Community Needs Assessment: Substance Abuse and Mental Health Circuit 1

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.

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 1 Total Population - 716,642 2015 Estimated Population Data

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

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) • 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 • 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%) • 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%)

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 • Children’s 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 • 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 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

30. Persons Served by CountyJuly 1, 2013 – May 31, 2014

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

36. Involuntary Exams Initiated

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

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 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

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)