As part of a multi-year collaboration between Advocates for Community Health (ACH) and UnitedHealthcare, Columbia Basin Health Association (CBHA) is one of five community health centers receiving $500,000 each to address complex problems affecting the overall wellness of the underserved communities where they provide care. We recently had a chance to talk to CBHA Director of Programs Dalina Hoffman to learn more about her health center and winning proposal.

Why is CBHA’s work in the community you serve so important?

CBHA strives to consistently provide high-quality, comprehensive healthcare services to those who live and work in our rural communities throughout Central Washington state. It is our mission to provide equal access to quality health care to all persons regardless of age, sex, color, ethnicity, national origin, or the ability to pay. Since 1972, the community of Othello, Washington, has relied on CBHA to support the healthcare needs of the medically indigent as well as migrant and seasonal farmworkers in our area. CBHA now sees over 38,000 patients and operates out of five clinics. We continue to expand our access to care by opening a dental clinic in Royal City and a medical clinic in Pasco, Washington. Additionally, local school districts turn to CBHA for help when students are dealing with behavioral health concerns, as well as student dental emergencies, and hearing and vision screenings.

We make it easy to access medical, dental, eye care, behavioral health, and family services all under one roof or through the convenience of telehealth. Most of our patient population are low-income families, including migrant and seasonal farmworkers. In 2022, 85% of patients reported incomes under 200% of the federal poverty guidelines; 54% of our patients are best served in a language other than English; 74% of patients are on Medicaid; 44% of our patients are migrant/seasonal farmworkers, and 23% of our patients are uninsured. CBHA is well-equipped with the resources and the experience to overcome the various challenges that rural clinics face such as language barriers, transportation difficulties, and the lack of medical professionals serving remote areas. CBHA’s focus on preventative care makes all the difference in keeping people healthy, preventing chronic conditions that affect people’s lives, and decreasing the cost of care. Access to mental health is in high demand and very difficult to find. With 50% of CBHA’s patients under the age of 18 years old, it was very important to partner with local schools to deliver care for this population.

Please briefly describe your winning proposal. How will the HIPAA-compliant ChatBot bridge the healthcare gap in your community?

CBHA was determined to find a best-in-class solution to meet the growing demand for increased access to behavioral health within our schools and throughout our communities. Even in the post-pandemic, our local school districts continue to notice absences across the board due to anxiety and emotional problems among students, whereas our CBHA clinics have noticed a steady growth in youth seeking care for anxiety and depression. The population that we serve in Central Washington State is primarily rural, and the cost of transportation has been proven to be an access barrier to care for most patients.

We know many students may feel uncomfortable telling their parents that they need to seek help, or quite possibly, the student needs to seek help due to an issue in the home involving the parents. Students spend most of their days at school, and most of them have smartphones that they are very accustomed to using. The solution was to create a uniquely innovative on-demand HIPAA-compliant ChatBot capable of collecting consent forms electronically, scheduling an appointment with a CBHA Behavioral Health Provider, and/or connecting them with immediate help through the local Adams County 24/7 crisis line. All the capabilities of the ChatBot are instantly accessible to the student by simply scanning a QR code on their smartphone or mobile device. Upon scanning the QR code, the student is greeted by Quincy, CBHA’s virtual ChatBot assistant, who instantly engages the student in a chat session to determine the level of help that they need at the current moment and immediately connects the student to someone who can help.  

This solution also allows for our providers to primarily stay within the CBHA clinics and continue to care for our general population while also seeing students via telehealth. Sending a provider to a school that is within close proximity of a CBHA clinic for an entire school day or traveling back and forth for multiple appointments at the school would not make sense for our small, rural communities or for the sake of patient care.

Now, a student seeking a telehealth appointment with a CBHA behavioral health provider may visit a school nurse/counseling office to use a dedicated iPad for scheduling/attending an appointment. Providing access within the schools is fundamental to our project because some students may forego accessing the behavioral health care that they need if they are unable to have their parents bring them to a CBHA clinic. Students may access the ChatBot without any worry that they will receive a bill or that they may face retaliation for seeking help. While CBHA always encourages parental involvement in a student’s health, it is important for older students to know that they can confidentially and safely reach out for support independently when needed.

Studies indicate that students who receive the appropriate behavioral health support have shown improved academic achievement, more likely to graduate, and more likely to attend and successfully complete college. Low-income and racial/ethnic minority groups, such as our specific patient population, are at a higher risk of not receiving needed behavioral health care. Specifically for youth, any untreated mental illnesses can absolutely interfere with their overall growth and development, which can continue into adulthood and beyond. Our goal is to remove barriers between a patient in need and the right provider. We have shifted our approach to be more proactive in reaching out to this target population at the right time and the right place.

How many students do you expect to impact during the first year of the ChatBot’s release, and what would a successful first year look like?

We anticipate impacting well over 5,000 students during the ChatBot’s first year, based on how many middle school-age and high school-age students are enrolled in Othello School District, Wahluke School District, Royal School District, and North Franklin School District. Any notable decrease in youth depression, anxiety, and suicides among youth through an increase in behavioral healthcare access due to the implementation of the ChatBot would be a true success. Also, a reduction in the stigma associated with behavioral health among youth encourages each other to reach out for the help that they need without feeling ashamed or embarrassed. Finally, an overall earlier detection of student behavioral health concerns within our local school districts to avoid the onset and progression of youth mental illnesses.

You can learn more about CBHA and its impactful work at https://www.cbha.org/.