Public Health and Mental Health “A Model for Success” Presented by Cynthia Farkas, RNC, MS, FNP Jefferson County Department of Health & Environment th Street, Golden CO August 25, 2003 Grant Funded by Caring for Colorado Foundation

Jefferson County... Gateway to the Rockies Located west of metropolitan Denver Suburban, business, industrial, rural and mountainous communities Population of 529,401 95% Caucasian, 5% Other –10% Hispanic Median Income $57,339 – yet a corridor of poverty is located along the eastern boundary of neighboring Denver County

Jefferson County Department of Health and Environment Public health... Everyday, Everywhere, Everyone Established in 1959 as an organized health department serving all of Jefferson County One of 15 local health departments in Colorado Mission: To create, promote and enhance health and vitality through innovation, collaboration and celebration 4 Divisions: Community Health Services, Environmental Health, Health Promotion and Administration

Public Health and Mental Health Program Mission Goals: provide assessment and identification of mental health needs and barriers to services provide education and brief treatment (1-3 sessions) to clients referrals and assistance for individuals and families who are in need of mental health intervention who are uninsured or underinsured provide education, training and consultation to JCDHE staff To address the mental health needs in the population served by the JCDHE clinic, home visitation and community outreach programs.

The Mental Health Program Unique public health/mental health model integrates into JCDHE’s already existing community health services and programs that include nursing services, nutrition, and health promotion services Holistic, comprehensive strength-based model aimed at bridging the gap for clients to mental health services in a supportive, non-stigmatizing and accessible manner

Addressing Addressing Community Need Created in response to community’s initial input regarding the need for services In the fall of 2000, JCDHE hosted several summits at various sites throughout the county to elicit community concerns and needs Public meetings hosted by Caring for Colorado Foundation and Coalition for the Medically Underserved Mental health was identified at all of the meetings as one of the major needs within the county that was not adequately addressed Continued reductions in funding have resulted in decreases in mental health services in the county

Background January 2002, JCDHE awarded a grant from Caring for Colorado Foundation to develop mental health program within public health setting. A Psychiatric Clinical Nurse Specialist with a background in consultation liaison psychiatry was hired into a.5 FTE position in April of Initial budget of $43, Role of JCDHE –Grant writing –Site of implementation –Staff provides referrals to program –Provide indirect costs

How it Works Referrals are received from staff on clients in need of mental health assessment, referral, and/or brief intervention  Clients are seen in three clinic sites, at WIC appointments, and during home visits with or without the community health nurse  Telephone screening, intervention, and referral as needed

Meeting the Needs of Clients Culturally diverse, high risk population Individuals and families experiencing a great deal of stress and crisis in their lives that affect their ability to utilize health services, improve health practices, and resolve health problems Reasons for referrals –Depression/anxiety/postpartum depression –Grief/loss/adjustment reactions –Requiring assistance with referral/follow-up mental health care/psychotropic medication needs –Family/marital issues –Physical/sexual abuse –Reactions to trauma/PTSD

Meeting JCDHE Staff Needs Staff Consultation –increasing awareness of incidence and prevalence of mental health issues with JCDHE client population –increasing skills to make assessments regarding the need for further mental health evaluation, treatment, and referral Monthly mental health consultation/staffings with CHNs, Nurse Family Partnership nurses, EPSDT Quarterly meetings with Clinic Nurses and WIC staff and as needed with other JCDHE groups/teams

Monthly Mental Health “Brown Bag” In- services Depression and Suicide Assessment Differentiating Delirium, Dementia, & Depression Therapeutic Communication Dealing with Difficult Clients Postpartum Disorders Bipolar Disorders Sexual Assault Anger and Conflict Management Staff benefits Increased work satisfaction Boundaries in a therapeutic relationship Self-care Meeting JCDHE Staff Needs

Barriers Encountered Lack of mental health services in community; impending budget cuts Access to population that is resistive, suspicious, and negative regarding mental health services Obtaining feedback on referrals to community mental health services, as clients are transient and difficult to reach Mental health resource list; liaison role of MHS; attends Health Care Access Coalition MHS collaborates with nurses and other staff, e.g. joint office/home visits Nurse and other staff assist with follow-up of clients; client satisfaction survey initiated; collaborate with key partners Strategies to Overcome

Lessons Learned Integrating mental health into a public health setting works by reducing barriers to access Having an advanced practice nurse in the role of mental health specialist is effective

First Year Accomplishments 87 client referrals – 40 seen in home/office; 47 via phone encounter 109 staff consultations - 37 client, 24 staff, and 12 program issues 16 group consultations 24 educational classes at noon 62 community contacts Funded for a second year – budget of $47,815 Program evaluated positively by staff

Next Steps Apply for a third year of funding Focus on outcome evaluation Explore continuation funding in light of the value of MHS has to staff and agency Continue to develop liaisons and partnerships with community agencies

How to Reach Us Cynthia Farkas…… Kelly Gaul…………