Ken Huey 0:00

Today's guest is Ricardo Santiago Ricky, behavioral health executive, author, and leadership strategist with over 20 years of experience leading multi-site treatment programs and driving organizational transformation. He's nationally recognized for integrating experiential and adventure therapy into mental health care, helping teams and clinicians grow through insight, empathy, and purpose. His new book, How Long to Sing This Song, explores resilience, healing, and the journey from pain to purpose. Ricky, thank you very much for being with us. Thanks for having me, Dr. Huey. Great. So I'd like to start with just asking how you landed here. You're in the behavioral health leadership space. What drew you to the field?

Ricardo Santiago 0:45

I uh tell a joke when I'm having a group with my clients and I tell them that I stumbled into my career, I stumbled into my calling. But over time, I have for 25 years of doing this work, I realized that it was always what I was meant to do. I never had ambition to be a therapist that I can recall. It just seemed like a series of accidents that I found myself working in a social work setting. And the uh opportunity to do work that helped people meant a lot to me. I couldn't imagine doing something that didn't have an impact. And I my mission has always been about preserving families. My first 13 years of my career, I was working with children and families in the dependency system and transitioned over to the addiction treatment side after that. But these days I've been able to integrate and really come to the realization that I do this for because I am a child of an alcoholic, and my mother died for the disease of alcoholism, and I'm really here to be a beacon of light for people who are struggling with addiction and also for their families and advocate for them as well. So I'm very blessed that I kind of stumbled into a calling.

Ken Huey 1:48

Oh, very nice. I'm also fascinated in the experiential adventure therapy. So I have a deep background in that for a lot of different reasons. A lot of the brain damage that you get, particularly from ACEs, is experientially created and experientially healed. What brought you to that? Why experiential and adventure therapy in traditional mental health?

Ricardo Santiago 2:07

Well, 13 years ago, I when I transitioned into substance abuse treatment, somebody gave me an adventure-based treatment center to run. And I didn't even know that adventure therapy was a thing. I had never done therapy outdoors or anything like that. I had never been on a kayak or wouldn't even consider myself an outdoorsy person. But it saw something in me and gave me that opportunity and then told me you need to go become an expert in this, because they have trained everybody here to be an adventure-based clinician, at least in understanding the modality of it. And I've been very much involved in that world ever since. I didn't realize that I was an adventure therapist until I found myself surrounded by these clinicians that were doing therapy in incredible ways, doing things that I'd never imagined. I don't know that I want to go back to 12 chairs in a circle again. Even if it if we're just walking and talking in the outdoors. I just believe in it and that we should be doing something. Adult learning theory tells us that we remember 90% of what we say and do. So the experiential piece is that piece about doing. The G.I. Joe fallacy tells us that what they used to say in that old G.I. Joe cartoon, that knowing is half the battle, that other half is the piece that's really key, which is we have to be able to do something with that and you have to practice that coping skill more than just talk about it. And just knowing what we're supposed to do to be in recovery is not enough. We have to put it into action and the experiential approaches are ways that are tangible that we can break through some all those barriers really that are there at the beginning. Because people are used to doing therapy in the doctor's office and sitting on the couch with a kid or but when you take them outside of that setting and you put them on a kayak, for example, they think they're talking about a kayak and about how they're gonna keep it balanced, but they're not. They're talking about their life, they're talking about their recovery. So I love that piece of it, the metaphorical piece of it. And it just seems some of the best therapy I've ever done or witnessed has been an experiential setting.

Ken Huey 3:56

Yeah, so I love thinking of the sort of overarching theory behind it, but I love the actual stories. Tell us about an instance where adventure-based therapy or nature therapy created a big shift for a client.

Ricardo Santiago 4:10

I've seen a lot, which is what are the approaches that the tenets of adventure therapy is this challenge by choice. So we're not forced to do anything that you're not willing to do. But change doesn't happen in the comfort zone. So we mean that challenge zone, which is the gap on one end you have panic, and on one end, and this other you have to safe, you have your safe zone. That place in the middle of challenge zone is where you want to live and that's where you want your life to be, actually. But that's where desperate change happens. And that's different for every client. For some client, it is I don't want to use the kayak as an example, or even a surfboard, just getting out into the water is the challenge. And for somebody who's more synesthetic and maybe an athlete, standing up and doing some of the other more challenging activities is there. That's their challenge. So and sometimes it's really just about whether you have whether you achieved the task or not. It's it is about the came the breaching campus where you pushed yourself beyond a limit that you didn't think you could. I use myself as an example all the time that I I found myself once at the top of a light pole. Uh of an electrical pole that I climbed up, and I am being tethered to a group of newly detoxed drug addicts who are holding me up, and I have to jump off this electrical pole to uh the trapeze and hope I get it. And it transformed me when I found myself at the top of the wonder, how did I get here? What am I doing up here? And seeing the transformation that it just does for me, the fact that I could even do it. It doesn't matter, I didn't make the trapeze, but that wasn't the point. The biggest thing just happened when people the finance was doing something they never figured they could ever do. Never mind the all the great things we can do when we that when we push them beyond those limits, but it's just the fact that being able to do something you never thought you'd seen yourself doing and that you were capable of doing.

Ken Huey 6:02

You have a deep background in the clinical excellence side of things, delivering experiential adventure therapies. And there's kind of operational efficiency that you have to go for at times too. This clinical excellence, operational efficiency, what do you do to balance that in an organization?

Ricardo Santiago 6:19

They're both not they're not really competing priorities. Those are interdependent because the clinical excellence requires strong systems to be in place. And if the workflow is unclear and the cases are unrealistic or supervision is not consistent, then even a really good clinician is going to struggle to deliver quality care in a system like that. I find that my job as a clinical director is to is part air traffic controller and then part interior designer in that I describe it as I just have to arrange the furniture so that the clinicians can not stumble into things or I just have to move the furniture around so that they can be successful in their work. And I do that by creating operational efficiency, by creating systems, giving them back time so that they are not having to shortchange the clinical work in favor of some process or some documentation, figuring out every possible way that we could make them be successful. And you cannot provide quality care if you're in a system that is as very chaotic or doesn't have enough structure in it, just like it does like anybody really, even the clients, the staff will respond well to that structure. They may complain about it behind closed doors, but I they know that when that system runs, it's like a machine that needs to be started up. And once that's and it becomes just second nature to us, and every day, what are the things that we have to do, what are our deliverables, and we have a system for doing, that's when the clinical work can really become very creative and be at that excellent level. But when you're having to be drawn in a bunch of different directions because you don't know what's supposed to be the priority, that's when I think a clinic, even a good clinician will struggle in a system like that.

Ken Huey 7:54

When you come into a system that's got some of that chaos as part of it, I mean it might seem self-evident just using the word chaos, but what jumps out to you? How do we know that the struggling having systems in place to not be chaotic?

Ricardo Santiago 8:08

The first piece is observing a lot. Then when you come into a new facility, I the job is that of the fin filter is essentially the same, no matter where you go. But every culture, every workplace, every company does things just a little bit differently. So I spend the first two or three months just observing the way that it actually runs. Not the way that it's designed, not the way that's in the handbook, but the way that it actually works day to day. And where are the sticking points for the staff? What are the things that they really struggle with? The measures of success that this particular company has. And once you've assessed where the efficiencies lack, you have to build that trust over time with the staff so that they'll go with you. Because you can you can have great ideas, but you don't change systems by just decreeing that this is what we're doing. You have to really set up everything for success. So I think some folks make the mistake of just think, well, if I just will it into existence, if I just say that this is how we're gonna do it, then it will happen and fail to look at what are all the different steps that we need to get there. And is this system regularly with this today, or is this a three-month goal, a six-month goal? How do I roll this out in steps so that we're making progress toward it? But it doesn't feel like you're c and like pulling a timer job trying to change everything. And the teams are first because they're gonna be skeptical and reading of all of those games because you have to convince them that this is it's gonna feel like more work in the beginning, but in six or seven or eight months we'll this is gonna work more and you have to build that trust with that in every opportunity that you can.

Ken Huey 9:39

Yeah. Is there a particular sort of systemic problem you find more often than not, or something that you see jump out frequently?

Ricardo Santiago 9:49

I think the importance of culture. If anything I learned the last 13 years working in substance abuse, when it when a company has good culture, and you have to be intentional about building good culture, and that is not just getting pizzas on Tuesdays and cupcakes on Friday, but really being very aware of of God, being very aware of the conversation that happens outside of the meetings that you're in, uh, and having building enough relationship with your staff where they will tell you the truth, they will tell you the where they struggle and seeing where there's conflict in between departments. And for that you really gotta spend a lot of time, I call them touch points during the day, where you spend time with people individually and re have and build a culture. It does not happen also by decree, it happens through small choices every single day. And I think the biggest challenge that I've seen has been a poor culture where there isn't any trust of the leadership, there isn't trust of the company, there is a a culture of fear or a culture of gossip, and those things are more corrosive than anything else. That I think the biggest stumbling block is a bad culture.

Ken Huey 10:55

What do you do to turn a culture like that around?

Ricardo Santiago 10:58

I describe it as not because it is a sinking ship, but as it is culture is a Titanic in that it is a very big ship with a small rudder. It does not correct, it doesn't turn on dying. It takes a while. It's a you have to make small corrections. It does sometimes mean you have to uh observe your staff. There may be some folks that are not going to be able to make it to the end of to where we're going because they're too stuck in the past. There can be very they're engaging in a lot of gossip and are very corrosive. That's the part that's staff specific, but also just looking at the culture all around interdepartment, do these is there that relationships in between the staff? And they're at lunch, are they all in their offices eating their lunch, or do they they sit together, they do they enjoy each other's company? That's when synergy starts to happen. And it happened on its own. So somebody's out sleek, you don't have to coordinate anything. Everybody naturally comes in and then fills in the gaps. But it does not happen overnight, and so and you have to be intentional about it, and that does sometimes mean you have to make decisions that are staff related. But you also have to be really, really aware of gossip and do something about that when it happens, because that stuff poison a culture very quickly. But that's what I found a lot of times is it's really it's having a very low tolerance for gossip, which is talking about a problem to folks that don't have any power to change the problem or address it or solve it. That's Dave Ramsey's definition of gossip. Yeah, that's what I find in how more than anything it uh fixes a culture.

Ken Huey 12:25

Huh. That for you is the biggest single man. You've got a culture that is out of control, is that gossip.

Ricardo Santiago 12:31

Right. Because then there's an agenda that is not pitted to you. You there's a conversation happening that you're not a part of. And it could be just a general skepticism because they've had a lot of leaders stand in front of them. I made promises to that. And you're just one more person that's making the promises about well, we're gonna this is gonna fix everything. This is gonna be, I'm the guy. And you gotta earn that, and that's being consistent, modeling what you what you're expecting, especially the consistency part. You're there, you're consistent with your expectations, the messaging is the same, and you you model what it is that you're wanting them to do, and being intentional about training in those areas too. But I think I just read a book called Eight and a Half. I think it's called If Disney Ran Your Hospital, and uh it talks a lot about that that Disney customer service model and how to apply it in the hospital setting in the case of this book. But I believe there's no reason why we can't provide a Disney level of service in behavioral healthcare. Yeah, if we're intentional about it.

Ken Huey 13:32

So in your own book, How Long to Sing This Song, you explore the space between pain and purpose. Talk to us a little bit about that.

Ricardo Santiago 13:40

The book took about 15 years to write. And I think it took that long because I needed to live more life. It didn't happen, it was an unfinished story until I had lived more life. And it's really it's about that place in between when you are contending for something, when things don't seem to be changing. And it's a place that I'd been in, and I'm sure And everybody has a one-point found themselves in that place, that hopeless place where you don't see things changing. And you're trying, you are praying, you are doing the things you're supposed to be doing. And the books designed for people that are in that place. To give them encouragement. Some of it is stories from my life, some of it is scenes from movies that I like, songs that mean a lot to me. It has spiritual components from my faith, and all of course the psychology. This is it's it's a very unique mix of all of those things to give encouragement to people who are in that place. And that's what the title comes from the Psalm 40, a song by my YouTube, that has a refrain at the end that says, How long to sing this song? The song is called 40. And I just that idea that stuck in my head 20 years ago when I heard that song. And and because I'm a musician, it resumes this. My prayer was always how long to sing this song? How long am I going to be in this situation? For the clients that are here, that are in treatment, they're feeling the same thing. How long do I have to sing this song? How when do I get to write a different song in my life? And the song being your metaphor. And so how do you find meaning when you're not when the end result, you're not there yet? So you have to find meaning in this the wilderness piece, the part where it just feels like suffering. How do you find that meaning in that in-between spot?

Ken Huey 15:14

Ricky, so there could be people that watch that that want to know more about your book, perhaps, or more about the work that you're doing. How should they find you?

Ricardo Santiago 15:22

The book is available on Amazon. It's on paperback and Kindle. I tell people all the time that that book was written to just kind of purge something out of me. It was never intended to sell a lot of copies or anything. I I think I've sold mostly to my family. It's really it's just something I needed to purge out of me. It's a message that really did come together beautifully, but they can find that on Amazon Kindle and on paperback. I'm hoping to very soon we'll be giving it to the clients that come here to our facility so they could have a welcome bag and read it while they're here. My current full-time work is we're clinical director at Recovery First, which is part of American Addiction Centers. This is in Hollywood, Florida. Where you'll find me, we do have music therapy programming. We have an adventure therapy program. There's some really exciting stuff happening down here as far as the programming that we are doing. And you can also look up Epic Adventures Therapy, which is my team building sort of side business that does team building for corporate groups, utilizing adventure therapy techniques and also clinical training and adventure therapy. That's FBAventures therapy.com.

Ken Huey 16:22

Fantastic, Ricky. Thank you very much for spending a few moments talking to us. I really do appreciate your time.