Behavioral Health Boulder County Public Health, Strategic Initiatives Branch/Health Planning and Epidemiology Program Boulder, CO Assignment Description The fellow will be part of the Health Planning and Epidemiology (HPE) group of the Strategic Initiatives Branch (SIB). SIB is a newly created branch that unites HPE, Communications and Marketing, Information Technology (IT), and Health Systems and Policy to serve BCPH s four health divisions (Environmental Health, Family Health, Community Health, Communicable Disease and Emergency Management), as well as community partners. SIB s mission is to provide strategic communication, planning, policy, and IT leadership to assure that all in Boulder County have the opportunity for a healthy life. HPE enables agency staff and community partners to assess local public health and environmental data; plan public health strategies; provide tools and data enabling staff and partners to act; and evaluate impact of action on health and the health system. HPE is a team of four that includes the health planning and evaluation manager, health planner, administrative specialist, and biostatistician. The team is responsible for guiding primary and secondary data collection and dissemination; strengthening data collection systems; guiding protection of human participants; supporting the agency in strategic planning; supporting workforce development in assessment, planning and evaluation; assuring suitable evaluation of BCPH work; and monitoring and sharing population health data. HPE supports all of the health divisions. The reduction of substance use and improvement of mental health are agency priorities, so much of HPE s work has focused on improving data collection in these areas to support implementation and evaluation of this work. That has included supporting a local health assessment in mental health and substance abuse and expanding local surveillance systems including syndromic surveillance and Colorado Hospital Observation Regional Data Service (CHORDS). The fellow will work closely with staff from the BCPH Communicable Disease and Emergency Management Division (CDEM) to carry out some of the proposed projects. The CDEM Division includes the Works Program, which leads agency harm reduction and opioid prevention work, in addition to outbreak and preparedness activities. The Works Program is a syringe access program that has expanded from mostly an HIV/hepatitis C prevention focus to also conducting work in opioid overdose prevention activities, such as naloxone training for local law enforcement, jail staff, and syringe exchange clients; coordinating a local opioid advisory task force; and conducting a landscape analysis to inform work. The program is experiencing a large increase in demand for services, and there are many efforts and need for data collection and evaluation support for their multi-faceted programs.
Day-to-Day Activities Day-to-day activities can vary widely and some activities will rest on the fellow s experience, skills, and interests. In the first few months, the fellow can expect onboarding, participating in Boulder County-run trainings, relevant epidemiology and data systems training with the primary mentor, and meeting with key staff working to address behavioral health concerns in the county in young children, adolescents, and adults. The bulk of the fellowship will be spent completing projects, collaborating to identify new ways that behavioral health data can be integrated into community work, and addressing ad hoc analysis requests. Day-to-day, the fellow can expect to meet with program staff, community-based behavioral health organizations, coalitions, and mentors to support the data analysis and development of surveillance indicators. The key to success for the fellow will be relationships built with participating programs, coalitions, other division staff (i.e. Communications and IT), etc. As a member of the Strategic Initiatives Branch, the fellow will participate in SIB and HPE team meetings and may participate in regular monthly meetings and conference calls with other local and regional efforts, including the Denver Metro Partnership for Health data infrastructure, syndromic surveillance, and CHORDs meetings. The fellow may also participate in state (e.g., State Epidemiology Outcomes Work Group, Consortium for Prescription Drug Abuse Prevention) and national (CSTE overdose and mental health) calls as time and interest permits. Additionally, the HPE Team receives and responds to ad hoc requests made for behavioral health and non-behavioral health data. Since the primary supervisor works with all health divisions, the fellow will have opportunity to work other health programs to address emerging data collection, analysis, and reporting needs. HPE also works as a team on large assessments and reports, which the fellow can support. Potential Projects Surveillance Activity Design a Local Mental Health and Substance Abuse Surveillance System We are interested in building a behavioral health surveillance system using all available data in the community. This activity will involve working with local and state partners to identify and secure appropriate data to describe both the strengths in the community and burden of mental health and substance use disorder. Priorities of a system will be established based on key informant interviews with local coalition members. Data partners include the Colorado Department of Public Health and Environment (CDPHE), Office of Behavioral Health (state treatment center funded by Substance Abuse and Mental Health Services Administration (SAMHSA), Mental Health Partners (local behavioral health treatment and crisis center), other local substance use treatment centers, and ambulance companies. Currently available data (i.e. death certificate, hospital discharge, CHORDS, syndromic surveillance, and early childhood screening data) would be accessed. Mental Health Partners and
other agencies are particularly interested in understanding how vulnerable populations in our community are impacted by behavioral health and barriers to treatment. There will be an opportunity for the fellow to help develop maps or other spatial analyses to measuring the correlation between neighborhood factors and behavioral health concerns in Boulder County and the Metro Denver sevencounty region. The impact of this system will be a common understanding of behavioral health issues, particularly among vulnerable populations. Subsequently, this data will help to inform the community coalitions and partners aiming to reduce substance use and improve mental health. Surveillance Evaluation Evaluating Representativeness of Colorado Health Observation Regional Data Service (CHORDS) in Boulder County CHORDS is a system developed by Denver Public Health to provide local outpatient data. BCPH will be able to query this data starting in 2017. A small but growing number of clinics in the county contribute data. Current indicators available include depression, body mass index, hypertension, diabetes mellitus, and tobacco use, though developing more mental health indicators is a priority over the next few years. The proposed project is to evaluate the representativeness of existing data by municipality or census tract using statistical methods established by Denver Public Health. The evaluation itself will use CDC surveillance guidelines. Depending on findings, the project may require key informant interviews or another process to prioritize clinics that BCPH should recruit into the CHORDS system to improve the system s ability to measure disease burden in our most vulnerable populations. More information is available at http://denverpublichealth.org/home/health-information-and-reports/dataand-informatics-tools/colorado-health-observation-regional-data-service-chords. Major Project Develop Syndromic Surveillance Indicators for Mental Health and Substance Use Disorders The Colorado North Central Region Syndromic Surveillance System is part of the CDC National Syndromic Surveillance Program (NSSP) and provides new surveillance capabilities to BCPH. It provides near real-time local emergency department data from all of the local hospitals in Boulder County. The major proposed project for the fellowship is to support the development of a syndromic surveillance system for mental health and substance use indicators, starting with indicators already developed by other NSSP agencies. Possible indicators to be developed include suicide attempts, severe mental illness episode, opioids overdose, alcohol intoxication, and accidental marijuana ingestion. Since the system is new to BCPH, part of the work will involve implementing a communication plan to communicate with local behavioral health centers, primary care clinics, and other healthcare partners to further strengthen the relationship between healthcare and local public health.
Additional Project Informing Communication Tools for Local Behavioral Health Surveillance Data. Communicating findings with our community partners in accessible and eye-catching ways is a valuable and in-demand component of our work. This project will involve coordinating with relevant substance use disorder prevention program staff to identify the best data (and the best way to display the data) to help tell the story about important topics, such as alcohol, marijuana, and opioid use in order to address substance use from initiation to treatment, unintentional overdose, and/or death. This project will also involve coordinating with the BCPH communication and marketing manager to develop communication tools to share with community partners and to help drive policy initiatives in Boulder County. Additional Project Surveillance of Adolescent Mental and Behavioral Health Local Healthy Kids Colorado Survey (HKCS) data (i.e., Colorado s Youth Risk Behavioral Risk Factor Surveillance System) guide implementation and evaluation of many programs in the BCPH Community Health Division for health promotion of local youth. This project will involve consulting with the Community Health Division Leadership Team to identify a limited set of questions that merit further analysis. Prevalence ratios or other measures can be used to identify correlation across shared risk and protective factors to better inform their work. Several HKCS mental health and substance use questions are asked that are ripe for investigation. The mentor and fellow will co-construct the most appropriate analysis and dissemination approach to best inform stakeholders and target audiences. Preparedness Role Each new member of BCPH is required to attend Incident Command System (ICS) 100 and National Incident Management System (NIMS) 700 trainings in person. Additional opportunities will be given to attend ICS 200, either in-person or online, and ICS 300, which is required for anyone participating on BCPH s Incident Command Team. The BCPH Emergency Management Program works closely with Boulder Office of Emergency Management and is a strong partner in emergency response in the county. During the past several years, BCPH has responded to several fires and a major flood in 2013. There are several tabletop and a large-scale emergency preparedness exercise throughout the year, so the fellow can participate in preparedness work and support a response as relevant. BCPH Emergency Management also coordinates a Community Infectious Disease Emergency Response Team that includes representatives from local hospitals, clinics, Mental Health Partners, etc. to develop the Infectious Disease Emergency Response (IDER) plan. This group will be revising an IDER pandemic response plan and will test the plan in an exercise in the next two years. The fellow can support this effort to meet required competencies and will support data collection and analysis in a large outbreak investigation or response.
Additional Activities BCPH is extremely collaborative across the agency and with community, regional, and state partners, so the fellow would have the freedom to work with internal or external partners to tailor any additional projects based on their interests. In BCPH, our Environmental Health, Family Health, Community Health, and Communicable Disease and Emergency Management Divisions are tackling everything from climate change to teen pregnancy. Based on skills, experience, and interest, the fellow could support grant writing, non-behavioral health data collection and analyses, or other tasks. For example, Environmental Health Division staff is interested in having syndromic surveillance indicators for their programs; support from the fellow could accelerate the utility of this system for all divisions. Other ad hoc survey development, data analysis, and requests arise regularly, so the fellow will be free to tackle other projects to meet core competencies of the fellowship and individual development goals. Additionally, as our partnerships in behavioral health strengthen, new unanticipated opportunities will appear. For example, Mental Health Partners is interested in conducting a clinical study to test how sensitive K6 screening is to change in mental health severity over time. The primary mentor and fellow could consult on study design and analysis for an administrative data study. Mentors Primary Secondary Talia Brown, PhD, MS Biostatistician Indira Gujral, PhD, MS Communicable Disease and Emergency Management Division Manager