It’s rigged. The people making the decisions don’t look like me. Why are fame and merit the same? Why are wealth and value the same? Why does it seem like the people who look like the slaveholders still have all the money? This is some of what Alex Brisco, the executive director of California Children’s Trust, has heard from the young people he’s worked with over the many years of his career. He refers to himself as a defunct therapist, recovered bureaucrat and Medicaid geek. His past experiences prepared him well for the present moment. He believes struggle is compelling, is motivated by injustice and finds meaning through service. Experience has taught him that people who suffer often hold great wisdom and intelligence, and we can actually learn a lot if we have enough courage and compassion to listen to them. He understands deeply that kids are trying hard to navigate a toxic culture that they did not create. He and his colleagues at the Trust are working to improve safety nets to better serve kids, so they can have hope for a better future by resisting and rejecting the toxic messages they are bombarded with each and every day.

Happening Right in Front of Them

In an interview with Remi Sobomehin, host of the Road to Ambition podcast and founder of Ambition Angels, Alex shared an experience he had while attending Vassar College that affected him deeply. His freshman year he played on the basketball team. They were not very good. The team had a high concentration of Black student athletes on a campus that didn’t have many Black students. The coach, whom the players did not like, always brought a teenage Black girl to keep score and assist him at away games. The players didn’t really understand why she was there. Until one day at the end of the season, the coach was arrested and taken from campus in handcuffs for abusing her. Alex and his teammates finally realized what had been happening and in the interview he said “they had real violence in their minds and also felt a lot of shame, because it had been happening right in front of them.”

After college, Alex worked construction with some of his friends in an historically Black neighborhood in his hometown of Philadelphia. They didn’t realize it at the time, but the community center that served as their base of operations was where W.E.B. Du Bois, the American sociologist and founding member of the NAACP, spent time writing. As they rehabbed houses, they got to know and started helping kids in the neighborhood who had dropped out of high school. The work they did with them evolved into the first charter school in Pennsylvania with the construction company using its profits to fund it.

The Sand Literally Shifted

Alex moved to California and planned on becoming a school counselor. But one of his instructors discouraged him from that path by explaining all he would end up doing is creating schedules and pushing paper. He was interested in children’s mental health, so he became a therapist instead and was hired by Children’s Hospital Oakland. Playing a lot of sports taught him that he is at his best when the stakes are high, so he worked with young people in Juvenile Detention and at the Chappell Hayes Health Center at McClymonds High School in West Oakland, where later he became the director. 

The work wasn’t easy, but it allowed him to learn and grow. One of his most important lessons was compassion requires restraint. That was made abundantly clear to him the day a Black female colleague told him to “get his help up off of her.” In that moment, the sand literally shifted beneath his feet.

Alex met Dr. Barbara Staggers while working as a therapist. Dr. Straggers retired in 2019 as the director of Adolescent Health at Children’s Hospital Oakland. She was a nationally-recognized leader in adolescent health and school-based health clinics. She also was a senior advisor for Adolescent Health for the Trust. Dr. Staggers understood the perils that too many teens faced just trying to live their lives. She taught Alex and many others that kids may act tired and broken, but that was not who they are and what they needed most was an adult who cared about them and would listen to them. Alex described Dr. Staggers as the most important person in his life after his wife and children and said she was able to see who he could be before he did. She passed away in February 2023.

If You’re Not Paying For It, Your Playing With It

Alex was happy serving as the director of the Chappell Hayes Health Center. The work was interesting and meaningful, and the staff was growing. But his career path would change when he got the chance to meet with the director of the Alameda County Health Care Services Agency. At the end of their conversation, the director looked at him and said he was the first person he had met who could replace him. Alex was gobsmacked! He was in his mid-30s and knew nothing about running a large county health system. Plus, he thought “Work for the county? Boring!” But when the job offer finally came, they enticed him by putting him in charge of designing the medical and mental health services for the new Juvenile Detention Center being built. He knew all too well just how bad the one being replaced was, so it was an incredible opportunity to make improvements. He also was responsible for a project with Youth Uprising, a community organization that to this day is very close to his heart.

Working for the county, he realized he was working for a multi-billion dollar agency. Within four years, he was the director of the Alameda County Health Care Services Agency where he was responsible for the hospital, 911 system, the homeless shelters, health clinics and much more. 

His time at the county taught him two very important lessons:

• If you want to do social justice at scale, it is a government play and anyone who says differently is wrong and hasn’t done the work. 

• If you’re not paying for it, you’re playing with it.  

Alex knows that in government things are done incorrectly, there are bad actors and it’s inefficient. But, California has the 5th largest economy in the world, and its Medicaid program has a budget of 122 billion dollars. The agency he ran was 5% of the state’s budget, and if you bundled up all of the philanthropy related to healthcare in the entire state, it equaled about one half of the budget he managed. The biggest challenge he faced at the county was the amount of money available was insufficient given the challenges they faced. They knew what to do, but they didn’t have the money to do it.

The World Is On Fire

Leading a failed bureaucracy is really hard. While good things happened during his tenure at the county, especially after the Affordable Care Act passed, Alex could clearly see the world was on fire. There was no way he could not see that, but the elected officials he worked for didn’t want to hear that. He began to wear on them, and they started fighting. He also was frustrated by the slow pace of change. Looking back he says he was angry and sad and knew he had to leave for his sake and the sake of his family.

He was recruited by Daniel Lurie, currently a candidate for mayor of San Francisco, to the Tipping Point Community, which he founded and is based in San Francisco. They needed someone to lead a homelessness initiative they were undertaking, and Alex was the perfect fit. He ended up raising $100 million from six families and did a lot of good, but he knew it wasn’t a long term role for him. 

It’s Hard to Change Systems You Haven’t Lived or Worked In

In 2017, a group of California philanthropies asked Alex what was going on with kids. Data showed a doubling of hospital admissions for self-harm. They valued his in-depth knowledge of how Medicaid and the state’s safety nets were designed and constructed. He told them what he thought and put forth a vision for how they could change systems for the better. That was the start of the Trust, a five-year advocacy initiative to improve the health and social and emotional well being of the state’s children, youth and families. 

Alex was given time, money and freedom to bring together a team of people to improve outcomes for kids and families. In addition to being experts in their respective fields with significant social capital to leverage, the constellation of people brought together have lived and or extensive work experience in the systems they were trying to change. As they got into the very real and difficult work, they kept each other from losing sight of why and what they were there to do. A stellar youth advisory board has guided and kept the team accountable. 

The first two years listening sessions were held across the state, partnerships with important stakeholders were developed and more money was raised (in total close to 14 billion.) At the time, no one was talking about the children’s mental health crisis and no one was interested in talking to them. Alex says it was like shouting into the wind. But the first two years gave them time to develop a set of goals and strategies that would become the framework for advancing reform.

Alex says they got lucky in the worst possible way. When the pandemic hit, everyone was talking about the children’s mental health crisis. People were finally wanting to talk with them, and they were ready with recommendations for how to address it:

• Expand who is eligible for treatment by eliminating the need for a medical diagnosis.

• Reimagine the provider class to include doulas, community health workers, peers and wellness coaches.

• Center schools and community clinics as primary locations for treatment because that is where kids are.

• Spend a lot more money at the state and county levels and fully claim federal matching funds.

• Center the impact of racism and poverty on the social and emotional well being of children.

The five goals are based on: 

• What Alex and his colleagues know to be true from their own experience, including not every kid needs a therapist, there aren’t enough of them and there aren’t enough who look like the kids who need one. 

• Trying to address the children’s mental health crisis strictly through a “meds and beds” approach is insufficient. 

• What they heard at listening sessions they conducted across the state and from partners, 

• The work of Dr. Nadine Burke Harris, the former surgeon general for the state of California.

• The fact that racism and poverty make people sick. 

• Other developed countries spend a lot more money on their social safety nets and get significantly better outcomes for children and families compared to the U.S. 

They also made communications a priority. They shared what they learned and the proposed changes they wanted to make in published papers like Babies Don’t Go to the Doctor By Themselves.

The Trust will sunset in December 2024. All five of the recommendations put forth were adopted and are in the early stages of implementation. There have been criticisms as the work has unfolded, which Alex says are fair. To help with the implementation phase, he founded Public Works Alliance to create stronger, more equitable public systems by shifting power and agency to the communities they serve. They recently accepted a grant from the state of Georgia to help them improve the health and social and emotional well being of kids. Working in Georgia appeals to him because of its legacy of slavery and the opportunity to work with people who don’t share his politics yet share his commitment to improving the health and well being of children.

The Alliance also administers a grant program to communities in California wanting to develop an EMS Corps. A 21 million dollar grant from the state to expand the program helped get the Alliance started. A lot of the young people who train in it have been vilified as drains on public resources. But this program is no handout. It turns out that the young people are really good EMS professionals, because they are from the communities they serve, they are not afraid to go into them, and they have compassion, kindness and an almost immediate connection with the people they are helping. Alex says it is powerful to see young people who are viewed as problems turn out to be the solution to a problem in their communities

Alex is often approached by mostly young white people wanting to do policy work to improve social safety nets. He asks them, “How much time have you spent working in those systems and getting to know people directly impacted by them?” They often confess they haven’t spent much time, if any. He then encourages them to work in them and get to know people who rely on them for their survival, because while they may not do it for long or be good at it, it’s hard to change systems you haven’t lived or worked in. When he started his career, Alex readily admits he had a noblesse oblige mindset. But he’s stayed in it by developing deep and authentic relationships with and honoring the struggle of children, families and adults who have suffered so much.

Hope is the architecture of a better future and without it our sense of what is possible is constrained. Alex doesn’t mince words that the toxic culture we live in is constraining the future for too many children and young adults. He believes coming together to support the healthy growth and development of children, so they can be the architects of their own better future is a chance to overcome the divisions that exist among us and heal our toxic culture.

Learn More

Visit California Childrens Trust and Public Works Alliance to learn more.

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