Metro Denver Partnership for Health’s Community Mental Health Ambassador Program

Collaboration

The Metro Denver Partnership for Health (MDPH) (colo.health/MDPH) is a partnership of key stakeholders committed to improving health in metro Denver through regional collaboration and action. MDPH is led by the local public health agency partners serving the seven county Denver metro area, including public health departments for Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson Counties.

MDPH also includes health systems, Regional Accountable Entities, human services, and regional health alliances and leaders. Partners work on a variety of population health issues, such as climate, equity, immunizations, COVID-19, and behavioral health. MDPH's work impacts over 3.3 million Coloradans — 60% of the state's population.

Public Health Issue

Mental health stigma is a significant barrier that stops people from getting the behavioral health care they need. According to the 2021 Colorado Health Access Survey (CHAS), 47.4% of people in the metro Denver region did not get needed mental health services because they did not feel comfortable speaking about personal problems. Furthermore, Coloradans who identified as Black or African American and Hispanic or Latino/o were more likely than their white counterparts to report not getting needed mental health services because of stigma.

Goals and Objectives

Goal 1: Reduce the percentage of self-reported mental health stigma among Black or African American, Hispanic/Latinx, and LGBTQ+ populations.

Objective 1A: Decrease the percentage of Black or African American, Hispanic/

Latinx, and LGBTQ+ populations in metro Denver who have reported eight or more days of poor mental health in the last month by 2025.

Objective 1B: Identify what mental health stigma reduction messages and strategies may resonate with priority populations.

Objective 1C: Ambassadors and community members report they have gained knowledge and improved understanding about stigma and mental health.

Goal 2: Increase the likelihood that ambassador organizations will partner with health care or public health partners (for example, hospitals and local public health agencies) to address challenges, barriers, and needs for future health topics.

Objective 2.A: Promote bidirectional information sharing and best practices in mental health messaging among community partners by hosting monthly Communities of Practice (CoP) meetings with community ambassadors and MDPH liaisons.

Practice Overview and Activities

MDPH is partnering with community-based organizations (CBOs), known as

ambassadors, to help reduce stigma associated with mental health. Ambassadors are trusted leaders in the community and serve populations that have disproportionately negative mental health outcomes. Ambassadors are experts in community engagement and help make public health messaging more effective. From December 2021-June 2022, MDPH contracted with six community-based organizations that serve the Black/African American and Hispanic/Latinx communities in metro Denver. In the current program cohort (October 2022 to present), MDPH is partnering with up to 15 organizations, including CBOs serving LGBTQ+ people.  

To promote positive mental health messages, ambassadors are encouraged to use research and language developed as part of MDPH's Let's Talk Colorado campaign (https://letstalkco.org/). The campaign encourages individuals to have conversations about their mental health with trusted sources. Ambassador organizations are paid up to $30,000 to increase their capacity, disseminate Let's Talk Colorado anti-stigma messaging, and adapt messaging to fit their community. For example, one ambassador participated in a large-scale radio broadcast campaign to promote mental health awareness.

To encourage connections between ambassadors and local public health and health care partners, each ambassador is supported by an MDPH liaison. Liaisons are MDPH-partner local public health or health care staff members. Liaisons support, train, engage, and equip ambassadors to act as influential messengers. MDPH also supports bidirectional information sharing and best practices through a regional CoP meeting among ambassadors, their partners, and MDPH liaisons.

In early 2022, ambassadors collected detailed information about perceptions of mental health, stigma, and anti-stigma messaging via a community survey and focus groups with community members.

Results and Outcomes

Reach: Over the first seven months of the program, ambassadors reached an estimated 32,900 people with mental health programs and messaging.

Local Information about Stigma and Messaging: MDPH helped ambassadors collect community-level information about perceptions of mental health through a community survey and focus groups. MDPH collected this type of data to identify needs in the community and continuously improve the ambassador program.

Improved Ambassador and Community Understanding of Mental Health: Results from MDPH's evaluation efforts indicated that after the program, ambassadors felt they knew more about available mental health resources and reported that community members were more willing to talk about mental health. They also felt more confident in their ability to decrease stigma in their communities.

Improved Health Care Partnerships: Results from MDPH's evaluation efforts indicated that all ambassadors were encouraged to partner with health care or public health agencies because of the program. Ambassadors also indicated that they were more likely to work with public health and health care partners in the future.

Success Factors

The ambassador program is successful because MDPH's track record of collaboration promotes high levels of trust between ambassadors and liaisons. Additionally, ambassadors have access to a wide range of resources through MDPH's regional network, including mental health experts in the various health departments and health care systems that are a part of MDPH. MDPH also has a backbone of administrative support to facilitate these activities so liaisons and ambassadors can focus their time on content creation.

Public Health Impact

By working with CBOs to inform and execute culturally relevant interventions, MDPH has improved community member understanding and retention of public health messages. Implementing culturally relevant interventions is associated with better outcomes and more positive experiences with the health care system. MDPH is collecting data on these outcomes biyearly through the CHAS.

Health Equity and Community Engagement

MDPH conducted interviews with priority populations to identify ways to better reach traditionally underserved people through the Let's Talk Colorado campaign. All interviews highlighted the need to meet people where they are, including providing materials in community locations, such as community-based organizations. Partnering with these types of organizations to increase visibility and trust are the key pillars behind the ambassador program and how MDPH ultimately aims to utilize approaches intended to improve health equity to support these groups.

Target Populations

Mental health stigma remains a significant barrier that prevents people from seeking the help they need. According to the 2021 CHAS, 23.5%of metro Denver residents reported eight or more days of poor mental health in the past month, up from 15.4 percent in 2019. Despite the need, many adults do not seek professional help because of stigma associated with mental health issues. According to the CHAS, 47.4% of people who did not get mental health services even though they needed them said they did not feel comfortable speaking about personal problems. Another 23.8% of people who skipped mental health care said they were worried what would happen if someone found out they had a problem. While stigma affects people from all groups, Coloradans who identified as Black or African American were 20.0-23.3% more likely than their white counterparts to report not getting needed mental health services because of stigma. Those who identified as Hispanic or Latino/a were 11.1% more likely than white survey respondents to report not getting needed services because they were worried what would happen if someone found out they had a problem.

To address these health disparities, MDPH partnered with ambassador organizations to reach Black or African American and Hispanic or Latino/a communities in the metro Denver region. The metro region is home to 60% of the state's population, or roughly 3 million people. Approximately 5.2% (168,000 people) of metro residents identify as Black or African American, 22.6% (731,000 people) identify as Hispanic, and 4.8% (103,000 people) identify as LGBT (Sources: Metro Denver EDC, UCLA Williams Institute). While it is difficult to determine the percentage of the target population reached, ambassadors interacted with an estimated 33,000 people in the metro region during the first seven months of the ambassador program.

Root Causes

Mental health stigma is deeply rooted in cultural norms and often comes from a lack of understanding or fear of mental health conditions. Many people are afraid of being diagnosed with a mental health condition because they fear they will be ostracized or rejected by society. Additionally, some historically persecuted communities have experienced high levels of trauma that have not been addressed, contributing to mental health stigma across generations. Addressing mental health stigma takes time; however, it can be reduced if trusted messengers in communities encourage people to talk about mental health and seek professional help if they need it. That is why MDPH partnered with community ambassadors — trusted leaders embedded in the community through the work that they do.

Although increasing access is also important to address behavioral health outcomes, addressing stigma is an upstream approach that tackles a prevalent barrier that discourages people from seeking services in the first place.

Health Equity

MDPH believes that sharing decision-making with communities can improve trust, address disproportionate COVID-19 impacts, prevent future health disparities, and lay the foundation for future partnerships. The MDPH's mental health ambassador program utilizes the Health Equity Community Involvement Spectrum (https://www.denvergov.org/files/assets/public/public-health-and-environment/documents/communityengagementspectrum.pdf), as a framework for community engagement.

The spectrum includes a range of community engagement, from inform,” which is the lowest level of community engagement, to defer to,” which is the highest level where community members drive decision-making. The MDPH ambassador program operates at the second-highest level of engagement, collaborate,” where community members play a leadership role in implementation of decisions. For example, MDPH supported ambassadors to make decisions about mental health interventions according to their view of the most relevant and appropriate approaches for their communities. By leading decision-making about interventions, ambassadors ensured that their activities were culturally appropriate and responsive to community needs and preferences.

Practice Innovation

The MDPH mental health ambassador program is innovative because it combines the resources of a large network of local public health and health care partners with community-level leadership and expertise to make collective impact. Mental health stigma is deeply rooted in cultural norms, so the best messengers to combat stigma are those who are embedded in the community. With the support of the MDPH network, MDPH liaisons, and MDPH's administrative structure, ambassadors increased their knowledge and expertise in mental health messaging and the capacity of their organizations to provide mental health events and services. This approach of investing in ambassadors and trusted leaders of public health interventions prioritizes health equity, as it funnels resources directly to leaders of underserved communities.

Evidence-based

As a starting point for mental health messaging, ambassadors received materials from MDPH's Let's Talk Colorado campaign (https://letstalkco.org/). The Let's Talk Colorado campaign was created in partnership with Washington D.C.-based  FrameWorks Institute. FrameWorks conducted extensive research on mental health stigma in Colorado and developed the language and tone of the Let's Talk Colorado campaign. FrameWorks interviewed mental health experts and members of the public to examine cultural models and find areas of similarity in thinking about mental health. Using the results of those interviews, FrameWorks developed the messages included in the Let's Talk Colorado campaign, which were then adapted by ambassadors to ensure they were responsive to the culture of their communities and the needs and barriers faced by their constituents.

As mentioned above, MDPH utilizes the Health Equity Community Involvement Spectrum to guide the ambassador program. The Health Equity Community Involvement Spectrum is an evidence-based framework for community engagement adopted by Denver Department of Public Health and the Environment and was adapted from the Spectrum of Public Participation from the International Association for Public Participation.

MDPH Collaboration

Strong cross-sector collaboration is at the heart of MDPH's work. MDPH's vision is improved health in metro Denver through regional collaboration” and its mission is to build partnerships between our agencies and across sectors to increase capacity for achieving our vision.”

MDPH partners believe that health care, public health, human services, and other partners can have greater reach and impact by working collaboratively and contributing unique skills and strengths. Aligned activities enhance, rather than replace, existing local or internal efforts. Collaboration around shared health priorities, including creating common goals, has greater impact by leveraging the existing priorities of individual partners.

In 2020, MDPH developed a shared multisector governance structure that fosters increased transparency, clarity around roles and responsibilities, and accountability, ensuring sustainability of a broad collaboration for many years to come. MDPH used these principles and sound infrastructure to support the mental health ambassador program.

Goals and Objectives

The mental health ambassador program has two main goals, broken down into objectives:

Goal 1: Reduce the percentage of self-reported mental health stigma among Black or African American, Hispanic/Latinx, and LGBTQ+ populations.

Objective 1A: Decrease the percentage of Black or African American, Hispanic/

Latinx, and LGBTQ+ populations in metro Denver who have reported eight or more days of poor mental health in the last month by 2025.

Objective 1B: Identify what mental health stigma reduction messages and strategies may resonate with priority populations.

Objective 1C: Ambassadors and community members report they have gained knowledge and improved understanding about stigma and mental health.

Goal 2: Increase the likelihood that ambassador organizations will partner with health care or public health partners (for example, hospitals and local public health agencies) to address challenges, barriers, and needs for future health topics.

Objective 2A: Promote bidirectional information sharing and best practices in mental health messaging among community partners by hosting monthly CoPs with community ambassadors and MDPH liaisons.

Actions to Achieve Goals and Objectives

The MDPH Behavioral Health Workgroup designed the community ambassador program based on work during the COVID-19 pandemic. Since 2020, MDPH has funded CBOs to promote COVID-19 and influenza vaccines and host community clinics. The Workgroup decided to pilot this model for mental health messages after learning through interviews (see previous section) that it would be more effective promoting Let's Talk Colorado with priority populations in community settings than through a large-scale media campaign. MDPH created a program plan, budget, and logic model to begin this work.

To achieve Objective 1A, ambassadors identified and led activities to promote mental health awareness, reduce mental health stigma, and encourage people to seek professional help if necessary. Each ambassador designed an approach that suited their community and organization through a program plan they developed in tandem with an MDPH liaison. Because Objective 1A is a long-term change in health outcomes, MDPH continues to monitor progress towards this objective using survey data as described in the evaluation section of this application.

To achieve Objective 1B, two ambassador organizations hosted five community focus groups to test specific messages from the Let's Talk Colorado campaign. The objective was to identify specific messages about mental health and stigma that resonate and collect suggestions for what adaptations could make the messages more culturally relevant. From these focus groups, ambassadors gathered community feedback on Let's Talk Colorado language that they used to tailor appropriate messages for their community.

To achieve Objective 1C, MDPH liaisons served as subject matter experts, connected ambassadors with public health and health care resources, and advised them on messaging strategies. All of this was meant to increase the ability of ambassadors to be influential messengers for positive mental health. Additionally, ambassadors spoke with and interviewed community members to gain a better understanding of stigma and unmet needs regarding mental health and mental health services.

To achieve Goal 2, each ambassador was supported by an MDPH liaison. Liaisons were either local public health or health care staff from MDPH organizations. Liaisons supported, trained, and equipped ambassadors to act as influential messengers. Ambassadors and liaisons met on a regular basis to update each other and troubleshoot any issues. Liaisons built trust between ambassadors and local public health and health care partners, so that ambassadors would feel comfortable working with these partners in the future to address other health needs.

To achieve Objective 2A, MDPH hosted monthly Community of Practice meetings for all ambassadors and liaisons. The aim was to (1) increase the capacity, knowledge, and skills of community ambassadors related to mental health needs and services, (2) enhance peer sharing and innovative strategies utilized by ambassadors, their organizations, and liaisons to inform local strategies, and (3) create a regional structure to share and respond to community concerns and needs related to public health.

Time Frame

The first round of the MDPH mental health program started in December 2021 and ended in June 2022. The program was renewed for a second round of funding that started in October 2022 and continues through June 2023.

The Role of Local Health Departments

The local health departments (LHDs) of the seven-county metro Denver play key leadership roles in MDPH. The LHDs, along with the other MDPH partners, designed the mental health ambassador program from the ground up, including the model for community engagement, evaluation efforts, and ongoing program support by acting as liaisons. LHDs and other MDPH partners meet at least monthly to discuss and continually improve the ambassador program, including developing topics for CoP meetings, creating resource lists for ambassadors, and other as-needed support. By acting as liaisons to ambassador organizations, LHDs form personal connections with ambassadors and build trusted relationships between community and public health.

Equity

To ensure that the populations most impacted by mental health stigma were served by the ambassador program, MDPH chose to partner with organizations that serve Black/African American, Hispanic or Latino/a, and LGBTQ+ communities. The ambassadors from these organizations are experts in communicating with their communities and took a leadership role in the design and implementation of mental health interventions. Additionally, MDPH committed to language justice throughout the program and provided services to translate materials to Spanish to accommodate community members who only speak or who prefer to speak Spanish. This included live interpretation in Spanish for all Community of Practice (CoP) meetings. The CoP was designed to ensure meaningful bidirectional collaboration with the target populations.  

Budget

Yearly program costs include ambassador stipends (up to $30,000 per CBO). Ambassadors' scope of work depends on the funding tier in which they participate. A higher funding tier includes focus groups, additional touchpoints with or events in the community, and a required presentation at a CoP.

Additional project costs include program coordination, administration, facilitation, and contracting support (0.4 staff FTE), as well as subcontracts for translation and interpretation services ($7,000) and support for adapting marketing materials ($25,000).

MDPH used a variety of methods to assess progress toward program goals and objectives, including both qualitative and quantitative data collection.

What MDPH Learned: Mental Health Stigma

 One of MDPH's objectives with the ambassador program was to collect information from community members about perceptions of mental health and stigma through surveys and focus groups as described below. MPDH found the following key themes related to stigma and barriers to care:

(1) Negative Attitudes Toward Mental Health: The fear of being judged, labeled, or perceived as weak keeps many community members from discussing mental health. Embarrassment and shame about mental health difficulties also keeps them from seeking help or talking about their mental health.  My community does not feel comfortable talking about their mental health with peers or mental health professionals,” one ambassador said. There is a stigma attached to mental health issues and the admission of issues among peers. There is a feeling that mental health issues are a luxury that those in my community cannot admit to.”

(2) Lack of Trust in the Health Care System and Government: Fear of unfair or discriminatory treatment by health care providers discourages people from seeking mental health treatment. Additionally, they are concerned about the security of their health and personal information and how involvement in the health care system interacts with government agencies, specifically the criminal justice system and immigration authorities. I mean, in [the Black] community, we have such a lack of [trust] in the criminal justice system, health care system, all of the systems you can think of, right?” a focus group participant said.

(3) Lack of Culturally Responsive Care: Not having access to a mental health care professional from the same cultural background can be a barrier to seeking care. For the Hispanic/Latinx community in particular, access to Spanish-language services is important for communicating and building trust with providers. As one focus group participant put it, The fact that mental health personnel do not speak the same language as the patients can cause difficulties because a translator is needed, and this complicates the chain of communication.”

(4) Concern for Cost of Care: The cost of mental health services is a deterrent for many community members, especially for those who are uninsured. Many Latinos are not looking for mental health services because they are also concerned about the cost this help may bring,” a focus group participant said.

Objectives Achieved: Outcome Measures Methods and Progress 

MDPH's first objective, Objective 1A, is to decrease the percentage of Black or African American, Hispanic/Latinx, and LGBTQ+ populations in metro Denver who have reported eight or more days of poor mental health in the last month by 2025. This objective is a long-term goal that will be measured over the span of a few years. To measure progress, MDPH utilizes data from the statewide Colorado Health Access Survey (CHAS), which is repeated every two years, and a community survey distributed by ambassadors to gather aggregate regional and specific local data about mental health stigma and service utilization.

In addition to analyzing the percentage of respondents who have reported eight or more days of poor mental health, MDPH uses the CHAS to select priority populations to collaborate with the ambassador program. MDPH will use the CHAS on a continuing basis to assess change in stigma and behavioral health access in 2023 and 2025 as well. This includes demographic information and other outcome data such as: (1) reasons why people do not get the mental health care they need, (2) percentage who spoke to a health care provider about mental health in the past year, (3) percentage who spoke to a mental health professional in the past year, and (4) percentage of people who needed but did not receive mental health services. Equity-specific outcome measurements include analyzing disparities in mental health stigma and access among priority race/ethnicities, gender, insurance types, location of residence, housing status, and age groups. 

Objectives Achieved: Process Measures Methods and Progress

Focus Groups and Community Survey: Objective 1B is to identify what mental health stigma messages and strategies may resonate with priority populations. To achieve this objective, two ambassadors — one from the Black/African American community and one serving the Hispanic/Latinx community — hosted focus groups to collect feedback on specific mental health messaging. In total, there were 41 focus group participants, 24 from the Black/African American community and 17 from the Hispanic/Latinx community. Focus groups were held both online and in person.

Focus group participants gave feedback on how mental health messaging should be shared and what topics they would like to see promoted in the future. For example, the Hispanic/Latinx focus group highlighted the need for youth-specific mental health messaging in their community. Participants felt that adapting messaging for youth about bullying and substance use was particularly important.

Participants also discussed how mental health messaging should be shared. For example, the Black/African American focus group suggested using a variety of media to reach different age groups in the community, including radio, social media, newspaper, TV commercials, graffiti art, and text messages. The focus groups also provided insight about mental health stigma in their communities; some of the quotes from those focus groups are featured above.

In addition to focus groups, ambassadors surveyed community members to further understand stigma-related barriers among the Black/African American and Hispanic/Latinx populations in the metro region. The community survey, made available in both English and Spanish and in both paper and electronic formats, was distributed by ambassadors in March 2021. In total, 144 people responded: 34% identified as white, 30% identified as Black/African American, and 56% of respondents were Spanish speakers.

MDPH used the survey to further explore CHAS results and asked respondents about a variety of mental health topics, including: (1) outlook on mental health, (2) mental health services, and (3) mental health conversations.

Key findings from each of these areas include:

(1) Outlook on Mental Health: MDPH found that most people (90%) view mental health as part of overall health and talk to their friends and family about it (69%). However, about three out of 10 people don't talk to their friends or family about mental health.

(2) Mental Health Services: Most people view professional services as helpful (85%), but many (54%) do not know what local resources are available or do not have local resources consistent with their beliefs/customs (62%).

(3) Mental Health Conversation: Over half (56%) of people said they are comfortable talking about their mental health when they feel safe and are able to confide in a trusted individual who does not judge them. Other respondents said they feel uncomfortable talking about their mental health because it's not something they talk about much and they are afraid of the other person's response.

MDPH aims to repeat the community survey in the future rounds of programming to assess changes in perceptions of mental health and availability of culturally relevant mental health resources and to inform approaches for the ambassador program moving forward.

These two methods, focus groups and the community survey, allowed MDPH to identify the messages and approaches to mental health conversations that most resonate with community members, fully achieving Objective 1B.

Ambassador Pre/Post Surveys and Monthly Report: Objective 1C is for ambassadors and community members to gain greater knowledge and understanding of stigma and mental health. Ambassadors completed monthly reports outlining the successes and challenges of their activities. Ambassadors also anonymously completed a pre- and post-program survey. The survey asked ambassadors to rate (1) their knowledge level about mental health stigma in their community, (2) comfort having conversations about mental health, and (3) level of partnership that their organization engages in with other public health entities. Results showed that:

(1) Ambassadors felt they were very knowledgeable about mental health stigma after the program and, on average, felt they knew more about mental health resources available in their communities. They also felt community members were more willing to talk about mental health after the program.

(2) On average, ambassadors felt more confident in their ability to decrease stigma in their communities, including by having mental health conversations with community members.

(3) All ambassadors were encouraged to partner with health care or public health agencies. Ambassadors indicated that their partnerships with these entities increased after the program. Additionally, five out of six ambassador organizations reported they were likely to work with public health partners in the future compared with only three out of six before the program.

Results from the pre/post ambassador surveys demonstrate that Objective 1C and Goal 2 (increase the likelihood that ambassador organizations will partner with health care or public health partners) were achieved.

Objective 2A is to promote bidirectional information sharing and best practices in mental health messaging among community partners by hosting monthly Community of Practice (CoP) meetings with community ambassadors and MDPH liaisons. Through the monthly reports, MDPH continually assessed the effectiveness of the CoP meetings and incorporated ambassador feedback and input to make the meetings more useful and informative.

Modifications

One of the most important lessons MDPH learned was to expect variety in ambassador activities and then embrace flexibility when measuring program impact. Ambassador organizations each had different programming capacities, connections to the community, and approaches toward delivering messaging — all of which resulted in a variety of activities. For example, some organizations conducted large-scale media campaigns, while others opted for small, intimate discussion circles. The variety of activities made it difficult at times for liaisons to gauge how ambassadors were doing compared with program requirements and expectations. It is important to anticipate and support a variety of activities and communication strategies from ambassador organizations, without valuing one over another. This is also related to understanding program impact and evaluation. It is difficult to compare strategy outcomes when ambassadors implement diverse interventions. Flexibility, and qualitative data are key, but what constitutes success should be dictated by ambassadors. This is an ongoing and continuous process.

Sustainability

MDPH has a shared, multisector governance structure that fosters increased transparency, clarity around roles and responsibilities, and accountability, ensuring sustainability of a broad collaboration for many years to come. MDPH has prioritized behavioral health as a focus for its activities. All partners are committed to contributing with financial and materials resources as well as personnel. The mental health ambassador program has been designated as the primary behavioral health activity for 2023, and MDPH has received three additional grants to continue the work and expand into new communities. MDPH's commitment will ensure multistakeholder engagement and sustainability of the program in years to come.

Additionally, MDPH has encouraged peer-to-peer learning by inviting an ambassador organization from the first round of funding to serve as a mentor to new ambassadors in the second round of funding. By creating peer mentorship relationships, MDPH hopes to build a wealth of knowledge among the ambassador cohorts that will facilitate the smooth continuation of the program.

Lessons Learned

Through monthly reports, MDPH collated information on common challenges that ambassadors faced; these challenges will be addressed by liaisons in future program iterations. These challenges include:

(1) Not having culturally appropriate materials, tools, and resources to share with community members.

(2) Let's Talk Colorado messaging has not been tested for those under age 18, and reaching young people was not a goal of this program. Ambassadors noted that having youth-specific materials, tools, and resources about mental health would have been helpful, considering the mental health crisis the nation is currently facing.

(3) Community events were difficult to host due to COVID-19 and adverse weather in the winter.

(4) Creating trust was difficult, especially in group settings. Ambassadors found it challenging to start a conversation about stigma when people think that mental health should be discussed privately.

MDPH liaisons and staff reflected on their experiences in the ambassador program and identified the following improvements that could be implemented:

(1) Need for translation services and bilingual liaisons: To ensure program communications were accessible to Hispanic/Latinx ambassadors and community members, MDPH used translation services to adapt Let's Talk Colorado messaging, emails, and other materials. Additionally, the CoP meetings included live Spanish interpretation. However, to best serve Spanish-speaking ambassador organizations, especially those with staff who speak only Spanish, MDPH should recruit a bilingual liaison.

(2) Equipping ambassadors with tools to follow up after stigma conversations: Part of addressing stigma and raising awareness of mental health means having a place to refer people to appropriate care. Liaisons should provide ambassadors with information about referral resources early on.

(3) Accessing culturally responsive providers: MDPH received feedback from both the focus groups and ambassadors that having culturally responsive providers was a priority for many community members. Therefore, it is important for liaisons to work with and connect ambassadors to providers who are trained in culturally responsive care.

(4) Matching liaison skills with the needs of ambassador organizations: Liaison involvement was different for each ambassador organization. It's important for liaisons to assess the support each organization needs (such as mental health resources, engagement strategies, etc.). This could include a preference for a bilingual liaison. Liaisons should also receive continuing education and training in culturally responsive approaches, including humility and continuous learning.

Programs like the ambassador model are important in building sustainable relationships among local public health, health care partners, and CBOs. CBOs have a wealth of knowledge about issues facing their constituents and can direct local solutions. We hope that MDPH or others can adapt the ambassador model to address other community health needs. Assessing how to best coordinate community engagement efforts is one important next step for MDPH.