H4.01 - Oral: Nourish and Flourish Conversation Guides: Health Equity Resources for Mental Health Community Support Programs

Brief Abstract Summary: Access to mental health services is often a challenge for low-income populations and people of color due to lack of insurance, stigma, and difficulty finding mental health providers. A strong link exists between food insecurity, the stress of unmet basic needs, and depression. The University of Minnesota Extension partnered with nine mental health community support programs (CSPs) to promote healthy lifestyle initiatives for clients and staff. A photovoice project with 40 CSP clients and staff identified key health messages for a customized resource. Seven conversation guides were developed for CSP staff to facilitate discussions on food, physical activity, and mental well-being. These guides use motivational interviewing, focusing on adaptable themes for dialogue, self-reflection, lifestyle changes, and goal setting. After a pilot test, feedback showed staff found the guides effective, while clients reported learning about themselves, feeling motivated, and setting personal goals.

Detailed abstract description:

Background: The University of Minnesota Extension established partnerships with 9 mental health community support programs (CSPs) to foster healthy lifestyles for clients and staff. A significant portion of the individuals served by the CSPs grapple with chronic health issues and are low-income. Accessing mental health services is challenge for low-income populations and marginalized communities for many reasons, including lack of insurance, stigma, and difficulty finding mental health providers from underrepresented communities. A strong link exists between food insecurity, the stress of not meeting other basic needs, and depression.

Initially, Extension educators implemented a direct education approach using multi-session curricula focused on mental wellbeing. Many clients had trouble fully engaging because of day-to-day challenges due to mental illness. Consequently, a pressing need existed for a more customized approach to nutrition and healthy lifestyle education within the CSPs. Almost half of all Minnesota counties identify mental health and well-being as a top priority in their Community Health Improvement Plans. Extension involved people diagnosed with chronic and persistent mental health illness, a community often left behind in our health care system, in the development of a more customized approach.

Description: A photovoice project involving 40 CSP clients and staff was conducted to identify essential health messages for inclusion in a customized educational resource. From the photovoice project seven Nourish and Flourish "conversation guides" were created for CSP staff to facilitate discussions with clients regarding food, physical activity, and their link to mental well-being. The guides incorporate motivational interviewing techniques and center around themes with a predefined discussion structure. The guides are adaptable rather than prescriptive, offering suggestions for opening dialogue, self-reflection, lifestyle adjustments, and goal setting using trauma-informed approaches.

Lessons Learned: After a pilot test involving staff and clients from nine CSPs, feedback was gathered through surveys and interviews. Staff responses (n = 49) indicated the guides were effective in initiating conversations and conveying key messages, while clients (n = 148) reported learning about themselves, feeling inspired to try new things, and setting goals at the end of the conversations (94%). Suggestions for enhancing the guides were also received and incorporated into revisions, refining their content and format.

Implications: The Nourish and Flourish conversation guides incorporate individuals' experiencing mental health challenges who participated in the photovoice activity. The guides were developed for CSP staff to spark relevant health and nutrition conversations, which may enable clients to practice healthy lifestyles. Unlike typical health resources, the guides utilize messages identified by individuals with lived experiences.