Boulder County Behavioral Health Roadmap

Our community invests in prevention strategies and addresses conditions in which community members of all ages and identities live, work, and play to foster community resilience and mental well-being.

Strategies and Solutions

Strategy: Community-Wide Prevention Strategy

Solution:

• Develop a shared community-wide prevention approach which promotes belonging, purpose, mental wellbeing, resilience, protective factors, and addresses risk factors at the individual, family, system, community, and policy level for mental and behavioral health. This prevention approach would be co-created with diverse community and partners and include culturally relevant approaches, community-informed practices, and best practices. It would also build upon existing efforts. (Also a Youth Solution)

Strategy: Community Education and Stigma Reduction

Solution:

• Provide coordinated community-wide education and stigma reduction efforts related to mental and behavioral health to include media campaigns, trainings, and skill-building with messages and offerings that are accessible, culturally appropriate, customized to varying audiences, trauma-informed, include a wide range of topics, and include community in development.

Youth Solutions:

• All Boulder County children and youth grades preK-12 have consistent, frequent social-emotional learning infused into the curriculum on topics such as communication, problem-solving, conflict resolution, stress reduction, identifying feelings, and emotional regulation.
• Provide expanded education and skill-building for adults and caregivers to better support and understand youth and children.

Strategy: Prosocial Activities

Solution:

• Provide accessible opportunities for social connection, community-building, cultural awareness and connection for the full community recognizing the diversity of the community.

Youth Solutions:

• Provide a broad range of free or low-cost prosocial activities for teens and youth that build connection, purpose, cultural connection, joy, and fun.
• Offer accessible support groups and opportunities for shared learning in small group settings for youth, parents, families, and the broader community.

Strategy: Addressing Social Determinants of Health

Solutions:

• Engage in focused and coordinated efforts to improve the social determinants of health, or the conditions in which we live, work, and play, that impact mental health and wellbeing and can prevent poor mental health.
• Consistently employ Housing First models and offer long-term, supportive, trauma-informed housing programs. Provide a variety of housing options and levels of support with the ability to match people to appropriate resources and transition between services as needs change.

Strategy: Policy

Solutions:

• Develop a shared policy agenda to advocate for policy changes, including organizational policies, that address the underlying challenges impacting access to mental and behavioral health support and community conditions for mental wellbeing Boulder County community members experience.
• Support local solutions and advocate for policy to increase private providers who accept Medicaid, insurance reform, a broader range of covered services through insurance to support behavioral health needs, and quality of services.

Solution from Youth Process:

• Build support and advocate for policies to address community norms and policies favorable to substance use to reduce risk and prevent youth substance use.

Strategy: Built Environment and Spaces for Connection

Solution:

• Create, supplement, or support opportunities to share space and co-locate resources in County, schools, or other spaces to expand ability to provide accessible resources, allow partners to facilitate programs, and reduce administrative costs.

Youth Solutions:

• Create additional free teen spaces or youth centers where teens can connect and explore prosocial opportunities with the support of positive adults.
• Provide access to safe, clean, and youth-friendly natural spaces and parks throughout Boulder County municipalities and unincorporated spaces with sufficient amenities such as drinking water and trash receptacles.

Strategy: Prevent Childhood Trauma

Solution:

• Expand efforts to prevent childhood trauma or adverse childhood experiences (ACEs) and increase protective factors using best practices and grounded in racial and health equity.

Strategy: Engage Youth as Partners

Youth Solution:

• Engage youth as partners to understand their needs and interests and co-create prevention initiatives with their leadership.

Our community identifies mental and behavioral health needs early, intervenes appropriately to avoid more acute symptoms, navigates community members to services, and provides low barriers to entry and access to innovative services that are welcoming to all identities and are customized to meet diverse needs and ensure culture familiarity.

Strategies and Solutions

Strategy: Community-wide Navigation

Solution:

• Provide a centralized resource with information about services and events available for mental and behavioral health as well as social determinants of health for the full community to include navigation, coordinated entry for mental and behavioral health, follow-along support including peers, resources for existing community connectors, and self-service options.

Youth Solution:

• Provide an easy and youth-friendly way to know about and access mental health resources as part of community wide navigation, coordinated entry, and self-service options.

Strategy: Harm Reduction

Solution:

• Increase use and understanding of harm reduction principles, support harm reduction efforts, and include people who use drugs in program development.

Strategy: Suicide Prevention

Solution:

• Expand use of suicide prevention and response best practices and just culture models, including the Zero Suicide Framework, to consistently support youth, adults, and priority populations with suicidal ideation in developing and following safety and support plans that are shared amongst physical health, education, and behavioral health providers.

Strategy: Easier Enrollment

Solutions:

• Address cost barriers to accessing mental and behavioral health services by providing low or reduced cost services and evaluations or subsidizing cost for all Boulder County community members.
• Provide expanded options for easier enrollment in services to reduce wait time.
• Create centralized intake location for inpatient substance use disorder treatment in which individuals can walk in for immediate help, find an open treatment bed, and go to treatment.

Youth Solutions:

• Increase options for youth ages 12 and over to access supportive and stigma-free mental and behavioral health services free of charge including through providing funding to programs or a scholarship fund for youth.
• Provide early access to services for mental health, substance use, and mentorship through easier and streamlined referral, intake, and enrollment process to service providers including home visitation, phone and virtual options, and in-person services.
• Provide trauma informed mentors for children and youth with higher acuity.

Strategy: Drop-in Supports

Solution:

• Create physical spaces accessible to community and in areas of need where individuals can drop-in for mental and behavioral health services including innovative models and approaches and culturally familiar supports for free or reduced fees.

Strategy: Increase Restorative Justice

Solution:

• Increase restorative justice as an alternative to involvement in the criminal justice system through consistent practices and local opportunities.

Strategy: Co-location and Integrated Services

Youth Solution:

• Increase and improve integration of mental and behavioral health services including use of universal screening and sharing resources in places where youth already are located such as schools, clinics, youth centers, etc.

Our community invests in focused approaches to advance equity, address disparate impacts, and ensure access to meaningful, culturally relevant, and effective mental and behavioral health supports for priority populations.

Strategies and Solutions

Strategy: Strategies for Priority Populations

Solution:

• Develop focused solutions and messaging for priority populations with disparate mental and behavioral health outcomes including suicide and overdose risk such as older adults, middle-aged white males, youth, transgender community members, LGBTQIA+ youth, and I/DD populations.

Strategy: Supports Beyond Medical Model

Solution:

• Provide a broad range of free and low-cost services to support mental and behavioral health beyond the western medical model for all community members that are rooted in traditional cultural practices, best practices, or other community-informed practices.

Strategy: Culturally Relevant Supports

Solution:

• Improve access to BH services and quality of services for residents who identify as BIPOC, LGBTQIA+, and for residents with disabilities through culturally relevant service models, staff who represent the population served, and environments that are welcoming, culturally competent, and affirming.

Youth Solution:

• Provide affirming, bilingual/bicultural, and culturally relevant youth mental and behavioral health supports to include mindfulness programs, education, parent support, and gender affirming care for LGBTQ+ youth.

Strategy: Language Access

Solution:

• Commit resources to language justice and ensure all outreach, services, and supports are accessible to non-English speakers, vision impaired, and for ASL.

Strategy: Community Leadership and Cultural Brokers

Solutions:

• Support community leadership to develop and provide mental and behavioral health supports by training and incentivizing cultural brokers in the community, offering paid leadership opportunities for Latine and LGBTQ+ individuals, parents, and youth, and investing in trusted organizations already providing mental and behavioral health support through cultural brokers.
• Support opportunities for people who use drugs (PWUD) and those in recovery to share challenges, support each other, and advocate for changes so services are stigma free, person centered, trauma informed, and meet the needs.

Strategy: Antiracist and Anti-oppression Efforts

Solution:

• Address systemic racism, discrimination, and oppression through local policy change and broader policy advocacy, implementing antiracist practices and practices eliminating bias, and educating the community and service providers about the behavioral health impacts of trauma caused by racism, hate crimes, and discrimination.

Our community is committed to offering a robust, connected, and culturally responsive continuum of mental health and substance use treatment and crisis services that provides access to the right care at the right time, regardless of acuity or level of care required. Such a continuum would effectively provide enough services in all levels of care that community members would be supported before they reach a crisis, support residents in crises, ensure fast follow-up and re-engagement after a crisis, and support people in transition between levels of care. The community further recognizes that levels of care are interconnected and investments in one level of care must consider the impacts on the full continuum and be planned in a holistic manner.

Strategies and Solutions

Strategy: Improve Access to Crisis Services

Solutions:

• Fund Behavioral Health Urgent Care clinics for adults and youth with drop-in and/or same day services. Design youth services with intention, if integrated with adult services.
• Expand access to crisis treatment beds with ombudsman services to ensure quality of care, increase Acute Treatment Unit (ATU) and Crisis Stabilization Unit (CSU) capacity for Boulder County residents.
• Increase mobile evaluation and establish more direct admit processes directly into treatment.

Youth Solutions:

• Open a 24-hr crisis center for youth.
• Develop more juvenile services that can respond quickly to the needs of children and youth and serve as alternatives to residential care and detention, services such as crisis intervention, behavior support, and family intervention.
• Develop respite programs for families with children who have mental health needs, but not child welfare issues, like Shiloh House Program. Develop additional respite options for foster families and families with kids at home in need of higher level of care.

Strategy: Expand and Improve Treatment Options for More Robust Services Across the Continuum

Solutions:

• Develop more options for inpatient and residential treatment for substance use treatment, ensure access for Medicaid members, the uninsured and under-insured.
• Increase dual-diagnosis program capacity in the community.
• Develop more options for mental health and substance use treatment across the continuum that accept Medicaid, including intensive outpatient, inpatient, residential and long- term, particularly inpatient treatment options for those who use methamphetamine, and first psychosis intervention programs.
• Expand jail-based mental and behavioral health services, including access to acute services.
• Expand wraparound care and community-based management (ACT, Forensic ACT, ASCENT-type programs) so these services are provided across the county, not just from one location.

Youth Solutions:

• Research models of intensive outpatient services that work for levels of acuity that we have. Look at other communities that have eliminated the need for higher level placements.
• Develop an intensive outpatient program for youth with substance use needs, and services for caregivers with substance use needs.

Strategy: Improve How People are Supported as They Transition Between Levels of Care

Solution:

• Improve discharge planning and follow-up support post-hospitalization.

Youth Solutions:

• Improve and expand post- inpatient/hospitalization navigation for children and youth.
• Ensure effective follow-up services after an evaluation for suicidal ideation.

Strategy: Improve Access to Treatment

Solutions:

• Streamline access to care – for example, get folks to substance use treatment quickly, 48 hours or less with entry points around the county.
• Put more services where people are by creating more in-home services and evaluations, co-locating/integrating resources, and services across systems for more leverage, reach and access, identifying hotspots and increasing community-based services in those areas, establishing more services outside of Boulder, and offering mental health and behavioral supports for parents and caregivers in the same places where youth access services.
• Develop more capacity in behavioral health services to better serve the growing geriatric population and build capacity of programs to handle more volatile patients.
• Offer services in a more flexible manner – offer transportation, offer services at flexible times, including evening, make services available to adults and youth, regardless of ability to pay.
• Promote harm reduction rather than abstinence as foundational philosophy for substance use treatment services.
• Ensure equitable access to services for priority populations.

Our community cultivates and invests in a recovery-oriented behavioral health system that supports county residents of all ages and identities in their journey towards recovery from substance use disorders and mental illness, and those living with lifelong symptoms requiring more intensive services.

Strategies and Solutions

Strategy: Supportive housing

Solution:

• Develop more long-term supportive housing for people living serious mental illness, chronic substance use disorder, people with history of criminal justice involvement, people in recovery, and aging adults with chronic behavioral health needs. This could include affordable sober housing, housing with services onsite, housing with higher tolerance for difficult behaviors, recovery housing models, recruiting recovery-friendly landlords, even long-term mental health beds, and assisted living facilities with capacity to care for people with chronic behavioral health issues.

Strategy: Peer workforce expansion

Solution:

• Expand the use of peers throughout the continuum of care, and particularly as recovery navigators to walk with people in recovery throughout their journey.

Strategy: Opportunities for Meaningful Employment and Social Connection for People in Recovery

Solution:

• Create more employment, education, and training opportunities for CJ-involved individuals, people in recovery from substance use disorder, and those living with serious mental illness. This could include expanding opportunities to work as peers, recruiting more recovery-friendly employers, and developing partnerships to create new opportunities for education and vocational training opportunities.

Youth Solutions:

• Create drop-in spaces and peer-run clubhouses for youth and adults so that people with serious mental illness have a place to belong, socialize, and receive services.
• Develop the capacity of community programs like camps and after-school programs to have more tolerance for difficult behaviors and high acuity children and youth, train staff in trauma-informed practices.

Strategy: Housing for People in Recovery from Methamphetamine Use

Solutions:

• Increase housing options for people with a history of methamphetamine use so that housing upon reentry, post-treatment, or if they have been sober for years, is possible and available. This could include a fund for meth remediation for landlords, finding an entity to serve as landlord of last resort, or as science progresses, possibly creating meth-proof housing.
• Establish more long-term treatment options that combine treatment and a post-treatment housing component.

Strategy: Expansion of Wraparound Care and Community-based Management

Solutions:

• Expand wraparound care and community-based management (ACT, Forensic ACT, ASCENT-type programs) so these services are provided across the county, not just from one location.
• Design these services to meet the needs of county residents living with serious mental illness, chronic substance use disorder, dementia, Intellectual disabilities, developmental disabilities, families with children experiencing SED, unhoused community members and those reentering the community from jail, regardless of payor.
• Fund the engagement and outreach services required to support stability and keep someone in housing that Medicaid may not cover.
• Expand support services designed for families so that loved ones with serious mental illness, dementia and youth with serious emotional disturbance can live at home.

To develop a clear and concrete vision of the changes that need to take place in the behavioral health system to achieve behavioral health equity, the Behavioral Health Planning Team convened an Equity Advisory Board of diverse community members in the spring of 2023. The group was comprised of community members who identified as LGBTQ+, Latine, Afro-Latino, Black, bi-racial, immigrants, people in recovery, and included residents from Nederland, Lyons, East Boulder County, Boulder, and Longmont.

The Equity Advisors developed 12 criteria for a trusted system of behavioral health that are designed to both serve as a guide for the implementation of the Behavioral Health Roadmap, and to be used by community organizations to hold service providers and programs accountable into the future.

• Services are affordable and offer provider choice for everyone, regardless of ability to pay or payor, including offering more services on sliding scale based on income, free mental health clinics, or scholarships to help pay for services needed
• Providers ask about and address an individual’s needs holistically so that people feel like a person and not a diagnosis, and collaborate and partner to help them meet their basic needs and support their stability
• Systems would be interconnected, sharing data across systems to reduce intakes and forms, and records would follow client to providers
• Providers are culturally competent, reflect the communities they serve, and local government invests in a diverse workforce that includes peers
• Providers are welcoming, inclusive, anti-racist, gender-affirming and provide “safe” spaces for clients that are free of stigma
• Service models are culturally familiar to clients, innovative and services are accessible to non-English speakers, particularly in Spanish and ASL
• Services are embedded where the people are like safety net communities, mountain communities, and in already trusted community organizations, mobile and street services
• Services for all ages across the continuum of care (prevention to recovery) exist and are easy to access, especially in, but not limited to, a crisis
• Documentation status would never be a barrier to care and providers would proactively engage in practices to protect undocumented people’s information
• There is centralized, easy to access, help (in-person and virtual) to find resources and navigate the system
• The system is accountable to the community, and the community holds the system accountable
• The county policy agenda reflects these criteria and works towards community conditions for wellbeing for all