community needs assessment: substance abuse and mental health circuit 14
DESCRIPTION
Community Needs Assessment: Substance Abuse and Mental Health Circuit 14. 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. - PowerPoint PPT PresentationTRANSCRIPT
Community Needs Assessment:
Substance Abuse and Mental Health
Circuit 14
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 14 Total Population – 299,957
2015 Estimated Population Data
Bay; 173292; 58%
Calhoun; 14827; 5%
Gulf; 16212; 5%
Holmes; 20138; 7%
Jackson; 50329; 17%
Washington; 25159; 8%
Race & Ethnicity Circuit 14
When compared to the State of Florida, Circuit 14:
has a higher and lower African American population Florida = 16.7%, Bay = 11.2%, Calhoun = 13.4%, Gulf = 19.0%, Holmes =
6.6%, Jackson = 26.9%, Washington = 15.5%
has a lower Hispanic population Florida = 23.6%, Bay = 5.4%, Calhoun = 5.7%, Gulf = 4.8%, Holmes = 2.7%,
Jackson = 4.5%, Washington = 3.4%
has an average number of individuals identifying as two or more races Florida = 1.9%, Bay = 3.0%, Calhoun = 2.1%, Gulf = 1.8%, Holmes = 2.0%,
Jackson = 1.6%, Washington = 2.1%
Age & GenderCircuit 14
has a lower population rate of females Florida = 51.1% Female, Bay = 50.4%, Calhoun = 45.6%, Gulf = 40.0%,
Holmes = 46.7%, Jackson = 45.0%, Washington = 45.4%
has a lower population rate of individuals over 65
Florida = 18.7%, Bay = 15.9%, Calhoun = 16.9%, Gulf = 17.4%, Holmes = 18.5%, Jackson = 17.6%, Washington = 16.8%
has a higher and lower population rate of children under 5
Florida = 5.5%, Bay = 6.2%, Calhoun = 5.6%, Gulf = 4.3%, Holmes = 5.2%, Jackson = 4.9%, Washington =5.0%
Has a lower population rate of children under 18 (except Calhoun)
Florida = 20.6%, Bay = 21.5%, Calhoun = 21.1%, Gulf = 15.7%, Holmes – 20.3%, Jackson = 18.7%, Washington = 20.3%
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) Bay = 25 (33,921)Calhoun = 28 (3,298)Gulf = 25 (3,439)Holmes = 27 (4,325)Jackson = 23 (9,375)Washington = 27 (5,385)Circuit 14 = 59,743 adults
Children without insurance coverage Florida = 12% (492,237)Bay = 11 (4,136)Calhoun = 11 (335)Gulf = 12 (294)Holmes = 11 (452)Jackson = 10 (956)Washington = 11 (573)Circuit 14 = 6,746 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%)
Services DeliveredMental 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
Services Delivered Substance 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
Breakdown of big bends funds by circuit
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
klin
Mad
ison
Leon
Libe
rty
Tayl
or
Esca
mbi
a
Flor
ida
Oka
loos
aGul
f
Sant
a Ros
a
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
Circuit 14
Bay
Calhoun
Gulf
Holmes
Jackson
Washington
Bay County
CARE – case management, intervention, outpatient individual, outpatient group, residential 2, residential 4, detox, incidental, aftercare individual, aftercare group, room and board 2 (30.8% intervention, 26% individual outpatient)
Life Management Center – assessment, case management, crisis stabilization, medical services, outpatient individual, outreach, supported employment, FACT, room and board, CCST Individual, CCST Group (51.2% CCST Individual, 29.0% medical services)
Calhoun County
CARE –outpatient individual, outpatient group, aftercare (98.8% in outpatient individual & group)
Life Management Center – case management, medical services, outpatient individual, CCST individual, CCST group (80.8% CCST Individual, 16.6% medical services)
Gulf County
CARE – outpatient individual, outpatient group, aftercare (96.8% individual and group outpatient)
DISC – intervention individual, intervention group, outpatient individual (66.7% intervention)
Life Management Center – medical services, outpatient individual, Outreach, CCST Individual (55.4% CCST individual)
Holmes County
CARE – outpatient individual, outpatient group, aftercare (64.5% outpatient individual)
Life Management Center – assessment, case management, crisis stabilization, medical services, outpatient individual, supported employment, room and board 3, CCST individual, CCST group (52.7% CCST Individual)
Jackson County
DISC – outpatient individual, intervention individuals, intervention group (3 persons served)
CARE – outpatient individual, outpatient group, aftercare individual, aftercare group (96.6% individual & group outpatient)
Life Management Center – assessment, case management, crisis stabilization, in-home and on-site, medical services, outpatient individual, supported employment, CCST individual, CCST Group (62.9% CCST Individual)
Washington County
DISC – intervention individual, intervention group (2 individuals served)
Life Management Center – case management, medical services, outpatient individual, CCST individual, CCST group (67.9% CCST individual)
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