Connecting the Dots

Kenneth D. Smith, PhD
Senior Health Policy Research Analyst
Texas Health Institute

Translating evidence and ideas, or “sense-making,” is a core competency of Texas Health Institute (THI) as the state’s public health institute. The Community Health team’s work over multiple projects in East Texas uncovered trends occurring regionally. That work offers a case study of how THI has strengthened local partnerships for collaborative impact at the regional level.

THI conducts community health needs assessments (CHNA) throughout the state. Two years ago, we conducted CHNAs for four of CHRISTUS Health System’s integrated health care delivery facilities in East Texas. Although we used the same approach, each CHNA was a separate product informed by local data, including the voice of the local community. Despite that, we observed similar patterns across health systems. Each health system identified at least one social determinant of health need, and all identified mental and behavioral health as a top priority.

Our CHNA work provided invaluable perspective for the East Texas Local Government Expenditures Project which focused on Harrison and Angelina Counties and their respective capital cities. Our CHNA for CHRISTUS Good Shepherd covered Harrison County, but we were also familiar with CHI St Luke’s CHNA for Angelina County which, incidentally, identified access to behavioral health as the second highest priority in the county.

The project was a collaborative effort with the Stephen F. Austin University (SFA) School of Social Work who recruited informants and conducted interviews and was funded by Episcopal Health Foundation. Authorized by the county and municipal legislators and executives, the project was designed to support recommendations to improve community health based on an analysis of budget spending trends over 10 years as well as informant interviews with officials familiar with the budget process. Although unexpected, the need to address behavioral health arose as a research finding.

Study interviewees from the two counties described the interaction between homelessness, substance abuse, co-occurring mental health conditions, and the criminal justice system. They painted a picture that researchers have observed across the country. This includes prior unrelated SFA research documenting the vicious cycle of substance abuse, prison time, and homelessness operating across rural counties in East Texas.

Recommendations offered by Harrison County interviewees suggested the need for a community-led effort to address these complex issues from a systems and regional perspective. This was the rationale for THI to partner again with SFA to respond to HRSA’s Rural Communities Opioid Response Program—Planning (RCORP) opportunity. The Panola-Gregg-Harrison Community Initiative to Address Substance Misuse is the result of our successful HRSA proposal. The initiative involves a regional gap analysis and community action plan to address prevention, treatment, and recovery from opioid and methamphetamine misuse in the targeted rural community.

The partnership with SFA creates synergies that ensure that we have a trusted local partner grounded in the community as we work regionally. THI is the convenor for the consortium responsible for implementing the community action plan.

This work emerged as a result of working with local stakeholders while seeing the big picture and seizing opportunities for collaborative action. It exemplifies the kind of regional work for which state public health institutes like THI are uniquely suitable.