Supporting Emotional Wellness in Frontier Areas

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Shannon Osborne
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1 Supporting Emotional Wellness in Frontier Areas Judith LaPan, MS, MBA Administrator, Richland County Health Department Sidney, Montana Presentation Overview Project Origins Process & Tools Identifying Solutions Project Origins 1

Background: Richland County, MT Located in the Bakken, an oil-impacted area Population recently rose from just under 10,000 to 20,000+ In a remote area of Montana where mental health resources are

Ponder How can we impact this issue with limited resources? Are there some methods that public health uses for other issues that could be applied here? Are there models we could follow?

2 Background: Richland County, MT Located in the Bakken, an oil-impacted area Population recently rose from just under 10,000 to 20,000+ In a remote area of Montana where mental health resources are scarce Montana is #1 in suicides in the country Mental and emotional health identified as community issues in multiple Health Assessments and Quality Life strategic plans Richland County Points to Ponder How can we impact this issue with limited resources? Are there some methods that public health uses for other issues that could be applied here? Are there models we could follow? Who is in a position to help address this issue? Results of our Pondering How can we make an impact on this issue with limited resources? Move the focus up-stream to create a resilient population. Address issues before they become crises. Work more efficiently between agencies. Identify Life Transition points (weak spots in our individual and community resiliency) and create supports that will minimize the impact. 2

Results of our Pondering What processes does public health currently engage in that would assist with this issue? building process to engage the community to create solutions to community challenges.

Results of our Pondering Are there models that we can use to find solutions? The National Council for Behavior Health used the Wagner Model.

The National Frameworks: - Based Promotion of emotional and mental health. National Prevention Strategy Recommendations.

3 Results of our Pondering What processes does public health currently engage in that would assist with this issue? building process to engage the community to create solutions to community challenges. Many multi-sector stakeholder meetings. Emergency preparedness planning and exercises. Access to data and other public health resources. Results of our Pondering Are there models that we can use to find solutions? The National Council for Behavior Health used the Wagner Model. Other areas in the state looked at sequential intercept mapping. Adverse Childhood Experiences (ACEs) training, as a trauma informed approach, was occurring across the state. The National Frameworks: - Based Promotion of emotional and mental health. National Prevention Strategy Recommendations. The Resiliency Model (CRM) Results of our Pondering What agencies, organizations, or individuals are in a position to move this work forward? Mental Health Local Advisory Council and Action Group (LAC): Multi-sector group identifying ways to address mental health issues in our county. In place for several years. Communities In Action Steering Committee: Multi-sector group using a Building Process (MAPP) to assess community needs (CHA) and create our County Quality of Life Strategic Plan (CHIP). In place since

4 Questions for the Viewer? Has your agency completed a recent community health improvement plan? If so, was mental health a top priority? A. Yes, and mental health was a top priority B. Yes, and mental health was not a top priority C. No D. Other (type in the chat box) Process & Tools Getting Started 1. Created a sub-committee of the LAC called CREW Connecting Resources for Emotional Wellness 2. Adapted the emergency preparedness Table Top to identify assets, gaps and processes 3. Termed the process Scenario-based discussion 4. Focused scenarios on life transitions Selected models: Wagner Model Sequential Intercept mapping Prevention Framework Resiliency Model 5. Included veteran-specific issues 6. Planned a stakeholders meeting 4

The Wagner Chronic Care Model We focused on : Healthy public policy Supportive environments Effective community action Policy Environment Action Service delivery Decision support Patient skills

Anita Dotts, and Darlene Ravensdale (2002) from Glasgow, R., Orleans, C., Wagner, E., Curry, S., Solberg, L. (2001). Does the Chronic Care Model also serve as a template for improving prevention?

Health Outcomes Scenario-Based Discussion To identify the current assets, gaps and map out the current state of providing community support we used scenarios that focused on Transitions Dave, a 58

5 The Wagner Chronic Care Model We focused on : Healthy public policy Supportive environments Effective community action Policy Environment Action Service delivery Decision support Patient skills Health System Information technology members partners Empowered patient Interactions & relationships Practice team Adapted from: Victoria Barr, Sylvia Robisson, Brenda Marin-Link, Lisa Underhill, Anita Dotts, and Darlene Ravensdale (2002) from Glasgow, R., Orleans, C., Wagner, E., Curry, S., Solberg, L. (2001). Does the Chronic Care Model also serve as a template for improving prevention? The Milbank Quarterly. 79(4), and World Health Organization, Health and Welfare Canada and Canadian Public Health Association. (1986). Ottawa Charter of Health Promotion. Health Outcomes Scenario-Based Discussion To identify the current assets, gaps and map out the current state of providing community support we used scenarios that focused on Transitions Dave, a 58 year old who lost his job and hasn t worked for 9 months. This individual doesn t have a high-school diploma making it difficult to find work. He is becoming very withdrawn and individuals at the job service are seeing a change in him and are concerned. Karen, a 20 year old divorced mom, is living with her parents and is experiencing changes in her behavior; her parents are worried. Alex is a 28 year old returning to his community after military service. He is married with 2 children, and having issues at work that may impact his continued employment. Scenario-Based Discussion Mapping Process Current State Preferred State How are individuals in the scenario currently dealing with stress? What would it look like if mental and emotional health and wellness were supported in our community? 5

Scenario-Based Discussion Questions With which community organizations or settings is this person likely to come into contact? What assistance would be offered? By whom?

6 Scenario-Based Discussion Questions With which community organizations or settings is this person likely to come into contact? What assistance would be offered? By whom? To what organizations would they be referred? What emotional health and wellness supports would they draw on? Mapping Tool Continuum: Emotional Health Model Health Services Crisis Increasing Awareness Supportive Environment Developing Skills Action Build Healthy Public Policy Screenings Delivery System Treatment Options Emergency Crisis Services Based on concepts from sequential intercept mapping and other tools Identifies gaps Assists in setting priorities Adapted from the Wagner model and the Sequential Intercepts for Developing CJ-8H Partnerships model. Produced by Richland County Health Department, Montana. Questions for the Viewer? What do you already have in place that you could use for mental health work in your community? A. campaigns B. Public health-hospital collaborations C. Awareness coalitions D. Support groups F. Crisis lines G. Publicly funded treatment H. Private treatment I. Other (type in chat box) E. Screening programs 6

7 Current State, Prior to CREW Continuum: Emotional Health Model Health Services Crisis Increasing Awareness Supportive Environment Developing Skills Action Build Healthy Public Policy Screenings Delivery System Treatment Options Emergency Crisis Services coalitions: CIA, CREW/LAC Limited mental health screenings Eastern Montana Mental Health Center Awareness Campaign: Out Of The Darkness Walk District II Alcohol and Drug Trainings: Mental Health First Aid as needed Question Persuade Response (QPR) monthly Independently run support groups Private counseling services Crisis phone line: local, state, & national Adapted from the Wagner model and the Sequential Intercepts for Developing CJ-8H Partnerships model. Produced by Richland County Health Department, Montana. Identifying Solutions 3 Priority Areas of Change Second stakeholder meeting plan to move priority changes forward: 1 Create and implement an Emotional Wellness Campaign. 2 Create a -Wide Training Plan to coordinate and sustain training efforts. 3 Institute a No Wrong Door Approach/-wide Policy to accessing resources for emotional wellness. 7

8 1 Create & Implement an Emotional Wellness Campaign This approach creates a supportive environment and strengthens community action. It will also address: Prevention Framework Primary Prevention -wide; cultural change; community engagement Resiliency Model Proactively inoculate the community from the effects of stress and trauma Use proven programs and best practices at the individual and systematic levels Instill a shared vocabulary and skills for resiliency across the community National Prevention Strategies Facilitate social connectedness and community engagement across the life span Promote early identification of mental health needs. 2 Create a - Wide Training Plan to coordinate and sustain training efforts This approach creates a supportive environment, could lead to healthy public policy, and meets the following: Prevention Framework Primary Prevention -wide; cultural change; community engagement Secondary Prevention Group supports and screenings. Resiliency Model Proactively inoculate the community from the effects of stress and trauma Use proven programs and best practices at the individual and systematic levels Instill a shared vocabulary and skills for resiliency across the community National Prevention Strategies Provide individuals and families with support for mental well-being. Promote early identification of mental health needs. 3 Institute a No Wrong Door Approach/ - Wide Policy to accessing resources for emotional wellness This approach creates a supportive environment, could lead to healthy public policy, and meets the following: Prevention Framework Primary Prevention -wide; cultural change; community engagement Secondary Prevention Group supports and screenings. Resiliency Model Proactively inoculate the community from the effects of stress and trauma Use proven programs and best practices at the individual and systematic levels Instill a shared vocabulary and skills for resiliency across the community National Prevention Strategies Provide individuals and families with support for mental well-being. Promote early identification of mental health needs. 8

Planned CREW Actions Continuum: Emotional Health Model Health Services Crisis Increasing Awareness Supportive Environment Developing Skills Action Build Healthy Public Policy Screenings Delivery

9 Planned CREW Actions Continuum: Emotional Health Model Health Services Crisis Increasing Awareness Supportive Environment Developing Skills Action Build Healthy Public Policy Screenings Delivery System Treatment Options Emergency Crisis Services coalitions: CIA, CREW/LAC Behavioral integration into primary care Eastern Montana Mental Health Center Awareness Campaign: Out Of The Darkness Walk Independently run support groups Limited mental health screenings District II Alcohol and Drug Emotional Wellness Campaign and Education CONNECT Referral System No Wrong Door referral policy Trainings: Mental Health First Aid As needed Question Persuade Response Training (QPR) Plan: Monthly Mental Health First Aid, Question Persuade Response (QPR), Adverse SBIRT Childhood Experience (ACE) Private counseling services Crisis phone line: local, state, & national Adapted from the Wagner model and the Sequential Intercepts for Developing CJ-8H Partnerships model. Produced by Richland County Health Department, Montana. CREW Current Status AmeriCorps member working on CREW implementation CREW toolbox that can be shared with others Current Status and Plans Created working groups for each of 3 priorities, drawn from current groups and stakeholder meeting attendees. Supported stakeholder group working to implement referral system called CONNECT on eastern side of Montana as well as western side. Obtained County funding to create a training plan and a process to identify, sustain, track, and evaluate trainings and trainers. Secured an AmeriCorps member to help local providers integrate behavior health into their practices. 9

Lessons Learned/Challenges and Solutions Creating a response to emotional wellness is a long term investment and permeates everything we do. Try to incorporate it into all your plans.

10 Lessons Learned/Challenges and Solutions Creating a response to emotional wellness is a long term investment and permeates everything we do. Try to incorporate it into all your plans. The process took longer than expected so you need to be flexible and expect that the commitment to emotional wellness will be larger than you anticipate. There is not one model that fits every community and there are few that focus up-stream. There are more resources in your jurisdiction than you think if you broaden your search. It is difficult to coordinate people and agencies or organizations. A plan is critical even though most people don t want to plan stay strong. The same thing goes for the associated measurement. It is difficult to keep the momentum going and focus on wellness vs. crisis. Advice for Other Communities Use a process you already have in place. (i.e. the process you used to complete your Health Assessment, Health Improvement Plan, Emergency Preparedness, etc. Use the multi-sector groups that you are currently working with. Build your approach on a community building system: assessment, planning, implementation and evaluation. Create the plan that works best for you by assessing your current state and defining your future state. Be sure to match your developed response to best practices. The tool kit we created provides tools that may be changed to fit your community. You may want to build your own so that the process can be repeated every 3-5 years. Questions? 10

11 Resources Resiliency Model: Mind Your Mind: National Frameworks: -Based Promotion of emotional and mental health l-emotional-well-being.pdf Positive Behavioral Intervention Supports: Wagner Model: e_model.htm Sequential Intercept Mapping: Prevention Framework: 11

Supporting Emotional Wellness in Frontier Areas

Supporting Emotional Wellness in Frontier Areas Judith LaPan, MS, MBA Administrator, Richland County Health Department Sidney, Montana jlapan@richland.org www.nwcphp.org/hot-topics Presentation Overview