Priority: Mental Health (M)

Transcription

1 Stearns County CHIP, Community Health Improvement Plan 45 Priority: (M) Key Data Findings 17% of all Minnesota adults report Mental Illness in the household. Approximately 55% of Stearns County adults consider depression among youth and depression among adults a moderate or serious problem in Stearns County. When considering the topics of suicide, difficulty obtaining mental health services, and eating disorders, more Stearns County adults consider these topics no problem or a minor problem as compared to a moderate or serious problem. Almost 15% of Stearns County adults have felt sad, blue, or depressed for 15 or more of the last 30 days. 42.6% of year old Stearns County adult males (compared to 4.8%-16.9% in other age groups) rate their overall level of stress as High. This is 2.5 times higher to the highest rate for females in the age category of at 17.3%. Almost a third of Stearns County adults identified a time in the last 12 months when they wanted to talk to or seek help from a health professional about emotional problems but delayed or did not seek that help. After saying that they did not go or delayed seeking help from a health professional about emotional problems, the top two reasons for Stearns County adults were I did not think it was serious enough (42.1%) and I was too nervous or afraid (36.5%). At 10 percentage points less, The care I needed cost too much came in at 26.5%. One third of all Stearns County 8th, 9th, and 11th grade females have felt sad, blue, or depressed in the last 12 months (17% for males). Stearns County student rates are slightly less than Minnesota students as a whole. Approximately 5% of all Stearns County 8 th, 9 th, and 11 th grade students across grade levels and gender indicated that they have attempted suicide at some point in their life, with 10% of the males and 15% of the females thinking about ending their life in the last 12 months. Minnesota rates are very similar to the Stearns County rates. From 2009 to2013, there was a 67% increase in the number of persons age accessing the PATH (Project for Assistance in Transition from Homelessness) project at Stearns County Human Services. These are adults who have mental illness and are experiencing homelessness.

2 46 Stearns County CHIP, Community Health Improvement Plan TABLE 3: ADULT - PERCENT OF ACES AMONG MINNESOTA ADULTS BY GENDER 2011 Minnesotans (%) ACE (Adverse Childhood Experience) All Men Women Incarcerated Household Member Sexual Abuse Drug Use Problem, Household Witnessed Domestic Violence Physical Abuse Mental Illness, Household Parent Separated or Divorced Drinking Problem, Household Verbal Abuse Table source: Minnesota Department of Health Adverse Childhood Experiences in Minnesota: Findings and Recommendations Based on the 2011 Minnesota Behavioral Risk Factor Surveillance System (BRFSS). PowerPoint presentation authored by Vincent Felitti, MD and Robert Anda, MD. (Jan 28, 2013) Discussion The Adverse Childhood Experiences Study (ACE Study) was conducted by Center for Disease Control and Prevention and Kaiser Permanentes Health Appraised Clinic in San Diego. The study findings suggest that certain experiences (including mental health) are major risk factors for the leading cause of illness and death as well as poor quality of life in the US. The 10 adverse childhood experiences included in the study were: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, parental separation/divorce, battered mother, parental substance abuse, parental mental illness, and parental criminal background. In 2011, the Minnesota Department of Health utilized the statewide data in the Minnesota Behavioral Risk Factor Surveillance System (BRFSS) to analyze the data looking specifically at the data elements related to adverse childhood experiences. 55% of all Minnesotans report 1 or more ACEs. Among Minnesota adults, there is a strong association between mental health and ACEs. Minnesota adults with an ACE score of 5 or more were 6 times more likely to have an anxiety disorder diagnosis compared to persons with no ACEs. (31% vs. 5%)

3 Stearns County CHIP, Community Health Improvement Plan 47 TABLE 4: ADULT - RANKING OF MENTAL HEALTH CONCERNS Ranking of community concerns by Stearns County adults identifying each concern as a moderate or serious problem, February Depression among adults (57.6%) 39. Suicide among youth (38.7%) 19. Mental Illness (55.6%) 41. Difficulty obtaining MH services for adults (38.1%) 21. Depression among youth (55.5%) 42. Difficulty obtaining MH services for youth (37.1%) 33. People not taking MH meds (45.3%) 47. Eating disorders (32%) 37. Suicide among adults (40.1%) BUT, Heart Disease or Stroke ranked at 13 (59.6%) Source: Central Minnesota Community Health Survey, February 2013 Discussion Out of a total of 68 community concerns, most mental health related concerns ranked in the bottom half by Stearns County adults. A high ACE (Adverse Childhood Experience) score doubles your chance of heart disease. o Many studies have stemmed off of the original ACE (Adverse Childhood Experience) study. o Source for this statement: Presentation by Jane Ellison (Greater St. Cloud Area Thrive) to the St. Cloud Area Human Service Council, 2/14/13. Research from 2004, Sep 28. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Authors: Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, Anda RF. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Out of a total of 68 community concerns, Stearns County adults ranked heart disease or stroke at #13.

4 48 Stearns County CHIP, Community Health Improvement Plan GRAPH M1: ADULT - VARIOUS COMMUNITY CONCERNS RELATED TO MENTAL HEALTH 100.0% Various Community Concerns related to In Stearns county, how much of a problem is... (Source: Central Minnesota Community Health Survey, February 2013) 90.0% 80.0% 13.8% 15.3% 17.7% 18.1% 21.8% 23.1% 20.9% 70.0% 60.0% 57.6% 55.5% 40.1% 38.7% 38.1% 37.1% 32.0% 50.0% 40.0% 30.0% 20.0% 10.0% 28.6% 29.2% 42.3% 43.2% 40.2% 39.8% 47.1% 0.0% Depression among adults Depression among youth Suicide among adults Suicide among youth Difficulty obtaining mental health services for adults Difficulty obtaining mental health services for youth Eating disorders No problem/ Minor problem Moderate/Serious problem No opinion Discussion The two community concerns related to mental health that Stearns County adults identified as more of a moderate or serious problem versus no or little problem were depression among adults and depression among youth. When considering the topics of suicide, difficulty obtaining mental health services, and eating disorders, more Stearns County adults consider these topics no problem or a minor problem compared to a moderate or serious problem.

5 Stearns County CHIP, Community Health Improvement Plan 49 GRAPH M2: ADULT - NUMBER OF DAYS IN PAST 30 DAYS FEELING SAD OR BLUE Stearns County adults: During the past 30 days, for about how many days have you felt sad, blue, or depressed? (Source: Central Minnesota Community Health Survey, February 2013) 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 44.3% 36.8% 13.8% 5.0% 0 days 1 to 7 days 8 to 14 days 15 or more days Discussion 36.8% of Stearns County adults have not felt sad, blue, or depressed in the past 30 days. Almost 15% of Stearns County adults have felt sad, blue, or depressed over half the days of the previous month.

6 50 Stearns County CHIP, Community Health Improvement Plan GRAPH M3: ADULT - LEVEL OF STRESS, MALES BY AGE Stearns County adults: How would you rate your overall level of stress broken down by age among males (Source: Central Minnesota Community Health Survey, February 2013) 100.0% 24.3% 16.5% 80.0% 39.3% 47.9% 60.0% 33.1% Low 40.0% 72.1% 43.8% Medium High 47.3% 20.0% 42.6% 0.0% 16.9% 11.4% 4.8% Discussion The Stearns County adult age group that has the highest group of high stress is (42.6%). This is 2.5 times higher than the highest rate for Stearns County adult females in the age category of at 17.3% Inversely, the Stearns County adult male group with the highest amount of low stress levels is aged Stearns County adult male age group has the smallest amount of low stress at 16.5% and the largest amount of medium level stress.

7 Stearns County CHIP, Community Health Improvement Plan 51 GRAPH M4: ADULT - LEVELS OF STRESS, FEMALES BY AGE 100.0% Stearns County adults: How would you rate your overall level of stress broken down by age among females (Source: Central Minnesota Community Health Survey, February 2013) 80.0% 20.5% 21.7% 30.7% 46.1% 60.0% Low 40.0% 62.9% 61.1% 56.6% Medium High 50.8% 20.0% 0.0% 16.6% 17.3% 12.7% 3.1% Discussion Stearns County adult females show a much more even distribution of stress across age levels than the Stearns County adult males. Adult females aged 18 through 50 have approximately the same level of overall stress. After the age of 50, the levels of high and medium stress decrease and the level of low stress increases. In the age group of the Stearns County females and Stearns County males have very similar distribution of stress.

8 52 Stearns County CHIP, Community Health Improvement Plan GRAPH M5: ADULT - PERCENT DELAYING OR NOT SEEKING HEALTH PROFESSIONAL HELP FOR EMOTIONAL PROBLEMS Stearns County adults: During the past 12 months, was there a time when you wanted to talk with a health professional about emotional problems but did not or delayed talking to someone? (Source: Central Minnesota CommunityHealth Survey, February 2013) Yes, 29.70% No, 70.30% Discussion Almost a third of Stearns County adults identified a time in the last 12 months when they wanted to talk to or seek help from a health professional about emotional problems but delayed or did not seek that help. The full question on the survey was: During the past 12 months, was there a time when you wanted to talk with or seek help from a health professional about emotional problems such as stress, depression, excess worrying, troubling thoughts, or emotional problems, but did not or delayed talking with someone?

9 Stearns County CHIP, Community Health Improvement Plan 53 GRAPH M6: ADULT - REASONS FOR DELAYING OR NOT SEEKING HEALTH PROFESSIONAL HELP FOR EMOTIONAL PROBLEMS Stearns County adults: Reasons for delaying or not obtaining health professional help for emotional problems (Source: Central Minnesota Community Health Survey, February 2013) 45.0% 42.1% 40.0% 36.5% 35.0% 30.0% 26.5% 25.0% 20.0% 15.0% 10.0% 15.8% 12.1% 9.5% 5.0% 4.2% 3.1% 2.9% 2.5% 0.0% Discussion The top two reasons for not seeking care for emotional problems are related to stigma. The highest reason for Stearns County adults delaying or not seeking care from a health professional for emotional problems is they did not think it was serious enough (42.1%). The next highest reason was because they were too nervous or afraid (36.5%). A little more than a quarter of Stearns County adults who delayed or didn t seek care from a health professional for emotional problems did so because the care they needed cost too much.

10 54 Stearns County CHIP, Community Health Improvement Plan GRAPH M7: YOUTH - STEARNS 8 TH, 9 TH, AND 11 TH GRADERS FEELING SAD, BLUE, OR DEPRESSED BY GENDER 40% 35% 30% Stearns County 8th, 9th, and 11th graders who during the last 12 months had SIGNIFICANT problems with feeling very trapped, lonely, sad, blue, depressed or hopeless about the future - by gender (Source: Minnesota Student Survey, 2013) 32% 33% 35% 25% 20% 15% 16% 17% 18% Male Female 10% 5% 0% 8th 9th 11th Discussion One third of all Stearns County 8 th, 9 th, and 11 th grade females have had significant problems with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future during the last 12 months. (17% for males) TABLE 5: YOUTH - MINNESOTA 8 TH, 9 TH, AND 11 TH GRADERS FEELING SAD, BLUE, OR DEPRESSED BY GENDER Male Female 8 th graders 17% 34% 9 th graders 20% 38% 11 th graders 24% 40% Minnesota male and female students as a whole experience problems with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future during the last 12 months more than the Stearns County 8 th, 9 th, and 11 th grade male and female students. Both Stearns and Minnesota students see increased problems as they age, but the Minnesota increase is more than in Stearns County.

11 Stearns County CHIP, Community Health Improvement Plan 55 GRAPH M8: YOUTH - 12 TH GRADE FEMALES ATTEMPTED SUICIDE 20% Have you ever tried to kill yourself? (Yes, more than a year ago) Stearns County and MN 12th Grade Females (Source: Minnesota Student Survey, ) 15% 10% 9% 9% 8% 8% 9% 10% 7% 6% 6% Stearns MN 5% 4% 0% Discussion From 1998 through 2007, Stearns County 12 th grade females had a lower rate of attempted suicide than the overall state. In 2010, Stearns County had the same rate as the state at 6%. From 1998 through 2010, there is a general downward trend for 12 th grade females attempting suicide. This is trend data to accompany the 2013 Minnesota Student Survey data. The questions were modified in the 2013 version of the survey and there were different grade levels that participated in the survey as well. The data in this graph cannot be directly compared to the new data, but it does present a history in this area of high school student mental health.

12 56 Stearns County CHIP, Community Health Improvement Plan GRAPH M9: YOUTH - STEARNS COUNTY 8 TH, 9 TH, AND 11 TH GRADERS ACTUALLY ATTEMPTING SUICIDE 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Stearns County 8th, 9th, and 11th graders having actually attempted suicide by gender (Source: Minnesota Student Survey, 2013) 7% 4% 4% 8% 5% 8th 9th 11th 5% Male Female Discussion Approximately 5% of all Stearns County 8 th, 9 th, and 11 th grade students across grade levels and gender indicated that they have attempted suicide at some point in their life. 8 th and 9 th grade females are slightly higher than 5%. TABLE 6: YOUTH - MINNESOTA 8 TH, 9 TH, AND 11 TH GRADERS ACTUALLY ATTEMPTING SUICIDE Male Female 8 th graders 3% 7% 9 th graders 4% 9% 11 th graders 5% 9% The Stearns County and Minnesota percentages of 8 th, 9 th, and 11 th graders actually attempting suicide are very similar. Stearns County 11 th grade females are 4% less than the Minnesota 11 th grade females as a whole.

13 Stearns County CHIP, Community Health Improvement Plan 57 GRAPH M10: YOUTH - STEARNS COUNTY STUDENTS HAVING THOUGHTS ABOUT ENDING LIFE OR COMMITTING SUICIDE 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Stearns County 8th, 9th, and 11th graders by gender who have had signficant problems with thinking about ending their life or committing suicide during the last 12 months (Source: Minnesota Student Survey, 2013) 10% 17% 17% 9% 10% 8th 9th 11th 15% Male Female Discussion Of Stearns County 8 th, 9 th, and 11 th graders, 10% of the males and 15% of the females have had significant problems with thoughts about ending their life or committing suicide in the last 12 months. TABLE 7: YOUTH - MINNESOTA STUDENTS HAVING THOUGHTS ABOUT ENDING LIFE OR COMMITTING SUICIDE Male Female 8 th graders 9% 18% 9 th graders 10% 20% 11 th graders 10% 15% The Stearns County and Minnesota percentages of 8 th, 9 th, and 11 th graders having significant problems with thoughts about ending their life or committing suicide during the last 12 months are similar. Stearns County 8 th and 9 th grade females are slightly less than the Minnesota 8 th and 9 th grade females as a whole.

14 58 Stearns County CHIP, Community Health Improvement Plan GRAPH M11: ADULTS - STEARNS COUNTY PATH CLIENTS BY AGE Stearns County Human Services PATH Clients PATH=Projects for Assistance in Transition from Homelessness {generally clients are 75% from Stearns and 25% from Benton} (Source: Annual Stearns County Human Services PATH grant reports) yrs yrs yrs 75+ yrs Linear (18-49 yrs) 40 Linear (50-64 yrs) Discussion Stearns County Human Services is seeing an increase in older adults who have mental illness and are experiencing homelessness that are being seen by the PATH (Projects for Assistance in Transition from Homelessness) project. PATH is a grant Stearns County receives where a PATH outreach social worker connects persons experiencing homelessness to community resources. 95% of all PATH clients have some type of mental health concern or illness. From 2009 to 2013, PATH clients aged years has seen a slight decline or remained fairly steady. On the other hand, from 2009 to 2013 there has been 67% increase in the number of PATH clients who are aged years was the first year when a client who was 75+ years old was served.

15 Stearns County CHIP, Community Health Improvement Plan 59 Health Equity assessment Disparities in access to mental health services affect individuals and society. Barriers to services include: Lack of availability, high cost and lack of insurance coverage. These barriers can lead to other problems such as unmet needs, delayed treatment, and hospitalizations that could have been prevented. Mental illness is still a stigmatized condition by society as noted by 36.5% who were afraid to get treatment. Community feedback PUBLIC COMMENT Public Health Task Force comments Public comment during comment period Comments were received between September 15, 2014 and October 15, Where applicable, the comments were added into the body of the plan. Alcohol Awareness Council Add Partners: Minnesota Department of Human Services, Minnesota Association for Children s Add Resource: Project Know, Understanding Addiction (online resource) - Behavior Health section ARC Midstate Presently one of the biggest challenges we witness is the availability for treatment and care for children and teens who are in need of therapies and/or inpatient treatment including residential services. This is especially true for those who have co-existing developmental or cognitive challenges. Include a goal about serving children and adults on the Autism Spectrum.

16 60 Stearns County CHIP, Community Health Improvement Plan Central Minnesota Center Add Goal: Maintain and enhance evidence-based training available to law enforcement about mental illness. An example would be Crisis Intervention Training (CIT). Additional Partner: Minnesota CIT (Crisis Intervention Training) Association Add Dental Access to the Priority Interconnections o It's a very difficult need for clients in the system to meet with current resources. Add Community Resources: ACT Teams and IRTS HealthPartners Like how we described priority selection Add Resource: Make it OK Campaign ( Consider forming a Center for Community Health as in Rochester: The Center for Community Health was established by the University of Rochester Medical Center to develop and expand academiccommunity health partnerships dedicated to improving the health of our community. THRIVE We feel it is important to consider the needs of New Americans in our area when addressing all the proposed priorities. We look forward to future collaboration in relation to early childhood, parenting, and family needs. Village Family Services, Inc. Would love it if all children and adults could undergo trauma informed assessment when seeking treatment. Add Resources: Anger Management, Domestic Violence, and Co-Parenting Support Groups, Trauma Informed Support Groups at the Village Family Services FOCUS GROUP FEEDBACK Focus group identified contributing factors/sub-issues Stigma - afraid to admit having mental health concerns, fear of being labeled crazy - applies to all cultures Access to care interpreters, transportation, availability, affordability Affordability of care Transportation

17 Stearns County CHIP, Community Health Improvement Plan 61 Language barriers Persons understanding they have a problem Identification of mental health concerns for very small children, 0-5 year olds Connections with babies - availability of maternity leave, importance of encouraging attachment during baby s first year Aging population - support needed for grief and loss Aging population - beware of withdrawal from society, fear and shame, dismissal of the severity of the mental health component New Brain Research Family won t allow treatment - parents don t believe in medicine or getting professional assistance for mental health concerns Jails/corrections/prison - End up in the system instead of getting care Homeless population Racial and Cultural Predisposition Post traumatic stress disorder (PTSD) Difficult to navigate the system. Difficult to understand how to obtain funding - Long Term Care and Medical Assistance Waiver funding. Difficult for English speaking Americans, even more so for other cultures and immigrants and refugees. Takes a lot of time to get better - if there are barriers, one appointment is hard enough - let alone considering months or years of ongoing appointments Early intervention is important, Focus on Primary Prevention o Early childhood screening and family screening o Include the family in the treatment It is difficult for the Native Americans, Latinos, Somali cultures to understand our mental health profession process. o Holistic/spiritual component missing o There is some distrust. There is discomfort or misunderstanding with the term of Intervention o Some things get lost in the interpretation the direct translation of mental health is uncomfortable Mental illness = crazy o Psychiatrists looked upon as weird o It is important to provide different services based on the different cultures - making sure the client understands with as little fear as possible. People not understanding that they do have a say in their mental health services There is such a wide variation of needs Our community needs a wide range of services to meet the full range of needs: in-home, skills workers, outpatient, inpatient Don t make people fit into the box - make the box fit the people. Must keep the best interest of the children in mind - outside of the money. ADHD/Autism spectrum Anxiety/regulation Misdiagnosis Need for provision of widespread Screening Process o Just like vision, hearing, or scoliosis screening in schools o We tend to Only deal with mental health when there already is a problem Bullying Abuse sexual, physical, neglect

18 62 Stearns County CHIP, Community Health Improvement Plan Some people don t understand that a pill only approach does not work as well as the pill in conjunction with talk therapy Medical trauma Secondary trauma of staff in the medical community, EMS, police, or fire personnel How to parent when you have a mental illness Lack of support groups -Ongoing support to address layers of needs Focus group prioritization of contributing factors/sub-issues Priority #1: Stigma - afraid to admit having mental health concerns, fear of being labeled crazy - applies to all cultures Priority #2: Our community needs a wide range of services to meet the full range of needs: in-home, skills workers, outpatient, inpatient Priority #2: Need for provision of widespread Screening Process Priority #3: It is important to provide different services based on the different cultures - making sure the client understands with as little fear as possible. Priority #4: Access to Care Priority #4: It is difficult for the Native Americans, Latinos, Somali cultures to understand our mental health profession process. Priority #4: Lack of support groups -Ongoing support to address layers of needs Priority #5: System Navigation Priority #5: Need to include family in treatment for children Priority #5: Must keep the best interest of the children in mind - outside of the money. Priority #6: Affordability of Care Priority #6: Persons understanding they have a problem Priority #6: Racial and Cultural Predisposition Suggested action from community dialogue Stigma o BLUR the line between medical and mental health - they are connected o Educate workers first Utilize Reflective Practice to help employees have comfort with the topic of mental health Educate workers at all levels: Courts, Corrections, Public Health, medical field, teachers, child care providers, peer mentors, state/dhs, insurance companies, community leaders (Elders, church community) o Educate clients about mental health diagnosis - include the physical and mental aspects - utilize recent brain research Individually - medical provider and client Also Utilize safe group settings o Some populations can best be educated through community leaders Spiritual leaders o Educate students in school Give them information just like what is done for STI s, alcohol, etc. Help/Allow identification feelings

19 Stearns County CHIP, Community Health Improvement Plan 63 Have information available for parents o Expand/Review definition of Include feelings, body language, ability to cope o Change the way we communicate about Normalize mental illness Change the message Know your audience Pay attention to vernacular Use Imagery - have the message come from famous/well known people with Mental Illness Get message into schools and General Medical Clinics -people are more comfortable going to these places than to clinics Teach modules/models on Resiliency, Mindfulness, Self Care, Deep Breathing/Regulation o Utilize Peer Mentors - make this practice more acceptable Provide support and social networks Have places where people can go to be heard/use group processes o Invest in Community Support Workers A great model where people can sit down 1-1 to find out what they need and connect to resources o Somehow get the word out about what resources are available Utilize 211 Identify a way to keep 211 updated Original identified need: Widespread Screening Process Group identified that there actually are already existing screenings available that are being conducted on a widespread basis, but on minimal basis o Lists already exist through THRIVE and the CommUNITY AMH initiative Resource list. New need: Identified system to use for persons who screen positive on a Screen o A clearly identified system to refer positive screens would allow the screens to take place more frequently and expand the use to schools and general doctors Utilize 211? o Need a directory or flow chart to identify which tool to use for which population Perhaps 211 could be used to store this o Electronic screening options need to be developed for the younger generation o Develop a community based system Our sense of community has been lost Answer the question, How can we help persons who screen positive? Need to identify a menu of options - scaffolding Be cognizant of how each population group is best served Utilize 1-1 connections o ARMHS workers, peer mentors o How can we provide this to the younger populations through technology? Get a community group together of persons/agencies who want to do this ongoing screening and follow-up to start the process.

20 64 Stearns County CHIP, Community Health Improvement Plan Similarities to national, state, and other local planning processes HEALTHY PEOPLE 2020 This is a topic area in the Health People 2020 looking at and promoting it as well as availability of treatment for mental illness and better understanding of mental illness as a society. [ Status Improvement and Treatment Expansion] HEALTHY MINNESOTA 2020 Goals include: (1) People in Minnesota at risk for or who live with chronic diseases receive the right care in the right place at the right time. (2) People in Minnesota have access to information about the burden of chronic diseases and injury, their associated risk factors, and best practices to address them. CENTRACARE HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT SUMMARY FOR HOSPITALS IN MELROSE, SAUK CENTRE, AND ST. CLOUD Community health issue identified as Services. ST. CLOUD COMMUNITY PRIORITIES Support aging in place. GREATER ST. CLOUD COMMUNITY PILLARS Housing: A full range of housing is available for all community members. Economy: Our community has an increase in employment and median income levels. Safety: All people feel secure and free from crime. Wellness: Our community will create sustainable environments that encourage healthy choices and support well-being. Transportation: All people have access to, from and within the region by means of public and other modes of transportation. Community engagement: All people feel ownership in local government, connected to the larger community and involved in social networks.

21 Stearns County CHIP, Community Health Improvement Plan 65 UNITED WAY OF CENTRAL MINNESOTA FOCUS AREAS Quality Out of School Time ROBERT WOOD JOHNSON FOUNDATION COMMISSION TO BUILD A HEALTHIER AMERICA Invest in early childhood for a lifetime of good health. Stearns County Goals Using the Control and Influence Matrix, is an Area to address. GOAL M1: DECREASE STIGMA RELATED TO MENTAL ILLNESS Objective M1.1: Make mental illness more visible. Suggested strategies a. Implement policy and system changes that support mental illness treatment and services. b. Develop more mental health services at the primary care level using advanced practice mental health specialists. c. Implement programs that foster healthy relationships and positive mental health. i. Assure persons living with mental illness provide input into programming. ii. Assure culturally appropriate programming is available. d. Implement the MakeItOK Campaign in the Stearns County area. GOAL M2: DEVELOP MORE POSITIVE MENTAL HEALTH PROMOTION SERVICES ACROSS THE AGE SPAN. Objective M2.1: Provide parental education on promoting positive mental health in young children. Suggested strategies a. Support Evidence-based programing for services that serve families such as Healthy Families America and Nurse-Family Partnership. b. Provide resiliency training for professional and community members. c. Provide infant mental health and attachment training for professionals and community. d. Incorporate infant mental health into school districts, child birthing classes, and other parent education centered services.

22 66 Stearns County CHIP, Community Health Improvement Plan Objective M2.2: Provide mental health resources throughout the life span. Suggested strategies a. Increase depression screening at critical times in life (i.e., adolescence, post-partum, senior). b. Assure referral practices are implemented after all depression screenings. c. Maintain and develop additional community mental health resources (i.e., one number to call for mental health access services). d. Work with local businesses to identify local resources that address mental health. e. Assure age appropriate resources are available (i.e., phone apps, telemedicine). GOAL M3: INCREASE MENTAL HEALTH PROVIDER CAPACITY. Objective M3.1: Explore ways to increase the capacity of primary care providers to provide mental health services. Suggested strategies a. Explore further collaboration between primary care providers and psychiatrists. b. Explore the use of technologies to increase collaboration between primary care providers and psychiatrists. c. Provide and educate primary care providers on evidence-based strategies to initiate early interventions for persons experiencing mental illness. d. Convene payers and providers to address and improve reimbursement around mental health treatment. Objective M3.2: Explore ways to increase the number of psychiatrists, specifically pediatric psychiatrists, practicing in the Stearns County area. Suggested strategies a. Increase education to college students about the field of psychiatry and pediatric psychiatry. b. Explore the use of economic incentives to attract psychiatrists to the Stearns County area.

23 Stearns County CHIP, Community Health Improvement Plan 67 Objective M3.3: Explore ways to increase the use of advanced practice professionals (i.e., advanced practice Registered Nurses or Social Workers) in mental health. Suggested Strategies a. Support policies that would promote loan forgiveness for providers practicing in underserved areas. b. Promote policies that incentivize persons of all cultures to pursue a mental health professional degree. GOAL M4-M13: ADDITIONAL GOALS TO CONSIDER Objectives and Strategies have not been developed for the following goals, but they are additional goals for the community to consider: Goal M4: Increase awareness of resources to address mental illness. Goal M5: Conduct mental health screenings across all ages. Goal M6: Increase the number of advocates to help people navigate the system to help people identify the next steps after the first no (i.e., no we can t get you in for another 5 months, no we do not take your insurance, no we do not have a pediatric psychiatric services). Goal M7: Increase community awareness on maintaining mental health. Goal M8: Increase social activities for senior populations to increase social contacts to decrease isolation. Goal M9: Decrease stigma of utilizing senior living communities/arrangements. Goal M10: Maintain and enhance evidence-based training available to law enforcement about mental illness. An example would be Crisis Intervention Training (CIT). Goal M11: Increase the capacity of the community to serve children and adults on the Autism Spectrum. Goal M12: Increase the capacity of the community to serve children and teens with co-existing developmental or cognitive challenges along with mental illness in need of therapies and/or inpatient treatment including residential services. Goal M13: For children, youth, and adults experiencing mental health challenges, create, maintain, and enhance promising and evidence based services such as TXT4Life, PBIS (Positive Behavioral Interventions and Supports), JDAI (Juvenile Detention Alternatives Initiative), and CTI (Critical Time Intervention).

24 68 Stearns County CHIP, Community Health Improvement Plan Measurements for success Measure Source Baseline 2019 Target MM1. Reduce total number of adults who do not receive mental health consultation Central MN Community Health Survey Question % did not or delayed talking to a health professional about emotional % did not or delayed talking to a health professional about emotional MM2. Reduce total number of people who did not receive or delayed receiving care because they were nervous or afraid MM3. Reduce total number of people who did not receive or delayed receiving care because they did not think the problem was serious enough MM4. Reduce the total number of children in Out of Home Placement that are placed in a residential treatment center Central MN Community Health Survey Question 8f. Central MN Community Health Survey Question 8h Stearns County Human Services Internal Report problems % of those who did not receive or delayed care did so because they were nervous or afraid % of those who did not receive or delayed care did so because they did not think the problem was serious enough residential treatment center placements problems % of those who did not receive or delayed care did so because they were nervous or afraid % of those who did not receive or delayed care did so because they did not think the problem was serious enough residential treatment center placements Individuals/Agencies responsible for implementing strategies for Mental Health priority Stearns County Human Services Department Existing community assets and resources Intensive home visiting programs (Early Head Start, Healthy Families America, Nurse-Family Partnership) School District school counselors St. Cloud Area Trauma Response Initiative at the St. Cloud Police Department Greater St. Cloud Area Thrive, a collaboration addressing children s mental health Providers offering Circle of Security, a relationship based early intervention program for parents and children Anna Marie s 24 hours domestic violence crisis hotline Stearns County Domestic Violence Court

25 Stearns County CHIP, Community Health Improvement Plan 69 Journey Home, a half way home for women who are chemically dependent and their children Clara s House, partial hospitalization program for children with mental illness United Way Success by Six United Way St. Cloud Area Human Service Council Project Know, Understanding Addiction (online resource) - Behavior Health section ACT (Assertive Community Treatment) Teams and IRTS (Intensive Residential Treatment Services) through the Central Minnesota Center Make It OK Campaign (online resource) Anger Management, Domestic Violence, and Co-Parenting Support Groups, Trauma Informed Support Groups at the Village Family Services Lutheran Social Services Resiliency Program for Children Minnesota State Advisory Council on and its subcommittee on Children s Mental Health, 2014 Report to the Governor and Legislature Workforce Development Steering Committee Stearns County Human Services, Public Health Division programs, WIC and Child and Teen Checkups Minnesota Statewide Suicide Prevention Plan Report and Recommendations on Strengthening Minnesota s Health Care Workforce from the Legislative Health Care Workforce Commission Preeminent Medical Discovery, Education, and Workforce for a Healthy Minnesota Final Report from the MN Governor s Blue Ribbon Commission on the University of Minnesota Medical School Gearing Up for Action: Workforce Plan for Minnesota Report from the Minnesota Health Workforce Steering Committee Potential partners Stearns County Human Services: Public Health Division, Family & Children Services Division, Community Supports Division, Community Corrections Division Sherburne County Health and Human Services Stearns County: Attorney s Office, Sheriff s Office Law Enforcement: St. Cloud Police Department, other Stearns County community Police Departments Minnesota Department of Health Minnesota Department of Human Services Minnesota Association for Children s Minnesota Department of Economic and Educational Development Minnesota Psychological Association Local policy makers Reach-Up, Inc., Head Start Early Head Start Resource Training and Solutions Universities/Colleges St. Cloud State University Child and Family Studies Department Sauk Rapids/Rice Early Childhood Programs Initiative Foundation

26 70 Stearns County CHIP, Community Health Improvement Plan Service Providers (Central Minnesota Center, Village Family Services, Caritas Clinic, Catholic Charities Young Learners Program, Center for Psychological Services, Child and Adolescent Specialty Care [CentraCare Health Plaza], Clara s House, HealthPartners Behavioral Health, ISD 742/St. Cloud School District Triage System, Lutheran Social Services, Pinecone Family Counseling, Four County Crisis Response Team, St. Cloud VA Health Care System, and individual therapists, psychologists, social workers, and counselors) Health Care Clinics Hospitals Health Plans: Health Care Home Coordinators Emergency Rooms, Behavioral Access Nurses Schools Child Care Choices St. Cloud Area YMCA Boys and Girls Club of Central Minnesota Anna Marie s Alliance St. Cloud Area Crisis Nursery New Beginnings ARC Midstate Rise Goodwill Easter Seals United Way Community Non-Profits National Alliance on Parish Nurses Minnesota CIT (Crisis Intervention Training) Association HealthForce Minnesota Rural Assistance Center Families for Depression Awareness (Massachusetts Non-profit) Stearns County community health priority interconnections Refer also to these Stearns County community health priorities: Parenting skills Lack of physical activity Poor nutrition Tobacco use by women Alcohol use Integration of newly arrived persons Financial Stress Dental Access