Connection on Colorado's Eastern Plains: Steady Movement to Address Substance Use and Stigma
Written by Hannah Groves of Trailhead Institute, made possible by the shared knowledge, expertise and work of Erika Greenberg, Regional Health Connector (RHC) in Region 1 and partnership of Centennial Area Health Education Center (CAHEC)
As an experienced nurse educator, Erika Greenberg brings a unique and important perspective to the Regional Health Connector (RHC) role in her region. Erika serves Region 1 in the northeast corner of Colorado, which encompasses Logan, Morgan, Phillips, Sedgwick, Washington, & Yuma counties. Erika and her host organization, Centennial Area Health Education Center (CAHEC), intimately understand the needs of rural and frontier communities that comprise the region they serve because they live, work, and play in this beautiful northeastern corner of the state. Erika also knows and appreciates that while change takes time in her region, particularly when addressing difficult and complex topics like mental health and substance use, change does happen. Erika has convened conversations and led action around these subjects in Region 1, catalyzing connection and collaboration to build the capacity of the community to address these health priorities through education and expanding awareness of resources available throughout the Eastern Plains.
Pictured: Erika Greenberg serves as RHC for Region 1 Region 1 (Logan, Morgan, Phillips, Sedgwick, Washington, & Yuma counties). The RHC regional map corresponds with the 21 Colorado Health Statistics Regions developed by the Colorado Department of Public Health & Environment’s Health Statistics Program in partnership with state and local public health professionals.
Through the Behavioral Health Recovery Act (BHRA) funding the RHC program received during the summer of 2021, Erika made key connections and brought providers and community members together to discuss substance use - particularly opioid use and the current crisis happening – and what it looks like and means to rural communities. Inspired by a similar event hosted by Wisconsin-based Area Health Education Center, Erika and the CAHEC team orchestrated a one-day conference, titled “Overcoming Addiction Together” in April 2022. This conference brought together both service providers and community members to talk about mental health and substance use resources already available in the area. The CAHEC event was unique in its approach by expanding its focus on connecting service providers to include the broader community who were welcomed to connect and learn about available resources alongside providers. The impact of this event has been profound, and Erika emphasizes that this project has evolved her role as an RHC noting that prior to the Overcoming Addiction Event, her role had focused on making connections and had not entailed delivering education in the community. She adds that prior to the event, CAHEC was engaging in some NARCAN and harm reduction work at a very small level – occasionally helping law enforcement – though it was not a primary focus of CAHEC’s efforts.
“Overcoming Addiction Together has actually changed my RHC role. As an RHC, I wasn’t out there doing education, I was attending the meetings and making those connections. CAHEC had always had some NARCAN and harm reduction work at a very small level, such as occasionally helping law enforcement, but it was never a big part of CAHEC’s efforts. From this project, during this conference, the connections made and the desire for education like harm reduction and NARCAN training has just exploded. I’m probably spending 15 hours a week doing trainings. We’ve given out close to 400 boxes of NARCAN since April. It’s huge. I don’t think we would have gotten there if it wasn’t for that original conference, because that’s really how those connections were made… I love it because I’m still in the RHC role, out there making connections but the connections are now coming to me. This project has definitely changed my RHC focus of just being out there, making connections, helping where I can, providing resources to now being part of those resources.”
Erika also asserts that there was no magic involved in the success of the project, but instead, it was a key example of the RHC role as a convener: bringing people and organizations together to meet each other, learn about each other’s work and resources, and making local connections to improve local health priorities. The buy-in and support from Erika’s existing relationships in the mental/behavioral health and substance use care were important as a pathway to getting 41 participants in the same space at the same time to talk, share, and collaborate.
Attendees were representative of community members, educators, healthcare providers, recovery support service providers, and students spanning four of the six counties that comprise Region 1. There was also representation from three of the four counties in neighboring Region 5, who is also hosted by CAHEC. The strength of Erika’s relationships with partners and the reciprocal trust demonstrated throughout the project meant that Erika and her CAHEC colleagues who supported the conference experienced very few reported difficulties. Notably, it enabled them to offer the one-day conference simultaneously at four different locations – one facilitated in-person, and three live-streamed screenings - across Regions 1 and 5. The hardest aspect of the conference, even in multiple rural locations, was figuring out who could deliver lunch on a Saturday!
Project Summary
According to Erika, all these entities and individuals are willing to hear each other and learn what each other has to offer, but that,
“People are so busy and often siloed that they don’t even have time to know people are working on the same project or share the ultimate goal of a healthy community. Really, it’s just connecting people. I don’t think there was a special formula... just connecting people. ”
The Overcoming Addiction Together event, along with Erika and CAHEC’s slow and steady efforts, are dismantling siloed responses to the opioid crisis and substance use in the region through these critical connections. While there were not new programs created nor new funding secured, community capacity was amplified through aligning existing efforts and inviting people to the same space to talk about how they are overcoming a community mental health issue and stigma.
As a result of the conference and the connections catalyzed by Erika’s BHRA Project, there has been an increased demand for NARCAN kits and harm reduction training. This is keeping Erika and the CAHEC team very busy, as these requests align with part of CAHEC’s mission and focus to provide education around mental health and substance use to local organizations and people in the area. As an RHC, this also means that Erika is working with many different organizations in order to reach as many people in the Eastern Plains as possible, since mental health and substance use are increasingly being viewed as a community issue. For example, Erika’s relationship with the local community colleges in her region were particularly important to this project as they provided space for the event as well as support and assistance with the virtual component. Exciting too, is the “total buy-in” Erika describes from these important partners when it came to embracing and encouraging Harm Reduction and NARCAN trainings. Community colleges throughout the region have been slow to bring in NARCAN, but now they’re calling Erika to provide training to better support their student populations.
Erika has learned that when approaching mental health and substance use – which is often stigmatized – with rural communities and service providers it is important to share the necessary information without being pushy and to build off of what’s already existing, without trying to fix things. Erika shares that this method “doesn’t work anywhere, especially in rural communities”.
“It’s a continuous process of just talking to people - bringing things up when you’re out at Farm Days, Health Education Days, where ever you are. You just start talking about it and at some point, people pull the information out and say, ‘Hey, yeah this might be important.’ Same thing with this conference; some people I didn’t hear back from for a few months and then you’d get an email bringing it back up and asking for more information. It’s a little slower but it doesn’t mean people don’t want to do it, or don’t care about the efforts.”
Utilizing this approach in her role as an RHC, Erika has seen slow and steady progress in her region over the years when addressing mental health and substance use. Now more than ever, she’s witnessed increased cooperation between counties in her region who are working together to look at overall community health. This is exciting to her, especially because when Erika does trainings, she emphasizes to attendees that substance use is a “we” problem – a full community problem that will take the whole community to address. With continued conversations like this, Erika is continually bridging connections and building local capacity and is an exemplary example of how RHCs are an asset to their communities. Erika’s BHRA project, its continued impact and the evolution of her role speak to the importance of the RHC workforce and program in several ways. In particular, this project perfectly highlights two of the RHC program’s core values.
Embodied RHC Values
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Health is Local
While RHCs are supported by a statewide program office (Trailhead Institute), RHC’s projects are driven by the local context in each region. Erika’s project demonstrates how important it is to leverage community resources and connections to address an issue using a local approach. By acknowledging substance use and mental health as a community-wide issue, it also encourages local buy-in and community-driven solutions.
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Coordination Leads to Better Health
While many entities and individuals in healthcare and health-related sectors connect with each other often (both formally and informally), convening and coordinating as a specific activity are often under- or unfunded. Coordination of care between healthcare and health-related sectors is best achieved when dedicated funding supports people’s time to make connections and create spaces for coordinating across health initiatives. RHCs like Erika are specifically funded to make connections across sectors and are provided tools and the time to do so. This can have powerful and long-lasting impacts in local communities when given appropriate resources and space.
In the future, Erika hopes to use her experience with this project and get more deeply involved with the Opioid Settlement Funds to ensure community perspectives are included. She also is excited to continue the steady, consistent conversations needed to combat stigma and support her whole community by continuing to improve capacity and provide education in mental health and harm reduction to overcome addiction together.
With so much happening in the landscape of mental and behavioral health in Colorado, such as the genesis of the Behavioral Health Administration and dispersal of the Opioid Settlement Funds, the RHC role as convener and connector is more important than ever.
With Gratitude To
Centennial Area Health Education Center
This work would not be possible without the partnership and collaboration of Centennial Area Health Education Center as the host organization for the Regional Health Connector position in Regions 1 & 5. The mission of Centennial Area Health Education Center is to positively impact health outcomes in Northeast Colorado by connecting existing and future health professionals and communities with resources and education.
The primary goal of the Colorado Area Health Education Center’s Program is to work to build state-wide network capacity and strengthen academic-community linkages in four core mission areas:
Health Education and Collaboration
Workforce Shortages and Diversity
Health Disparities
Wellbeing