When you rank last in anything, there are two ways to respond: accept defeat or embrace the opportunity. After all, there is nowhere to go but up.
It is safe to say that the latter is the mindset that FNU alumnus Dr. Tracy Hicks DNP (Class 23), MBA, APRN, FNP-BC, PMHNP-BC, CARN-AP, FIAAN, FAANP, adopted when she opened C-Trilogy Comprehensive Clinical Care/C-Trilogy Outreach (C-Trilogy) in Longview, Texas. In 2022, Mental Health America, a nonprofit advocating for people with mental illness, ranked Texas 51st for mental health care access, behind every other state and Washington, D.C.*
That ranking came a full seven years after Hicks organized her practice, which officially opened in 2016. Since then, C-Trilogy has grown significantly with the intent of helping as many people as they can.
“I started in 2015 with myself and a front desk person,” Hicks said. “By 2020, I had a front desk person and a part-time nurse.”
Currently, the clinic has 12 staff members, including a psychiatrist/medical director, a physician assistant, a licensed master social worker, a licensed vocational nurse, a medical assistant, a licensed chemical dependency counselor, three psychiatric-mental health nurse practitioners, two patient navigators/crisis interventionalists, and a front desk manager/executive assistant and assistant clinical director. Incredible to think that this vitally important clinic almost never existed.
Hicks always wanted to be a nurse, but it wasn’t until she was in the family nurse practitioner (FNP) program at the University of Texas at Arlington that she was drawn to the possibility of being a psychiatric-mental health nurse practitioner.
“We had to take a full semester of psych with a 45-hour clinical rotation,” Hicks said. “The PMHNP Director at the time asked me if I would be interested in the PMHNP program because of my performance in didactic and clinical. I told her I wanted to complete the FNP program because I wanted to offer a holistic care model, but I promised her that I would take a semester off and return because I did love the psych rotation. I did just that, and my Program Director remains in my life today as a mentor and like a second mom.”
Hicks’ real mom was also a nurse but encouraged her to become a physician. “I told her I wanted to become a nurse because I had watched her and how her colleagues and patients loved her,” Hicks said. “She loved her work. She made me promise that if I wanted to be a nurse, I would go to the top and make an impact.”
Establishing a psychiatric-mental health clinic in the state with the lowest access to mental healthcare certainly makes an impact. Hicks credits FNU’s DNP program for helping prepare her to establish and manage her own practice.
“When I researched universities online, I was attracted to FNU's rural health focus,” said Hicks, who is also an associate professor in the College of Nursing at the University of North Texas Health Science Center. “I remember being inspired by Dr. Diane John. She was so helpful and supportive throughout my journey at FNU. I met Dr. Khara’ Jefferson toward the end of my journey, and she was instrumental in my grounding toward the end. Dr. Eileen Thrower taught the ‘nurse as an educator’ course, which solidified my interest in teaching at the graduate level. I also used some of my courses as a guide in setting up and refining my clinic.”
Part of refining her clinic to meet the community's needs included the establishment of C-Trilogy Outreach, a non-profit branch of C-Trilogy, in 2020. This came in response to a growing number of patients, both insured and uninsured, who were presenting with more complex issues during the pandemic.
“I established a non-profit in 2020 in hopes of securing funding to expand and transform the practice to meet the needs of the community,” Hicks said. “I researched and studied the Certified Community Behavioral Health Clinic (CCBHC) model and met with stakeholders, including the local mental health authority. I applied for grant funding through SAMHSA and was blessed to receive funding in 2022 for the planning, development, and implementation of a CCHBC Certified Community Behavioral Health Clinic Planning, Development, and Implementation Grant.”
The CCBHC model ensures access to coordinated comprehensive behavioral health care and serves those who request mental health or substance use care. C-Trilogy has established relationships with the Harris County Jail System and the Jim Meyer Comprehensive Health Center, which is partially funded by the Ryan White HIV/AIDS Program.
“We used to have contracts with them, but now we work collaboratively referring patients between organizations when needed,” Hicks said.
Understanding that C-Trilogy cannot fix the state’s mental healthcare needs alone, Hicks has become a vocal leader in advocating for increased awareness and funding. As a presenter and speaker, she addresses the importance of the social determinants of health in providing individualized and holistic care on a broader scale.
“My motto is ‘restricted NP practice anywhere is restricted access to care everywhere,’” Hicks said. “Increasing access to mental health services is key. We have to take a more proactive approach versus a reactive approach. Mental healthcare tends to get more attention when there a tragic events such as mass shootings and the pandemic, which highlighted health inequality. Issues such as this wreak havoc on the population's mental health. We need to continue to be proactive and promote and cultivate crucial and fierce conversations on the state of mental health and the solutions that are needed. We need all healthcare providers to practice to the fullest extent of their education without unnecessary barriers and restrictions.”
Balancing her duties as a clinician, educator, and advocate might seem daunting to most, but to Hicks, it is the most effective way for her to serve her community and her state.
“I plan to continue work as an educator and clinic owner/entrepreneur while being an exemplary leader and addressing the needs of underserved populations,” she said. “I hope to expand my clinic model into Full Practice States. I intend to continue to support Texas Nurse Practitioners and the American Association of Nurse Practitioners as we work with legislators to secure Full Practice Authority in Texas and across the nation.”