Jefferson County Missouri is the 8th largest county in Missouri with a population of 226,423 according to the most recent United States Census data with, 7.8% of the population living in poverty and 11.2% being uninsured. Jefferson County is a unique community with urban and rural populations. Many individuals in the county reside thirty or more minutes away from needed resources.
Over the past decade Jefferson County Health Department (JCHD) has identified a significant trend of increased needs specific to behavioral health and substance use. The COVID-19 pandemic has accelerated the need to bridge the gap for health inequities and connection to resources. JCHD facilitates an ongoing network of partners, Jefferson County Health Network (JCHN), designed to connect key stakeholders and implement positive change within the community. Through the utilization of these partnerships, JCHN developed a framework to address increasing needs magnified by the pandemic.
During 2020 and 2021 JCHN task force members, through the leadership of JCHD staff, developed a concept to utilize a virtual platform to connect individuals easily to resources within the community and house a library of virtual resources. This platform is known as ASPEN, standing for Access to Services Providing Essential Needs. Much like an aspen forest, ASPEN has interconnected roots providing access to shared resources. Phase one of development focused on creation of a universal assessment tool designed for connection to each public and private school in the county and surrounding regions with protentional to expand on a statewide level. Having access to a universal assessment tool better enables school counselors and staff to triage behavioral health and substance use needs. The platform was developed with algorithms to link students to resources that meet their specific needs. This helps to reach disproportionately impacted student and family populations with necessary services. Utilizing an interconnected resource will link licensed counselors, school staff, pediatricians and other key providers to better meet student and family needs. This method not only addresses urgent issues, but it also helps put proactive methods in place for all students while identifying levels of need. An additional layer has the ability to activate quickly and be utilized during emergencies or difficult times when increased access to resources, including behavioral health is needed.
Next phases of development include unique platforms for foster children, first responders, health care workers and the general public. This platform was designed to expand as community needs continue to rise and change at regional and state levels. Successful implementation of the tool will have both short-and long-term accomplishments.
Sustainability and ongoing evaluation are taken into consideration during each development phase. Currently ASPEN is in the process of being utilized in 2 public schools and 1 St. Louis City private school. 7 schools have begun initial training. JCHD anticipates a majority of Jefferson County schools will be fully utilizing ASPEN by summer and fall of 2022.
The ongoing pandemic has impacted access to care and mental health for individuals and families throughout the world with individuals and families seeing steadily increasing needs. Studies from multiple sources, including the Impact of COVID-19 Pandemic on Mental Health in the General Population: A Systematic Review by J affect Disord in December of 2020 show the unprecedented hazards to mental health during the pandemic to all populations. Many vulnerable populations often face life without a safety net, and the COVID-19 pandemic has made ongoing struggles much harder. The nature of these unique populations contains repeated exposure to painful experiences, PTSD, erratic schedules; all of which can cause a significant increase in risk for behavioral health issues. In 2021 the Jefferson County Health Department (JCHD) completed a community survey where 9% of all survey respondents indicated they had at least one child with a mental health disability and 47% of those with children indicated that more mental health services and screenings are needed. Per the census bureau, 11% of Jefferson Counties children live in poverty and multiple studies show children in poverty have a higher risk of behavioral health or substance abuse issues. Barriers to these vital services often include lack of availability of appropriate resources, prohibitive costs, insufficient or no insurance, long waitlists, lack of training, limited access to services and no transportation.
Access to resources and behavioral health services should not be a question of income; it is a fundamental human right. As a public health department, JCHD’s core values include building a culture of health and a community where everyone can live longer, healthier lives – this includes access to care and behavioral health resources. JCHD sought innovative and collaborative approaches and formed a network of key stakeholders, the Jefferson County Health Network (JCHN). This partnership comprised of around 40 agencies formed a significant interconnected system to better share information and bridge gaps in services. JCHD has a long-term view on how a unique network of providers connected through in-person opportunities and virtual platforms can more effectively lead to better mental health, decreased substance use and improved holistic health in the region. JCHD through JCHN partnerships hosted a task force to develop an innovative resource navigation system that includes a universal behavioral health assessment component to provide better access to resources for all county youth, including those more vulnerable.
Implementing a universal virtual assessment tool will allow more children, including those in vulnerable circumstances such as foster care, to more quickly connect to resources including behavioral health counselors that meet their specific needs and financial circumstances. JCHN task force members developed a framework to support the rapid deployment of collaborative workgroups. Individuals in the work group were comprised of representatives from community behavioral health partners and school districts offering a deep pool of knowledge and experience. All assessments were developed utilizing vetted tools such at the PHQ-9, GAD-7 and C-SSRS. These assessments are commonly utilized in schools throughout the region for student identifying risk. Housing these tools in a virtual platform allows for consistency between schools and providers as well as the ability to include risk identification for substance use. Each student between grades 6-12 has the opportunity to complete a self-assessment, once completed they are identified as a low, moderate or high-risk level and connected to resources. The student’s school or licensed counselor connected to their district and building is notified and they are able to follow up accordingly to complete higher level assessments, identify substance use or suicide risk. Staff, students and families through the systems technology algorithms and geo-mapping are connected to an array of resources including behavioral health, substance use, social services and transportation that may be needed. Maslow’s hierarchy of needs shows it is not an “all-or none” process, where there is a deficit that impacts how a person is able to function it is important to meet the demand. Helping a student and family meet their basic needs while providing appropriate behavioral health support will guide them towards resiliency. The COVID-19 pandemic has shown increases in poverty and behavioral health needs. Current methods to address connection to resources for students and families take an individual or school counselor hours of sorting through resource documents, tools and phone calls. Prior to JCHD developing the virtual platform ASPEN (Access to Services Providing Essential Need) there was no current resource virtual navigation system available in this region that also has the ability to analyze a behavioral health assessment for triage and connection to care. Development of the ASPEN tool is a groundbreaking way to address inequities exasperated by the COVID-19 pandemic.
The Jefferson County Health Department (JCHD) was committed to engage multidisciplinary teams to address unmet needs prior to the pandemic through implementation and facilitation of multiple community partner networks including the Jefferson County Health Network (JCHN) and The Jefferson County Drug Prevention Coalition and Opioid Task Force. The COVID-19 pandemic increased the need for ongoing and often urgent communication between key stakeholders and surrounding partners to minimize negative impacts of silos. JCHD along with the local hospital Mercy Jefferson began a Community Outreach task force that has met weekly and bi-weekly since March of 2020 to share vital information pertaining to the ongoing pandemic and ripple effects on the community. These unique and important partnerships form a network of bridges within the community breaking down silos. Along with addressing the ongoing urgent needs of the pandemic in collaborative methods, JCHD leaned into these networks to address the rising mental health and substance use crisis accelerated by the pandemic.
The most influential group in the development of a virtual platform Access to Services Providing Essential Needs (ASPEN) was a work group conformed of licensed counselors, crisis counselors, school counselors, school administrators, regional and state behavioral health networks and hospitals. JCHD was able to act as the backbone of the task force through facilitation and securing funding through grant resources such as the Missouri Foundation for Health, Jefferson Foundation and Overdose Data to Action to help launch development. Task force members met on a regular basis, often in virtual formats due to unprecedented times to cooperate and develop a collaborative model that would meet needs of a broad youth and school community. This labor of love allowed JCHD and partners to address immediate needs and develop a virtual platform that would better address the behavioral health and substance use crisis.
Collaborative Community Health Assessments have been completed with facilitation from JCHD, Mercy Jefferson Hospital, COMTREA, Jefferson Franklin Community Action and Jefferson County Community Partnership and additional 2021 community surveys were conducted by JCHD staff in partnership with the Jefferson County Drug Prevention Coalition. These vital surveys helped engage the community and shed light on growing issues accelerated by the pandemic including poverty, access to care and rising behavioral health needs.
Ongoing partnerships have been able to better address goals while effectively maximizing resources to address emergent issues. With utilization of partnerships and subject matter experts the Access to Services Providing Essential Needs (ASPEN) platform was systematically vetted and includes community and provider insight. Ongoing collaborations include a first responder and health care work group to address the rising behavioral health needs for this unique and exhausted population, along with a specialized group for foster care. Each implementation of the tool involves a specially designed network of change makers connected to JCHN designed to implement wide solutions that lead to innovative change.
Challenges often occur while implementing a new program. Many of these challenges surrounded timely hiring of qualified staff, staff retention, participation and maintaining strong partnerships. Unique challenges that occurred due to the pandemic magnified current challenges and included other barriers such as illness, increased technology needs, staff and partner time availability and frequent timeframe changes.
Objectives and barriers were minimized by utilizing robust technology opportunities developed by the JCHD IT department including SharePoint, virtual meeting options and Teams. These platforms allowed for teams of partners to more easily share information and connect on an ongoing basis. Technology components that became necessary during the peak of the pandemic, have become key pillars for ongoing success. As JCHD continues to enhance current partnerships and development of the unique virtual resource navigation tool and universal behavioral health tool ASPEN (Access to Services Providing Essential Needs) more areas of the population will have access to vital care and resources decreasing health inequities.
Trust is a key component to ensure partnerships maintain and thrive through all situations, including an ongoing pandemic. Trust was built through ongoing communication and follow through. When partners were actively invested and passionate about the goal outcomes there was high volumes of participation and distributed workloads.
ASPEN, much like an aspen forest has interconnected roots providing nutrients and resources throughout. Much like these forests ASPEN has the ability to rejuvenate the community as we rise from the ashes of the pandemic.
Health Equity and Social Justice
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