From Classrooms to Communities: Building Bridges Between Sexual Health and Youth Mental Wellness in Pueblo

Written by Hannah Groves of Trailhead Institute, made possible by the shared knowledge, expertise andwork of Hannah Kochen, former Regional Health Connector (RHC) in Region 7 and the partnership of Pueblo Department of Public Health and the Environment (PDPHE). Additional support and context provided by Justin Gage, Program Manager with PDPHE.

Pictured: Hannah Kochen served as the RHC for Region 7 (Pueblo County) from August 2021 to June 2023. 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.

In the two years she served as Regional Health Connector (RHC) in Pueblo County, Hannah Kochen made a big impact to support young people’s mental health in Pueblo County, which is RHC Region 7. Her journey to understanding and addressing young people’s mental health needs started in what some might consider a surprising place: in a sexual health classroom.

Hannah split her time at Pueblo Department of Public Health and Environment (PDPHE) between RHC work and PDPHE’s Adolescent Pregnancy Prevention Program (APPP). This means she spent a lot of time with teens (ages 12 – 19) talking about sexual and reproductive health and hearing where they were succeeding and where they were struggling.

A common theme she heard from the teens she worked with was that many of them do not have healthy, satisfying relationships with themselves or with others (including friends, family, and intimate partners). Another theme that arose was that many young people in Pueblo County were needing additional support for their mental health.

“I already worked with adolescents through our Adolescent Pregnancy Prevention Program (APPP), and being in the schools and in youth organizations, there was a need for mental health services that really had a tie to sexual and reproductive health. Especially with healthy relationships and not knowing what a healthy relationship is. Adolescents are the next generation to be in the workforce, to go to college… if we can help them navigate these situations and feelings then we can help them have a healthier and better life.” – Regional Health Connector, Hannah Kochen

Hannah leveraged her existing connections and relationships with youth-serving organizations and teens to meet young people where they are at, which included listening to what teens themselves are worried about and who they go to in order to support their own mental health. To dive deeper into the conversations Hannah was having in classrooms and with youth-serving organizations, a survey was developed for youth.

The survey was filled out by 165 teens and asked them questions about their mental health and their access
to supportive services and resources. This included assessing barriers to services that young people experience, what resources they do use, and who they trust to talk to about their mental health. The survey revealed that there are many things on teens’ minds about their mental health needs: affordability and timing of services, confidentiality concerns, cultural beliefs, language accessibility, and more. Hannah and the team at PDPHE are considering all these concerns as they work to build partnerships and improve access to and knowledge of resources.

For more information on data in Pueblo County click here to visit PDPHE’s webpage.

Upon seeing the results of the survey, something immediately jumped out to Hannah, a takeaway which sparked a longer-term project and effort across Pueblo County; when it comes to mental health,

“Teens feel more comfortable going to other teens- their peers – than going to an adult.” -Regional Health Connector, Hannah Kochen

A first step Hannah and PDPHE took upon seeing this preference was to begin fostering stronger support networks among teens. When looking at existing tools, Question, Persuade, Refer (QPR) suicide prevention trainings were identified as an opportunity to create and strengthen internal networks for peer support. So, Hannah and her partners started implementing QPR trainings for youth through the school and organizations they were working with.

QPR is an evidence-based training program that is intended to teach people how to intervene in potential suicide attempts; it is intended to be an emergency intervention much like cardiopulmonary resuscitation (CPR) response (QPR Institute). There are many options for suicide prevention trainings, but QPR was selected because it is a trusted, wellutilized, and relevant tool in the Pueblo area.

Through a partnership with the Suicide Prevention Coalition of Pueblo County and the school district, a local trainer was able to modify the existing training materials for a middle school audience. QPR is not typically taught at this age level, so it was exciting to Hannah, PDPHE, and their partners to be able to offer age-appropriate and tailored training to young people in the community.

Learn more about Pueblo School District suicide prevention efforts here.

As peer-to-peer teen networks continued to be built by offering QPR training to middle- and high-school students, Hannah also worked on improving teen’s access to mental health services in other ways. When teens expressed not knowing about existing mental health services in the area, Hannah coordinated with her partners at youth-serving organizations to host presentations from local service providers by meeting teens where they are at. Organizations who provide mental health support and services were able to come talk to teens where they already hang out, particularly in schools and after-school organizations.

Our approach was meeting teens where they’re at. They don’t want to come to the health department in one of our conference rooms and have someone talk to them about mental health services. It can be an intimidating place, ot maybe you don’t want to run into someone you know. We’re meeting teens where they’re at, which is lowering the barrier for those that are unable to get transportation – those that can’t drive or don’t have a car – so we’re seeing them where they spend the majority of their time, at school or where they feel safe such as youth organizations. -Regional Health Connector, Hannah Kochen

By coordinating these service provider talks, Hannah and the team at PDPHE realized that there were a lot of smaller behavioral health providers in Pueblo County who many people do not know about, as they were eclipsed by the larger, well-advertised provider in the area. The drawback to this well-known provider is that they are highly utilized, and people often experience significant wait times (up to six months!) to access services. Hannah was able to connect the smaller providers identified over the course of this project to schools and to teens directly, which was of mutual benefit to teens and their families as well as the providers themselves.

Additionally, to address teens’ concerns about affordability, providers who offer a sliding fee scale and/or accept Medicaid or Medicare are identified and these affordable services are highlighted so teens know what options exist for individuals and families with limited financial resources.

Another way Hannah and PDPHE met teens where they are at was to help bridge connections between schools and local mental health providers. Teens expressed a need for a counselor or therapist on-site at school, whose sole role was to provide mental health counseling and therapeutic services (as opposed to existing services that mainly supported career or college counseling). Hannah connected a local school district with one of the smaller mental health providers identified through the project. This provider now
offers on-site drop-in hours at school so teens can stop by to talk about things that are bothering them. The hope is to be able to expand the hours and the number of providers offering this service over time, and to integrate this service into other schools in Region 7.

This is one example of how PDPHE is still working to identify community-led solutions, and that improving access to mental health services for youth and their families will continue to be a priority for the health department and future RHCs. Gaps still to be addressed include improving accessibility of services for the significant Spanish-speaking populations in Pueblo County and supporting the high proportions of grandparents raising their grandkids as primary caregivers in the areas. These are unique
needs of Region 7, which will require continued collaboration and innovative solutions to address.

Addressing mental and sexual health is a current priority for PDPHE, who hosts the RHC role. “It’s a priority of the health department because the community health assessment and community health improvement plan have identified behavioral and mental health as a need,” Justin Gage explains.

To help address this data-driven and community-identified need, PDPHE was recently awarded funding to focus on supporting healthy relationships among young people, which improve their mental health. This includes supporting protective factors for healthy relationships and continuing to provide needed health education.

The nuances of Pueblo communities’ need, and in particular the needs of young people, highlight why a locally embedded RHC is important to understand community context, strengths, and how to leverage existing resources to address gaps in care. Hannah moved on from the RHC role in June of 2023, but the impact of this project will continue. Before she left the role, Hannah summed up the immense impact her focus on youth mental health has had:

The impact that this project has had on the community is connecting a lot of the smaller organizations to schools and youth organizations, rather than just the generalized mental health organization that’s widely known in Pueblo. We were able to get other local organizations involved, connect teens to bilingual services, and offer other resources to meet everyone’s needs. Also, we listened to what teens’ needs are rather than making assumptions through our data collection. We made action items out of that – not just collecting the data and seeing what they said… but we responded to what they said. -Regional Health Connector, Hannah Kochen

One of the most unique aspects of this project is that it started within the realm of sexual health education. The teens Hannah talked to through her Adolescent Pregnancy Prevention Program (APPP) consistently brought up their desire for healthy, satisfying relationships and how the presence or absence of healthy relationships impacted their self-worth, self-confidence and overall mental health. For folks who work in sexual health promotion and education, the link between sexual health and mental health is clear.

“[Mental health] ties into every public health topic, especially sexual and reproductive health where we talk about healthy relationships and consent. A lot of our teens don’t know that information and then they go down a rabbit hole and can’t get out…. They feel a lot of peer pressure and can feel like mental health is taboo. That’s why we emphasize in our sexual health presentations that mental health is ok to talk about.” – Hannah Kochen, Former RHC

Trailhead Institute’s Youth Sexual Health (YSH) Program also understands this link, which is why they advocate for and support implementation of comprehensive sexual health education in Colorado. Comprehensive sex education has been shown to support mental health by improving confidence and self-esteem as well as improving knowledge, attitudes, and skills to promote healthy relationships. When students are provided medically-accurate, age appropriate, inclusive education, taught by trained educators, they receive valuable life skills and confidence to navigate relationships with others and themselves, which supports their overall mental wellness. Comprehensive sex education provides other mental and physical health benefits, too, summarized in this handout.

Learn more here about Trailhead’s Youth Sexual Health program and their services and offerings. You’re also invited to check out the State of Adolescent Sexual Health (SASH) report. The SASH is the dynamic result of a multi-year initiative rooted in liberation, reimagining, and collaboration between young people and adults to evolve the delivery of youth sexual health education in Colorado.

RHCs live, work, and play in their communities meaning they are immersed and can respond to emerging needs, have important community conversations, and then listen to and act on what they learn in real time. Hannah’s work within the Pueblo community is an exemplary model of this commitment to local solutions and flexibility that drives the RHC program to address key community health priorities.

Pueblo Department of Public Health and Environment (PDPHE)

This work would not be possible without the partnership and collaboration of Pueblo Department of Public Health and The Environment (PDPHE) as the host organization for the Regional Health Connector position in Region 7. The Pueblo Department of Public Health and Environment is committed to promoting the health and protecting the environment of Pueblo County.