Background: Comprehensive, collaborative, collective action public health work requires coalitions built on trust, a unified vision, and shared knowledge and language. Over the past few years, the public health workforce has been asked to play an increasing number of new roles, creating workforce burnout and turnover, particularly in geographic areas with fewer resources. As a result, public health coalitions have had to adapt to a continuously changing workforce, needing to build trust, vision, and shared language with each new member.

Description: Funded through CDC’s Comprehensive Suicide Prevention Program and State general funds, the Colorado National Collaborative (CNC) is a public health approach whose goal is to reduce the number of suicides in Colorado by 20% by 2024 through a constellation of upstream and downstream suicide prevention activities in Colorado counties at highest risk of suicide. Since its inception in 2018, the CNC has experienced a high rate of county-level staff turnover, accelerated during the acute phase of the COVID-19 pandemic. It has also added 9 new counties to its efforts. To be effective, the CNC had to create a member orientation process to teach new members about its rich history, bring members up-to-speed on current activities, and create space for contributing to shared language and a shared vision. Because the CNC uses a participatory action model for its evaluation, new members must learn how and why past decisions were made and quickly engage with the information needed for successful participation.

Recommendation/Lessons Learned: In addition to initial meetings and one-on-one bi-weekly meetings between individual counties, national partners, and state leadership, the CNC’s orientation approach relies on the following strategies:

• Use of automated learning, creating PowerPoint presentations and videos that can be easily accessed through a shared location.
• Use of peer-support models, connecting new members with those who have historical knowledge to create connection and encourage shared learning.
• Use of monthly group meetings to allow for community-building and a space to share resources.

In this presentation, we offer a sample approach to support new members as they engage with their counties, collaborate with the CNC and grow Colorado state suicide prevention efforts.

Background

The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. An estimated 61% of U.S. adults experience at least one ACE. Rural children are more likely than urban children to have ACEs. ACEs are an upstream factor for multiple adult sequela, including substance and opioid use disorder. The purpose of this project was to develop and implement a workforce training curriculum tailored to Missouri providers (particularly rural) so they can provide evidence-based care to high-needs patient populations in resource-limited settings.

Methods

Our methods included: assess the current science; design the training tailored to rural providers to facilitate practice transformation; implement the training; and evaluate. From July 2021-June 2022, we conducted literature reviews, and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources. We developed the course in the Canvas learning platform with the assistance of instructional designers. We pilot tested the course. The course was launched via key stakeholder email invitations and snowball recruitment in November 2022. The course was certified for continuing medical education as well as continuing education for licensed professional counselors, psychologists, and social workers.

Results

Course content included five modules: What are ACEs? How do ACEs impact health? How common are ACEs? How did the COVID-19 pandemic affect ACEs? What can we do to address ACEs? To date, 115 individuals across Missouri have requested enrollment. Credentials include: MDs, PhDs, LCSWs, MSNs, RNs, FNPs, MSs, MAs, CBHLs, licensed professional counselors, Provisional Licensed Professional Counselors, therapists, and Criminal Justice Addictions Professionals. To date, 64% have completed enrollment, and 18% have completed the training. Of those completing the course evaluation, 100% agreed the course is relevant, clear, informative, the resources are helpful, they feel confident in the knowledge gained, intend to apply the content to their work, and would recommend the course to others. 80% found the discussions helpful.

Conclusions

This project demonstrated feasibility and effectiveness in interprofessional workforce training of ACEs. Robust interest statewide reflects recognition of the topic’s importance and the potential for this training to effect change at the state level.

The COVID-19 pandemic has inflicted an ongoing surround of social, economic, personal, professional, spiritual, and emotional stress and anxiety on healthcare workers. As difficult as this was in the US, the pandemic affected healthcare delivery to vulnerable communities in a myriad of ways, compounding long-standing stressors. In May 2020, we developed a program to address the spiritual, emotional, and moral toll on CMMB’s program sites in Peru, Haiti, Kenya, Zambia and South Sudan, and to build caregiver and institutional resilience by bringing needed psycho-social-spiritual support to CMMB staff. Using the theoretical framework of post-traumatic growth, the Building Resilience program, a remotely-delivered seminar series running from June 2020-August 2021, made space for staff members from all CMMB program sites to share their stories with their colleagues, to build community, to foster creativity and hope, and to intentionally integrate faith and spirituality into both personal self-care as well as the common life of the organization.

The program was evaluated qualitatively and quantitatively, including pre- and post-assessment surveys. This evaluation yielded extraordinarily positive response from participants, from leadership to staff members. Particularly striking was the regularity with which participants reported that the concepts and material presented strongly resonated with their experience—across global contexts. Other positive outcomes are the sense of empowerment and the deepening and strengthening of relationships among CMMB staff members. We hope that, longer-term, this work will lay the groundwork for building subsequent tiers of low-cost/appropriate mental healthcare for CMMB staff, community health workers, and members of rural communities.

Background: One of the greatest concerns to meet behavioral health needs in medically underserved communities, such as U.S.-Mexico border region is the significant shortage of behavioral health providers who are trained to meet specific needs of this population. This calls attention to the development of culturally and linguistically competent behavioral health providers that are representative of the populations in the region. To address this need, three education programs (Social Work, Nursing, and Psychology) in the U.S.-Mexico border region worked together with community agencies to develop an innovative HRSA-funded project, Behavioral Health Workforce Education and Training (BHWET) Program and prepare culturally and linguistically competent behavioral health providers focusing on integrated behavioral health (IBH) model. The purpose of this presentation is to describe the BHWET project and present its outcomes.

Description: The BHWET project aimed to expand diverse behavioral health workforce within the three behavioral health professions of master-level social workers (MSW), doctoral-level clinical psychologists (CP), and psychiatric mental health nurse practitioners (PMHNP) to serve populations in the U.S.-Mexico border region. Selected students of three professions were required to participate in experiential practicum/internship at integrated behavioral healthcare settings, two inter-professional education trainings/year, two simulation trainings/year, and eight trainings focused on enhancing cultural and linguistic competency for working with border populations and their integrated behavioral healthcare.

Lessons Learned: A total of 114 MSW, CP, and PMHNP students participated in the project over 5 years. A majority of them were female (81%), identified as racial/ethnic minority groups (89 %) and with economically disadvantaged background (54%). The post-graduation survey data show that a majority of them (84%) were working in the U.S.-Mexico border region and at integrated behavioral healthcare settings (70%). Nearly 70% of them have obtained professional licenses. Focus group data of the participants also suggest positive impact of the project to prepare them with cultural competency, increased knowledge and skills to work in behavioral health profession, and interdisciplinary teamwork.

Implications: The findings from the BHWET project suggest that targeted training opportunities for future behavioral health professional workforce could help alleviate the shortage of behavioral health providers in medically underserved communities.

Background. Working in correctional settings often affects correctional officers' mental health and well-being. However, very little training on mental health is provided to help them identify symptoms of mental health challenges and substance use disorders. This study aimed to understand the perspectives of correctional officers participating in Mental Health First Aid training. Methods. A total of 54 correctional officers participated in a remote Mental Health First Aid training from November 2021 through August 2022. Correctional officers completed a pre-test at baseline, mental health knowledge checks, post-test follow up, and two focus group meetings. The focus groups were analyzed using thematic analysis. Results. Over half (66.6%) of the correctional officers were 35-54 years old. About three-quarters (83.3%) identified as male. Most were Caucasian/White (44.4%) or African American/Black (33.3%). Over one-third (38.8%) of the participants are Veterans, and over half (61.1%) of the participants worked in correctional settings between 6-20 years. The themes of the focus group meetings were: (1) working in corrections has negatively impacted their lives. (2) Mental health is stigmatized in correctional settings. (3) Correctional officers need mental health resources. (4) Mental Health First Aid training equipped them with skills and tools to assist someone experiencing a crisis. Conclusion and Implications. In summary, correctional officers emphasized the need for additional mental health resources to cope with their unpredictable and sometimes difficult work environment. Correctional settings should prioritize the mental health of correctional officers and work toward destigmatizing mental health by implementing Mental Health First Aid for correctional professionals.

Background:

Arizona has among the highest rates of behavioral health disorders and largest proportion of underserved areas in the nation. Faculty from the Arizona State University (ASU) School of Social Work and the Doctor of Behavioral Health (DBH) designed a multi-level program to prepare social work interns for placement, address care gaps through quality improvement, and build sustainability through a pro forma business case model.

Objective/Purpose:

Our program is designed to improve the supply of an integrated behavioral health workforce by enhancing and expanding our current network of internship sites for students enrolled in the ASU School of Social Work internship training program.

Methods:

We designed and implemented an asynchronous, online curriculum that transfers best practice knowledge for integrated healthcare to social work graduate students at ASU. We placed students at 10 local clinics, offered stipends, and enrolled each student in the online curriculum. Students completed weekly productivity reports across two semesters. We worked directly with clinic managers to administer clinic-level assessment measures and implement quality improvement initiatives. We collected and compared clinic data with community needs assessment data. We connected clinic managers with a consultant to build design sustainability plans using a pro forma business case model.

Results:

To date, 680 productivity reports have been submitted by students. Five quality improvement initiatives have been designed and started with participating clinics. All clinics have completed clinic-level assessment measures and met with the consultant to begin designing sustainability plans.

Discussion/Conclusions:

The mission of our training program is to enhance the experience of our internship trainees and the site clinical and management team to support the hire and retention of a new integrated behavioral health workforce. Our results suggest that student productivity increases throughout the internship and that clinics respond to and engage in quality improvement initiatives for integrated behavioral healthcare.

Background/context: Children, youth, and families of color have historically experienced greater challenges accessing mental and behavioral health (MH/BH) care, partly due to the limited number of clinicians, especially clinicians of color. The COVID-19 pandemic further impeded access to care as MH/BH challenges increased and worsened, demand for services grew, and providers resigned, resulting in a widespread workforce shortage.

Having a diverse MH/BH workforce is vital to understanding the needs and improving the care of patients of color, and also to educate and mentor providers of color. In 2022, Boston Children’s Hospital launched the Mental Health Systems initiative to expand the number of underrepresented individuals in the children’s MH/BH workforce as a means of increasing access to culturally and linguistically appropriate care.

Description: Six partners were selected (five academic institutions, one multi-service agency) to improve the recruitment, training, supervision, and retention of underrepresented providers, defined as being from a population traditionally underrepresented in the medical profession relative to its numbers in the general population. Boston Children’s emphasized supporting graduate degree level providers as a pathway to increased economic opportunity.

Partners committed to collecting participant race and ethnicity to ensure support for individuals from underrepresented backgrounds.

Lessons Learned: In the first six months, partners engaged 85 matriculating students and existing professionals. 40% self-identified as Black/African American and 32.95% as Hispanic/Latinx. Students received financial support for tuition and basic needs (housing, childcare, etc.), culturally responsive field training with child, youth, and family-serving organizations, and/or peer and faculty mentoring. Existing professionals received compensation for mentoring or supervision, licensure preparation, and/or professional development.

Partners noted that financial support permitted some students to continue their studies. They created intentional mentor-mentee matches and spaces to openly share lived experiences.

Recommendations/Implications: Due to the long-term investment of training providers, efforts to expand and diversify the MH/BH workforce require a comprehensive approach with continuous supports at different points throughout a provider’s training and career. Race and ethnicity data collected from this initiative could encourage sustained investment in diversifying the children’s MH/BH workforce. To demonstrate commitment to enhancing linguistically appropriate care, partners will begin collecting data on participant language capacity.

Objective: To determine the prevalence of burnout syndrome and post-traumatic stress in frontline medical personnel in the response to COVID-19 in Santiago de los Caballeros, D.R. in the period January-March 2023.

Methods and techniques: A descriptive, observational, cross-sectional study was implemented. The population of interest for this study were frontline medical professionals in the response to COVID-19, during the height of the pandemic. The selected professionals had to practice in 3rd level establishments in the city of Santiago de los Caballeros, DR. For data collection, a self-administered questionnaire was applied by the participants. It was made up of three sections: one of them belongs to the general data of the participant, the second has Maslach's burnout inventory and the third covers the Inventory of Post-traumatic cognitions.

Results: The results showed that there was a significant association between age, estimated monthly income, and PTSD, with younger healthcare workers being more likely to experience traits of PTSD. Furthermore, there was a significant association between gender and PTSD, with female healthcare workers being more likely to experience PTSD symptoms.

Conclusion: In conclusion, this study aimed to investigate the prevalence of burnout syndrome and post-traumatic stress disorder in health workers during the COVID-19 pandemic and to explore the association of its existence with sociodemographic characteristics.

The creation of trauma sensitive and informed workplaces for children’s mental health providers continues to be a public health need. The challenges of COVID-19 accelerated the need to provide trauma informed workspaces for practitioners and highlighted the limits of already strained systems. Burnout and secondary trauma contribute to the challenges that currently plague the mental and behavioral healthcare workforce (Taff et. al., 2021), making this a timely topic.

The completed needs assessment included administration of the Professional Quality of Life (ProQOL) scale along with qualitative data. Participants included administration staff, occupational therapists, physical therapists, licensed marriage and family therapists, and speech language pathologists. Pre-program data indicated that about 50% of staff was experiencing moderate levels of burnout and secondary traumatic stress. Therefore, a pilot program with the aim of mitigating the impact of burnout and secondary traumatic stress among team members was designed and implemented.

The pilot program was implemented across three pediatric clinics, all providing mental and behavioral health services. Program design was aimed at mitigating the impact of burnout and secondary traumatic stress among providers. Program design combined evidence using the public health model "Trauma Informed Oregon" (Trauma Informed Oregon, 2016), Spielmann's (Spielmann, 2020) guide for professional reflection, along with current guidelines for Trauma Informed Systems for allied health professionals (Ashcraft & Lynch, 2021).

Evaluation of this program includes qualitative data collected at the one-year mark of program implementation. Analysis of qualitative outcome measures revealed that practitioners found high value in the interventions implemented and the clinics have continued the programing as ongoing support for practitioners. Lessons learned will be presented and include considerations of peer reflective models and addressing workload needs that contribute to burnout. Next steps include modifying interventions based on feedback with use of pilot data to support implementation at other children’s mental health settings. Needs assessment data, intervention strategies, and outcome measures will be presented with a reflective component for participants to consider relevance in their own setting.

Background: In an effort to create the healthiest nation, it is important not only to promote access to healthcare, but to provide quality healthcare. Training providers in evidence-based practices (EBPs) is one way to improve access to quality mental healthcare (Frank et al., 2020). However, there is a lack of research examining how previous EBP training influences behavioral health providers’ implementation of new EBPs. The aim of this presentation is to examine the impact of previous EBP training on the success of implementing a modular, evidence-based treatment within the behavioral health workforce through structured training and implementation initiatives.

Methods: Implementation of the modular treatment was conducted through two Learning Collaborative cohorts (LCs) held from 2018-2021 that brought together a total of 11 community mental health centers. Behavioral health providers (N=70) from each LC reported their previous EBP training and completed a self-efficacy assessment for the modular treatment at the start and end of the LC. Multiple regression analysis evaluated the impact of previous EBP training on final provider self-efficacy score for the modular treatment at the conclusion of the LC.

Results: Findings demonstrated that the intensity of previous EBP training (0 = No previous training to 3 = Used EBP with client and received consultation) and LC cohort significantly impacted provider self-efficacy for the modular treatment at the conclusion of the LC. These two predictors explained 64.9% of the variance (R²=.649, F(2,8)=7.387, p=.015). Less intensive previous EBP training significantly predicted higher self-efficacy for the modular treatment at the conclusion of the LC (β=-.734, t(8)=-3.304, p=.011), as did LC cohort (β=.656, t(8)=2.952, p=.018).

Conclusions: Our findings suggest that EBP training initiatives are most impactful for behavioral health providers who have had less intensive previous EBP training, which speaks to the benefit of offering intensive EBP training earlier in provider careers. The cohort effect may have been driven by the fact that the two LCs were located within behavioral health delivery systems with substantial contextual differences (e.g., funding for mental health services, mental health professional shortages). Recommendations for training providers in EBPs to improve the quality of care will be provided.