LSF Health Systems and Well Florida

Needs Assessment for Northeast FloridaLSF Health Systems and Well Florida

PurposeThe purpose of this needs assessment is to identify the treatment needs of children and adults with an identified mental illness or substance abuse disorder in the 23-county region of Northeast Florida, which includes Circuits 3,4,5,7 and 8. This needs assessment will help reaffirm current need priorities and discover new priorities, as well as uncover strengths, weaknesses and gaps in services. These priorities will be used to refine appropriate goals, objectives and activities of programs and agencies to better serve the treatment needs of children and adults with identified mental illness or substance abuse disorder in the 23-county region.Ultimately, the needs assessment will serve to improve the quality of mental health and substance abuse services provided in the service area.

County Population Density

Total Population in the Region - 3,544,337Source: US Census Bureau, 2010 Census, Table QTP3.

Race, Ethnicity and GenderSource: US Census Bureau, 2010 Census, Table P12H.

Population by race is similar to Florida's population by race.Gender is comparative to Florida overall with 49% males and 51% females.The LSF service area has a much lower % of Hispanic population as compared to Florida. Hispanics account for 22.5 % of the population in Florida, but only 8.5% of the population in the LSF service area.Median Household IncomeSource: US Census Bureau, American Community Survey, 2006-2010 5-Year Estimates, Tables B19013, B19013A, B19013B, and B19013I. Poverty EstimatesSource: US Census Bureau, Small Area Income and Poverty Estimates, 2009-2011; Florida Charts Population Estimates for 2009-2011.Estimated percent of all persons in povertyEducational AttainmentSource: US Census Bureau, American Community Survey, 2007-2011 5-Year Estimates, Tables B15002.Prepared by: WellFlorida Council, 2013-2014.

Health OutcomesSource: University of Wisconsin Population Health Institute, County Health Rankings website http://www.countyhealthrankings.org, 2013.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)

CIRCUIT 3 CIRCUIT 4 CIRCUIT 5 CIRCUIT 7 CIRCUIT 8Health FactorsSource: University of Wisconsin Population Health Institute, County Health Rankings website http://www.countyhealthrankings.org, 2013.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)

CIRCUIT 3 CIRCUIT 4 CIRCUIT 5 CIRCUIT 7 CIRCUIT 8Percentage of Counties in Each Quartile Source: University of Wisconsin Population Health Institute, County Health Rankings website http://www.countyhealthrankings.org, 2013.Mental HealthSource: Florida CHARTS; Behavioral Risk Factor Surveillance Survey (BRFSS) Query, 2007 and 2010.

% of Adults who said they had poor mental health on 14 or more of the past 30 days CIRCUIT 3 CIRCUIT 4 CIRCUIT 5 CIRCUIT 7 CIRCUIT 8Binge DrinkingSource: Florida Department of Health; Florida Behavioral Risk Factor Surveillance Survey (BRFSS) State and County Data Report Summary, 2007 and 2010.

% of Adults Who Engage in Heavy or Binge Drinking CIRCUIT 3 CIRCUIT 4 CIRCUIT 5 CIRCUIT 7 CIRCUIT 8Change in Binge Drinking from 2007 - 2010Source: Florida Department of Health; Florida Behavioral Risk Factor Surveillance Survey (BRFSS) State and County Data Report Summary, 2007 and 2010.

% Change in Adults Who Engage in Heavy or Binge Drinking CIRCUIT 3 CIRCUIT 4 CIRCUIT 5 CIRCUIT 7 CIRCUIT 814Health Insurance CoverageSource: Florida Department of Health; Florida Behavioral Risk Factor Surveillance Survey (BRFSS) State and County Data Report Summary, 2007 and 2010.

CIRCUIT 3 CIRCUIT 4 CIRCUIT 5 CIRCUIT 7 CIRCUIT 8Suicide RatesSource: FloridaCHARTS, 2010-2012.

Age Adjusted per 100,000 populationYears of Potential Life Lost Due to SuicideSource: FloridaCHARTS, 2010-2012.

Measures premature mortality.Domestic ViolenceSource: Florida Department of Law Enforcement; Domestic Violence Annual Reports, 2009-2012.

Rate per 100,000 populationBaker Acts InitiatedSource: University of South Florida, AHCA, Annual Report of Baker Act Data, Summary of Data, 2010 and 2011; Special Report of Baker Act Data by County of Resident for Children and Adults, 2009; Florida Charts

Rate per 100,000 populationME Statewide Comparison

Total Contracted Dollars for All Services,LSF ME Counties, FY 2013-2014

Total Contracted Dollars for Mental Health Services FY 13-14

Total Contracted Dollars for Substance Abuse FY 13-14

% Population/Funding/ClientsSource: Summary of Budget by Circuit File from Lutheran Services Florida for FY 13-14 received on February 5, 2014; Florida Charts Population Estimates Query for 2013.

If the total number of clients served per circuit in FY 13-14 mirrors what occurred in FY 12-13 the following approximations can be made regarding the managing entity service region.Percentage of Funding and Individuals Served in the RegionSource: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013.

% of Funding% of Clients ServedAMH47.21%58.32%ASA27.99%27.36%CMH10.31%8.31%CSA14.50%6.02%Top 10 Services Provided Source: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013.

Top 10 Services Provided (cont.) Source: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013.

Service Delivery In and Out of CircuitSource: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013.

Service Delivery In and Out of CountySource: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013.

Total Clients (LSF region)Source: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013. Prepared by: WellFlorida Council, 2013-2014.Data ClarificationTo avoid confusion, each slide that contains information from focus groups and surveys in this needs assessment will be labeled.

Surveys (S)Focus Groups (FG)

All other data has been pulled from researched sites or domains and cited in the technical assessment. MethodologyFocus Groups(9) Consumer/Caregivers - 103 participants(3) CEO and Providers - 10 participants (1) Advocates - 6 participants

SurveysConsumer/Caregivers - 216 SurveysProviders - 157 Surveys

Word Cloud fromConsumer/Caregiver Focus Groupsappointmentcarechangecommunitycountycrisisfacility family farfeelfocus fundinggrouphealthhelphospital illness insurance issue issues jail job kidskindlong medicaid medication money monthsmoreneedneeds pay program providerservicessocial staffsubstance system talk threetimetreatmenttrying understandwantwellworkworkingMost Important Mental Health Service By Consumer (FG,S) Most important Substance Abuse Services - By Consumer (FG,S)Most important Mental Health Services by Family Member (FG,S)Most Important Substance Abuse Services - by Family Member (FG,S)Barriers to Services - Consumers/Family Members (FG,S)Provider Qualities and Satisfaction Level - Consumer/Family Members (FG,S)Circuit 4Specific InformationTotal Population in C4 1,128,442Source: US Census Bureau, 2010 Census, Table QTP3.

Total Clients in Circuit 4Circuit 4 Median Household IncomeSource: US Census Bureau, American Community Survey, 2006-2010 5-Year Estimates, Tables B19013, B19013A, B19013B, and B19013I.

Circuit 4 Health Factors State Ranking from 1 Healthiest to 67 Least HealthyCountyHealth OutcomesHealth FactorsHealth Outcome State QuartileClay7161Duval47313Nassau29152Source: Mobilizing Action Toward Community Health (MATCH) collaboration project between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute

Circuit 4 Risk FactorsRisk Factor (Florida Average Percent)ClayDuvalNassauPercent of adults who engage in heavy or binge drinking (15.0)17.617.614.6Percent of adults with any type of health care insurance coverage (83.0)83.788.181.0Percent of adults who are very satisfied or satisfied with their lives (93.1)93.093.996.4Percent of adults who always or usually receive the social and emotional support they need (79.5)84.781.386.8Percent of adults who had poor mental health on 14 or more of the past 30 days (11.8)12.010.311.2Percent of adults whose poor physical or mental health kept them from doing usual activities on 14 or more of the past 30 days (16.8)21.719.216.4Source: Mobilizing Action Toward Community Health (MATCH) collaboration project between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute

Most Common Services Provided (S) ServicePercent ResponseAssessment92.0Outpatient Individual80.0Case Management80.0Prevention72.0Least Common Services in the Region (FG,S)Mental Health Clubhouse Services

Project Recovery

Respite Services

Sheltered Employment

Room and Board with Supervision IIIMost Provided Services in Clay County Source: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013. Prepared by: WellFlorida Council, 2013-2014.

Service CategoryService Type# of individuals served% of total individuals servedAMHOutpatient-Individual126528.38%AMHMedical Services78517.61%ASAOutpatient-Individual46210.37%CMHOutpatient-Individual3307.40%ASAAssessment3197.16%AMHOutpatient-Group2475.54%ASAOutpatient-Group1944.35%AMHCase Management992.22%ASAIntervention992.22%ASAOutreach962.15%Most Provided Services in Duval County Source: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013. Prepared by: WellFlorida Council, 2013-2014.

Service CategoryService Type# of individuals served% of total individuals servedAMHMedical Services238611.70%AMHCrisis Support/Emergency233711.46%AMHCrisis Stabilization214710.53%AMHCase Management15137.42%ASAAssessment13346.54%ASAOutpatient-Group9894.85%ASAOutpatient-Individual9774.79%ASACase Management8454.14%AMHOutpatient-Individual6803.33%ASAIntervention6613.24%Most Provided Services in Nassau County Source: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013. Prepared by: WellFlorida Council, 2013-2014.

Service CategoryService Type# of individuals served% of total individuals servedAMHCase Management45118.98%AMHOutpatient-Individual29512.42%ASAAssessment27611.62%AMHAssessment2309.68%ASAOutpatient-Individual2229.34%AMHMedical Services1918.04%ASACase Management1908.00%ASAOutpatient-Group1255.26%ASAIntervention1225.14%AMHOutpatient-Group763.20%Circuit 4: % Clients served by type of service and whether served in same or different county as residenceSource: Special Data Report from Lutheran Services Florida for FY 12-13 received on October 30, 2013. Prepared by: WellFlorida Council, 2013-2014.

Most Needed Services Provider Survey52Top Barriers Providers Face to Meeting the Needs of Consumers (FG,S)

Goal Statement:To create standardize data gathering procedures for all providersStrategies:Utilize standard forms and incorporate error prompt for missing informationObjectives: To incorporate invoicing for data being put into SAMHISAction Steps/ActivitiesWhat will be done?Responsible PartiesWho should do it?Resources NeededFunding/time/people/materialsTime HorizonBy when?Data submitted in March Five Point will put in validations to include Demo and Admission issue are in the system.Error Prompts for missing data; what works and what does not work.Data tied to invoicing and tied claims and unit costs.Five Points; LSFFive Points; CFO @ LSF; ProvidersFive Points; LSF; ProvidersTraining for providers; Technical Assistance; TimeProvider feedback and time from work groupsProvider feedback; Start Adjustment WorkgroupImmediateImmediateImmediateLutheran Services Florida: Strategic Issue 1 Strategic Issue 1: Data ManagementStrategy: The overarching method/ approach that will address the priority issue. There will be one strategy for each priority issue.Action Step/ Activity: The critical steps or activities needed to achieve the identified strategy. Resources Needed: Financial, organizational, individual, etc that will be needed to complete the desired strategy.Responsible Parties: Agencies, organizations, individuals, etc that will be responsible for or participate as a key contributor to the completion the desired strategy.Time Horizon: Immediate (0-6 Months); Short Term (6 Months 1 Year); Medium Term (1-2 Years); Long Term (>2 Years) Strategy and Action Plan Worksheet

Goal Statement:To create standardize reporting procedures for regulatory requirementsStrategies:Advocate for reduced number of audits to satisfy multiple regulatory organizations.Objectives: To reduce the burden of regulatory requirements for providers Action Steps/ActivitiesWhat will be done?Responsible PartiesWho should do it?Resources NeededFunding/time/people/materialsTime HorizonBy when?Work with DCF to reduce the number audits and lessen the burden on providers. If third party external audits can comply with State and other mandated audits-how can we work to reduce the number of audits that occur and cover the same data. Advocate for State agencies to communicate to each other: DCF, AHCA, ProvidersLSF; DCF; Providers; Auditors that do audits for multiple providers.LSF; DCF; Providers; Auditors that do audits for multiple providersLSF, State-wide Managing Entities; LegislatureStaff time; research auditing agenciesTime to outline scope; Staff time; Provider time; Auditing Checklist; Understanding of audit tools; Recommendations from auditors; Consultation with LBA Group FAME Associations; Legal advice; FADAA; FCCMHShort TermShort TermLong TermLutheran Services Florida: Strategic Issue 2 Strategic Issue 2: Provider Regulatory RequirementStrategy: The overarching method/ approach that will address the priority issue. There will be one strategy for each priority issue.Action Step/ Activity: The critical steps or activities needed to achieve the identified strategy. Resources Needed: Financial, organizational, individual, etc that will be needed to complete the desired strategy.Responsible Parties: Agencies, organizations, individuals, etc that will be responsible for or participate as a key contributor to the completion the desired strategy.Time Horizon: Immediate (0-6 Months); Short Term (6 Months 1 Year); Medium Term (1-2 Years); Long Term (>2 Years) Strategy and Action Plan Worksheet

Goal Statement:To create equity among funding across the catchment areaStrategies:To utilize data management and data reports to coincide with funding to produce equity across catchment areaObjectives: To develop a formula of equity funding across catchment area Action Steps/ActivitiesWhat will be done?Responsible PartiesWho should do it?Resources NeededFunding/time/people/materialsTime HorizonBy when?Form workgroup to determine equity formula, and how it will be applied.Create historical framework of how funding has happened in the past and how it can be improved for the future.Define how the impact of funding inequality affects the delivery of services and systems of care. Method to ensure that LSF is payor of last resort. LSF; Providers; Health Care Modeling ExpertiseLSF; Providers; DCF; HistoriansLSF; Providers; Consumer Advisory GroupFive Points; LSF; ProvidersStaff time; research for health care modeling; needs assessmentStaff time; research materials for history of fundingStaff time; engagement of workgroup and Consumer Advisory GroupStaff time, cost of building automated system; feedback from providersImmediateImmediateImmediateShort TermLutheran Services Florida: Strategic Issue 3Strategic Issue 3: FundingStrategy: The overarching method/ approach that will address the priority issue. There will be one strategy for each priority issue.Action Step/ Activity: The critical steps or activities needed to achieve the identified strategy. Resources Needed: Financial, organizational, individual, etc that will be needed to complete the desired strategy.Responsible Parties: Agencies, organizations, individuals, etc that will be responsible for or participate as a key contributor to the completion the desired strategy.Time Horizon: Immediate (0-6 Months); Short Term (6 Months 1 Year); Medium Term (1-2 Years); Long Term (>2 Years) Strategy and Action Plan Worksheet

Goal Statement:To increase clients access to servicesStrategies:Address issues of waiting lists and transportation to servicesObjectives: To address issues of access including transportation and waiting listsAction Steps/ActivitiesWhat will be done?Responsible PartiesWho should do it?Resources NeededFunding/time/people/materialsTime HorizonBy when?Developing a navigation tool to inform clients what services are available and where to get servicesAnalyze utilization data, bed tracker data, and wait list dataExplore funding opportunities for transportation for clientsExplore alternative services that do not require transportationLSF; Providers; Five PointsFive Points; LSF; ProvidersLSF; Ombudsman; Circuit Advisory Group; local transportation authorities; Medicaid transportationLSF; ProvidersStaff time; provider input; develop marketing tool to distribute to consumersStaff timeStaff time; Ombudsman; Circuit Advisory Group; local transportation authorities; Medicaid transportationStaff time; Provider time; research for materials that have been successfully implementedShort TermImmediateShort TermShort TermLutheran Services Florida: Strategic Issue 4Strategic Issue 4: Patient IssueStrategy: The overarching method/ approach that will address the priority issue. There will be one strategy for each priority issue.Action Step/ Activity: The critical steps or activities needed to achieve the identified strategy. Resources Needed: Financial, organizational, individual, etc that will be needed to complete the desired strategy.Responsible Parties: Agencies, organizations, individuals, etc that will be responsible for or participate as a key contributor to the completion the desired strategy.Time Horizon: Immediate (0-6 Months); Short Term (6 Months 1 Year); Medium Term (1-2 Years); Long Term (>2 Years) Strategy and Action Plan Worksheet

Goal Statement:To establish a training and technical assistance program to address staff retention, training, and leadershipStrategies:Offer training and technical assistance to the networkObjectives: Support staff retention and develop opportunities to improve health outcomesAction Steps/ActivitiesWhat will be done?Responsible PartiesWho should do it?Resources NeededFunding/time/people/materialsTime HorizonBy when?Survey providers for technical assistance on staff retention and personnel issues. Add recruitment and retention to trainings offered (incorporate retention, additional training, leadership)Advocate for funding opportunities to pay providers market rate for servicesLSF; ProvidersLSF; Specialists in areas of employee retentionLSF, Providers, Associations, Consumers/Family membersProvider Feedback; Staff timeStaff time, Provider time, Cost of trainingsStaff time, Provider timeImmediateShort termShort termLutheran Services Florida: Strategic Issue 5 Strategic Issue 5: Provider IssuesStrategy: The overarching method/ approach that will address the priority issue. There will be one strategy for each priority issue.Action Step/ Activity: The critical steps or activities needed to achieve the identified strategy. Resources Needed: Financial, organizational, individual, etc that will be needed to complete the desired strategy.Responsible Parties: Agencies, organizations, individuals, etc that will be responsible for or participate as a key contributor to the completion the desired strategy.Time Horizon: Immediate (0-6 Months); Short Term (6 Months 1 Year); Medium Term (1-2 Years); Long Term (>2 Years) Strategy and Action Plan Worksheet

Action Steps for Circuit 4 Over the Next 16 Months1.

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