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Community Needs Assessment: Substance Abuse and Mental Health Circuit 14
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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.
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DEMOGRAPHICS Population Size Gender Ratio Ethnic and Racial Make-Up
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Total Population in the Region 1,457,783 2015 Estimated Population Data
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Circuit 14 Total Population – 299,957 2015 Estimated Population Data
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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%
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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%
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ECONOMIC DATA Median Household Income Poverty Rates
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Median Household Income
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Poverty 2014 Federal Poverty Guidelines Family of 4 100% - $23,850 $300% - $71,550
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Community Health & Social Factors Health Outcomes and Health Factors Uninsured Rates
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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
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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)
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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)
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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
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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.
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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
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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%)
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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
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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
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Statewide Comparison Per Capita Funding
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Breakdown of big bends funds by circuit
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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
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Persons Served in the NW Region – July 1, 2013 – May 31, 2014
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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%)
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Persons Served by County July 1, 2013 – May 31, 2014
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Mental Health Secondary Data and Service Data Poor Mental Health Days Impact of Mental Health on daily activities Rate of Involuntary Examinations Services Delivered
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Mental Health Average Number of “mentally unhealthy” days reported
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Involuntary Exams Initiated
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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
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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)
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Substance Abuse Secondary Data and Services Delivered Alcohol Related Crashes Excessive Drinking in Adults Binge Drinking – High School & Middle School Services Delivered
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Excessive Drinking % of Adults Who Engage in Heavy or Binge Drinking
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Binge Drinking
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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
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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%
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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
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ASAM Recommended Levels of Care for Adults at Admission
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ASAM Recommended Levels of Care for Children at Admission
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Circuit 14 Bay Calhoun Gulf Holmes Jackson Washington
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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)
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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)
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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)
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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)
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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)
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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)
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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
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Surveys Stakeholder concerns and strengths Provider concerns and strengths Consumer concerns and strengths
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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)
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Provider Survey 22 Respondents 77.27% Circuit 1 18.18% Circuit 2 18.18% Circuit 14 9.09% Madison/Taylor
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Consumer and Family Member Survey Most Important Mental Health Services
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Consumer and Family Member Survey Most Important Substance Abuse Services
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Consumer and Family Survey Benefits and Support Available
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Consumer and Family Survey Barriers Experienced
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