Background: Primary care practices often screen for food insecurity. However, short-term patient outcomes after screening are not well understood. We used a mixed-methods approach to examine satisfaction with screening and connection to resources among adults screening positive for food insecurity at two Western Slope federally qualified health centers.
Methods: Patients completed REDCap surveys on food assistance resource referrals and usage at three timepoints: identification of food insecurity, one, and three months later. Interviews were conducted with a subset of survey respondents using a semi-structured guide and were analyzed via rapid qualitative analysis.
Results: Thirty-four patients completed surveys and 18 also participated in interviews. Among survey respondents, 69% reported receiving a referral to food assistance programs. Of those referred, 75% rated referrals as ‘very helpful’ and 25% as ‘a little bit helpful.’ At baseline, 25% of respondents reported current use of the Supplemental Nutrition Access Program (SNAP) and 28% reported past use. At months one and three respectively, 39% and 36% reported current use of SNAP. At baseline, 34% reported current use of community food pantries and 34% reported past use, increasing to 40% at one month and 42% at three months. Topics emerging from key informant interviews included: limited recall of screening processes but no specific objections; few new resources received following screening; patients in acute medical or socio-economic crisis recalled attention to social needs more clearly; and inability of current community options to meet needs due to barriers such as pantry schedules, dietary needs, and transportation.
Implications: Screening for food insecurity can identify needs, but existing resources may be insufficient. Healthcare and community organizations may need to deepen collaboration and communication to advocate for policies and funding that increase availability and accessibility of food assistance resources.
Oral health is a critical component of whole-person health, yet significant gaps in access, utilization, and affordability persist across Colorado, particularly in rural and underserved communities. To address the lack of accessible statewide dental data, the Center for Improving Value in Health Care (CIVHC) partnered with the Colorado Dental Association to develop Colorado’s first public Dental Health Dashboard, using data from the Colorado All Payer Claims Database (CO APCD). This project reflects the conference theme, Stronger Together: Public Health in the Heart of the Rockies, by demonstrating how collaboration among public health organizations, dental providers, and health care stakeholders can advance data-driven solutions to improve community health.
This session will present findings from 2022–2025 commercial and Medicaid claims data, examining dental utilization, procedure frequency, and out-of-pocket costs across rural and urban communities, payer types, and demographics (including age groups, sex, and race/ethnicity). Presenters will demonstrate the interactive Dental Dashboard, highlighting disparities in utilization and spending patterns, including lower rates of care among rural residents, younger adults, and some racial and ethnic populations, alongside higher treatment costs in rural communities and among older adults.
Attendees will learn how publicly available claims data can support oral health planning, outreach, policy development, and equity-focused interventions. Participants will leave with practical strategies for using the dashboard to identify disparities, inform local decision-making, and strengthen collaboration between oral health and broader public health initiatives. Time for attendee discussion and interactive dashboard exploration will encourage participants to share challenges, identify potential applications in their own communities, and provide feedback to inform future dashboard enhancements.
Background/Purpose: Functional Neurological Disorder (FND) is a common neurological condition associated with disability, psychiatric comorbidity, stigma, fragmented care, and high healthcare utilization. Despite growing evidence supporting FND treatment, inconsistent diagnostic communication and limited provider education remain major barriers to engagement and continuity of care. This project aimed to design a multi-sector communication strategy to improve diagnostic understanding, reduce stigma, strengthen referral pathways, and support sustainable care delivery within an academic FND clinic.
Methods: Using principles from the Health Belief Model, stigma theory, and implementation science, a multi-level communication intervention was developed for six stakeholder sectors: patients, caregivers, referring providers, behavioral health clinicians, administrators, and payers. Materials were designed to align with real-world clinical workflows and included standardized diagnostic scripts, patient-facing educational materials, provider referral guides, transition-of-care toolkits, executive briefs, and a proposed website redesign. A pragmatic evaluation framework was developed to assess patient-, provider-, and system-level outcomes using pre/post implementation measures.
Results: The intervention established a standardized communication ecosystem designed to improve diagnostic clarity, reduce stigmatizing language, increase treatment engagement, and support continuity of care following participation in a 12-week Multimodal Adapted Psychotherapy (MAP) program. Planned evaluation metrics include diagnostic understanding, provider confidence, referral appropriateness, treatment engagement, and healthcare utilization indicators.
Implications: This project positions communication as a scalable public health intervention capable of improving engagement and reducing fragmentation in complex neurological conditions. The model demonstrates how interdisciplinary communication strategies can strengthen integrated behavioral health systems, improve equity in access to specialty care, and support sustainable implementation within academic healthcare settings.
Community organizations know the importance of reliable, representative, local data, especially for smaller geographical areas and subpopulations. The landscape of local data is changing, and public health agencies need to adapt as well. Since 2007, the Weld County Department of Public Health and Environment (WCDPHE) has conducted a triennial household-based Community Health Survey (CHS) using scientific random sampling to obtain population-level metrics for Weld County adults. Over the past few survey cycles resident response rates have steadily declined (similar to national trends). Therefore, for the 2025 CHS WCDPHE collaborated with healthcare partners (who utilize WCDPHE’s local data), to launch an incentive program in the hope that it would boost the response rate.
Agreements were made with local healthcare partners for their financial support and in return preliminary findings were shared with them in advance of the public data release. The CHS was sent out to 20,000 randomly selected households with instructions to claim a “$5 reward for completing the survey”. As part of the program a reward platform vendor was selected to distribute the post-survey incentives.
The 2025 CHS response rate increased by 36% with the most improvement in Greeley/Evans and the Southwest regions of the county. Younger and lower income residents requested incentives more often compared to older and higher income residents. This indicates there is potential for incentives to boost response rates for the aforementioned hard-to reach groups. Overall cost of the incentive program was around $12,500.
Higher incentive request rates from hard-to-reach populations support the notion that incentive effectively promote survey participation. This successful partnership demonstrates that robust, high-quality data at a local level is still achievable in a time when data is getting harder to come by.
MPH, Weld County Department of Public Health and Environment
Maya Swanson, MPH, is a Health Data Analyst at the Weld County Department of Public Health and Environment, where she has worked for just over a year. She received her Master of Public Health from the Colorado School of Public Health and holds a B.S. in Sociology and a B.S. in Cell... Read More →
Background/Purpose: Public health professionals make complex decisions amid competing priorities, rapid change, limited resources, and expanding data. However, more data does not consistently lead to better decisions. Decision Intelligence (DI) is a framework that integrates data, human judgment, and context to improve decision quality. DI Maps relationships between actions and outcomes, enabling faster learning compared with testing one intervention at a time. This presentation introduces two DI interventions and their results. Methods: A DI framework was applied within two continuous quality improvement projects. Participants included public health staff and clinical partners. Procedures included elicitation sessions to develop Causal Decision Diagrams, a DI tool that maps decision-making by identifying goals, outcomes, external factors, actionable levers, and intermediates. One project focused on increasing referral capture within a practice, while the second examined conversion of referrals into scheduled visits. Data sources included referral volume, provider participation, and scheduling outcomes tracked over time. Analysis involved iterative PDSA cycles, trend monitoring, and refinement of decision levers to improve system performance. Results: The first of two DI projects is more mature, with initial results showing meaningful improvements in outcomes. Referrals increased from a baseline of 30% to 34% in Q4 2025 and was sustained at 33% in Q1 2026, with average monthly referrals increasing from 12.5 to approximately 14–14.25. The number of referring providers increased from three to six. These outcomes, alongside the associated Fussing Hard campaign, generated interest from Family Connects International for nationwide scaling. The second DI project, focused on conversion of referrals to scheduled visits, is newer, with preliminary results expected in September. Implications: DI helps public health professionals move faster and with greater clarity in complex systems. Rather than relying on slow, trial-and-error approaches, DI makes it possible to identify high-impact actions earlier and focus effort where it matters most.
Political rhetoric often stigmatizes immigrants as a drag on the U.S. health care system, but the Colorado Health Access Survey (CHAS) finds that immigrants use less health care than U.S.-born residents. The pattern is consistent for every form of health care use measured by the CHAS. It reflects a mix of interconnected factors, such as cost, access, and, more recently, fears about federal immigration actions that have led many immigrant community members to delay or avoid care altogether.
By combining data from the 2023 and 2025 CHAS surveys, CHI examined interactions with the health care system through the lens of insurance coverage, care utilization, employment, education, and food and housing security. One of our strongest findings shows a 12-point gap between immigrants and U.S.-born Coloradans who had at least one health care visit in the previous year. For immigrants who speak Spanish at home, the gap is twice as large.
The environment has shifted even since the survey was in the field. One multistate survey found that 84% of health care workers reported a significant or moderate decrease in immigrant patient visits following the January 2025 executive orders on immigration. Physicians have reported increased no-show rates among immigrant patients, and the presence of Immigration enforcement near health care settings has been driving care avoidance, including among people with legal status.
These fears carry real health consequences. When people avoid care, conditions go unmanaged, and outcomes worsen. This is an important issue for public health professionals because health care settings have long been understood as spaces where safety and care are guaranteed regardless of background. When patients fear that seeking care could lead to an immigration enforcement encounter, the result is a chilling effect that extends well beyond undocumented people and into mixed-status families and communities broadly.
Suicide continues to be a prominent public health concern in Colorado, even as the statewide age-adjusted suicide rate has stabilized in recent years. Because suicide is complex and isn’t caused by a single factor, suicide prevention requires multiple strategies and diverse, collaborative partnerships - which the National Strategy for Suicide Prevention calls community-based suicide prevention. Since 2019, the Colorado Office of Suicide Prevention has led and funded the Colorado-National Collaborative (CNC) to implement local community-based suicide prevention strategies in 15 Colorado counties with high counts and/or rates of suicide fatalities. Using a collective impact model, local CNC backbone organizations coordinate local partnerships and activities to reduce suicide by implementing and evaluating efforts to increase connectedness, education and awareness, access to economic supports, access to safer suicide care, lethal means safety, and postvention support. This presentation shares the following findings to date from the CNC implementation: 1) What are the key activities needed to implement a community-based suicide prevention program? and 2) How can a community-based comprehensive suicide prevention program be evaluated and monitored using a collective impact model? Using data from the CNC’s ongoing evaluation efforts, the presenters will also share findings on how the CNC’s six pillar strategies might be expanded into similar community-based comprehensive suicide prevention models in new communities.
(30-minute session submitted for consideration, but addendum below addresses activity for 1-hour session. ) Presenters will lead an interactive session that guides attendees through a planning exercise to bring community-based suicide prevention efforts to their community. In doing so, this session will introduce how a collective-impact design can be used by local backbone organizations to effectively collaborate with community partner organizations to develop local suicide prevention strategies. This exercise will also show how a collective impact model informs data collection for program evaluation when resources are limited.
PhD, Colorado Department of Public Health and Environment
Tate Steidley is the evaluator for the Colorado Office of Suicide Prevention. He supports the Office with data collection and evaluation activities across a wide range of programs administered by the Office. He holds a PhD in Sociology and is passionate about helping the Office of... Read More →
Background/Purpose: Rural Colorado communities continue to experience persistent health inequities influenced by social determinants of health (SDOH), including healthcare workforce shortages, transportation barriers, housing instability, food insecurity, limited broadband access, behavioral health service gaps, and geographic isolation. These challenges disproportionately affect older adults, agricultural populations, low-income families, and frontier communities. This presentation examines the question: How can public health professionals and community partners create sustainable, equity-focused approaches that improve health outcomes in rural communities? The session explores how cross-sector and community-driven strategies can address barriers while strengthening resilience and well-being.
Methods: This presentation draws upon community assessments, rural behavioral health initiatives, public health literature, and applied examples from Colorado communities. Participants will review population-level data related to rural health disparities and examine case examples of collaborative interventions. Methods highlighted include community engagement approaches, collective impact strategies, systems-level partnerships, and implementation frameworks designed to improve access and equity.
Existing research and practice demonstrate that integrated and community-centered approaches can improve access to care, strengthen service coordination, reduce barriers to behavioral and physical healthcare, and enhance community capacity. Emerging evidence suggests that partnerships involving healthcare systems, Extension services, community organizations, and local stakeholders can create more sustainable solutions for addressing SDOH and reducing disparities.
Participants will leave with practical tools for identifying key social determinants affecting their communities and strategies for designing collaborative, equity-focused interventions. Take-home messages include the importance of leveraging community assets, strengthening cross-sector partnerships, and implementing systems-level solutions that support long-term health improvement.
Additional time is requested to allow participants to engage in facilitated discussion and small-group activities focused on identifying local barriers and developing actionable strategies that can be adapted to their own communities. Interactive discussion will promote shared learning and peer-to-peer problem solving aligned with the conference theme of strengthening communities through collective action.
