Community Health Needs Assessment April, 2018
The Centers, Inc. 2018 Community Health Needs Assessment Table of Contents Description of The Centers... 3 Annual Budget:... 4 Provided Services Include:... 4 Description of the Service Area... 5 Potential Service Population:... 5 Demographic Information of the Service Area:... 5 Additional Community Resources for Behavioral Health... 9 Data on Projected Behavioral Needs... 9 Assessment of Behavioral Health Services... 10 GAP Analysis... 12 Specific Action Items to be Addressed... 13 2 P age
Description of The Centers The Centers is a comprehensive community mental health and substance abuse organization serving primarily Marion and Citrus Counties with a full array of services provided at two main campus locations: Marion County 5664 SW 60 th Avenue Ocala, FL 34474 Citrus County 3238 South Lecanto Highway Lecanto, FL 34461 3 P age
Annual Budget: The annual budget of The Centers is roughly $30 million dollars, obtained from the following sources: Annual Budget by % of Contribution Insurance / Patient 4% Other 7% Medicare 6% Medicaid 23% State Funding 54% County Funding 6% Provided Services Include: Level of Service Description of Service Location of Service Acute Care / Emergency Adult Crisis Unit of 24 beds Children s Crisis Unit of 12 beds Detox Unit of 6 beds Adult Psychiatry Unit of 10 beds Emergency Services Unit Marion County Airport Marion County Airport Marion County Airport Marion County Airport Marion County Airport Residential General substance abuse unit of 35 beds Marion County Airport Outpatient Community Programs Mother / Female with dependent unit of 15 beds Adult medication clinic Child medication clinic Adult Mental Health and Substance Abuse Therapy Child Mental Health and Substance Abuse Therapy General Mental Health case management Community Action Team for children Family Intervention Team for adults Prevention Services Citrus County Lecanto Marion and Citrus Marion and Citrus Marion and Citrus Marion and Citrus Marion and Citrus Marion County Citrus County Marion and Citrus 4 P age
Description of the Service Area Potential Service Population: The potential service population (2016) from the US Census Bureau (or from the official 2010 census if not estimable) finds the following: Marion County: 349,020 Citrus County: 143,621 City / Unincorporated Population City / Unincorporated Population Town Town Ocala 59,253 Hernando 9,054 Marion Oaks 15,000 (est.) Beverly hills 8,445 Silver Springs Shores 6,539 Inverness 7,347 Belleview 4,869 Lecanto 5,882 Dunnellon 1,803 Crystal River 3,108 Homosassa 2,345 Demographic Information of the Service Area: Age: Age Over 65 Ages 18 65 Ages 5 18 Under 5 0 20000 40000 60000 80000 100000 120000 140000 160000 180000 200000 Citrus Marion 5 P age
Race: Race by Population Hispanic Asian African American White 0 100000 200000 300000 400000 Citrus County Marion County Race by % of Population Hispanic Asian African American White 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Citrus Marion Economics: Per Capita income: $23,000 Poverty Rate: 17.2% (roughly 85,000 people) Median Monthly Rent: $800 6 P age
Health: Disabled Individuals under age 65: 12.8% Uninsured (health) Individuals: 16.1% Population: Land Area (square miles) Density Citrus County: 581.7 square miles 242.8 people / square mile Marion County: 1584.6 square miles 209.1 people / square mile Total: 2166.3 square miles 227.4 people / square mile According to the Bureau of Economic and Business Research, Marion and Citrus Counties have low to moderate population densities. Both counties, being around 200 people per square mile, are in yellow in the map below. https://www.bebr.ufl.edu/population/website article/measuring population density counties florida 7 P age
Low to moderate population densities reduce the effectiveness of community based programs as health workers driving to houses spend greater amounts of time in travel and less in direct provision of care. Another impact of having a low to moderate population density is that people requiring health services are often not near providers. They must rely upon transportation systems. Marion and Citrus Counties have some limitations with public transportation. A map of SunTran, the public transportation system in Ocala, demonstrates adequate routes within the city of Ocala and to Silver Springs Shores (southeast of Ocala). However, there are no routes proceeding to the developing sections southwest of Ocala. The Centers campus in Marion County is not on an existing bus route. http://www.suntran.org/home/showdocument?id=9067 8 P age
http://www.citruscountytransit.com/orange/interactive map.html Additional Community Resources for Behavioral Health 1. The Vines Hospital: ~ 70 adult psychiatric beds 2. Phoenix House 3. Meridian Behavioral Health (Gainesville, 45 miles) 4. Lifestreams Behavioral Centers (Leesburg, 30 miles) There are currently five medical/ surgical hospitals within Marion and Citrus Counties. Data on Projected Behavioral Needs National Statistics extrapolated 1. Percentage of Adults with thoughts of suicide: 3.4%. Likely affected individuals in service area: 13,750 people. 2. Percentage of Adults with Serious Mental Health: 3.7%. Likely affected individuals in service area: 15,000 people. 3. Percentage of individuals over age 12 reporting alcohol dependence: 6.0%. Likely affected 9 P age
individuals in service area: 26,000 people. 4. Percentage of individuals over age 12 abusing illicit drugs: 2.4%. Likely affected individuals in service area: 10,000 people. Comparison to services provided by The Centers 1. US projections are that 37.3% of adults received treatment for serious mental health diagnoses. The Centers provided treatment to 8,000 individuals with serious mental health concerns. 2. US projections are that 7.9% of individuals received treatment for alcohol use disorders. The Centers provided treatment to 500 individuals with alcohol use concerns. 3. US projections are that 12.6% of individuals received treatment for illicit drug use disorders. The Centers provided treatment to 1,500 individuals in need of help due to illicit drug use. Assessment of Behavioral Health Services Overview of Assessment Strategy The primary sources of data for this assessment were a combination of historical data from WellFlorida Council s 2015 Community Health Assessment for Marion and Citrus Counties, current US Census estimates, SAMHSA reports regarding prevalence of behavioral health conditions in Florida ( The Behavioral Health Barometer for Florida, 2015 ), and data obtained from the participation of The Centers in community 10 P age
meetings (including the Baker Act Task Force for Marion County). Assessments have been completed in partnership with Marion and Citrus County Health Departments, Healthy Start, local coalitions, and area hospitals, had completed an assessment using the Essential Public Health Services framework. Economic factors (income and poverty) heavily influenced results, particularly by contributing to high correlation between physical and mental health conditions. The 10 Essential Public Health Services (CDC website) As taken from the CDC website (https://www.cdc.gov/stltpublichealth/publichealthservices/essentialhealthservices.html), the 10 essential services are as follows: ES 1 Monitor Health Status to Identify Community Health Problems ES 2 Diagnose and Investigate Health Problems and Health Hazards ES 3 Inform, Educate, and Empower People about Health Issues ES 4 Mobilize Community Partnerships to Identify and Solve Health Problems ES 5 Develop Policies and Plans that Support Individual and Community Health Efforts ES 6 Enforce Laws and Regulations that Protect Health and Ensure Safety ES 7 Link People to Needed Personal Health Services and Assure the Provision of Healthcare when Otherwise Unavailable ES 8 Assure a Competent Public and Personal Healthcare Workforce EHS 9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population Based Health 11 P age
Services EHS 10 Research for New Insights and Innovative Solutions to Health Problems The survey within Marion County identified the following results. GAP Analysis Based on the essential services and community meetings, there are broad categories of deficiencies within the community that are likely to result in worsened outcomes for behavioral health services. General Deficiencies within the community 1. Insufficient funding for quantity of services due to population growth 2. Lack of coordination between health providers (e.g. general hospitals / primary care providers and behavioral health) 3. Lack of coordination between related organizations (e.g. school and behavioral health) 4. Limited transportation 5. Greater need for specialty forms of care 12 P age
Specific Population Deficiencies within the community 1. Limited coordinated outpatient services for veterans 2. Individuals abusing opiates (as part of national crisis) 3. Limited services for individuals with intellectual disabilities and pervasive developmental disorders Specific Action Items to be Addressed ITEM DESCRIPTION ACTION PLAN Lack of coordinated care between urgent / emergent hospital referrals and behavioral health system Insufficient awareness of behavioral health resources and concerns in local community. Insufficient integration with support groups locally. There is no consistent, organized means for general hospitals to track referrals for admissions to acute behavioral health units. Referrals currently are made using faxed records without clear feedback. This results in excessive delays for admissions and in discharges from emergency rooms. There is a highly fragmented nature to support for behavioral health in the service area. Organizations like NAMI have low participation rates. Develop a comprehensive communication plan to engage the area hospitals in developing a cohesive referral process, which will allow for the tracking of referrals and the provision of feedback regarding the referral to reduce the time a patient spends in the emergency room pending admission to an acute behavioral health unit. Increase community awareness of behavioral health issues and resources by developing and implementing a marketing/outreach campaign utilizing social media platforms, involvement in community organizations, and involvement in community events. Marginal coordination with school system resulting in frequent urgent referrals under the Baker Act. Behavioral health resources on school campus locations are limited. Services are fragmented. This results in largely numbers of children being referral for emergency evaluations under the Baker Act. Transportation costs, loss of school time, and increased Develop outreach materials to educate the patient s support system about community organizations that provide support for the patients and their support system (parent, relative, caregiver, significant other or friends). Outreach to the local school districts to partner with them in meeting the requirements of Governor Scott s Action Plan to Keep Florida Students Safe https://www.flgov.com/2018/02/ 23/gov scott announces majoraction plan to keep florida 13 P age
Limited professional recruiting of behavioral health specialists. law enforcement costs are incurred. It is problematic to hire professionals such as physicians, nurse practitioners, and licensed clinical social workers. Due to the less urbanized setting of the area, competition for professionals results in salaries that are often difficult to support financially. students safe following tragicparkland shooting/ Link to Governor Scott s Action Plan: https://www.flgov.com/wpcontent/uploads/2018/02/major ActionPlan_02.23.18.pdf To assure better communication between the school system and the behavioral health care providers; and to possible provide counseling services on site. Develop and implement a recruiting campaigns in the following areas: Master s level graduates which includes the agency s provision of clinical supervision for licensure at no cost to the employee. Newly licensed behavioral health practitioners (LCSW, LMHC, LMFT) including the agency s designation as a National Health Service Corps location in both Marion and Citrus Counties. Develop participation in federal loan forgiveness programs for psychiatrists and psychiatric nurse practitioners (ANRP s). Outreach to colleges and universities that have psychiatric residence and Fellows programs and psychiatric nurse practitioner programs. Develop and implement recruiting campaign for psychiatrists and psychiatric nurse practitioners. Complete a salary analysis for the identified positions to assure the 14 P age
Insufficient housing for individuals with low income (or no income). Transportation limits reduce access to care. Homeless individuals demonstrate high levels of recidivism to crisis units and general hospitals are they seek shelter and food. There are unnecessary admissions to facilities and increased law enforcement costs resulting from this use of health care services to solve homeless. The majority of the population in both counties is not within identified census statistical areas (e.g. Ocala). However, the public transportation routes largely run within these more developed locations. agency is in line with state and/or national median salary ranges. Study the viability of expanding the Supported Housing program with the possible inclusion of low income housing. Identify community resources for the homeless and develop partnerships to assist low income clients in finding housing. Explore the viability of expanding the SOAR (Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach, Access, and Recovery services currently provided. Increase the utilization of telepsychiatry and tele health for individual counseling when possible (in accordance with payer guidelines). Explore the feasibility of colocating therapy providers with the CMA to provide assessments and individual/family counseling. Explore the feasibility of operating store front locations in identified areas or co locating staff with primary care provider practice groups in those areas to provide assessment and individual/family counseling services or brief therapeutic intervention services. Advocate the Ocala/Marion Transportation Planning Organization expand existing transport routes to include the State Road 200 corridor include a stop at the Ocala, Airport Road (SW 60 th Avenue) Campus. 15 P age
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