Community Needs Assessment:

Substance Abuse and Mental Health

Circuit 1

Purpose

The purpose of this needs assessment is to educate, inform and discuss:

Demographics, including population size, gender, ethnic and racial make-up of the Northwest Region.

Social and economic data such as: domestic violence rates, poverty rates, median household income, uninsured rate and health factors/health outcome rankings.

Secondary data related to substance abuse and mental health including: suicide rates, number of Baker Acts, days of poor mental health, binge drinking rates, and service utilization data specific to the Big Bend Community Based Care Managing Entity System of Care.

Primary data related to substance abuse and mental health services including: Consumer and/or Family Member survey results, Provider Survey results and Stakeholder survey results.

This needs assessment will help identify key concerns and strengths regarding the substance abuse and mental health system of care managed in the Northwest Region by Big Bend Community Based Care and should be used as a starting point for community conversations on systems improvement and strategic planning.

DEMOGRAPHICS

Population Size

Gender Ratio

Ethnic and Racial Make-Up

Total Population in the Region 1,457,783

Circuit 1; 716,642

Circuit 2; 398,411

Madison/Tay-lor; 42,773

Circuit 14; 299,957

2015 Estimated Population Data

Circuit 1 Total Population - 716,642

2015 Estimated Population Data

Escam-bia;

302,871

Okaloosa; 190,832

Santa Rosa;

162,526

Walton; 60,413

Race & Ethnicity Circuit 1

When compared to the State of Florida, Circuit 1 (Escambia, Okaloosa, Santa Rosa and Walton Counties):

has a lower African American population (except Escambia County) Florida = 16.7%, Escambia = 22.8%, Okaloosa = 9.9%, Santa Rosa = 6.5%,

Walton = 5.9%

has a lower Hispanic population Florida = 23.6%, Escambia = 5.2%, Okaloosa = 8.3%, Santa Rosa = 5.1%,

Walton = 6.2%

has a higher number of individuals identifying as two or more races Florida = 1.9%, Escambia = 3.0%, Okaloosa = 3.9%, Santa Rosa = 3.0%, Walton

= 2.4%

Age & GenderCircuit 1

has a lower population rate of females Florida = 51.1% Female, Escambia = 50.3%, Okaloosa = 49.20%, Santa

Rosa = 49.0%, Walton = 49.20%

has a lower population rate of individuals over 65

Florida = 18.7%, Escambia = 15.5%, Okaloosa = 14.7%, Santa Rosa = 14.0%, Walton = 18.10%

has a higher population rate of children under 5

Florida = 5.5%, Escambia = 6.1%, Okaloosa = 6.7%, Santa Rosa = 5.8%, Walton = 5.5%

Has a higher population rate of children under 18

Florida = 20.6%, Escambia = 21.0%, Okaloosa = 22.20%, Santa Rosa = 22.8%, Walton = 20.4%

ECONOMIC DATA

Median Household Income

Poverty Rates

Median Household Income

$3

2,4

80

$3

4,3

61

$3

4,6

34

$3

4,9

28

$3

5,5

93

$3

7,4

28

$3

8,5

36

$3

8,9

17

$3

9,2

25

$3

9,5

35

$4

1,1

63

$4

3,8

06

$4

4,2

54

$4

5,9

15

$4

7,3

09

$4

7,3

64

$5

3,3

85

$5

4,1

18

$5

7,4

91

Poverty

2014 Federal Poverty Guidelines

Family of 4

100% - $23,850

$300% - $71,550

Community Health & Social Factors

Health Outcomes and Health Factors

Uninsured Rates

Health Outcomes & Factors

• Collaboration between the Robert Wood Johnson Foundation and The University of Wisconsin, Population Health Institute

• Health Outcomes – length of life (mortality) compared to quality of life (morbidity)

• Health Factors – health behaviors, clinical care, social/economic, and physical environment

Health OutcomesRankings are based on an equal weighting of one length of life (mortality)

measure and four quality of life (morbidity) measures. 1 is the "healthiest", 67 is the "least healthy" (out of 67 counties in Florida)

69

19

29323436

46474851

545758606161

66

Health FactorsRankings based on 4 types of factors; Health Behaviors, Clinical Care, Social and economic, Physical Environment. 1 is the "Healthiest", 67 is

the "Least Healthy“. (out of 67 Florida Counties) 

Leon

Oka

loos

a

Sant

a ...

Wak

ulla

Wal

ton

Jack

son

Bay

Esca

mbi

a

Hol

mes

Jeffer

son

Libe

rtyGul

f

Fran

klin

Calh

oun

Was

hin.

..

Tayl

or

Mad

ison

Gadsd

en

9 1014

28 29 31

38 39

46 47 48 4952

5659 60 61 63

Health Insurance Coverage

Adults without insurance coverageFlorida = 25% (3,911,314) Escambia = 21% (49,730)Okaloosa = 19% (42,961)

Santa Rosa = 18% (22,624)Walton = 24% (11,474)Circuit 1 = 126,789 adults

Children without insurance coverage Florida = 12% (492,237)Escambia = 9% (5,945)Okaloosa = 10% (4,268)

Santa Rosa = 10% (3,683)Walton = 15% (1,890)Circuit 1 = 15,786 children

Substance Abuse and Mental Health

This Needs Assessment will focus on the Substance Abuse and Mental Health system of

care across the 18 counties in Northwest Florida. Specifically, it will focus on the Substance

Abuse and Mental Health system of care funded by the Department of Children and Families through a Managing Entity contract with Big

Bend Community Based Care.

Funding and Service Delivery for Substance Abuse and Mental Health

Federal Block Grant Funding

Other Federal Funding Sources

State General Revenue Funding

Statewide Managing Entity Comparison

Big Bend Community Based Care & the Northwest System of Care

Funding

State of Florida

Total Funding = $537,819,677

Federal Funds = $152,719,283 (28.4%)

State Funds = $385,100,394 (71.6%)

Category Funding

AMH = $280,668,680 (52.2%)

CMH = $56,343,687 (10.5%)

ASA = $131,573,662 (24.4%)

CSA = $69,233,648 (12.9%)

Big Bend Community Based Care

Total Funding = $48,648,802 (9.0% of statewide

funds)

Federal Funds = $13,207,157 (27.1%)

State Funds = $35,441,645 (72.9%)

Category Funding

AMH = $27,881,458 (57.3%)

CMH = $4,121,277 (8.5%)

ASA = $10,265,992 (21.1%)

CSA = $6,380,075 (13.1%)

Funding StreamsMental Health

Adult Mental Health

Projects for Assistance in Transitioning from Homelessness (PATH)

Florida Assertive Community Treatment (FACT)

Temporary Assistance for Needy Families (TANF)

Indigent Drug Program (IDP)

Federal Block Grant and General Revenue Base Funding

Children’s Mental Health

Purchase of Residential Treatment Services (PRTS)

Behavioral Health Network (Bnet)

Federal Block Grant and General Revenue Base Funding

Funding StreamsSubstance Abuse

Adult Substance Abuse

Prevention

Temporary Assistance for Needy Families (TANF)

Set-aside for special populations (women, IV drug users, HIV positive)

Federal Block Grant and General Revenue Base Funding

Children’s Substance Abuse

Prevention & Prevention Partnership Grants (PPG)

Temporary Assistance for Needy Families (TANF)

Federal Block Grant and General Revenue Base Funding

Statewide ComparisonPer Capita Funding

Northwest Northeast Suncoast Central Southeast Broward South $-

$5.00

$10.00

$15.00

$20.00

$25.00

$30.00

$35.00

$40.00

$33.37

$24.95

$29.88

$22.85

$25.38 $25.87

$28.10

All Funding AMH CMH ASA CSA

Big Bend Community Based CareSystem of Care

18 Providers in Network

18 Counties in catchment area

64,726 total number served (all fund sources)

July 1, 2013 – May 31, 2014

67.1% served in Mental Health

32.9% served in Substance Abuse

Persons Served in the NW Region – July 1, 2013 – May 31, 2014

31,673, 49%

33,053, 51%

Numbers Served by Gender

Male Female

Persons Served in the NW Region – July 1, 2013 – May 31, 2014

White Black American Indian/Alaska Native

Asian Native Hawaiin/Pacif

ic Islander

Multi-Racial

46,939 (72.5%)

14,533(22.5%)

338(0.5%)

311(0.5%)

153(0.2%)

2,452(3.8%)

Puerto Rican

Mexican

Cuban Other Hispanic

Haitian

Non-Hispanic

Mexican American

Spanish/Latino

230(0.4%)

193(0.3%)

82 (0.1%)

749(0.2%)

61(0.1%)

63,146 (97.5%)

139(0.2%)

126(0.2%)

Life Man-agement29.60%

Lakeview25.88%

CDAC12.76%

Apalachee10.17%

Bridgeway6.44%

DISC5.37%

CARE4.46%

COPE4.45%

CHS0.41%

Turn About0.21%

Escambia County0.18%

Okaloosa County0.07%

DOH0.01%

Persons Served by CountyJuly 1, 2013 – May 31, 2014

Bay12.78%

Calhoun0.52%

Escambia40.42%

Franklin0.58%

Holmes2.23%

Gadsden1.69%

Gulf0.31%

Jackson2.83%

Jefferson0.60%

Leon12.85%

Liberty0.36%

Madison0.79%

Santa Rosa6.10%

Taylor0.79%

Walton6.06%

Wakulla1.34%

Washington0.61%

Okaloosa9.15%

0-41%

5-129%

13-1714%

18-2414%

25-6459%

65+4%

Numbers Served by Age Group

Mental Health Secondary Data and Service Data

Poor Mental Health Days

Impact of Mental Health on daily activities

Rate of Involuntary Examinations

Services Delivered

Mental HealthAverage Number of “mentally unhealthy” days reported

Gulf

Libe

rty

Sant

a Ros

aLe

on

Oka

loos

a

Gadsd

en

Hol

mes

Jack

son

Flor

ida

Fran

klin

Mad

ison

Wak

ulla

Wal

ton

Jeffer

son

Esca

mbi

a

Tayl

or

Calh

oun

Bay

Was

hing

ton

3.0

3.0 3.1 3.2

3.2 3.3 3.6

3.6 3.8 3.9 4

.3 4.4

4.4 4.6 4.8

4.8

5.5 5.6 5.8

County Percent (%)Bay 10Calhoun 16Escambia 14.6Franklin 12.7Gadsden 9.2Gulf 9.2Holmes 14.9Jackson 12.1Jefferson 9.5Leon 12.4Liberty 14.7Madison 15.7Okaloosa 12.1Santa Rosa 11Taylor 14.8Wakulla 16.3Walton 15.3Washington 19.1

Adults who had poor mental health on 14 or more of the past 30 days, Overall, 2010

County Percent (%)Bay 4.7Calhoun 7.6Escambia 6.2Franklin 6.6Gadsden 4.3Gulf 7.2Holmes 6Jackson 4.7Jefferson 5.1Leon 4.4Liberty 6.7Madison 5.7Okaloosa 4Santa Rosa 4.2Taylor 6.4Wakulla 5.2Walton 6Washington 6.2

Average number of days where poor mental or physical health interferred with activities of daily living in the

past 30 days, Overall, 2010

Involuntary Exams Initiated

3.2

8

3.8

7

4.3

1

4.6

6

4.7

4

5.4

8

5.8

6.2

6.3

8

6.4

8

6.5

4

6.5

4

7.4

7

7.5

6

7.7

9

8.0

5

8.7

8

12

.12

14

.11

Mental Health Services Delivered

18,625 individuals served in Mental Health Services (SAMH funds only)

Adults most commonly diagnosed with – Schizophrenia, Psychoses and Anxiety Disorders

Children most commonly diagnosed with – Mood Disorders, Adjustment Disorders and ADHD

33.0% of the individuals served have been on Baker Act status

Criminal Justice Status of those in Mental Health Services

Children

28.5% of children served are delinquent or in physical custody (criminal status)

2.1% of children served are Dependent (DJJ) and in physical custody

55.1% of children served are under the supervision of their family, relatives or a guardian

.6% of children served are Incompetent to Proceed (ITP)

Adults

90.6% of adults served are competent, with no charges or are on probation

2.1% of adults served are Not Guilty by Reason of Insanity (NGI)

1.6% of adults served are Incompetent to Proceed (ITP)

Substance Abuse Secondary Data and Services Delivered

Alcohol Related Crashes

Excessive Drinking in Adults

Binge Drinking – High School & Middle School

Services Delivered

County Count RateHolmes 51 85.2Washington 70 94.3Florida 54,900 97.2Jackson 151 100.9Santa Rosa 519 113.4Leon 1,000 121Gulf 60 126.1Liberty 36 143.9Okaloosa 803 147.6Wakulla 138 149.8Gadsden 217 153.8Jefferson 71 160.9Calhoun 72 163.7Escambia 1,542 172.1Franklin 61 176Walton 292 176.5Madison 105 181.4Taylor 123 182.1Bay 1,147 226.3

Alcohol-related Motor Vehicle Traffic Crashes, 2009-11

Excessive Drinking% of Adults Who Engage in Heavy or Binge Drinking

Was

hing

ton

Calh

oun

Hol

mes

Jeffer

son

Gadsd

en

Jack

son

Fran

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Mad

ison

Leon

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Esca

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Flor

ida

Oka

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f

Sant

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Wal

tonLe

onBay

7

8

9 9

11

11

13

13 14 14

14 1

5 16

16 1

7

17 1

8 19

21

Binge Drinking

Client Specific Services – Circuit 1July 1, 2013 – May 31, 2014

Substance Abuse

16,962 ASAM’s Completed

34.4% for children

65.6% for adults

44.2% for initial admission

10.7% for continued stay

45.1% for discharge

Substance Abuse Diagnoses Alcohol Related Dependency Diagnoses – 19.3%

Drug Related Dependency Diagnoses – 44.4%

Non-Dependent Diagnoses – 36.3%

Drug Related Dependency Diagnoses: Opioid – 29.5%

Sedative, Hypnotic or Anxiolytic – 1.8%

Cocaine – 13.0%

Cannabis – 34.1%

Amphetamine/Psychostimulant – 12.9%

Hallucinogen - .10%

Other - .10%

Combined with Opioid Use - .15%

Combined without Opioid Use – 7.6%

Unspecified - .75%

Individuals Served in Substance Abuse Treatment

2.1% of those served in SA treatment are pregnant

15.9% in SA treatment are involved in drug court

15.6% have indicated they are involved with child welfare

1.2% are assessed or treated on an involuntary basis

26.8% have a mental health diagnosis identified

Most common – schizophrenia, bipolar, anxiety, depression, adjustment disorders, and ADHD

ASAM Recommended Levels of Care for Adults at Admission

Res. 10.06%

Res. 24.24%

Res. 30.02%

Res. 40.97%

Detox0.52%

Opt. Tx.55.60%

IOP2.48%

Intervention34.77%

Methadone Tx.1.34%

Res. 22.82% Res. 3

0.16%

Res. 40.04%

Detox23.16%

Opt. Detox0.04%

Opt. Tx.12.13%

Interven-tion

61.66%

ASAM Recommended Levels of Care for Children at Admission

Escambia County CHS – assessment, case management, in-home/on-site, individual

outpatient (34.1% in outpatient individual)

CDAC – case management, day/night, in home/on-site, outpatient individual, incidentals (80.4% in case management)

Escambia County – assessment (100%)

Lakeview – assessment, crisis stabilization, crisis support/emergency, day/night, in-home/on-site, intervention, medical services, outpatient individual, outpatient group, prevention, residential 2, residential 3, residential 4, detox, supported employment, supported housing/living, TASC, FACT (31.3% in medical services, 19.6% in case management)

Okaloosa County

Bridgeway – case management, crisis support/emergency, drop-in/self-help center, intervention, medical services, individual outpatient, group outpatient, supported housing/living, TASC (55.1% in individual outpatient, 32.1% in medical services)

CDAC – case management, in-home/on-site, incidentals (82.8% in case management)

Lakeview – day/night, individual outpatient, group outpatient (59.3% in individual & group outpatient)

Santa Rosa County

Children’s Home Society – assessment, case management, in-home/on-site, individual outpatient (only 10 individuals entered for service in this county)

CDAC – case management, in-home/on-site, individual outpatient, group outpatient, residential1, incidentals (70.0% case management)

Lakeview – crisis support/emergency, day/night, in-home/on-site, intervention, individual outpatient, group outpatient, residential 1, supported housing/living (58.1% individual outpatient)

Walton County

CDAC – case management, incidentals

COPE – case management, crisis support/emergency, in-home/on-site, intervention, group intervention, medical services, individual outpatient, group outpatient, residential 2, residential 3, TASC, after care/follow-up, room & board 2 (39.7% outpatient individual, 33.8% medical services)

Information and Referral & Drop-In/Self Help had 0 data entries for individuals served

Non-Client Specific ServicesJuly 1, 2013 – May 31, 2014

Outreach Crisis Support/Emergency

Prevention

16,406 persons 264 persons 8,658 persons

64.8% 1.0% 34.2%

33.6% are 22 years +

72.3% are 15-17 years old

96.7% are 22 years +

92% delivered in Bay County

100% delivered in Walton County

97.0% delivered in Escambia County

Brief Needs AssessmentJuly 2014

Recommendations:

Mobile Crisis Response

Increased Mental Health Outreach

Residential Treatment & Detoxification

(adults and adolescents)

Case Management in rural areas

In-home therapy programming

Drug Court in select counties

School based prevention

Jail based services

Increased CAT Teams

Increased funding for pregnant women

Surveys

Stakeholder concerns and strengths

Provider concerns and strengths

Consumer concerns and strengths

Stakeholder Survey

37 Respondents

75.68% Circuit 1, 24.32% Circuit 2, 10.81% Circuit 14 and 2.70% Madison/Taylor

Child Welfare represented the greatest survey response with 27.03%

Over 75% of respondents indicated they know where to refer individuals for any category of service (AMH, CMH, ASA, CSA)

Over 10% of respondents indicated that do not know where to refer individuals for any category of service (AMH, CMH, ASA, CSA)

Provider Survey

22 Respondents 77.27% Circuit 1 18.18% Circuit 2 18.18% Circuit 14 9.09% Madison/Taylor

Provider SurveyAdult Mental Health

Most Critical Services Provided

50% Outpatient

36.36% Psychiatry

22.73% Crisis Stabilization

18.18% Residential Care

18.8% Prevention

9.09% Inpatient

Most in Need of Increased Availability

68.18% Outpatient

54.55% Psychiatry

54.55% Residential Care

40.19% Crisis Stabilization

36.36% Inpatient

13.64% Prevention

Provider SurveyAdult Substance Abuse

Most Critical Services Provided

54.55% Outpatient

31.82% Prevention

22.73% Crisis Treatment

22.73% Residential

18.18% Psychiatry

Most in Need of Increased Availability

59.09% Residential

50.00% Outpatient

36.36% Crisis Treatment

27.27% Psychiatry

27.27% Prevention

Provider SurveyChildren’s Mental Health

Most Critical Services Provided

45.45% Outpatient

31.82% Psychiatry

22.73% Crisis Stabilization

13.64% Residential Care

22.73% Prevention

9.09% Inpatient

Most in Need of Increased Availability

54.55% Outpatient

45.45% Psychiatry

31.82% Residential Care

36.36% Crisis Stabilization

40.91% Inpatient

27.27% Prevention

Provider SurveyChildren’s Substance Abuse

Most Critical Services Provided

54.55% Outpatient

22.73% Psychiatry

31.82% Crisis Stabilization

22.73% Residential Care

54.55% Prevention

40.91% Inpatient

Most in Need of Increased Availability

59.09% Outpatient

13.64% Psychiatry

22.73% Residential Care

18.18% Crisis Stabilization

13.64% Inpatient

54.55% Prevention

Provider Surveyability to meet consumer needs

Strengths 68.18% staff enthusiasm

54.54% timely access to care

40.91% educational opportunities for staff

27.27% easily available workforce

Barriers 54.55% adequate funding not

available

45.45% consumer housing is unavailable

40.91% burdensome regulatory requirements

27.27% inadequate rate of reimbursement

Provider Surveysupports or barriers for consumers

Supports 59.09% Location is

convenient

54.55% Assurance of confidentiality

50.00% Affordable access to services

4.55% None

Barriers 81.82%

transportation unavailable

50.00% lack of availability of services

45.45% unaffordable treatment

40.91% stigma

Consumer and Family Member SurveyDemographics

132 Surveys Received as of August 8th, 2014

82.6% consumers; 17.4% family members

70.6% Caucasian, 20.6% Black, 6.4% Multi-racial, 2.4% American Indian or Alaskan Native

6.9% Hispanic

.8% seniors, 59.5% adults, 17.4% young adults, 9.9% teens, 9.9% children, 2.5% young children

20.6% identified as co-occurring treatment consumers, 44.4% as mental health and 34.9% as substance abuse

4.7% of individual indicated they receive a treatment service in a different county than they reside

Consumer and Family Member Survey

Consumer and Family MemberSurveyPrimary Mental Health Provider/Treatment Attributes

(scale of 1 to 5; 1 = always and 5 = never)

Highest ranked attributes

staff are respectful of my privacy

my providers office is neat and comfortable

staff treatment with respect

Lowest ranked attributes

my provider coordinates my care with other healthcare providers

my symptoms are improving

I am able to schedule appointments when needed

Consumer and Family MemberSurvey

Primary Substance Provider/Treatment Attributes

(scale of 1 to 5; 1 = always and 5 = never)

Highest ranked attributes:

my providers office is neat and comfortable

staff are respectful of my privacy

I am knowledgeable on relapse prevention

Lowest ranked attributes

my provider coordinates my care with other healthcare providers

my providers hours are convenient

I am included in decisions regarding my care

Individ

ual

Med

icatio

n

Case

Man

agem

ent

Group

Fam

ily

Residen

tial S

uppo

rt

MHA/N

AMI

Drop-

in

CSU/In

patie

nt

Supp

orte

d Em

ploy

men

t

Altern

ative

Car

e

Peer

Spe

cialis

t

None

Clubh

ouse

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Consumer and Family MemberSurvey

Most Important Mental Health Services

Individ

ual

Group

12 S

tep/

Supp

ort G

roup

Case

Man

agem

ent

Residen

tial T

reat

men

t

Residen

tial S

uppo

rt

Med

icatio

n

Detox

Fam

ily

Supp

orte

d Em

ploy

men

t

Altern

ative

None

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Consumer and Family MemberSurvey

Most Important Substance Abuse Services

Consumer and Family Survey

Benefits and Support Available

Afforda

ble

Acces

s

Conve

nien

t loc

ation

Supp

ort o

f Fam

ily/Frie

nds

Neede

d Se

rvice

s Ava

ilable

Awaren

ess o

f Ser

vices

Ava

ilable

Assur

ance

of C

onfid

entia

lity

Availa

ble

Tran

spor

tatio

nNon

e0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

none

stigm

a

lack

of a

vaila

ble

serv

ices

Tran

spor

tatio

n Una

vaila

ble

Lack

of K

nowle

dge

abou

t ser

vices

Unaffor

dable

Care

Not con

venien

t loc

ation

conc

erns

abo

ut con

fiden

tiality

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Consumer and Family SurveyBarriers Experienced