Clay County Public Health

Report date
February 2018

What has been most instrumental to your progress?

Work groups. "ReThink" Mental Health established work groups to address, Mental Wellbeing, Prevention and Early Intervention, Crisis and Treatment and Recovery Support. Each group includes experts and a variety of stakeholders. These are/were the "arms and legs" of Rethink, analyzing the problems, identifying actionable steps, acting on them and evaluating strategies. They meet routinely to discuss the work being done, to affirm it, and refine it. The implementation steps that have occurred have been the result of ideas generated by individuals in these groups and then vetted by the group. As an example, in the crisis and treatment group a psychologist and a psychiatrist felt strongly that we needed to initiate a community-wide suicide strategy to include the use of simple screening tool. Others agreed and helped develop a triage protocol based on community resources to use with the suicide screening tool. These same work group members helped to provided education in the community on the screening tool and triage plan and when necessary, to help overcome resistance to its use.
Leadership team. A leaderships team was established to provide high-level steering for "ReThink". This group represented health care, clinical practice, and public health. It is a highly engaged group that ensured the work being done was meeting the mission of ReThink and that it had the potential to create sustainable change. Leadership also thinks broadly and inclusively, looking to a multitude of partners, including non-traditional partners to engage in this work. Most cases, leadership team members are also active participants in a specific work group. One leads the Recovery Support group. Another leads the Mental Wellbeing group. It was the team that provided the liaison work between workgroups, so it could help identify how each part connected and could work together. They were the group to vet ideas that had come from workgroups or ones to be brought to workgroups. Getting the right people on this team has been vital to the progress ReThink is making.
Summits. Annual summits were key to bringing a broad population of stakeholders together to provide education on diverse topics and to build momentum for the collective work being done. It allowed ReThink to address topics that many were less knowledgeable about, like mental wellbeing. It allowed us to cast a wide net to determine the interest level and to recruit participation for efforts to expand a community-wide suicide screening. At the most recent summit, a cardiologist from Minneapolis presented the scientific case for mental well-being, a local psychologist shared the "how" & "why" of a community-wide suicide plan, and a woman from the ND Department of Corrections engaged attendees with stories of how different the prison system is in Norway, what they are doing to change in ND, why it matters for mental health, and how we can apply it in different sectors. These events brought together diverse professionals from law enforcement, schools, non-profit agencies, clinical providers, and more. They provide opportunities for such a diverse audience to come together and each find meaningful content as well as to begin to think differently and more deeply collaborativel

Key lessons learned

Rely on your partners. It can be easy to believe you know what is best for a community but it is really those who are on the front line, or are experiencing a behavioral health issue who can speak to the need to improve systems response to needs. It was the result of discussions at the Crisis and Treatment workgroup meetings that led ReThink to focus on a community-wide suicide screening. Those people are immersed in the crisis response and treatment sectors. They knew what we were doing wasn't enough to identify those in crisis, to get them appropriate care, and to use community resources wisely. There were many potential crisis response problems that were identified, each benefiting from a focused intervention. It was the result of extensive discussions including health care providers, first responders, mental health clinicians, and stakeholders that prompted ReThink to commit to using the Columbia-Suicide Severity Rating Scale and to developing a community triage plan to support its use. If not for strong partners advocating for this and for doing leg work to develop the triage plan and for providing the nudge to those reluctant to adopt, it would not have happened.
Highlight prevention and kids. It is easy, while doing community health work to migrate a focus on clinical care provided in a traditional clinical setting or treatment and rehabilitation, because it is more tangible, yet this initiative challenged stakeholders to look at the full continuum of care, starting with prevention and focus on children's experiences. ReThink learned, or it was reinforced, that by focusing on schools and children it could make a big impact on preventing mental health problems, addressing many issues before they become big. The fact that teachers, school counselors, and school administrators have been so engaged, caught our attention. School teachers are asked to do so many things and schools are asked to partner in so many ways, that capturing their attention about an issue can be challenging. Not in this case. The need by schools for help was obvious. ReThink had hoped to recruit 5 school districts to participate in a yearlong training series on trauma sensitive schools. Instead, it ended up with 16 schools and two out of school time programs. All 18 organizations have now committed to a second year of training.

Reflections on the community innovation process

ReThink spent much of the grant period generating ideas. As such it was most important. It was both exciting and scary. The problem had been identified. Now solutions needed to be addressed. It was the hard working of formulating and vetting ideas that ReThink to a place it could begin to test. The process took time. It wasn't possible to "will" it to go faster. Different partners were on different timelines. ReThink was at different place on each partners priority list. Fortunately, when sound ideas were developed, progress to implementation moved rather quickly.

Progress toward an innovation

The most notable innovation in Rethink's work is its ability to bring organizations together that otherwise wouldn't. An assistant superintendent from Fargo Public Schools said their district alone wouldn't have benefited to the same degree from a yearlong training on building compassionate schools had their not been other districts like West Fargo and Northern Cass involved. It gave them an opportunity to look outside their system to see what others were doing. We heard the same thing about ReThink's community-wide suicide screening effort. First responders naturally talk with emergency rooms. However, mobile crisis response teams, suicide hotlines, school counselors, hospital emergency departments, public health nurses, and others don't naturally interact to know what each other is doing and to coordinate efforts. The convening of groups around a defined topic has brought groups together to create a more concerted community-wide effort.

What it will take to reach an innovation?

There is no endpoint in the community innovation being pursued. Grant funding allowed for capacity to be built to begin focusing on improved improved mental health and access to care at an affordable cost. ReThink feels it accomplished its goals in building a foundation.

What's next?

ReThink is continuing to lead the work to improve mental health in Cass and Clay counties. In the areas that have begun with implementation and testing, their work will continue. It is far from done. Reinforcement and partner support are necessary to ensure long lasting change. In addition, as implementation continues it exposes other opportunities and challenges that need to be addressed. For the area (mental wellbeing) that has generated ideas but hasn't begun implementing, their effort is to determine if what they are doing works and makes sense. It will require time to test it. ReThink will lead the community discussions that address current and future mental health issues. It will continue to pursue funding to support its efforts.

If you could do it all over again...

Keep your focus narrow and go deep. Ultimately ReThink is arriving at such a destination but only after spending time investigating many options. In hindsight, it is obvious to see which path is shortest and most efficient. Without the benefit of hindsight, however, it is difficult to say we could have chosen that path without exploring others first. It was through discussion, thought, and frankly time that allowed ReThink to choose what appears to be sound interventions.

One last thought

It takes a dedicated community leader to truly guide a community innovation. If the leader wears multiple hats, it becomes increasingly challenging to devote the time necessary to engage, plan, and coordinate efforts.The work of ReThink includes the engagement of many community members. However, without a person dedicated to leading the work it is unlikely it would progress as it has. Funding from Bush allowed the hiring of a position that allowed Fargo Moorhead to build the necessary capacity to support and drive their work.