Beginning in July 2015, BHWP launched its work on the three-year Collective Impact for High Public Service Utilizers project (Collective Impact Project) under the sponsorship of the Office of Health Equity at the Colorado Department of Public Health and Environment (CDPHE). A coalition featuring key community partners—namely the Metro Denver Homeless Initiative (MDHI) and the Colorado Mental Wellness Network (CMWN)—was formed to determine and design the scope and approach of the work to be performed, as well as to support the work over the three-year timeline. During a time of great need, the project aimed to reduce health inequalities around the greater Denver metropolitan area. Specifically, the project sought to provide people who were homeless or at-risk of homelessness with support by offering screening, education, and services navigation in relation to prominent chronic diseases. Moreover, the project served to identify appropriate people for housing opportunities.
Of critical importance, the Collective Impact Project utilized Peer Navigators—people with relevant lived experiences—in order to better connect with and assist the clients they served. Working directly with vulnerable clients, the Peer Navigators provided general knowledge and support via role modeling recovery, advocacy, navigation to services, and education. This direct client connection was made possible by placing the Peer Navigators at participating community partner locations, including at the STRIDE Community Health Center (previously the Metro Community Provider Network), the Denver Public Library, and HOPE for Longmont. Under the supervision of skilled site managers, and with the ongoing support of BHWP, MDHI, and CMWN, the Collective Impact Project’s Peer Navigators reached a total of 1,071 needy people, of whom 823 were screened effectively for chronic disease, and a further 429 were referred successfully to healthcare services for treatment. The project’s innovative approach and the successes it achieved continue to serve as a model for agencies interested in implementing similar programs.