Multiple challenges face communities in accessing mental health. Existing resources and trainings often focus on crisis needs and immediate suicide risk. However, many people suffer from distress and moderate depression or anxiety, sometimes acutely and/or undiagnosed, that significantly impact their health and well-being. COMET fills that gap in resources for people in this "vulnerable space" and aims to prevent crisis.
COMET was developed by the High Plains Research Network (HPRN) Community Advisory Council (a grassroots group of ranchers, teachers, small business managers, students, retirees in rural eastern Colorado), rural mental health professionals, and health researchers. Supported by the Patient Centered Outcomes Research Institute, this partnership conducted a rigorous exploration of mental health gaps and assets in rural communities.
Recognizing that mental health functions on a spectrum, COMET™ (Changing Our Mental and Emotional Trajectory) teaches people how to intervene when they encounter someone who is in a “vulnerable space” and help shift the person’s mental health trajectory back to a place of wellness instead of proceeding towards a mental health crisis. COMET™ helps fill a gap and is a strong complement to other strategies to reduce the suffering resulting from the high levels of stress in rural, agricultural communities.
COMET aligns with rural cultural values of neighbor helping neighbor and communities being their own best resource. COMET empowers friends and neighbors to be more prepared to support others’ mental health needs – especially before a crisis. COMET does not to ask community members to “be the fix.” Rather, the program trains community members how to initiate a supportive interaction for a potentially emotional conversation using a simple, conversational seven-question guide. The seven questions/statements include: acknowledgment that someone “is not yourself,” asking how they are, observation of behavior or other change, asking about family or social life, an invitation to engage (continue the conversation then or later), optional self-disclosure, and next steps (help person more or exit). The COMET Questions are built around evidence-based techniques of using lay educators, mindfulness, and motivational interviewing approach. COMET is easy to teach and aims to make these tools more accessible to a broader community.
COMET™ Training Options
1. “COMET Community Training” for community members to learn and use the COMET Questions. Delivered by a two-person training team.
2. COMET “Train-the-Trainer” (TTT) Program: Trains local community members to successfully deliver the COMET Community Training. Provides Regional Trainers with program background, key concepts, and a thorough review of content and COMET questions. Identifies opportunities for local tailoring, such as local resources and health providers to which people can be referred. Also provides basic teaching tips.
Both trainings are 90-minutes and include experiential and didactic sections covering local mental health data, shared examples of being “the other person,” the COMET questions, role-playing, and action planning. Ideally, COMET trainings are delivered in-person; however, virtual versions of both trainings are available.
Trainees have included farmers/ranchers, law enforcement, coroners, health care professionals, teachers, and retail workers. 78% reported they were likely to tell someone that they have noticed a change in their mood or behavior after training compared to 50% before, and 81% were likely to invite an acquaintance or co-worker to talk about a potentially emotional situation after training compared to 57% before. Further, 74% reported an eight or higher on a scale of 1-10 for likelihood of using the COMET questions in the next 3 months.
Maret Felzien, MA
COMET Training Director
Maret Felzien is a native of rural northeast Colorado and is the Director for the COMET Training Program. Ms. Felzien is a founding member of the High Plains Research Network (HPRN) Community Advisory Council. She is a fourth-generation dry-land farmer and cattle rancher and recently retired from a 26-year career as associate professor and reading specialist at Northeastern Junior College. She has conducted multiple local and national workshops on engaging the community health research and programs. Previously, Ms. Felzien served as Chairperson for the Colorado Clinical and Translational Sciences Institute’s Partnership of Academicians and Community for Translation (PACT) Council. Ms. Felzien also was the first U.S. Patient representative for the Board of the North American Primary Care Research Group and is a current member of the PaCE (Patients and Clinician Engagement) Committee.
Kristen Curcija, MPH
COMET Program Director
Kristen Curcija, MPH, is a Research Services Senior Professional at the University of Colorado Department of Family Medicine. Her work focuses on practice-based and public health research, particularly in rural regions. She supports the High Plains Research Network and its Community Advisory Council. Her research experience and interests include diabetes, mental health, and treatment for opioid use disorder. She holds a Masters degree in Public Health from Benedictine University.
Joseph (JC) Carrica III, Ed.D., CAS
President & CEO, Southeast Health Group
COMET Lead Trainer
JC Carrica, a southeast Colorado Native, has dedicated his career to improving the lives of residents of rural areas with a focus on advocating for those struggling with addiction and mental illness. Carrica has served Southeast Health Group for two decades and is currently CEO. In 2020, Carrica was named to the National Council on Mental Wellbeing Board of Directors. He is involved in multiple community and statewide organizations and is head coach of a high school softball team.
If you've attended a COMET Community Training or a Training the Trainer (T4) event, and you've used the COMET questions in your community, we want to hear from you! Share your experiences with us online or by email so we can continue to improve this program.
IT MATTTRs™ helps communities and primary care practices reduce suffering from opioid dependence and use disorder (OUD).This program helps communities change the conversation around opioids and treatment and trains and supports primary care and behavioral health practice teams so that effective, outpatient treatment is locally available.
Developed by community members, OUD experts, and health researchers, IT MATTTRs™offers a host of evidence-based materials and resources to inform community members and increase access to local medication assisted treatment (MAT) for OUD in your community.
Primary care practices can play a key role in reducing a huge nationwide treatment gap for OUD. Over 40 primary care practices have been trained in the IT MATTTRs™ Practice Team Training, which provides information, implementation support, and resources that primary care practices need to provide treatment for opioid dependence and OUD. This training, and our Train the Trainer Program, help practices be part of the local solution.
Using a community-based participatory research method called Boot Camp Translation, a community-based awareness and action intervention around MAT for OUD has been developed for the IT MATTTRs™ program. Community-based campaigns were developed to change the conversation in rural communities around OUD, and increase awareness, knowledge, and utilization of MAT in rural local primary care practices. A variety of printed materials were created for the IT MATTTRs™ community intervention, including coasters, posters, program inserts, restaurant placemats, newspaper articles, letters to judges, movie advertisements, and websites.
Rural Diabetes One Day Education and Support Program (R-D1D)
Diabetes is more common in rural areas than the rest of the state. While diabetes self-management education and support (DSMES) is an evidence-based standard of care in optimal diabetes management, many people living in rural communities often do not have access to DSMES locally and it may not be culturally relevant, or integrated into the primary care practices where patients receive their diabetes care.
A time-efficient DSMES program delivered in English and Spanish via telehealth that encourages care partners and peer support is a creative solution to increasing access to DSMES and reducing the negative health outcomes associated with diabetes.
Working with community partners, this study will adapt, implement, and evaluate an existing DSMES program, called Diabetes One Day, for use in rural communities and practices. The program, called the Rural Diabetes One Day (R-D1D) will be implemented in two clinics in rural Eastern Colorado. The results of this study will inform a larger-scale study and, ultimately, the sharing and spread of this Rural-Diabetes One Day program throughout eastern Colorado and other rural regions of the country.