Introduction

Behavioral health, especially for children and young adults, remains critical in the Cascade Pacific region. This is clearly evident and is more pronounced for rural and more geographically isolated communities and locations which have significantly large number of unhoused individuals and fewer health providers. Also, the region faces enormous barriers to attracting, recruiting and retaining needed workforce including specialized and experienced mental health experts. Other challenges that have been noted through the work of the Cascade Pacific Action Alliance (CPAA) include COVID-19 related spikes in substance abuse and substance use disorder, suicidal ideation, anxiety attacks, and depression.

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Over the years, a range of interventions have been suggested and implemented in attempt to address the problem. There have been mixed results. The number of actors involved in addressing behavioral needs has increased and there has been significant improvements on a select number of key metrics tracked by the Health Care Authority. While this progress is welcome, data indicates considerable scope for further growth in performance across the region.

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Cambia Grant

In December 2020, Cambia Health Solutions awarded CHOICE Regional Health Network (the backbone agency of CPAA) $245,000 grant to support the organization’s efforts in addressing the mental health and wellbeing of people and families in rural communities impacted by the COVID-19 pandemic. It is imperative to reiterate that this grant is: (a) to support a rural population by (b) implementing interventions that would reduce stigma, increase equitable access to behavioral health services and/or address the mental health and their wellbeing. Upon receiving these funds, CHOICE/CPAA began conducting internal discussions geared towards identifying ideal and qualifying geographical region and communities across its seven counties to be served. We also considered possible actions that could be taken that are consistent with the terms of the grant.

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Pilot Mobile Unit for Wahkiakum and Pacific Counties?

CHOICE considers the rural communities in Wahkiakum and Pacific counties to be in the greatest of need when it comes to accessing timely, reliable and affordable behavioral health services. With a combined population of less than 25,000, lack a critical mass to attract new providers to meet the obvious need for their people. Budgetary restrictions faced by their Human and Health Services departments imply that the two counties can neither recruit needed staff nor provide incentives and support to providers of mental and behavioral health services. Additionally, lack of adequate housing and ancillary services such as public transportation system imposes further obstacles that may not be resolved in the foreseeable future.

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In the past months, CHOICE has been working with a range of partners to organize COVID-19 vaccination clinics and community-led discussions around COVID misinformation and other factors that cause vaccine hesitancy and resistance across the region, including Wahkiakum and Pacific County. This work is twofold; with the support of a generous funding from the CDC Foundation, this work is being done as part of health equity, focusing principally on communities of color. Also, a HRSA grant has allowed the agency to boost its COVID-19 related activities across the region. We have mounted a robust social media campaign and acquired a 14-seater van that is helping bring services to the remote and isolated communities.

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CHOICE has explored several ideas regarding the Cambia Grant. This includes a proposal to undertake biannual screening of all school-aged children in Wahkiakum County by integrated pediatric- behavioral health providers.

We have also considered the possibility of using these resources to help stand a behavioral health mobile unit that would operate in the two counties. The goal is to have a pilot team of two that follows a predetermined route and schedule to initially develop a relationship and build trust with the target population, and later offer basic services that may include but not limited to mental/behavioral health screening, prescribing and referral services. This unit would also make CHOICE-provided resources available to the community, such as naloxone and other care packs. We would consider the pilot successful if the provider/operator would be able to fill the needs-gap, and successfully bill for services and receive reimbursements that would keep the project sustainable. Also, our hope is to see the project eventually integrated with physical health.