Over its 23 year history, the Commonwealth Fund Fellowship, along with California Endowment Scholars program and Joseph Henry Oral Health Fellowship, has a proven track record of creating physician/other health professional leaders; the Alumni Spotlight interviews showcase the expertise and dedication to care for vulnerable populations as a testament of that success. Interviews have been edited for length and clarity.
Shairi R. Turner, MD, MPH (CFF '02)
Chief Health Officer, Crisis Text Line, Tallahassee, FL
Q. Please describe your current role in your organization and your journey to that role.
A. I am the Chief Health Officer for Crisis Text Line, which is a national, not-for-profit organization that provides free 24/7 high-quality mental health support and crisis intervention in English and Spanish, solely on a text platform (via text message, WhatsApp, or WebChat). Crisis Text Line is also the largest backup text Lifeline Network provider for 988, which is our new three-digit short code for the Suicide Prevention Lifeline.
I lead our Public Policy and Advocacy team. We handle all of the partnerships with other non-profit organizations, state and federal government entities, and educational institutions. I also lead the Student Learning Practicum Program, which is a unique program in partnership with colleges of social work that enables their students to volunteer time on our platform for their supervised practicum hours. I'm also one of the spokespeople for the organization, so I do quite a bit of media work, podcasts, conferences—sales pitches, really, to advocate for and raise awareness of all that Crisis Text Line does.
My journey to this work started at Stanford. I was an undergrad biology major, and I had wanted to be a physician ever since I was in high school. After Stanford, I went to Case Western Reserve University School of Medicine, and went to the Harvard Combined Medicine Pediatrics Program, which was at Massachusetts General Hospital and Boston Children's Hospital.
That was a rigorous, four-year program during which I was training both in medicine and pediatrics. It was also a significant time for me because during my internship year, I lost a close family friend, who was incarcerated at the time, to suicide. I didn't realize how much that would play ultimately into my career choices. But I continued on and finished residency.
This was the early 2000s, fairly early in the transition that was taking place then in medicine as the insurance industry was getting more involved. There were more requirements on physicians, and the time that we were supposed to spend with patients suddenly became much shorter. I had wanted to be a primary care provider, but I saw my mentors and the burnout that they were experiencing trying to see one patient every 15 minutes. For me, the relationship between the doctor and the patient was really important. I felt like I wouldn't be happy if that were rushed. So, I took some time working in Urgent Care and as a liaison at Mass. General Hospital, working with minority faculty and students in the Multicultural Affairs Office.
And then I came upon the Fellowship. I had seen the fliers, and it sparked such an interest in me, because I was trying to figure out where I was going in medicine at the time. Once accepted into the Fellowship, my practicum project was with the Department of Youth Services, which was the juvenile justice system in Massachusetts. I looked at some research that existed in the Department of Youth Services around substance abuse. There wasn't much, but it showed differences between drug use amongst Black youth as opposed to white and Hispanic youth at that time, and how Hispanic and white youth were using ecstasy and alcohol, and Black youth were using marijuana primarily. I remember one of the facility directors saying to me, "You know, if we learned how to treat hopelessness, we would be able to solve a lot of these kids' problems." Sometimes things happen in your life that plant these seeds. He said that, and it stuck with me, but the significance of it wouldn't arise until much later.
I finished the Fellowship. I still wasn’t sure exactly what I wanted to do, but I definitely had developed a passion for incarcerated populations – both because of my family friend who had been incarcerated, and just seeing the large number of minorities, Black men primarily, who were in the justice system. How did that affect the health systems of communities of color?
With that in mind, my next step was the Yerby Postdoctoral Research Fellowship, which was also based at Harvard. I worked with Dr. Angela Browne and Dr. David Hemenway in the Harvard Youth Violence Prevention Program. Angela had helped pioneer the self-defense plea for women who had been abused and ultimately incarcerated. I started to dive into these stories about women who wound up incarcerated because they injured or killed their partner.
And what it was, before we really were speaking about it, was the larger cycle of trauma. That cycle of childhood abuse and neglect led to domestic violence situations, and ultimately could have led to the woman trying to defend herself or escape from a dangerous relationship.
Fast forward: I finished the Fellowship, planning to leave Boston and move to Atlanta. And I received an e-mail from someone who had worked with us at Harvard, letting me know that the Florida Department of Juvenile Justice was looking for its first Chief Medical Director. And she had offered up my name.
They were filling this position because a child had died of appendicitis in a detention center over the course of a weekend -- it was just profound neglect that had impaired his ability to get care. By the time he was put in a wheelchair to get into an ambulance, he was deceased. So, the Legislature funded just one position, a Chief Medical Director, and that was me. And at the age of 35, I thought, "I can do this." I had never worked with incarcerated populations. But I knew that, as a physician, I would be there to ensure that they received the care that I would want for my child if he or she were incarcerated.
And that was my approach, in retrospect, fairly naive, but ambitious, because Florida was one of the largest incarcerators of adults and children, primarily children of color. It was a huge system. And not only did I help to build that office -- with policies, with more staffing, with additional funding from the Legislature -- I also was able to bring in the trauma-informed lens. At that time, people were just beginning to look at adverse childhood experiences, abuse and neglect, and family dysfunction -- how that impacts children’s behavior, their mental health, their physical health. And when you looked at it through that lens, the whole juvenile justice system was filled with children who were traumatized, who had very, very severe abuse and neglect histories, which led them into the cycle of the juvenile justice setting and contributed to their mental health issues and their behavioral issues. I started bringing in that trauma-informed understanding. And Florida has maintained itself as one of the leaders in trauma-informed care in juvenile justice settings.
Then, I moved over to the Florida Department of Health, where I was the Deputy Secretary for Health. And even there, I focused on the public health effects of trauma. The CDC recognized the Florida Department of Health for establishing child maltreatment as a public health issue, which -- again -- speaks to trauma and how that impacts public health.
At that point, my children were 7 and 8 years old, and I really wanted to be very present for them. So, I stepped aside from the Department of Health and started consulting with the National Center for Trauma-Informed Care. We periodically traveled around the country educating and raising awareness about adverse childhood experiences and their impact. It was my role to talk about the neurobiology of trauma as a physician and a pediatrician. What’s the impact on the developing brain when it experiences severe trauma? After that, I worked with the Office on Women's Health to develop a series of modules for physicians to help them learn comprehensively about trauma. It was the first full curriculum that had been developed specifically for physicians.
And then I received an e-mail from the founder of Crisis Text Line, who had identified me through professional networks. She asked me if I wanted to be the first Chief Medical Officer for Crisis Text Line. I joined in 2017. It was still very much a startup -- five years old. But it was innovative and really resonated for me, because we were helping texters in crisis with volunteers who were trained for over 30 hours, and those volunteers were supervised by our staff mental health professionals. I led that team of mental health professionals who supported the volunteers on the platform. At that point, people in crisis were supported primarily by telephonic hotlines only; there really was no national text platform for crisis intervention or mental health support. It was the first, and it was free. At that point, it was only in English -- now it's in Spanish, too.
We had the ability to gather confidential and anonymized data to understand what people were texting about, what crises and stressors were impacting our nation, and providing in-the-moment support and an in-the-moment understanding. For most studies, the data took a year to be released. We had minute-by-minute data on what people were stressed about.
I stayed for 18 months, after which time, I briefly started an executive coaching practice, helping physicians find innovative careers. Because one of the things that I learned throughout the Fellowship is that as a physician you can do almost anything, and you can find a role in any space.
I then returned to Crisis Text Line in the summer of 2020 as the Chief Transformation Officer, to lead the transformation that was occurring at Crisis Text Line. At that time, every company was looking at its race and equity practices. I was able to help lead that work, along with the new CEO, building from the ground up and embedding equity in everything that we did: for staff, for volunteers, for our presence as an organization committed to equity. I helped to hire our Vice-President of Justice, Equity, Diversity, and Inclusion. Then I stepped back into the Chief Medical Officer role, and then transitioned in title to Chief Health Officer.
That's where I’ve landed -- leading the Public Policy and Advocacy team. It really integrates everything for me: my trauma expertise, government experience, and background in public health, because we're dealing with large systems of people in crisis. We supported 1.3 million conversations last year, so it's crisis intervention in a public health model at large scale. It also leans into my work in government. We have relationships in D.C. with legislators and we’re helping to move policy there.
You know, life is a journey. And everything leads you in the direction that you're supposed to go. I'm really happy where I am now at Crisis Text Line.
Q. What's the best leadership advice you've ever received?
A. Something that sticks with me is the Maya Angelou quote: "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." In leading my teams, I try to model servant leadership and help people grow and be the best that they can be in their role. And that's not about dragging people along; it's about building consensus, listening to people's expertise, and valuing them as individuals.
Q. What are the biggest barriers you see for leaders advancing health equity?
A. I think many times, our greatest obstacles are in our own heads. But if we can believe wholeheartedly in what we want to do, we will be resourceful in getting there. That being said, there are still institutional obstacles. For those of us who are trying to advance health equity, one of the biggest barriers I see in recent years is captured by the adage: "An organized lie is more dangerous than a disorganized truth." What we're seeing now is the dismantling of truth, the retelling of the histories of people of color: the retelling of the history of Black people in this country, and the continued erasure of the history of Native Americans.
I live in Florida, where we're revising our history books -- changing history because it makes people feel uncomfortable. We have to experience that discomfort, because if we don't, we're going to find ourselves repeating history. So, the barrier is the organized lies. We have to dismantle the unclear and untrue narratives, while we're trying to advance health equity, and while we're dealing with the systemic oppression and the barriers that exist for people of color.
When we talk about health equity and challenging oppression, it's not easy, because minoritized communities are vastly different from each other. They're not monolithic. Every different race and culture has had an experience of oppression in this country, but it's been a different experience. And we have to address it with that lens. Achieving health equity is about addressing the specific needs and the specific experiences of these groups.
Q. Anything you’d like to add?
A. The ripple that has come from the Fellowship is monumental -- in the ways we touch public health with the compassion and the lens that we learned during the Fellowship.
I was just attending a conference (the HLTH 2023 conference) and I happened to run into three or four other Fellows. And it was one of those moments where we were together again, and we understood why we were there. We were able to make new connections professionally in the work that we did. It was rewarding.
And I always feel like the Fellowship created this ever-growing network of people that I can rely upon, reach out to, advise, mentor, be mentored by, whenever I need. And that's an incredible situation to be in as a person of color, and as a physician of color. Just to have that support network is invaluable.
