Learning Can Help Public Health Cross Silos in the Opioid Epidemic

The Public Health Training Centers like nothing better than to see learning take hold and actualized in the real world of public health, particularly on an important issue like the Opioid Epidemic.

In this post, NEPHTC is celebrating work done by a public health team in Kansas, that started with a learning program developed by NEPHTC and Systems Thinking expert Julia Ross for the Vermont Department of Health.  Learning is like that, it grows, it morphs, and can be passed along for use and re use by different funders and different teams.  The team leaders were Cristi Cain, Director, Local Public Health Program, Kansas Department of Health and Environment, and Amber Dean, Project Manager, Public Health Initiatives, Community Engagement Institute, Wichita State University.

NNPHI replicated the NEPHTC Systems Thinking Training Program with Coaching at the PHIT training in June 2019.  One of the teams who attended that training was made up of members from the Kansas Department of Health and Environment and the Wichita State University.  The team decided to use Systems Thinking Coaching to address the issue of having no roadmap for local health departments to address behavioral health.






See their description of the issue and the systems thinking work they did to describe the underlying causes here:

Issue Selected

In Kansas, nearly half of the 100 local health departments prioritized behavioral health during community planning processes. Unfortunately, there is no current roadmap about what to do next. As a result, the majority of local health departments that have prioritized behavioral health are not achieving their stated goals. This is the issue this team chose to focus on. Their vision is it to have all of their local health departments seamlessly integrate behavioral health services, including cross referral capabilities, and provide ease of access for all clients.

Underlying Causes

Using a systems thinking approach, the team identified a number of underlying causes which are contributing to this issue remaining in place.

  • Silos within state system (Kansas Department of Health and Environment is different than Kansas Department for Aging and Disability Services – which handles behavioral health; Local Health Departments (LHDs) are different than Community Mental Health Centers (CMHCs)
  • Crisis intake assessment must be completed by a very narrow set of professionals (other states allow more variation in who completes)
  • Organization of Mental Health is different than physical health – they have historically not been co-located; can have a neurologist and a cardiologist in the same building but not a mental health specialist and primary care provider
  • Some CMHCs are uncomfortable that LHDs want to work on behavioral health – example: they are uncomfortable that some LHDs are being trained to do Mental Health First Aid
  • Stigma – people will not use available services because they don’t want people to know they have a behavioral health need
  • Perspective from some LDHs that “Behavioral health is not my job” and “Behavioral health is outside my wheelhouse.”

After more coaching and processing the team decided to implement a pilot event, a Behavioral health Community Planning Day, which they held in 2019.  Importantly, they invited a wide range of community organizations to attend the day, deliberately creating an environment in which people could meet others across silos:

Community Mental Health Centers

  • Education (pk-12 and Higher Ed)
  • Healthcare Providers
  • Insurance/Managed Care Organizations
  • Kansas Department of Aging and Disability Services
  • Kansas Department of Health & Environment
  • Kansas State Research & Extension
  • Law Enforcement & Corrections
  • Judicial/Court
  • Local County Health Departments (12 out of 100 Health departments represented)

The team was richly rewarded for their innovation, planning and taking the risk of getting different groups together, using a systems thinking approach.

The evaluation data show:

  • 100% would be interested in participating in another similar session
  • 96% learned of a resource/strategy of which they were previously unaware
  • 7 out of 10 in assisting with ideas and resources for addressing behavioral health priorities

In addition, Aetna Insurance has awarded nine mini grants to local health departments to replicate similar events.

To see the agenda of the behavioral health day, and to read a description of the team’s process and evaluation results, please download the final report here.