. It's important to know what the deadlines are for some of those processes because sessions, especially at the state level, for example, are sometimes only three months in the spring on average. So if you have a great idea and it's June, you're going to have to wait until January in many situations. Try the best you can to understand the system's inherent biases. What are the dominant norms? How does the system manage change? And I'll give you a tip. Most systems do not manage change very well. So it's really important to be aware of that so that you don't become discouraged and you find ways to perhaps message around the biases that are inherent in every system. We've been talking about advocacy as a number of skill sets. I see we've kind of broken down the skill sets to really three, although certainly there's others, but collaboration, negotiation, and communication. And I'm going to talk about those briefly. I'm going to talk about collaboration briefly and we're going to see a third of four videos then. But collaboration is something that all of you have learned. Certainly when you were in your training, you worked oftentimes on multidisciplinary teams. You know how to collaborate and to use your expertise to further whatever clinical care you are providing. And so collaboration skills are just basically recognizing that you need to work as a team and that advocacy also is best accomplished by working with others to not be siloed in your own kind of angst about the issue, but also trying to reinvent the wheel. So network with colleagues who share your advocacy interests. Get involved with advocacy organizations, whether it's your district branch or other organizations that you are passionate about. And don't just sign up or join. Actually open their emails. If they tell you to email a state legislator, do that. Volunteer and you will be helping them. And so with that in mind, Dr. Eric Raflayuan is a great example of a collaborator and Dr. Fonseca is going to introduce him. So Dr. Raflayuan is an early career psychiatrist, award-winning researcher, and educator, and a nationally recognized policy expert. He currently works in private practice and consultancy. He is vice president for the Association of LGBT Psychiatrists and chair for the Caucus on the Social Determinants of Mental Health within the EPA. In 2022, he served as staff director for the 988 and Crisis Services Congressional Task Force. Dr. Raflayuan is also an assembly district 78 delegate for the California Democratic Party. I'm not the best editor. Hi, everybody. My name is Eric Raflayuan. I'm really excited to get to share a little bit with you today about my advocacy journey. I'll start off by saying mentorship and opportunities for advocacy were how I was first introduced to any of this at all. So I had the amazing opportunity to be at a residency program for advocacy mentorship and kind of funding and supported opportunities for part of the curriculum. One of the activities that we got to participate in that was really kind of formative for me was going to Sacramento, the state capital, for an advocacy day with our state psychiatric association. So this is not a novel thing to have them all across the country in psychiatry and across medicine and other fields. So generally, what these things look like is about a half day of training on designated issues for the day, and then also some training and tips on how to interact with legislators. Then the exciting part, meetings with various elected officials about these topics. Another thing to keep in mind, so often they will try to pair newer advocates and trainees with more experienced positions who have been doing this for a little while. So having this live interactive process is a really important learning opportunity, and that was for me. So I still remember my very first advocacy day in Sacramento. I still remember who was there. I still remember the more experienced position. I think I've probably forgotten the topics though. But another thing I remember is that I think the only thing I said during pretty much all of those meetings with elected officials was my name during the introductions because I was so overwhelmed and kind of so nervous about this. It was all very new. But I'm happy to share I've come a long way since. And I will say another way to find great mentors is to be involved with professional organizations. So this has also been very true for me. And so one of the opportunities that has really helped launch my career, both in advocacy, but just generally, was the Jean Spurlock Congressional Fellowship. So this is an APA program where I lived and worked in Washington, D.C. for a year in the office of Congressman Tony Cardenas from Los Angeles. And then after the fellowship ended, I actually got hired on the senior staff directing health policy for him and also as staff director of the 988 and Crisis Services Congressional Task Force, which was a bipartisan effort to support, implement, and fund 988 when it launched in 2022 and continues. So in D.C., I really got to see the importance of physician involvement in not just policymaking, but even on the political side of things and how important this is to have the policy change that we need to be able to better take care of our patients, but also just to improve health in the communities that we live in. Now that I'm back in California, I continue to be involved in various advocacy opportunities and leadership capacities, including 988. So I was recently appointed as a 988 technical advisor for state agencies. On the APA side, I also was appointed as the caucus chair of the newly formed APA Caucus on the Social Determinants of Mental Health. One of my initiatives there as chair of the caucus has been to help psychiatrists and the public at large understand how politics and policy influence health and the role that physicians can have in improving this process. Finally, I'm also running for president-elect of HLP, the Association of LGBTQ Psychiatrists, where my proposed presidential initiative is to develop a national advocacy campaign for LGBTQ plus mental health. Very important. In this journey, mentors were necessary every step of the way. I will also say it's important to identify multiple mentors because different mentors will be able to provide support or have areas of focus, connections, networking, be able to open up opportunities in different areas. And so you want to have different mentors for different things. Best of all are champions who will actively lift you up when there are opportunities. And I'll end by saying don't forgive back and don't forget to give back and mentor our next generation of psychiatrists. So you can see he went from being afraid to say anything more than his name in a meeting with a legislator to accomplishing an incredible amount. And so I'm just going to go over, I mentioned there were three skill sets. I'm just going to go over the other two and then we're going to have our fourth video and then we're going to have a workshop portion of this workshop. So negotiation skills. You already use negotiation skills in your clinical work. If you've ever spoken with a patient who may have concerns about a medication you're prescribing or concerns about something that you're recommending, explaining to them, negotiating with them what their needs are, how you see it is an example of how you are already negotiating. But negotiation skills are really important in a lot of different aspects of advocacy. And it's just very important I think first of all to recognize that when you're working with people in power, in whatever level you're working, that they have different agendas, they have different distractions and ideas, and they are going to see things very differently. So the best that you can, try to imagine what they are thinking, what they want to hear, and tailor your message accordingly. It's also important when you're meeting with someone in power, if they say yes to something that you're asking them to do, to stop talking. That's sometimes the hardest thing to do, to stop and to say thank you, see you later, get out of there. Because sometimes if you keep talking, they may take back their yes or it might give them an opportunity to say well maybe I'm not sure. Sometimes the hardest person to negotiate with is yourself. And I say that because sometimes we want the whole thing right away, but advocacy is incremental. The Husky for Immigrants, what is so inspiring to me about their coalition, is that they fight every step of the way. But to give, expand Medicaid to children who are eight and under, what happens to their nine and ten year old sibling? But they keep working. But sometimes it's hard, so you have to learn to accept you're not going to get everything all at once, but incremental change is moving forward. And no matter what, because you never know when you're going to see someone who may have been a bit more of an adversary, they may be a potential ally in the future, so no matter what, even if you win or lose, always express gratitude. No matter what. My person who I keep in mind for a good negotiation approach is our House Minority Leader, Hakeem Jeffries, who says that basically the idea of negotiation is agree to disagree without being disagreeable. So keep that in mind if you're wondering what that means. All right, the third skill, communication skills. Again, think about who your audience is. If you are writing an email listserv to people in psychiatry, you can use certain language. If it's to your colleagues in medicine, you may need to change it. If it's to the general public, whatever it is, think about your audience and tailor your message to their perspective. In any advocacy communication, I suggest you use the respect mnemonic, which is basically be rational. We're so passionate about what we are doing that sometimes we realize we need to kind of cool ourselves in order to be taken seriously. Be evidence-based, meaning put a smidge of data in whatever you're doing because that will satisfy people who are looking for that. Make it as simple as possible. Always choose to be positive. We certainly see that people oftentimes when advocating for something will fearmonger, will say if this doesn't happen, then that is going to happen. And that's good for short-term change, but really long-term change requires a more visionary, inspiring message. So just try to frame things positively if it's at all possible. Be empathic, meaning think about who your audience is. Check with others. Even if you're going to send an email, check with a colleague. Does this sound okay? Am I missing something? How are people going to hear it? We all are inherently biased and can't really reflect on how we're perceived. So always check with others and be transparent. Advocacy is best accomplished when you are open and honest about everything and your integrity is never in question. Lots of different communication methods that are used in advocacy that if you have an opportunity to take a class are ones that are useful formats to learn and to practice, whether it's an elevator speech, how to write an email that will get opened up, how to provide educational materials, how to write a petition that people will sign. The leave-behinder one-pager is the document that you leave with a legislator once you meet with them, how to write a letter to the editor or an op-ed or a blog post or a social media post. An oral and written testimony is what you might give to a legislator at a public hearing. Anyway, all of those, you need mentorship. You need people to show you how to do it, but certainly those are useful skills. But now I want to stop before we go to our last video and I'd like you to think about, before we hear that video, what issues are you interested in? It doesn't have to be related to psychiatry. I actually got my start in environmental advocacy. But we're going to take about a minute or maybe a little bit less. I'd like you to just reflect about what issue might you want to advocate for after this APA meeting. And so let's just take a minute to think about that for a moment and then we will. All right, Dr. Dionne Hart is an adjunct assistant professor of psychiatry at the Mayo Clinic Alex School of Medicine in Rochester, Minnesota. She provides clinical care services in multiple community settings, including an emergency department and state-operated community behavioral hospital correctional medical facility and a short-stay withdrawal management center. As the incoming Area 4 representative to the APA Board of Trustees, she has been involved in organized medicine at every level, repeatedly breaking barriers and mentoring trainees. She was the first chairperson of the AMA's Minority Affairs Section Governing Council and currently serves as AMA's representative to the National Commission on Correctional Healthcare. She was also the first black woman elected and re-elected to the Minnesota Medical Association's Board of Trustees. Hello. My name is Dr. Dionne Hart. I'm a psychiatrist and an advocate. I want to share with you pieces of my advocacy journey. My first time speaking as a delegate at an American Medical Association House of Delegates meeting was memorable because it was so horrible. I was nervous, I remember sweating, stuttering, and really just wanting to run out of the room. But I stayed, and I stayed because I had wonderful mentors, and two stand out, Dr. Ada Stewart who is a family medicine physician, and Dr. Diana Ramos who is an OB-GYN doc. Both were instrumental in helping me to become effective by managing my anxiety, not running out of the room, and learning how to prepare. Leadership has been an essential part of my professional journey, particularly with becoming an advocate. A little bit of advocating for some audio adjustments here. Good to go? Hello, my name is Dr. Diane Hart. I'm a psychiatrist and an advocate. I want to share with you pieces of my advocacy journey. My first time speaking as a delegate at an American Medical Association House of Delegates meeting was memorable because it was so horrible. I was nervous, I remember sweating, stuttering, and really just wanting to run out of the room. But I stayed, and I stayed because I had wonderful mentors, and two stand out, Dr. Ada Stewart who is a family medicine physician, and Dr. Diana Ramos who is an OB-GYN doc. Both were instrumental in helping me to become effective by managing my anxiety, not running out of the room, and learning how to prepare. Leadership has been an essential part of my professional journey, particularly with becoming an advocate. Because I learned how to be uncomfortable in a room with people who didn't share my vision, didn't share my perspective of a particular policy or an event, and learning how to either help them to understand parts of my experience and my beliefs and why I was passionate about a particular issue or concern, but also sometimes learning some of the pitfalls in my arguments and improving them, and improving the policy that I thought I knew the ins and outs of. So it was learning from them and also learning to persuade them and advocate for my patients and my profession. I recall the most, to me, moment when I felt like, okay, I can become good at this was when I was on a plane, can't remember what meeting I was going to, but I was really looking forward to just kind of turning everything off, not being accessible by phone or email or pager, and just leafling through a magazine and waking up after a nap, you know, just all those things that we do on planes. And I was looking at a magazine, Essence Magazine, which is really geared towards black women, and there was an article about a five-year-old who had been arrested, even placed in hand restraints crying after she had an emotional outburst and broke something in her classroom. And I learned about the school-to-jail pipeline, something that I had heard patients describe but never knew the terminology, and I was outraged. I was outraged because I knew working in corrections, what would happen to that child or other children if they were introduced to the juvenile justice system. So I started writing a resolution. Not what I intended to do, but what I felt I needed to do, and when I eventually took it to the House of Delegates at the American Medical Association, people didn't understand. They were where I was before I walked on that plane, and I was trying to educate them about why it was a public health problem and why it impacted our patients. There were a lot of naysayers, a few very memorable advocates and proponents, and eventually, not during that meeting, but after a time of study and more reference committee meetings, it became AMA policy, a policy that has been revised a couple times by students, students who now reach out to me for advice on how to shape similar policies. I learned from that journey that it wasn't something that I could turn off, even when I thought I needed to, when it was an issue that came across that I knew had to change. That's when you know that you're an advocate to your core because it breathes life into you. I walked out of that plane fresh. I deplaned with new information, a new challenge, a new passion. My spirit was renewed, not just by turning the world off, but listening to its stories, listening to patients' stories in a place where I didn't expect to find it. That's what, to me, it means to be an advocate, to always be listening, always be learning, and always be trying to make our patients' lives better, our communities better, and our profession better. My advocacy journey is still going on, so one day I'll probably learn from someone listening to this. Thank you for allowing me to share parts of my journey. All right. So we did take a minute already to do that reflecting. So I'm going to ask that we maybe get a little comfortable with each other here and have a little chat amongst ourselves about some of the things that are important to us and then come up and share. But maybe we can start with getting folks to move closer, maybe a little bit of mingling. You could pair up. Whatever is more comfortable. I think pairing up is easier. Teddy, why don't you pair up with the person in the back? Yeah. It's all right. You have something to share. What are they sharing about? Issues. Oh, this one? Yeah. Okay. Issues. Okay. I knew you were going to do that. I thought they would just share it. Because they might build connections too with each other. So I think then what I would do is we're at 234. So then I would just say, I wouldn't have people get up to the microphone. I would just have people in pairs just say, shout out, shout out. And then I would say, let's combine the two topics, two questions. Like, what are the challenges and what are your next steps to finding? And we'll have them pair again and then share. And then we'll hopefully be done with 10 minutes of questions. I had thrown in a question about what would you want to advocate about? What do you have in mind? I think it's going to be too much. I think they're going to talk about what they want to now. And then it's like finding mentors. This is sort of getting at that question anyway. This is what you care about. I think that's too much otherwise. That sounds good. Let me just quickly make that edit. Also, I'm happy to see the focus on kind of destigmatizing Massachusetts. It's a pretty dramatic transition. Of course. It's having a whole session of civil rights. That's cool. That's really awesome. I think I'm going to go with this. I meant to want to work around lifting the veil a little bit. So it's going to sort of vary. It's like, okay, he's going to talk about fighting, obviously, and others. I'll just do a quick shout-out. And then there's another one. This guy created a stop stigma. All right. Let's bring it back and maybe hear some of your ideas. And folks can just kind of shout out from your group, too. You don't have to come up to the mic if that's awkward for you. Does anyone want to share what they were talking about? Just give us some of the ideas that you might want to advocate for. I can give you a quick snippet of my little thing here. Do you want me to use the mic? My voice tends to carry. We can hear you. I'm Rob. I'm an emergency physician in Australia. Which is how I ended up at this conference. I've been involved in the Australian Medical Association from when I was a resident. We ended up doing a big advocacy campaign around physician well-being and physician burnout. So in Australia, the lifetime prevalence of physician burnout is 97% in research. Lifetime prevalence, which to me has always said that 3% of physicians lack insight. So we used a resident hospital health check, so a survey of about 800 junior doctors in Queensland, that said that about two-thirds of them or so were healthy with maybe medical error due to fatigue and burnout. And then took that, embarrassed the government, did a whole bunch of media, and eventually got legislative change that made the hospital boards of directors. It became an enumerated thing in the legislation that they are responsible for the psychosocial well-being of their staff. At the board level. So we got it off the agenda at every board of directors meeting across the state for the 16 hospital services that we have. It sounds better than it is because nobody's enforcing it at all. So it's on the agenda, and there's lots of lip service paid to it now, but it hasn't actually changed anything on the ground, because it's not the board level that the bullying and harassment comes from. It tends to be further down the central, and it would change those things. So it sounds really impressive, but it's actually changed nothing. So the next challenge for us is how to operationalize that advocacy, and the fact that that's now in legislation, to actually accomplish some change on the ground. But that's my little advocacy journey thus far. Yeah, thank you so much. And somebody else? It's a big concern that's uniquely in the U.S. Again, along the theme of kids, like, since 2021, I believe. No, 2020, firearms have been the number one killer of children in the U.S. And we also talked about, like, geriatrics, the notion of loneliness. And I think the same, like, thinking about our queer elders, for example. Like, that's, it's, like, it's the worst. So, yeah, I think we all know abuse and advocacy. Like, we all have to care about it. Wow, that's great to hear. A little geriatrician here loves that. Yes. A little bit from that side of the room. Yeah. I first wanted to share with our Australian. I feel like it takes a while for it to trickle down. It's like the same thing happened with our work hours, right? Like, I was around when it first started that you could have more than 80-hour work weeks, but no one enforced it for, like, maybe a decade. So, to take part, it will happen. And I was just going to add that Brenda and I are forensic psychiatrists, and advocacy comes up a lot because we see firsthand things that happen in the criminal justice system, which we know isn't always fair. But we also have to strive for objectivity and inner roles. Great. All right. Thanks for sharing. Anyone else? I can share a little bit. Yeah. I'm really passionate about increasing access to information. So I'm going to share a little bit. right now, so there are also a lot of. Hopefully, some of these conversations can continue on outside of here, too. We have some other questions for you to maybe chat about a little bit more. So challenges, you mentioned some challenges, and I think all of you did, really, in your kind of passions there for advocacy. But what are challenges that you might face defining mentors or role models, sponsors within advocacy work? What are maybe some next steps that you've thought about to help you find someone to support you along this journey? So go back to your pairs. Do some more stuff. Or if you want to do a musical, chairs, that's fine, too. But who are... How much time are we giving? Just... Two minutes. Two minutes. Two or three minutes. I'll time. Yeah, three minutes. I think so. Well, we're at 2.40. 2.40. Then we'll have a little bit of a discussion. Yeah, we have to do it. So we're a little bit... We should have finished it. We should have finished it. And that's when we should have started the Q&A. We'll have, like, conversation. Yeah, I'll see if I want to stick around. We'll give you all the info you need. Yeah, we only have 17 minutes. End at 3 o'clock. My thought it was 3.15. 1.30 to 3. Thank you so much for having me. Thank you. So we're going to wait maybe 10 minutes. And here, are you waiting for me? Oh, I am. Yeah. OK. I thought I was going to say that I'm more of a pet. She's beautiful. She's beautiful. Like, even though I was hiding, I was like, oh, no. Oh, the kids are going to stand up for all of us. I mean, ultimately, the Q&A part is just a field of the question. So I'm happy to do it. What are your goals for the rest of the team? Mutually. Top than me? No way. I am. I feel like I'm the liaison. I don't know. I can do it. Do what? I can just do it. You'll do what? Can you start there? Right. And then I can go back. OK. I like that. Symmetry. It's good. Very nice, sir. A lot of quality. Thank you. All right, it's sharing time. So we can bring it back to the large group. And I'm seeing some faces there on that side of the room looking kind of ready to share. So go for it. So, I feel like maybe reaching out to that person again, they might be able to. Yeah, that's a really good point. I think something we didn't really talk about, but for folks who aren't comfortable like being in the limelight and like being the one doing the talking, I know we talked about op-eds and blogs and letters to the editor and things like that, but even if you know friends, colleagues who are doing that advocacy work and maybe they just want someone to like share like these are the resources, this is the data, these are articles I've read, I have them kind of organized for you, like that is also kind of like behind the scenes ways of supporting other people as they're doing that work, and we used to kind of contribute in that way, but I think, and I may be reading between the lines a little bit here, but there is some risk in advocating, that there is a vulnerability that comes with it, there is that authenticity piece, but as a trainee you might not be in as much of a position of power, you got to get your training done, and there are definitely like power differentials to be navigating, so like finding where it's comfortable for you and starting there for sure. Other thoughts in the room? Yes? I was saying like, I feel like I'm like a needy, bad mentee, in a sense, like I'm just like inconsistent in like reaching out to people that I know, because like I know good people, like I've been, like I've done all the check boxes, and like what you're supposed to do is like a fellow, and then I'm just like why am I still without, because I don't know what I'm doing, because I haven't asked for help, so I wouldn't do that to my students. Wow, that's important, really important. Yes? So maybe a little bit of reaching out to be more actively engaged, but also maybe knowing when to kind of pull back and take back some of your own space. Yeah. Other thoughts? Yes? I'm kind of, to some degree, self-taught, then deciding, okay, the imposter syndrome of being an advocate and trying to mentor someone else, because I feel like I have a lot to learn about myself, I think can play a role in like the availability of mentors and role models in your area if nobody is willing to kind of just step up and start And I might suggest, again, maybe to reconceptualize what it means to be a mentor, which is like you are not, doesn't mean you're an expert, it means you're on this journey to learn, and you can say this is what I've learned, this is what I know, you can be a sounding board, just getting feedback, this is how I hear it, and that can really go a long way to helping both of you develop your skills, even if you don't have an identity yet of being an advocate. And that is all we have, but we're going to open that up now to Q&A, so I'm going to hand it off to… Although I just want to see, anybody else, next steps for advocacy, you know, mentors? Did anybody have anything that wasn't mentioned about how to find one? Aloha everybody, I'm Jeff Cut from Honolulu, Hawaii, and so much of becoming effective has to do with relationships. I'm talking about when I was six years old, I would march around the Capitol. And against a lot of people, I won. After three months of marching around the Capitol. What they taught me was, no matter what the odds against you, you can win. If you stick to it, no matter what the odds. It's calling them on the phone, wearing their t-shirt, running for office, giving them $25 at their fundraiser. That's what you do to create relationships with the legislators. Now, I had two big advocacy things in my career here. One was getting the annual meeting to Hawaii. And the other was keeping our patients safe from these crash course discardment programs. And what I did was creating a relationship with the legislature. I called them. Well, I went to APA and said, listen, we've got to bring the meeting back to Hawaii. It's a nice idea. Not going to happen. But then I found out that the APA was sending a delegation to the AMPA meeting in Hawaii in 1998. And so I thought, oh, they're going to be in Hawaii. Let's advocate for the meeting there. And I called the convention bureau and said, hey, can you give me $3,000 because I want to throw a party to entertain these visiting delegates. And we might be able to get an interesting green meeting. And I made another phone call to the Hawaii legislature. And I called up the chair of the House Tourism Committee. And I said, oh, Chairman Chang, you don't know me. But what I want to do is bring a whole bunch of money into Hawaii. Can you help me? Psychiatrists are coming from Hawaii. Can you come and help me lobby them? And in the end, we had five members of the House and two members of the Senate show up at this reception. And that blew the psychiatrist out of the water because not only did legislators allow themselves to go to a psychiatric event, which was just never done in those days, but they even allowed themselves to have their pictures taken as the psychiatrist. So we got a setting where. Loving is the practice to bring the meaning to a word. Not a single crash course conspiring mule is even allowed to be introduced in the House Horse Center for the State of Hawaii. So if you can create these kind of relationships, you know, some you're born with, some you fall into, make use of them. But if they're not there, create them. Dr. Kaka, thank you very much. I mean, it looks like we're going to be signing up for mentorship from you shortly. Those are really great, vivid examples, real-world kind of things that we can all do. I'm going to share just a little vignette myself, nothing on that level at all, but just sort of thinking about civic engagement as a way of participating in advocacy. So in 2010, and I'm from Wisconsin, there was a sea change that took place when Governor Scott Walker took over, including banning unions from, state employees could no longer form unions. And there was a huge march on the Capitol. There were tens of thousands of people around, and there were hearings held for days on end. And I took my daughter, who was then, let's see, what was that, 14 years ago, so she was about 10 years old, took her to the State Capitol. We waited in line, and about 1.30 in the morning, we got in and were able to hear some of the debate going on. And I was like, what did, you know, the side that I was on lost, but it was an incredible example of just, like, participate, you know, civics happening right in front of us. And so I would take any, just like Kiki was saying earlier, vote every time, participate in those sorts of activities as well, and bring your friends and family with you to kind of really see what that sort of civic engagement looks like. We have three minutes left for questions. So we've been asking you all questions. What questions do you have of our experts up here? We're not experts. We're on our own journey. Yeah. I am a liaison between these two beautiful consuls. So that is my role. Where do you find the resources to get connected? That's great. You know, through mentorship, or you get some coaching, and... Well, so that was the question that we asked you. Where can you find mentors in your... I mean, I think one of the things we hope is going to be a take-home is that you can find mentors in your patients, in their family members, in your own, like, community, in your colleagues, and that it may not be the mentor who can do... Each mentor is going to have different skill sets. And so one may be able to help you with op-ed writing. Another may be able to help you with engaging more in this particular activity or organization. So I think what we're hoping is that you realize that mentors are all around you, but it's up to you to reach out and make that connection. I think I was thinking of the district branches. So the district branches often have, they'll have, like, legislative committees, for example. We have one in Wisconsin. And so folks who are... And we have a lobbyist, so someone who can actually give us some practical advice about, oh, talk to this senator about that, and this is their... That person's interested in that topic, and so on. So I'd look at the DB level and see what resources are available. Yeah. You know, part of our putting together... And I really want to applaud Dr. Franzeca, who did all those incredible videos and organized all that. Part of our idea is we want to create a library of mentors so that you can see there's very different journeys and ways that they engage in advocacy, so that the title of this is You Can Be What You Can See. We want to create more so that you can understand that mentors are everywhere. And so these may be on the APA website. We're hoping to get that up there. But if you're... Think about the topic that you spoke about that you might want to advocate for. Look in your community for an organization, whether it's the district branch or something else. Reach out, and you may find people in that organization who you can network with who can mentor you. I'll say, also, if you have some idea of the kind of advocacy work you want to do and you know that there are other people doing it, even if they seem like, I don't know, APA celebrities, like Kiki... I'm sorry, I'm just enjoying this too much. Even if it could be maybe intimidating that there's someone you really look up to, shoot them an email. Worst case scenario, they don't respond. They might be able to point you in the direction of someone else if they don't have the bandwidth to. So it's just worth it to kind of see who's doing similar work in that area, or even if it's not in that particular area, just the way that they're approaching things and reaching out to them. Yeah, and I'm not a celebrity, but katherine.kennedy at yale.edu, happy to answer any questions. I'm just saying that right before you said that, someone took your picture or so. I would add too, I mean, there are plenty of other sessions on advocacy here as well. So right after this, in this very same room, is Mental Health in America, Lifting the Veil of Ignorance, which is going to talk about various public health approaches to addressing stigma and mental illness. And there are a variety of other sessions like this across the meeting, so I'd encourage you to attend those and listen to those stories as well. That is our time. I want to thank so much Dr. Fonseca, Dr. Kennedy, it was absolutely astounding. Dr. Woloszek.

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