Community Needs Assessment:

1

• Community Needs Assessment
• Substance Abuse and Mental Health
• Circuit 1

2
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.

3
(No Transcript)
4
DEMOGRAPHICS

• Population Size
• Gender Ratio
• Ethnic and Racial Make-Up

5
Total Population in the Region 1,457,783
6
Circuit 1 Total Population - 716,642
7
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

8
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

9
ECONOMIC DATA

• Median Household Income
• Poverty Rates

10
Median Household Income
11
Poverty

• 2014 Federal Poverty Guidelines
• Family of 4
• 100 - 23,850
• 300 - 71,550

12
(No Transcript)
13
Community Health Social Factors

• Health Outcomes and Health Factors
• Uninsured Rates

14
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

15
(No Transcript)
16
Health Outcomes

• Rankings 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)

17
(No Transcript)
18
Health Factors

• Rankings 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) 

19
Health Insurance Coverage

• Adults without insurance coverage
• Florida 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

20
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.

21
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

22
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)

23
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
• Childrens Mental Health
• Purchase of Residential Treatment Services (PRTS)
• Behavioral Health Network (Bnet)
• Federal Block Grant and General Revenue Base
  Funding

24
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
• Childrens Substance Abuse
• Prevention Prevention Partnership Grants (PPG)
• Temporary Assistance for Needy Families (TANF)
• Federal Block Grant and General Revenue Base
  Funding

25
Statewide ComparisonPer Capita Funding
26
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

27
Persons Served in the NW Region July 1, 2013
May 31, 2014
28
Persons Served in the NW Region July 1, 2013
May 31, 2014
White Black American Indian/Alaska Native Asian Native Hawaiin/Pacific 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)
29
(No Transcript)
30
Persons Served by CountyJuly 1, 2013 May 31,
2014
31
(No Transcript)
32
Mental Health Secondary Data and Service Data

• Poor Mental Health Days
• Impact of Mental Health on daily activities
• Rate of Involuntary Examinations
• Services Delivered

33
Mental Health

• Average Number of mentally unhealthy days
  reported

34
(No Transcript)
35
(No Transcript)
36
Involuntary Exams Initiated
37
(No Transcript)
38
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

39
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)

40
Substance Abuse Secondary Data and Services
Delivered

• Alcohol Related Crashes
• Excessive Drinking in Adults
• Binge Drinking High School Middle School
• Services Delivered

41
(No Transcript)
42
Excessive Drinking

• of Adults Who Engage in Heavy or Binge Drinking

43
Binge Drinking
44
Client Specific Services Circuit 1July 1, 2013
May 31, 2014Substance Abuse

• 16,962 ASAMs Completed
• 34.4 for children
• 65.6 for adults
• 44.2 for initial admission
• 10.7 for continued stay
• 45.1 for discharge

45
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

46
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

47
ASAM Recommended Levels of Care for Adults at
Admission
48
ASAM Recommended Levels of Care for Children at
Admission
49
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)

50
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)

51
Santa Rosa County

• Childrens 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)

52
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)

53
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
54
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

55
Surveys

• Stakeholder concerns and strengths
• Provider concerns and strengths
• Consumer concerns and strengths

56
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)

57
(No Transcript)
58
(No Transcript)
59
(No Transcript)
60
(No Transcript)
61
Provider Survey

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

62
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

63
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

64
Provider SurveyChildrens 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

65
Provider SurveyChildrens 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

66
Provider Surveyability to meet consumer needs

• Barriers

• Strengths

• 68.18 staff enthusiasm
• 54.54 timely access to care
• 40.91 educational opportunities for staff
• 27.27 easily available workforce

• 54.55 adequate funding not available
• 45.45 consumer housing is unavailable
• 40.91 burdensome regulatory requirements
• 27.27 inadequate rate of reimbursement

67
Provider Surveysupports or barriers for consumers

• Supports

• Barriers

• 59.09 Location is convenient
• 54.55 Assurance of confidentiality
• 50.00 Affordable access to services
• 4.55 None

• 81.82 transportation unavailable
• 50.00 lack of availability of services
• 45.45 unaffordable treatment
• 40.91 stigma

68
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

69
Consumer and Family Member Survey

• 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

70
Consumer and Family MemberSurvey

• Primary 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

71
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

72
Consumer and Family MemberSurveyMost Important
Mental Health Services
73
Consumer and Family MemberSurveyMost Important
Substance Abuse Services
74
Consumer and Family SurveyBenefits and Support
Available
75
Consumer and Family SurveyBarriers Experienced