Integrating Community Engagement with Mental Health Service Delivery: Breaking Down the Micro-Macro Binary

Background and Purpose:

It is well supported that older adults seek mental health services at lower rates than their younger counterparts. After a natural disaster, when older adults are particularly vulnerable, this lack of access to mental health care can be detrimental to their well-being, resulting in symptoms ranging from mild depressive disorders to severe psychiatric disturbances. Using a collaborative approach combining community outreach and clinical methods, the Sandy Mobilization, Assessment, Referral and Treatment for Mental Health (SMART-MH) intervention was designed to address prolonged mental health needs among Superstorm Sandy survivors across New York City. This paper examines the results of the outreach strategy used in this innovative academic-community collaboration of psychiatrists, social workers, public and non-profit service providers, and student interns through the lens of integrating micro-macro practice. The theoretical framework of the SMART-MH outreach plan combined elements of locality development, social planning, and community building approaches of organizing to identify and assess mental health needs among older adults in targeted neighborhoods affected by the storm.  The theoretical framework informed the outreach portion of the curriculum to train workers (students and employees) to (a) seek partnership opportunities with community stakeholders, and (b) connect with older adults and assess for mental health needs.

Methods:

Outreach workers were trained in both macro and micro level skills, including strategies for conducting community assessments, engagement skills with older adults, and geriatric assessment of mental health needs. Outreach was then conducted in all five boroughs within New York City and in multiple languages (including Spanish, Cantonese, Mandarin, Russian, and English). Using an online tracking system for the project, mental health outreach workers documented the number of outreach contacts with community gatekeepers as well as the number of screenings and full assessments conducted. Records of outreach activities and individual interactions with clients were analyzed using descriptive statistics. Process evaluation of outreach trainings and activities included facilitated discussions during outreach team meetings for the purpose of collecting qualitative feedback.  

Findings:

Multiple gatekeepers were contacted and SMART-MH staff were invited to participate in multiple communities. This paper will present a description of the activities and types of gatekeepers contacted. Preliminary findings of process evaluation results suggest that some elements of community assessment training were valued by outreach workers. Successful engagement with older adults was attributed to structured activities conducted in congregate settings.  

Conclusions and Implications:

There is a growing need for successful models of academic-community partnerships that combine macro and micro-level interventions. This paper describes one promising model with recommendations for replication. Further analysis of process and outcome indicators will offer implications for future research and practice settings.