H.O.P.E. grows: An academic-public health partnership to reimagine public health services and increase mental health access among socially vulnerable populations.

OBJECTIVE: To illustrate the process of developing and sustaining an academic-public health partnership for behavioral health integration through an expansion of the Aligning Systems for Health (ASfH) framework. STUDY SETTING: Practice-informed primary data (2017-2023) from the Holistic Opportunity Program for Everyone (HOPE) Initiative based in Charlotte, NC. STUDY DESIGN: The unit of analysis in this descriptive case study is inter-organizational, specifically focusing on an academic-public health relationship. We illustrate the partnership process across the ASfH four core areas, including key challenges and insights. DATA COLLECTION: Utilized a Critical Moments Reflection methodology and review of HOPE program data. PRINCIPAL FINDINGS: (1) Formal partnership structures and processes are essential to monitoring the four ASfH core components for on-going system alignment. (2) Aligning systems for health principally involves two ecologies: (i) the health program and (ii) the partnership. The vitality and sustainability of both ecologies require continuous attention and resource investment. (3) Relationships rest at the heart of aligning systems. (4) With comparative advantages in research methods, the academic sector is especially poised to collaborate with healthcare systems and human service organizations to study, develop, implement, and scale evidence-based health interventions. CONCLUSIONS: The academic sector shares overlapping purposes with the public health, healthcare, and social services sectors while providing complementary value. It is a critical sectoral partner in advancing population health and health equity.

Enterprise Evaluation: A New Opportunity for Public Health Policy.

Standard evaluation practice in public health remains limited to evaluative measures linked to individual projects, even if multiple interrelated projects are working toward a common impact. Enterprise evaluation seeks to fill this policy gap by focusing on cross-sector coordination and ongoing reflection in evaluation. We provide an overview of the enterprise evaluation framework and its 3 stages: collective creation, individual data collection, and collective analysis. We illustrate the application of enterprise evaluation to the Gulf Region Health Outreach Program, 4 integrated projects that aimed to strengthen health care in Louisiana, Mississippi, Alabama, and the Florida Panhandle after the Deepwater Horizon oil spill. Shared commitment to sustainability and strong leadership were critical to Gulf Region Health Outreach Program's success in enterprise evaluation. Enterprise evaluation provides an important opportunity for funding agencies and public health initiatives to evaluate the impact of interrelated projects in a more holistic and multiscalar manner than traditional siloed approaches to evaluation.

Lessons Learned From a Quad-State Postdisaster Project: Developing Accessible and Sustainable Integrated Mental and Physical Health Care Services.

The Mental and Behavioral Health (MBH) Capacity Project had a mission shared among 4 states to support MBH sustainability along the Gulf Coast. Integration of mental health into undersourced primary health clinics was an important goal of the project. The findings from the collaborative evaluation demonstrate long-term outcomes including the following: community has greater capacity and sustainability for quality health care; better informed and connected communities; and individuals are more informed, connected, and resilient. Lessons learned indicate that improved population health outcomes are possible even in low-income, high-stress regions through intentional and collaborative efforts integrating MBH into primary cares settings.

ACTively Integrating Suicide Risk Assessment Into Primary Care Settings.

Adequate evaluation and response to suicide risk require (i) awareness of need, (ii) comfort gathering key information, and (iii) ongoing training. A survey administered at 2 urban primary care settings in the process of implementing integrated care measured awareness, comfort, and training related to suicide risk assessment among 31 primary care providers (PCPs). Greater PCP comfort asking patients about psychological trauma was associated with more frequent engagement in safety planning with suicidal patients. Findings highlight the need for trauma-informed primary care while showcasing the importance of enhancing PCP training to support their expanded role within the integrated health team.

Four States, Four Projects, One Mission: Collectively Enhancing Mental and Behavioral Health Capacity Throughout the Gulf Coast.

CONTEXT: The 2010 Deepwater Horizon oil spill triggered numerous concerns regarding the health and well-being of citizens within the already vulnerable Gulf Coast region. Four Mental and Behavioral Health Capacity Projects (MBHCPs) united to form the Quad-State MBHCP component of the Gulf Region Health Outreach Program (GRHOP). Their shared mission was to increase mental and behavioral health (MBH) capacity within coastal counties of Louisiana, Mississippi, Alabama, and the Florida Panhandle. OBJECTIVE: To describe strategies used to collectively enhance the impact of the 4 state-specific MBHCPs and to share lessons learned from a multistate collaborative flexibly designed to meet a shared mission. MATERIALS AND PROCEDURES: Archival materials were assessed. They included attendance sheets/notes from regularly scheduled group meetings, GRHOP quarterly and annual reports, and state-specific MBHCP logic models. Nationally available data on MBH services provided in project-relevant primary care sites were also examined. RESULTS: Three strategies were found to be effective facilitators of collective success: (i) reciprocal participation in the backbone organization (GRHOP); (ii) creation and comparison of state-specific MBHCP logic models and activities; and (iii) cross-fertilization among the MBHCP state-specific logic models, a unified Quad-State, and the GRHOP-wide logic model to generate additional synergistic endeavors and measureable outcomes. Examples of region-wide MBHCP success, such as uptake in integrated health services in health care clinics across the jurisdiction of investment, are presented. CONCLUSIONS: Isolated approaches to complex issues are, at times, ineffective. The Collective Impact (CI) model, with an emphasis on coordination among existing organizations, stakeholders, and the public, can serve as a guidepost to facilitate sustainable change even when used in a modified form. Strategies discussed herein for maximizing the 5 prescribed CI conditions provide an important roadmap for how to interface among multidisciplinary projects seeking to address the same, large-scale public health problem.

The Prevalence and Mental and Physical Health Correlates of Posttraumatic Stress Disorder Symptoms in Vulnerable and Underresourced Primary Care Patients Referred to a Behavioral Health Provider.

CONTEXT: The prevalence of trauma exposure among vulnerable, impoverished patients seeking primary care services is considerable. However, assessment of trauma-related symptoms is rare, even among behavioral health patients receiving primary care services within integrated health care centers. OBJECTIVE: To determine the prevalence of clinically noteworthy trauma-related symptoms and their associations with other co-occurring mental and physical symptoms as well as self-reported resiliency. PARTICIPANTS: Primary care patients (n = 120) referred to behavioral health services (76.7% black/African American; 70.8% female). SETTING: Federally qualified health center. MAIN OUTCOME MEASURES: Abbreviated Posttraumatic Stress Disorder Checklist-Civilian, 2-item version; Patient Health Questionnaire (PHQ)-15: physical health symptoms; PHQ-9: depression symptoms; Generalized Anxiety Disorder Scale, 7-item; Connor-Davidson Resilience Scale, 2-items. RESULTS: Seventy-three percent (n = 88) of provider-referred behavioral health patients screened positive for potential posttraumatic stress disorder. Patients most likely to meet criteria for posttraumatic stress disorder reported significantly higher levels of stress, depression, anxiety, and suicide ideation as well as more severe headaches, chest pains, dizziness, and poorer health care. CONCLUSIONS: Results support the need for a trauma-informed integrated approach to health care within primary care settings, particularly those serving vulnerable populations. Integrated health care services foster an environment in which patient access to and satisfaction with services is maximized while overall well-being is enhanced. Adding resiliency-enhancing strategies to patients' integrated health care treatment plans might also be health-promoting. PTSD symptoms can be assessed as part of routine integrated practice via a 2-item screener. Information obtained from trauma screening provides the health care team with useful contextual information about patients' physical and behavioral health symptoms.