Alexa Colgrove Curtis PHD, MPH, FNP-B

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Alexa Colgrove Curtis, PHD, MPH, FNP-BC, is the recipient of CANP’s 2020 Bridging Health Care Needs Award. Alexa has more than 30 years of experience as a family nurse practitioner caring for underserved populations in rural California communities. She currently leads a team that developed a rural opioid treatment program and directs a Youth Opioid Response grant creating walk-in services for youth dealing with substance use disorder and other behavioral health challenges.

Connections: You began your career as a family nurse practitioner in the Mojave Desert in Needles, Calif. and have worked with rural populations ever since then. What motivated you to choose rural practice setting?

Alexa: I was exposed to working in rural and remote communities through my work with the San Bernardino Health Department, which sent me to Joshua Tree and Needles, Calif. Since that time, I have continued to be drawn to the opportunity to make a significant impact in the lives of individuals and communities through nurse practitioner practice in medically underserved communities. There is so much needed and equally so much reward.

Connections: You have served in community health departments in Nevada and Placer counties, both of which include underserved rural areas. What were the needs you were trying to address while serving in those positions?

Alexa: Although I have also worked as an FNP in general family practice, my specific focus areas have consistently been adolescent health, reproductive health, and the prevention and management of substance use disorders. 

Connections: In recent years your work has focused on the health care needs of rural youth. Why are rural youth particularly vulnerable?

Alexa: Youth have actually been the focus of my clinical practice throughout my career. Rural youth have similar risk behaviors and health needs as urban and suburban youth with less access to health services and often fewer protective youth development resources. 

Connections: In addition to county-based work, you have focused on schools. What role should schools have in supporting the mental and other health needs of rural young people? 

Alexa: Schools are a great access point and a hub for health promotion activities for youth across the socioeconomic spectrum. There is consistent evidence that school-based health centers improve access to care, and improve health and education outcomes. Collaborations with school districts are an essential component of addressing the health needs and psychosocial well-being of youth, particularly for underserved populations. Nurse practitioners in schools is a win for communities. 

Connections: You have dedicated yourself to supporting people in recovery from opioid addiction. Can you describe the scope of the problem in the communities you serve?

Alexa: I think all you need to do is listen to the news to appreciate the scope of the opioid crisis, leading to overdose deaths, in the United States. Rural communities are particularly hard hit, again with a higher proportion of persons with addiction and a lack of treatment resources. It is important to remember that we are not just dealing with opioids; addiction to methamphetamines, benzodiazepines, marijuana, and alcohol, often in combination, are severely impacting the well-being of individuals, families, and communities.  

Connections: You are a Waivered Medication Assisted Treatment provider. Why is it important in the care and treatment of opioid addiction disorder? 

Alexa: Because MAT (Medication Assisted Treatment) works! Unfortunately, best-kept secret in addiction medicine is “recovery happens,” and it is nothing short of miraculous to see how lives are transformed. NPs are having great success in bringing MAT treatment to communities in need. I am very happy to be part of this effort.   

Connections: Can you talk more about the work you do in this field and describe how nurse practitioners throughout California can play a greater role in this arena?

Alexa: A big push for NPs in California is to make sure they have the opportunity to become waivered providers and then are supported by clinical systems to provide opioid use disorder treatment in underserved communities. And of course, we are all looking forward to opportunities to expand access to care as AB 890 is implemented and barriers to NP practice are reduced. 

Connections: During the wildfire power shutdowns in California opioid addicts who rely on narcotic replacement medications were at risk of withdrawal and relapse. Can you describe what you and your colleagues did to address this potential crisis?

Alexa: Yes, that was an interesting time for sure. Systems in small communities like mine were not fully prepared for the ramifications of the first round of wildfire power downs. Our MAT clients are reliant on the ability to obtain their medications and will go into withdrawal and be at risk of relapse without access. When the power went down, many pharmacies lost connectivity and the ability to provide refills. While working by lantern, our team was able to establish contact with one local pharmacy using  a personal cell phone to make sure our patients were maintained on their medications. We now have wildfire contingency plans in place for our organization and patients!    

Connections: As an educator and Director of Nurse Practitioner Programs at the University of San Francisco, you are working to build a pipeline for practitioners who can address the behavioral needs in rural communities. Can you tell us more about that work?

Alexa: I am currently part of two grant teams, one from the Substance Abuse and Mental Health Services Administration (SAMHSA) and one from Health Resources and Services Administration (HRSA) to ensure NP learners graduate with the skill and motivation to prevent and treat substance use disorders, in particular opioid use disorder. All of our NP learners graduate having completed the MAT training. My HRSA grant also funds scholarships for NPs from rural communities with an interest in providing behavioral health care in underserved communities after graduation. We work closely with clinical agency partners to support NP training and interprofessional quality improvement initiatives to address a variety of behavioral health issues in underserved communities.   

Connections: You have a distinguished career not only serving rural communities but also in highly regarded research that informs public policies that affect rural communities. What are the most pressing public health needs in rural communities that demand further research and clinical activities to address them?

Alexa: Certainly, addressing mental health disparities, particularly in this COVID-19 era, is a priority. The emerging data on the effect of COVID-19 on mental health  is very concerning. Longstanding mental health disparities and a critical behavioral health workforce shortage has been acutely exacerbated. Likewise, there has been an escalation in substance use and relapse among persons in recovery. Continued research in these areas is a priority. Access to care among rural populations and best practices for the prevention and treatment of chronic diseases remains a priority. Additionally, as an element of access, the continued development of telehealth practices to expand the reach of the best evidenced-based care for all persons. And finally, we need to continue to examine the impact of NP-led care on the health of communities. 

Connections: You served as Co-Chair of CANP’s Health Policy & Practice Committee during the AB 890 process. What key learning do you have about the legislative process? 

Alexa: Foremost, I learned that success in the legislative process requires relentless dedication by a large and diverse group of passionate champions for a just cause. AB 890 was successful because of a history of NP champions and legislative allies who never gave up on pursuing what is right for communities. I also learned that the political process is full of really great people willing to listen and consider the best approaches for the constituents they represent. 

Connections: As a long-standing member of CANP, where have you seen this organization grow in terms of its place in California’s health care associations?

Alexa: The voice of NPs in California, largely articulated by CANP, has grown steadily in influence over the years due to decades of exceptional leadership and committed membership. The organization and its membership have established themselves as leaders on practice and policy throughout California. The recent passage of AB 890 has definitely furthered the awareness and respect for NPs and the CANP organization, not only among California’s health care organizations but also nationally. 

Connections: AB 890, signed into law by Gov. Gavin Newsom, aims to increase access to care, especially in rural communities. What impact do you imagine it will have on the care for people in the areas you serve who are struggling with opioid addiction and other serious health conditions?

Alexa: Removing barriers to access to the high-quality care provided by NPs in the treatment of opioid use disorder is a big win for underserved communities in California. Established health care organizations will now be able to fully maximize the utilization of NPs on the interprofessional team. In areas where there are no available providers to meet the critical needs of communities, experienced NPs with an established trajectory of safe and effective practice will ultimately be able to provide care as independent providers, thus improving access and outcomes, and reducing health care costs. 

Connections: You’ve been a leader at the local level and state level for this association. What would you share with those up-and-coming nurse practitioners who are considering taking a more active role in their organization?

Alexa: Please do join the fun! In my experience, you will not find a more supportive and fulfilling professional organization. Engage at the local level in whatever area of interest intrigues you. Your contributions will be welcomed and appreciated. And then, down the line, we all look forward to watching you grow into the next state and national leader. 

Connections: Congratulations on receiving the 2020 Bridging Health Care Needs Award. Is there anything you would like to see CANP or other professional nursing organizations do to advance the work you have done in the field of rural adolescent health?

Alexa: Thank you very much. My ask of CANP is to continue the trajectory of excellence in leadership and practice with a particular focus on supporting the next generation of NPs who will take what we have started and expand the current successes beyond our imagination.