Could you tell me about your project?
We are interested in examining the engagement levels in mental health services in community-based versus home-based care and between rural versus urban settings. There has been an initiative in recent years with a focus on community-based mental health. “Community-based” refers to bringing services to homes and schools, which increases the level of engagement. Engagement can be defined in many different ways. We are looking at a number of appointments at the outset of services in a one month or 90 day period. Other folks might see engagement as no-show rates, things of that nature.
As the community partner on this project, what has your role looked like within the broader team?
I am the community provider of a mental health and substance use agency here in Georgia. We’re the largest private provider of these services in the state of Georgia for the Medicaid population. It’s been helpful that I’ve been able to share the unique challenges of a community-based mental health provider. It has really helped operationalize some aspects of what we’re measuring. I’ve been able to share how some of the state-level guidance and policies shape the utilization of services. That’s been helpful to create the narrative that supports the data.
Could you speak to what you mean by “narrative,” how that narrative looks within your role?
An example of being on the ground level and seeing how the state’s policies and procedures impact utilization? Depending on the payer source, there’s a vast difference in the philosophies around what psychosocial services in Georgia are intended to be. There’s two main funding sources in Georgia: the Department of Behavioral Health and Developmental Disabilities and the Department of Community Health. The Department of Behavioral Health sees skillbuilding services as a supplement to therapeutic services. The Department of Community Health sees them as a more acute level; for more severe cases, you would add these skill-building services. You find that the managed care companies don’t approve those services as much as the Department of Behavioral Health. You would see that play out in the data with utilization, engagement. That’s just an example of how my knowledge of things on a state level can provide the narrative behind the data.
How did you come to this project?
Dr. Cummings, one of the Team Georgia research partners, has been a colleague of mine for years. She partnered with our agency to do some focus groups for some previous research that she had. We stayed in touch. I shared with her at one point that I’m a researcher at heart. I love research. When this opportunity came up and a community partner was a requirement, she reached out to me. It was a no brainer. The ability to provide valid and reliable research to support the effectiveness of community-based mental health is of tremendous value to me as a leader in this space.
The funding for community-based services is not always reflective of the cost of doing services. I hope to bring this research to state leaders with decision-making capabilities and say, “Look at what this research is showing, that community-based mental health is much more effective at reaching and engaging clients, and this is how much it costs to do the work. Let’s negotiate some new rates.”
For example, we typically have an extreme mileage expense. In our line of work, that’s not a Medicaid reimbursable cost. We’re in 28 counties in northwest Georgia. We serve between 8,000 and 10,000 clients a year. We’re talking about thousands and thousands of dollars a month just in mileage expense.
What haven’t I touched on that you were hoping to discuss?
There are statistics about suicide being an epidemic in the United States of America. There’s been some attention paid to that. I don’t know that when you’re talking about a mental health epidemic versus a health epidemic that you’re getting the same level of response, attention, funding. There’s a lot of stigma around mental health and substance use. There’s a long way to go as far as approaching people with a trauma-informed orientation no matter what walk of life either you or they are coming from.
Research in our space has a ways to go to get the attention and funding it needs. I’m happy to be part of a project where I can be a conduit to our communities and state leaders in having these conversations about how we can align our policies and funding with what the research is saying.
Was there anything else?
IRL’s been great. I appreciate the opportunity to continue doing what I love. Working with Janet and Nicoleta has been a wonderful learning experience for me. Thank you.
Nikki Raymond is an IRL fellow from Cohort 2018-2021 of Interdisciplinary Research Leaders (IRL). To learn more about Nikki and Team Georgia, read about their research project: Community-Based Approaches to Improve Behavioral Health Services for Underserved Youth in Rural Georgia.
Interviews conducted, transcribed and condensed by Maria Bertrand, MPH ‘21. [Nikki Raymond reviewed and approved this blog.]
The views represented in this post are those of the authors, not of Interdisciplinary Research Leaders or the Robert Wood Johnson Foundation.