1. Community Needs Assessment: Substance Abuse and Mental Health Circuit 14

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.

4. DEMOGRAPHICS  Population Size  Gender Ratio  Ethnic and Racial Make-Up

5. Total Population in the Region 1,457,783 2015 Estimated Population Data

6. Circuit 14 Total Population – 299,957 2015 Estimated Population Data

7. 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%

8. Age & Gender Circuit 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%

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

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

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)

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) 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

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. Services Delivered Mental 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

24. 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

25. Statewide Comparison Per Capita Funding

26.  Breakdown of big bends funds by circuit

27. Big Bend Community Based Care System 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

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

29. WhiteBlackAmerican Indian/Alaska Native AsianNative 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 MexicanCubanOther Hispani c HaitianNon- Hispani c Mexican Americ an 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%)

31. Persons Served by County July 1, 2013 – May 31, 2014

33. Mental Health Secondary Data and Service Data  Poor Mental Health Days  Impact of Mental Health on daily activities  Rate of Involuntary Examinations  Services Delivered

34. Mental Health Average Number of “mentally unhealthy” days reported

37. Involuntary Exams Initiated

39. 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

40. 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)

41. Substance Abuse Secondary Data and Services Delivered  Alcohol Related Crashes  Excessive Drinking in Adults  Binge Drinking – High School & Middle School  Services Delivered

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

44. Binge Drinking

45. Client Specific Services – Circuit 1 July 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

46. 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%

47. 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

48. ASAM Recommended Levels of Care for Adults at Admission

49. ASAM Recommended Levels of Care for Children at Admission

50. Circuit 14 Bay Calhoun Gulf Holmes Jackson Washington

51. 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)

52. 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)

53. 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)

54. 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)

55. 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)

56. 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)

57. Brief Needs Assessment July 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

58. Surveys  Stakeholder concerns and strengths  Provider concerns and strengths  Consumer concerns and strengths

59. 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)

64. Provider Survey  22 Respondents  77.27% Circuit 1  18.18% Circuit 2  18.18% Circuit 14  9.09% Madison/Taylor

65. Provider Survey Adult 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

66. Provider Survey Adult 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

67. Provider Survey Children’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

68. Provider Survey Children’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

69. Provider Survey ability 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

70. Provider Survey supports 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

71. Consumer and Family Member Survey Demographics  132 Surveys Received as of August 8 th, 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

72.  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

73. 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

74. Consumer and Family Member Survey 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

75. Consumer and Family Member Survey Most Important Mental Health Services

76. Consumer and Family Member Survey Most Important Substance Abuse Services

77. Consumer and Family Survey Benefits and Support Available

78. Consumer and Family Survey Barriers Experienced