Analysis of the First Year of Implementation of a Multi-Year Intervention Based on Community- Initiated Care: A Mixed Methods Case Study Design

Background and Purpose: The need for culturally responsive mental health education and treatment has soared since Covid-19, disproportionately impacting individuals in historically under-resourced communities. To combat the shortage of mental health professionals in these communities, a community- initiated care (CIC) model, Healthy Minds Healthy Communities (HMHC), was implemented in Houston, Texas. The community- initiated care model is based on “democratizing and empowering individuals” to respond to mental health needs by task-shifting from traditional mental health providers to community members (Wellbeing Trust & Empower Change, 2021). This presentation examines the first year of implementation of the HMHC project with the aim of understanding implementation successes and challenges while examining variation in community needs across the ten zip codes targeted by this project.

Methods: The local mental health authority, Harris Center for Mental Health and IDD, received funding through the American Rescue Plan Act to implement HMHC to target ten zip codes disproportionally impacted by COVID-19 and death by suicide along with low mental health service utilization. An external evaluation team, consisting of members from three local universities met biweekly with program staff, to provide bidirectional feedback. To obtain baseline data on communities participating in the program, the ten zip codes were analyzed as a group of single case studies, utilizing the following methods: Geographic Information System (GIS) mapping and specialized focus groups called Community Learning Circles. GIS mapping visually depicted descriptive data and mezzo and macro-level indicators of mental health. The implementation at the program level was also examined through qualitative interviews conducted with staff (n=11) and community stakeholders (n=3).

Results: Findings revealed that differences in a community’s primary language, racial and ethnic makeup, and infrastructure impacted their mental health related priorities and needs. Based on visual GIS maps, the following factors differed across groups: proximity to mental health service providers, housing infrastructure, and floodplains. This finding was echoed in focus groups, where participants identified varying priorities for mental health resiliency. Data on programmatic elements revealed the challenges and strengths of installation and initial implementation. Stakeholders identified that simultaneously developing and implementing an intervention is challenging and expressed both optimism and frustration and the importance of organizational cohesion in this stage of implementation.

Conclusions and Implications: Centering the democratization of knowledge calls for restructuring the process of building community- based interventions, which are traditionally missing community input in the development phase. As the first program based on a CIC model in the United States, HMHC’s programmatic processes are a learning opportunity for other community-based interventions that are not based on traditional methods of service delivery. Findings of this study indicate that agencies should maintain a continuous feedback loop with community stakeholders, and when possible, tailor interventions to match their distinct needs. This complex process can be supported through university-agency partnerships, as exemplified in this study.