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Community and Population Strategies Needed to Prevent Crises
The recent horrific shootings at Covenant School in Nashville again convey a very urgent message to behavioral healthcare. Clearly, such events highlight the need for our field to move upstream to promote community and personal wellbeing, and to address social care concerns.
We have known for almost 2 decades that behavioral health conditions almost always originate from trauma-inducing problems in the social fabric. We also know that such trauma can be personal or affect entire communities. Thus, to mitigate or prevent such traumas, we must intervene in communities and populations.
Today, many of our local communities do not function well. They are not cohesive or empowered; they do not incorporate historically excluded groups; they do not have indigenous leaders; and they do not come together to celebrate important community events. As a result, they do not provide necessary support to community members, and they do not reach out to those experiencing difficulties.
The Hogg Foundation, under the leadership of Octavio Martinez, MD, MPH, has undertaken a very important project to foster self-empowered communities in several rural Texas counties. This project is based upon several key principles that include the following:
- Listening to the community;
- Reaching out to excluded groups;
- Fostering local leaders; and
- Celebrating community successes.
Brooks County is a key example of the positive effects of this work. Currently, the foundation is developing a related initiative for urban areas in Texas.
Thrive Allen County, under the leadership of Lisse Regehr, is a similar initiative in rural Kansas already in its 15th year. Its mission is to “support and encourage programs, policies, and resources that promote access to healthcare, healthy lifestyle, and positive community conversation that improves the wellbeing of residents….” The Thrive website reports numerous activities and successes for the community over the life of the program.
Role of Behavioral Healthcare Organizations
A fundamental question is how behavioral healthcare can best become engaged in this important work. This could be from a community or personal perspective.
From the community perspective, a likely route is for behavioral healthcare to partner with community public health entities. The latter espouse community and personal wellbeing as overarching goals, and they use practical strategies for working with communities.
From the person perspective, a likely route is to incorporate related social care services into our care management practices. Social care includes personal care, physical and practical assistance, and social work. It seeks to improve personal quality of life and enable people to live as fully and independently as possible.
A separate avenue is to employ population health management strategies. This approach can be used for an entire community population or for a subset, e.g., all adults, just those on Medicaid, just those with behavioral health conditions, etc. It requires that the social and physical life determinants likely to cause trauma be identified for the members of the population being considered. This can be done either directly via questions or indirectly through predictive analytics models. Once these factors are known, efforts can be made to mitigate or eliminate these factors for those who are likely to experience them. Periodic outreach can be undertaken to assure that the original determinants have not recurred or new determinants have not developed.
As one example, CalAIM, is a new state population health initiative being undertaken in California. It seeks to “establish a comprehensive, accountable plan of action for addressing member needs and preferences across the continuum of care, which requires [participating] plans to:
- Build trust and meaningfully engage with members;
- Gather, share, and assess timely and accurate data on member preferences and needs to identify efficient and effective opportunities for intervention through data-driven risk stratification processes, predictive analytics, identification of gaps in care, and standardized assessment processes;
- Focus on upstream approaches that link to public health and social services and supports members staying healthy through wellness and prevention services;
- Provide care management, care coordination and care transitions across delivery systems, settings, and life circumstances; and
- Identify and mitigate social drivers of health to reduce disparities.
It is far too early to tell how well this initiative will address the concerns I have raised here, but it does include the key elements that are necessary for deploying population health interventions.
We can and must develop and implement strategies to prevent behavioral health crises that result in personal or interpersonal harm. Community and population interventions will play key roles in this endeavor. Without doubt, we must move from being a “stage 4” care system to one that is “stage 0.”
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
Hogg Foundation for Mental Health. A Community-Led Collaborative Moves Forward. University of Texas.
