Designing a Public Health Intervention

Introduction
Setting
Mental health is a growing concern and the worrying trend has been reported

among the school going youths. In the USA, it is estimated that 25% of school going

youth experience behavioral and mental health challenges, yet they are among those

that are least considered for treatment (Colizzi et al., 2020; Swick & Powers 2018).

These make this demographic vulnerable to the poor academic outcomes because of

problems such as irregular or lack of school attendance and other behavioral changes.

The main challenge to reaching out to this cohort is the lack of assessment and

intervention. The primary role of Northeast Nebraska Public Health Department

(NNPHD) is to ensure appropriate mechanisms of disease prevention are operational.

Besides, the NNPHD is tasked with improving quality of life through better health

thereby contributing to prolonged life. To achieve these strategies, public health

departments need to organize efforts and make informed choices for communities and

individuals. Besides, the public health officials should seek ways and means of

analyzing determinants of health of the local population, the threats it faces, and

possible ways of averting it (Robin &Leep, 2017). The NNPHD serves rural northeastern

Nebraska, consisting of around 30,000 people and two tribal districts, the Omaha and

Winnebago tribes (NNPHD, 2019). The objectives of public health span individuals'

physical, psychological, and social well-being. Local public health departments offer

various services to their communities without suffering from health-related problems.

For my health intervention, I plan to focus on improving access to mental health

providers for children and adolescents who attend schools in Cedar and Dixon County.

Cedar and Dixon have ranked lowest in the health district for the population ratio to
mental health providers (County Rankings, 2022). For individuals residing in northeast

Nebraska, the mental health provider ratio is 2,997 to 1 per population (Northeast

Nebraska Behavioral Health Network). Research indicates that youth, particularly

under-resourced youth, are most likely to receive mental healthcare in schools, given

impediments to receiving community mental health services.

The coalition and members that provide insights into the community needs

consist of community members, practitioners, non-profit community organizations,

clergy, school educators, and staff to obtain diverse perspectives, experience, and

expertise to provide essential and accurate community knowledge. The ethical

consideration one needs to consider while pursuing health promotion research is the

protection of individuals' dignity and the publication of the information in the research

Colizzi et al., 2020; Swick & Powers 2018). The major ethical issues in conducting

research are informed consent, beneficence, respect for anonymity and confidentiality,

and privacy. The most important thing a government should consider is helping a

society remain safe and free from diseases.

Framework/Design

The proposed new intervention would be based on the health belief model. The

is to plan to utilize different educational opportunities in teens' lives; school, home, and

after-school activities to give students improved mental health services and access to

providers. My intervention is an all-encompassing plan of an educational intervention to

focus on educating and empowering individuals to advocate for their mental health

needs and know a point of contact to get help. Using the health belief model to

encourage long-term behavior change and empower decision-making. The manner

 school districts implement school-based mental health services ranges. A critical

necessity is hiring school-based therapists or social workers, along with having a school

psychologist.

Early recognition and resources can indicate that the school environment is

comfortable speaking about and addressing mental health. Thus, decreasing the stigma

associated with receiving mental health services. to address the challenge, the following

conceptual framework will be adopted..

Educational intervention
Formulate treatment programs

School-based therapists or social workers, a school psychologist

Deal with
Bullying and conflicts,
Solve problems,
Healthy peer relationships, Student and family support an
Activities to prevent suicide & substance use

oving access to mental health -children & adolescents

School Model
Skill groups to deal with grief, anger, stress, & sadness.

Generate a referral proced

Long-term behavior change & empower decision-making

Recognize students' early indications of mental health problems
 Purpose/Objectives

To establish a health intervention that focus on improving access to mental health

providers for children and adolescents attending schools in Cedar and Dixon County,

the following objectives will be studied.

1. To investigate and identify main barriers hindering access to mental health by

learners in Cedar and Dixon County

2. To investigate existing psychosocial services currently offered in Cedar and

Dixon County schools so as to leverage on them for improved delivery of mental

health services

3. To establish strategies of implementing school-based health centers as a model

for improved delivery of mental health services in Cedar and Dixon County

Methods

Setting

The proposed way of assessing the community would be through public engagement

and seeking audience with the target stakeholders. For instance, the public health

department will be engaged to consider setting funds, personnel and spreading their

approach to include issues that looks into mental health among the young adults in

schools, while parents will be tasked with ensuring they provide support for the

implementation of the program. The school community will play a significant role in

entrenching some of the proposed strategies into their curriculum and ensuring the

program functions as intended.

To achieve the above objective a structured questionnaire will be administered to the

target respondents so that the information obtained can be used to help in designing the

strategy.

Results

To investigate and identify main barriers hindering access to mental health by learners

in Cedar and Dixon County, the occurrence of attributes associated with mental health

and the most likely factors were captured in the questionnaires and administered. It

was observed that most respondents were likely to be exhibit mental health illness

based on signs such as anxiety, fear, anger, and depression (Fig. 1), and these were

attributed to cost, lack of psychiatric, and distance to access services (Fig. 2).

Interestingly, it was noted that at least 80% were willing to utilize school based model

(Fig. 3).
Figure 1: proportion of mental health attributes evidenced among school going youth.

Most of the respondents reported signs of mental health illness such as anxiety, fear,

anger, and depression. A majority are comfortable with their fellow learners.

Figure 2: Factors that hinder access to mental treatment. Most respondents’ attributes

cost, lack of psychiatric, and distance as challenge impacting of access.

Figure 3: Showing the likelihood of respondents utilizing the proposed school based

model. More than 80% of the respondents were willing to utilize school based model.

To investigate existing psychosocial services currently offered in Cedar and Dixon

County schools so as to leverage on them for improved delivery of mental health

services. it was observed that limited assessment strategies were available in schools

with counseling reported below 10%. However, medication and psychosocial support

were considerable as indicated (Fig. 4)

Figure 4: Showing the existing psychosocial services being implemented in the schools.

There is limited counseling support. However, there is considerable medication and

psychosocial support.

To establish strategies of implementing school-based health centers as a model for

improved delivery of mental health services in Cedar and Dixon County, it was observed

that additional assessment strategies through recruitment of counselors and

psychiatrics (Fig. 5) could help in the implementation of the intervention.

Figure 5: Showing the most likely ways of enhancing the adoption of school based

model. The recruitment of counselors and psychiatrics is perhaps the best alternative to

improve the intervention.

Discussions

Assessing the Community

It is estimated that mental health services has not received the required attention

in the setting of this study. A community-based intervention would look to establish

mental health services within the school districts in Cedar and Dixon County. The goal

is to educate school staff, parents/caregivers, and students about mental health

concerns. Educating students, the health risks and encouraging healthy discourse

around the subject will allow them to feel empowered in their own decisions. This

information can be incorporated into health classes courses. Promoting learning from
different areas encourages students to make well-informed decisions. I propose

educational materials be available to parents to continue the conversation at home to

expand on education. Adolescents are heavily influenced by their social circles.

Educating parents on proactive ways to discuss the impact of mental health with their

children at home can help them feel more confident in their decision-making. Lastly, I

also propose funding to be expanded in after-school activities.

There is limited information on the involvement of community actors in enhancing

health delivery. This could be informed by the lack of information on priority areas and

how they can get their foot on the ground. Therefore, the focus would be towards

engaging non-profits and after-school programs and organizations to support

adolescents by creating sports teams, clubs, and social groups that adolescents can go

to after school or on the weekends. After-school activities prevent alienation while

building self-esteem. If given the opportunity, building relationships with peers is a

strong influence on adolescents. This will have a long lasting impact in entrenching

models that target to improve health of the community in a big way. To achieve these

needs, the following gaps will need to be addressed:

 Insufficiency of campaigns emphasizing mental health awareness within schools.

 Services and information are difficult to access and not widely reachable for

students and caregivers/parents.

 Deficiency of mental health services that are age and culturally appropriate to

help overcome the barriers to mental health services

 Shortage of proper socialization or social support to the individuals suffering from

mental illness
 The stakeholder in this mental health intervention would be students who receive

treatment for mental health services, caregivers /family members, healthcare and social

service providers, administrators, social justice/patient advocates. Institutions like

charitable organizations, government services, educational institutes.

Some of the features/opportunities that can be explored to address the need

gaps of stakeholders could be: Charitable and educational organizations can

collaborate with the government agencies to design and build a mental health

awareness campaign at various levels of the society - e.g., in institutes, corporates,

schools, highlighting its significance. Having a database of professionals/organizations

who are into mental health services enhances accessibility

Planning a community-based Intervention

The requirement needed to access the intervention is that the student must be

enrolled in a public or home school within Cedar or Dixon County. The ideal ages would

be from kindergarten through seniors in high school. School infrastructures allow for

large-scale implementation of prevention interventions. Given the number of factors

involved in delivering school interventions, consideration of policies, school culture,

environment, and leadership structure will be considered. Furthermore, developing

sustainable interventions in schools that are genuinely responsive to the needs of

students can take years, thus ensuring all academic-community partnerships maintain

collaborations. The following figure summarizes the implementation of the proposed

model.
 Target group
Kindergarten through seniors in high school

Planning a community-based Intervention

Resources
Collaboration Personnel

Sustainable

Stakeholders
School community Appropriate policies
Adjacent community & parents
Public health department

Implementing a community-based Intervention

A projected timeline for schools to adopt this intervention would be around

eighteen months. This considers funding allocation, school board meetings, hiring of

new staff, providing appropriate training for teachers and staff, incorporating mental

health into the curriculum, and providing helpful tools for students. To engage

stakeholders involved: school districts, students, parents, school staff, educational

authorities, and mental health professionals, the intervention needs to demonstrate

focus and outcome of interest. The focus of the intervention is the whole school,

classrooms, educators, and families. This is done through promoting, preventing,

screening, and treating mental health disorders. The anticipated outcomes of interest

would be educational achievements, psychological measures, social functioning.

To bring awareness and distribute educational material this will be done through

the media; everyone is directed to a certain point of uniformity when addressing the new
interventions. The agencies will provide openness and inclusivity ensure that the locals

are adequately informed and equipped with materials and information. Mass media

such as social media platforms, websites, and local papers will educate the community.

This has proven to have been highly instrumental in spreading the word of collaboration

and educating the public on new interventions. The following table provides the

summary of planned milestones and their delivery schedule.

Timelines (Months)
1st - 3rd 5th - 7th - 9th - 11th - 13th - 15th - 17th -
Milestone 2nd - 4th 6th 8th 10th 12th 14th 16th 18th
School Board/Teachers
Meetings
Assessment of Curriculum
Meetings Students
(Identify Needs)
Engage Stakeholders

Media Awareness
Funding Allocation

Interventions
Report

References

Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in

youth mental health: is it time for a multidisciplinary and trans-diagnostic model

for care?. International Journal of Mental Health Systems, 14(1), 1-14.

County Health Rankings & Roadmaps. 2022. County Health Rankings & Roadmaps.

[online] Available at:

 <https://www.countyhealthrankings.org/app/nebraska/2021/measure/factors/62/

map> [Accessed 13 March 2022].

Durlak JA, Weissberg RP, Dymnicki AB, Taylor RD, Schellinger KB. The impact of

enhancing students’ social and emotional learning: a meta-analysis of school-

based universal interventions. Child Dev. 2011;82:405–432.

Guttmacher, S., Vana, K. P., & Ruiz-Janecko, Y. (2010). Community-Based Health

Interventions (3rd ed.). Jossey-Bass.

Lai K, Guo S, Ijadi-Maghsoodi R, Puffer M, Kataoka SH. Bringing wellness to schools:

opportunities for and challenges to mental health integration in school-based

health centers. Psychiatr Serv. 2016;67:1328–1333

Northeast Nebraska Behavioral Health Network | BHECN | University of Nebraska Medical

Center. (2018). Northeast Nebraska Behavioral Health Network. Retrieved March 13,

2022, from https://www.unmc.edu/bhecn/about/stories/organization-spotlight-mar-

2018.html

Northeast Nebraska Public Health Department, Pender Community Hospital, & Providence

Medical Center. (2019, November). NORTHEAST NEBRASKA COMMUNITY HEALTH

IMPROVEMENT PLAN. Northeast Nebraska Rural Health Network Core Team.

Robin, N., &Leep, C. J. (2017). NACCHO's national profile of local health departments study:

Looking at trends in local public health departments. Journal of Public Health

Management and Practice, 23(2), 198-201.

https://doi.org/10.1097/phh.0000000000000536
Swick, D., & Powers, J. D. (2018). Increasing Access to Care by Delivering Mental

Health Services in Schools: The School-Based Support Program. School

Community Journal, 28(1), 129-144.