Public Health and Mental Health “A Model for Success” Presented by: Kelly Gaul, APRN, BC Cynthia Farkas, RN, Jefferson County Department of Health & Environment July 17, 2003

Mission Goals: provide assessment and identification of mental health needs and barriers to services provide education and brief treatment (1-3 sessions) 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 and JCDHE clients 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. Mental health was identified at all of the meetings as one of the major needs within the county that was not adequately addressed.

Addressing Community Needs High risk population; high need; difficult to access; few mental health services available to them; tend to be resistive, suspicious and negative regarding existing mental health services Continued reductions in funding have resulted in decreases in mental health services available in the county –Jefferson Center for Mental Health decreased funding –Governor mandated reductions in Medicaid contract payments for mental health services as part of an effort to balance the state budget

Background January 2002, JCDHE awarded a grant from the Caring for Colorado Foundation to develop mental health program within public health setting. Grant will be continued from 5/03 – 05/04 A Psychiatric Clinical Nurse Specialist with a background in consultation liaison psychiatry was hired into a.5 FTE position in April of 2002.

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 Lakewood, Arvada, and Conifer clinics, 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 High risk population becoming increasingly high risk –Poverty, domestic violence, drugs and alcohol, homelessness, tobacco use, poor nutrition, educational disadvantages, psychiatric illness Diverse population: Caucasian, African American, Spanish, Asian Adult, child and family 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

Some of the reasons for referral: Depression Anxiety Stress Situational issues/problems/crises Postpartum disorders Adjustment reactions Family issues Marital issues Parenting problems/concerns Unwanted/unplanned pregnancy Grief reactions Reactions to trauma/PTSD Postpartum newborn assessment Physical/sexual abuse Requiring assistance with referral/ follow-up mental health care Psychotropic medication needs

Meeting JCDHE Staff Needs Staff Consultation –increasing awareness of incidence and prevalence of mental health issues with JCDHE client population –and increasing skills to make assessments regarding the need for further mental health evaluation, treatment, and referral

Monthly Mental Health “Brown Bag” In- services Monthly mental health consultation/staffings with CHN’s, Partners for Health Family Nurses, EPSDT Quarterly meetings with Clinic Nurses and WIC staff and as needed with other JCDHE groups/teams Meeting JCDHE Staff Needs

What’s Ahead Improve the mental health status of the JCDHE client population Improve assessment and intervention skills of staff regarding mental health needs of their clients Develop liaisons to community agencies