[Editor's Note: The Grant County Commission work session meeting on Oct. 10, 2023, lasted just shy of 3 hours, so readers can expect several articles. The fourth one continues with the final update.]

By Mary Alice Murphy

Dr. Stacey Cox, Center for Health Innovations Public Health Institute director. gave the last update at the Grant County Work Session on Oct. 10, 2023 and said she would talk about the Grant County Community Health Council and CHI Public Health Institute.

"I came into this position last November, so this is my first presentation to you," Cox said. "When I took this position it became very clear to me that people in Grant County don't really know what we are and what we do. We are one of two public health institutes in New Mexico. CHI got the designation in 2019. Covid hit and nothing happened. I have been hired to pick up the baton to make it work. The public health institute is a designation and it takes quite a bit of work to get. Our purpose is to better public health, both the groups and individuals. We improve health outcomes through strengthening partnerships and through public assessments, as well as back office support. Many of the non-profits need back office support. We also do training, such a mental health first aid. We've trained many law enforcement personnel on healthy masculinity. We've done a lot of training around mental health and behavioral health. We also do a lot of medical detailing, which is CMEs (continued medical education) for providers. Additionally we strengthen partnerships through conversation. We bring communities together for conversations. We also do prevention services, workforce development and data initiatives. We have a great data department. We have a $500 million budget, and we are a driver in this community as well as having 35 employees across the state."

She said in March, the county invited CHI to take over the health council. "We did and completed the last scope of work for the past couple of years. We had a community meeting in early July, which was well attended. We talked about the history of the health council across the state and what people wanted. Over the past decades health council funding has been incredibly unstable, with no one ever knowing how much funding the councils would get that year. One of the benefits of having the health council be part of the CHI Public Health Institute is that we can leverage those funds in a different way. As a result of that meeting, we put together a transition team of nine members and leaders of the community. We are glad to have Chairman Ponce and County Manager Webb to be part of the team. We have our third meeting next week. The team will meet through December. The first thing that came out was that the council needed a community needs and strengths assessment, because one hadn't been done since 2012, I believe. We wanted to make sure we were not duplicating anyone else's work by collecting every survey, every report we could find. Sabrina Pack and her students are helping us with the survey as well as with key informant interviews. The survey will last through the end of October. We have preliminary results every week, so I can tell you now the things that are popping to the surface. We hope to get 500 survey responses and we have already gotten more than 300 and have done a bit more than 60 interviews. We also have a provider survey that goes to all behavioral health providers. We've gotten feedback that the survey is too long. We're also doing focus groups. All that will be completed by the first week in November. We will use all the information we gather for the health council to use over the next about three years. Every couple of years, we will look at the survey, and do minor updates."

"As many of you know, we hired Valerie Kling to be full-time health council coordinator," Cox continued. " I want to talk about the funding cliff, because the direct funding from the state for the health council this year was $16,500. That's not a huge basket of money to pay an employee. For the past few years, the Kellogg Foundation has given health councils money for data work. That helped keep the health councils afloat. That money, as far as we know will be going away. We're trying really hard to make two years worth of money go for three years, because it will give us the runway to keep going while we look at the needs assessment information and look for other funding. We need health councils not to rely on state funding but will need recurring funding from somewhere. We're hearing that next year, it may be less than the $16,500. If we find the health council useful in our community, we have to think about it differently. That little bit of money we get is so driven by the Department of Health. We're lucky that whatever we come up with in the needs assessment, the Department of Health will support, but we need stable funding, so how do we shore it up? We will make it last while we look for additional funds. We have to take care of ourselves."

She said she wanted to talk about some other things that overlap with the health council. One of those is crisis response. "We're glad to share all that we know. One of the first pieces is the mobile crisis response on 988 and how to promote it. It's a little complicated because the state put out reimbursement rates, then pulled them back. As those rates are promised again to come out soon, there are things we can do, such as train people on 988 and take advantage of what already exists in the community. Several of you attended the first behavioral health meeting, which was the first of three we will have. The second one in November is for the community to come to tell you their needs. There will be tabling with behavioral health providers, so people can ask their personal questions quietly about payment and what shall they do. The final meeting will be Dec. 3 to unveil the behavioral health mapping that we've been doing. It's a visual map of what the system looks like, with what's missing and that sort of thing. We want to support everyone that is working on behavioral health. We want to know who is paid inside and outside Grant County to provide service on behavioral health to Grant County and what they are doing and whether we are getting our fair share. I think it's another data point for when we talk to legislators to ensure what they know and we all know is that it costs more in rural counties than in say, Las Cruces. We will have that along with personal stories and possible ways for local funding, as well as state funding. I firmly believe that the state model doesn't work for our community, so we go to the state and tell them what doesn't work for us and ask for some changes. We will have a pretty good report for the Legislature, but it is something we will be honing into infinity."

She said she thought it was important to say that CHI is a statewide organization, "but it started here, it was founded here and it is important to us to meet the needs here. Chairman Ponce asked us to create a poster for all public buildings that has the contact numbers of behavioral health providers. Eventually we will have that online, but it will be changing always. I hope this work we are doing brings us to together and brings clarity about where to go from here and how to think about behavioral health."

District 3 Commissioner Alicia Edwards asked about the goal for 500 responses, then "you mentioned key informant interviews and focus groups How many of those are people off the street ?"

Cox said all of them, except for the key informants. "The 500 doesn't include the key informants or focus groups."

Edwards said since she has been in the community, the health council did three assessments. The first two had around 500 responses each and the last one had 5,000 responses in 2012. "The data from that one was so much better."

"Wow!" Cox said.

Edwards then said she was surprised to hear that Cox is also working on 988 stuff. "Has the open beds issue been resolved, so that people who want to provide services are accessible?"

"No," Cox said. "Dr. Lindstrom said that open beds is not working unless it is mandated by the state. So we need to get it mandated. We need to make sure that people here and other surrounding counties know about it, so they don't have to go to Las Cruces for help. I'll talk with you offline. It's been a bear because of the back and forth payment issue. We need to resolve the issue with 911 operators not quite trusting the 988 calls and not transferring them over to 988, and sometimes 988 operators send the calls to 911. It feels like a training issue."

Edwards said she wanted to expand on the 988 issue. "We have a list of more than 70 providers in this community that would like to be in the open beds program. There are about 30 clinical providers and close to 40 non-clinical providers. There is no way to get those providers into the open beds program. We can't figure out even who to talk to. You said open beds should be state mandated. I don't think we should even consider open beds yet. Maybe we need a different provider. We are spending a lot of tax dollars on something that we can't provide. The whole crux of 988 is if someone is in crisis and think they can get help by dialing 988. In Grant County, they can't. We have a mandated service that is not serving the community. It feels like the state is mandating it and they should be providing it, but why aren't they?"

Cox said she didn't think it would be a surprise to anyone in the room from the $16,000 awarded to the health councils to conversations with the Human Services Department that things cannot happen right now because there is such a jam in their system on everything from payment to the fact that "every contact we had has left in the last year. The whole system is really frustrating right now."

District 5 Commissioner Harry Browne said he is not very up-to-date on all this, but "it is music to my ears that we are creating a visual map of the services, as well as who is getting paid to provide services and what they are actually providing."

Cox said the system map would likely be presented at the December meeting for people to poke holes in it and improve it. "I believe that public health is so important, but what we need to work on is the wellness end."

The next presentation on the agenda was to hear about the removal of obstruction from the easement for the Sheriff's Office parking lot, but no one was present. County Manager said all issues had been resolved.

The next article will get into the regular meeting agenda review at the work session and decisions made at the regular meeting.

For the previous articles, please visit: https://www.grantcountybeat.com/news/news-articles/80944-grant-county-commission-holds-work-session-101023-part-1 ; https://www.grantcountybeat.com/news/news-articles/81097-grant-county-commission-holds-work-session-101023-part-2  ; and https://www.grantcountybeat.com/news/news-articles/81122-grant-county-commission-holds-work-session-101023-part-3  .