On this episode of the Catalyst Podcast we speak with Chestnut Health Systems' CEO Dr. Dave Sharar. We discussed:

• Dave’s 35-year career at Chestnut Health Systems, including his current role as CEO and his previous leadership of Chestnut Global Partners, where he managed behavioral health services for over 600 employers and 1 million employees worldwide.
• The significant shift in public and political attitudes toward mental health and substance use disorders over the past decade, with increased recognition and bipartisan support for expanding treatment resources.
• Medicaid’s role as the largest funder of mental health and substance use services in the United States, providing essential healthcare access for millions of Americans, including the working poor.
• Chestnut’s evolution into an integrated healthcare organization, now a federally qualified health center, combining behavioral health with primary care.
• The benefits of an integrated care model, where multidisciplinary teams coordinate to reduce inefficiencies and improve outcomes for patients with complex needs.
• The potential negative impact of Medicaid funding cuts, particularly on rural areas and small towns, where access to substance use disorder treatment is already limited.
• The success of Chestnut’s walk-in medication-assisted treatment program for opioid use.
• Challenges associated with proposed Medicaid work requirements, including the failure of previous attempts and the likely overestimation of able-bodied, non-working Medicaid recipients.
• Dave's cautious optimism that policymakers will appreciate Medicaid’s importance and approach any reforms thoughtfully.

We’re joined by Melissa Sienna, Executive Director of MDFT International (Multidimensional Family Therapy), and by Sandra Arguelles, National Trainer, also with MDFT International. MDFT transforms lives through family-centered treatment for youth struggling with mental health and other challenges, including

• Substance Misuse
• Mental Health
• Crime & Delinquency
• Antisocial & Aggressive Behaviors
• School & Family Problems
• Emotional Difficulties

MDFT has more than 30 years of rigorous research that proves its efficacy, and the widespread adoption of MDFT demonstrates its feasibility. Today, clinicians implement and sustain MDFT programs in over 150 public and private settings throughout the U.S. and Europe. We discussed:

• The MDFT for OUD program: the gaps in care that it was created to address, how the program’s enhanced training, overdose protocols, and medication access differ from standard MDFT approaches.
• The Connecticut Demonstration Project, a pilot study/program evaluation involving participants aged 15 to 19 diagnosed with OUD. They tell us about the methodology and their findings.
• Plans to expand the program beyond the 6 sites statewide it is currently in.
• MDFT’s history of partnering with LI in working with the GAIN (Global Appraisal of Individual Needs) and the most significant outcomes achieved through their collaboration.

Dateline: Washington, DC. This week’s guest is Chuck Ingoglia, President and CEO of the National Council for Mental Wellbeing, the. unifying voice of America’s community mental health and addiction treatment organizations. Together with more than 3,300 member organizations, they serve more than 10 million adults and children living with mental illnesses and addictions. For fifty-five years, the organization has been a voice on Capitol Hill, driving policy and social change. We discussed:

1. The organization’s mission and Chuck’s role (on the morning we spoke, he was just back from a meeting at the White House ).
2. With Medicaid funding under threat, the messages are likely to resonate with lawmakers.
3. The Mental Health First Aid (MHFA) program, which has been used to train more than 3 million people in the U.S. to identify, understand and respond to signs and symptoms of mental health and substance use challenges.
4. The importance of storytelling to showcase the value of services promoting mental wellbeing.
5. The intersection of AI and mental health - AI’s potential to help clinicians cut the time spent on note-taking and administrative processes, improve decision-making and client access, etc. Chuck also raised concerns, such as whether AI can be entrusted to generate duty-to-warn notifications when necessary.
6. The importance of keeping engaged with elected officials to help them understand the crucial role Medicaid plays in healthcare delivery.

There’s lived experience…and there’s lived experience. Patrick Hibbard, Assistant Research Scientist at Chestnut Health Systems, has had anything but a conventional career path. Patrick shares his journey, from incarceration to his current role with Chestnut, and how his background inspires and informs his work. We discuss:

• How he uses econometrics and quantitative methods in evaluating public health interventions.
• The challenges of causal inference in public health research and the need for quantitative data to measure community-level impacts.
• The need to balance research with lived experience.
• The effectiveness of drug courts and their evolution (while drug courts can be effective, they may not always be the best approach, especially where there are structural inequities in policing).
• The connections between/among different organizations in the recovery ecosystem.

What’s ultimately so compelling about Patrick’s story is how he’s used it in combination with data-driven insights to increase community-level impacts, improve public health…and save lives.

Dale Shreve is President and CEO of MHCA (Mental Health Corporations of America), a national association of innovative, entrepreneurial behavioral healthcare organizations focused on the development of C-suite executives. We discuss:

• MHCA's Role in fostering executive development for behavioral healthcare leaders, highlighting the importance of peer connections among CEOs and the organization's evolution over 40 years.
• How the field changed over the past 5 years - how Covid prompted a shift to virtual healthcare services and how it affected the field.
• The meaning of “entrepreneurship in behavioral healthcare”.
• The biggest impediments in transforming healthcare delivery and how behavioral health organizations have adapted technologies, such as AI, to improve service delivery.
• Increased demand for behavioral health services, Medicaid funding, revenue constraints, and the need for integration with primary care.
• MHCA’s role promoting continuous learning and encouraging leadership skill enhancement.
• Whether Dale is related to Michael Shreve, a former percussionist with Santana.

For more on the organization, visit www.mhca.com.

Jordan Green is the Founder and CEO of Remble Health, developers of a mental health app that empowers individuals, providers, and clients with innovative AI tools, mental health resources, and 24/7 AI-powered chat support. With Remble, mental health support is accessible, confidential, and personalized to each user’s unique journey. We discuss:

• What Jordan was seeing and experiencing during the pandemic that prompted her to start Remble Health in 2020.
• How the Remble app and Mia, the chatbot, work.
• Remble’s “escalation protocols” and “duty to warn” functionality.
• The importance of balancing safety and privacy in digital mental health.
• How Remble expanded beyond serving individual consumers to supporting providers, payors, and public sector agencies.
• The increasing stress and anxiety in today's workforce, particularly due to AI-related job uncertainties, and how Rumble helps address these issues.
• Remble’s partnership with Chestnut and Lighthouse.
• Remble’s plans for the coming year - the ability to engage Mia verbally, an update to Remble’s massive content library (which currently includes over 300 short videos, 150 in-depth courses, a coping skills library, and guided meditations).

We have the two founders of CogniTrainer on to find out (spoiler alert: it can). CogniTrainer uses AI to create a simulated training environment for students and mental health professionals, ensuring that they’re prepared for real-world clinical encounters. Michael Glowik, Emile Rutherford, and I discussed:

• The gaps in mental health training and education CogniTrainer fills.
• The challenges in mental health education that they believe have been overlooked by conventional programs.
• How their AI chatbot/avatar technology so effectively replicates the nuances of real-life therapy sessions.
• Ethical considerations - bias, etc.
• How the technology will be used in police training.
• Where they see their technology evolving and the future of online learning.

Check it out! For more on the company, go to https://cognitrainerai.com/

A lot can change in just ten years. This conversation with Emory University’s Justine W. Welsh, MD, discusses recommendations for updating adolescent use treatment and policies that have been in place for over a decade.

Dr. Welsh is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, where she is Vice Chair of Child, Adolescent, and Young Adult Services, and Director, Addiction Services, for Emory Healthcare. She is also the Medical Director of the Addiction Alliance of Georgia.

Dr. Welsh was lead author and editor of a new paper titled "Recommendations for Adolescent Substance Use Treatment and Policy ” (co-writers/editors include Chestnut’s Lora Passetti and Mark Godley*). The paper updates the 13 original principles espoused in the 2014 paper, “Principles of Adolescent Substance Use Disorder Treatment” published by the U.S. National Institute on Drug Abuse. We discussed:

• What prompted Justine and the team to update the paper.
• How integrating care for co-occurring mental health disorders and substance use disorders improves treatment outcomes.
• The most effective ways to integrate substance use treatment within the educational system.
• The biggest barriers to maintaining adolescent engagement in substance use treatment, and how can providers overcome them.
• How SBIRT, an important screening and intervention tool, has been effectively used in adolescent populations.
• Harm reduction services remain controversial in some areas - Justine discusses the evidence that supports increasing funding for harm reduction in adolescent substance use treatment.
• The most effective ways of engaging families in adolescent substance use treatment.
• The one policy change she’d make that has the potential to have the greatest impact on adolescent substance use treatment.

*Welsh JW, Dopp AR, Durham RM, Sitar SI, Passetti LL, Hunter SB, Godley MD, Winters KC. Narrative Review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy. J Am Acad Child Adolesc Psychiatry. 2025 Feb;64(2):123-142. doi: 10.1016/j.jaac.2024.03.010. Epub 2024 Mar 25. PMID: 38537736; PMCID: PMC11422521.