Improving Community Health

Imagine you are a single parent working two jobs, you have young children to care for, you use the bus for transportation and you rely on a community clinic for medical care. Getting yourself or your kids to the clinic could be a logistical nightmare. Or, perhaps you live in rural Rifle, Colorado, and commute three hours a day to and from your job in Vail. If you’re commuting and working 12 or more hours every day, how do you fit in a medical appointment?

These are some of the real challenges that rural and medically underserved Coloradans face in accessing primary health care. There are even more barriers to accessing behavioral health care, including cost, stigma, language and cultural differences, long wait times for an appointment and long distances to reach a provider. For people in crisis, these barriers can have life-or-death implications.

The University of Denver Graduate School of Social Work (GSSW) and its Butler Institute for Families are working to remove some of those barriers and make culturally and linguistically competent behavioral health services more accessible to more people. The school has received a $1.9 million grant from the U.S. Department of Health and Human Services Health Services and Resources Administration to train social workers to meet the state’s behavioral health care needs. The grant is funding CLIMB@DU (Collaborative Learning and Innovative Educational Models of Behavioral Health), a four-year initiative with more than 10 public and private partners statewide.

Social workers are the leading providers of behavioral health in the U.S., but in Colorado, 56 of the state’s 64 counties have a shortage of mental health professionals. “Innovative, statewide integrated-care models present opportunities to address this health-care crisis; yet, these models will remain ineffective without an increase in the number of trained behavioral health care professionals,” says GSSW clinical associate professor Michael Talamantes, a lead faculty member for CLIMB@DU along with GSSW Associate Professor Michelle Hanna.

CLIMB@DU will do more than just meet Colorado’s need for additional behavioral health providers, Talamantes emphasizes. It also will train more providers who have the cultural and linguistic competence necessary to improve care and outcomes for an increasingly diverse patient population.

Mountain Family Health Centers is a CLIMB@DU partner and one of Colorado’s integrated-care innovators. The nonprofit, community-led program provides integrated medical, behavioral and dental care to more than 18,500 people in rural Garfield, Eagle, Pitkin and Rio Blanco counties, regardless of their ability to pay.

“We provided behavioral health care to thousands of people last year, but five years ago that number was zero,” says Mountain Family Chief Executive Officer Ross Brooks. “Having behavioral health as part of a team gives us a depth of service we didn’t previously provide.”

The growth doesn’t necessarily mean there is more need now than there was five years ago. The need was there, but it wasn’t being met, Brooks notes. There simply are not enough providers in enough places in Colorado.

In addition to GSSW’s Denver and online MSW programs, its Four Corners and Western Slope MSW programs have helped to fill the provider gap by training a local behavioral health workforce in rural areas. Now CLIMB@DU will expand that capacity by making the GSSW degree more affordable for more students. The CLIMB@DU grant will fund a $10,000 stipend for students, and by 2021 GSSW will have trained 115 social workers to provide culturally and linguistically competent behavioral health service in underserved areas. GSSW’s Butler Institute for Families is leading the evaluation of the impact of these efforts over time. 

“I’m thrilled that we’ll be training a workforce that can serve in an integrated-care setting,” Brooks says. “What I love about the DU program is it helps to grow people from our own communities, which is better for recruitment and retention.”

In southwest metro Denver, CU Sheridan Health Services (CU-SHS) has experienced many of the same challenges as providers elsewhere in the state. The nonprofit nurse-led federally qualified health center — another integrated-care innovator and CLIMB@DU partner — has expanded from three part-time positions in 2011 to six full-time behavioral health providers (three are GSSW graduates) today, and the health center is still at capacity. The health center particularly needs behavioral health students who are Spanish-bilingual and/or interested in addiction treatment. With GSSW student help, CU-SHS also will expand its capacity through tele-health to increase patient access to behavioral health care.

The health center plans to continue hosting GSSW student interns, “training the future generation of health care professionals within the health care environment they need to be in,” says Mary Kay Meintzer, behavioral health program director at CU-SHS. “Collaboration between academia and community organizations can serve as a model of inclusive, integrated, multidisciplinary care.”

At the National Mental Health Innovation Center, “Our vision is that we will ultimately reach a state where mental health and physical health are considered equally essential to human vitality,” says CLIMB@DU advisory board member Peggy Hill, the center’s deputy director. That includes providing equity in access to health care and mental health care, and fully integrating mental and physical health. “The degree to which we become more skillful at receiving people from diverse backgrounds into care, the more we’ll be able to manifest that vision.”

It’s a vision shared by GSSW and its CLIMB@DU community partners.

Read more about CLIMB@DU.

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