Transcript Duval County Behavioral Health Services Duval County

DUVAL COUNTY HEALTH DEPARTMENT
Maternal & Child Health Division
JACKSONVILLE, FL
Integrating Behavioral Health Into Primary Care
Donna Buchanan, MSW, LCSW
Behavioral Health Services
Outline
Overview of Duval County Health
Department
Community Profile
Mental Illness in Jacksonville, FL
Duval County Behavioral Health Services
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Holistic Approach to Care Model
Medicaid Reform Challenges
Study of Maternal Depression
Future Program Plans
Overview of Duval County
Health Department
DCHD mission-“To lead continuous improvement in the
health and environment of all people in Greater Jacksonville,
Florida ”
 Largest public health clinical program in Florida. 4th largest
metropolitan area in the state.
 21 health centers and clinics, 15 community based sites
 Adolescent health
Adult health
 Communicable Diseases
Dentistry
 Immunizations
Pediatrics
 Psychiatry
Women’s Health
 Florida state and National Healthy Start Initiative are funded
and implemented through Maternal and Child Health.
Overview of Duval County
Health Department
The focus is on addressing health disparities
in communities that have higher rates of
infant mortality, diabetes, heart disease and
other issues.
DCHD serves culturally diverse families and
individuals of all ages.
Overview of Duval County
Health Department
As of 2007, the population of the greater
Jacksonville area is over 1.2 million.
2005 Census Data:
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White population
Black population
Hispanic population
Asian population
Persons of 2 or more races
Other
506,961
240,117
43,604
28,646
12,689
19,739
Mental Illness in
Jacksonville, Florida
62,000 residents with severe mental illness such as
Schizophrenia
26% of children and adolescents in Duval County
experience the signs and symptoms of a mental health
disorder
1 in 4 adults suffer from diagnosable mental disorder
50% of all severe cases of mental illness manifest by age 14
and another 25% by age 24
11,000 Jacksonville adults with severe mental illness receive
public assistance
Mental Illness in
Jacksonville, Florida
Mental healthcare resources are scarce in
Jacksonville as are providers.
Psychiatrists, Psychologists, LCSW, LMHC,
LMFT’s
The uninsured, the working uninsured and the poor
find themselves unable to access mental health
services because of the inability to pay.
Holistic Approach to Care Model
As a result of the shortage of providers and services, Duval
County Health Department Behavioral Health Services was
formed in 2004 to provide counseling services to Medicaid
clients in our health delivery system. Staff is composed of:
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An adult and child psychiatrist
2 LCSW’s,
1 LMHC
2 MSW’s.
A licensed professional is available 24 hours a day, 7 days a week for
emergency or urgent services.
Prior to that time we were focused on providing services to
Healthy Start families especially in the area of postpartum
depression.
Program goals are to empower individuals and families in
our community to become self-sufficient and able to deal
with difficult life circumstances.
Holistic Approach to Care Model
DCBHS provides services in 9 of the Health
Departments area clinics. All are located in
areas to serve high risk populations.
Services are available to:
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Children 6 years old +
Adolescents
Adults
Holistic Approach to Care Model
Research indicates that 25 – 30% of clients that
come for medical appointments have underlying
behavioral health related disorders.
Holistic Approach to Care Model
DCHD provided medical services to 28,764
Medicaid recipients in 2005.
DCBHS provided 963 client sessions and
generated $183,000 in revenue.
Referrals generated by DCHD providers to
mental health licensed providers and
psychiatrists
One stop shopping:
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increases access to mental health treatment
reduces barriers to treatment as clients are seen in an
already familiar environment.
Holistic Approach to Care Model
DCHD provided Medicaid services in 2005 to:
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18,710 African Americans
3,826 Caucasian
2,303 identified minorities
DCBHS has monthly behavioral health partners
meetings to:
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Conduct peer review
Training
Provide staff support
The client’s prognosis for recovery and adherence
to other medical treatment is increased by
integrating behavioral health into primary care
with our team approach.
Monthly/Quarterly audits are conducted internally
and externally.
Holistic Approach to Care Model
 Treatment Interventions:
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individual, family and group
brief solution focused
Cognitive behavioral
Reality/insight
Empowering young men and families to
succeed; Child/parent rites of passage/skill
group
SPECIALTY SERVICES
Foster care children at our Kids N’ Care
program are seen by a Pediatric Psychiatrist,
licensed mental health counselor and a
master’s level social worker.
The goal of Kids ‘N Care is to be the premier
health system for children in foster care and so
far has provided care to over 5,000 children in
Duval County.
Last year 3,937 teens were seen at The Bridge
Adolescent Health Center for Medical and
Behavioral Health Services.
SPECIALTY SERVICES
Last year 1,399 HIV/AIDS clients and
their families were seen at our
Boulevard Comprehensive Care Clinic
(BCCC) for Medical and Behavioral
Health services.
DCBHS links to services within the
community that support the care and
treatment of mentally ill people.
SPECIALTY SERVICES
Behavioral Health staff are involved with the local child
and adult mental health task force of N.E. Florida.
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Assess community mental health needs
Make recommendations
Bring together stakeholders
Community relations are also fostered with a local
historical black college in a predominantly African
American community.
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Health fairs
Mental health month
Collaboration with student counseling center
Attending monthly professional support groups
BEHAVIORAL HEALTH PROGRAM
OUTCOMES
 Mothers reunited with their children – no longer living in violent
home environments = stabilized families.
 Healthy pregnancy = positive development of early mother &
child relationships. Improved depression and postpartum
depression scores; increased self-esteem.
 High school diplomas, GED and employment obtained.
 Client satisfaction surveys and feedback from referral sources
indicate that individual mental health has improved which
indicates that the overall health of the community have improved.
MEDICAID REFORM CHALLENGES
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Impact to clients:
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Confusion
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Uncertainty
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Provider/plan unknown
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Clients frequently move to a new residence
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Often times mail is not received by the client because
of failure to notify the postal service of their new
address.
MEDICAID REFORM CHALLENGES
 Financial Impact:
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delay in reimbursement from reform
health plans
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delay in client services due to providers
needing notifications/authorization from
managed care companies prior to providing
services.
MEDICAID REFORM CHALLENGES
 Impact to provider:
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new requirements, guidelines and paperwork
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obtain notification and pre-authorization upon
admission to program
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reauthorization after 250 units of service every 6
months
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quarterly audits
Study of Maternal Depression
 In 2005, a candidate for Doctorate for Public Health in Community Health and
Prevention, at Drexel University in Philadelphia, chose DCHD for her internship
from the Bureau of Maternal and Child Health.
Goals and Objectives of Internship = analyze and evaluate depression data on 195
pregnant and postpartum women enrolled in the Healthy Start program.
Screening Tools:
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Are you in danger of post partum depression?
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Assess women at risk for PPD
Identifying support system or lack of
Stressful life events
Lack of income
Family History
Edinburgh Postnatal Depression Scale:
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10 item questionnaire which screens women 6-8 weeks postpartum, as to how they have
felt over the previous 7 days.
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Range 0-30
Score of 9-13 may indicate depression
Score of 14 and above is indicative of depression and the person should be followed by a clinical
interview
Findings
 Race:
 African American
66%
 Caucasian
32%
 Other (Indian and Latino)
2%
 Depression:
 113 women completed the Edinburgh
- 38% of the women scored 13 or higher
- Average score was 14
 Race and Depression:
 Research indicates that African American women are more likely
to have stressors in their lives which leads to depression but did
not indicate any significant findings.
 Both groups scored higher than 13 indicating that both groups are
depressed.
 White women scored slightly higher on the Edinburgh.
Findings
Age: average age was 22 (range 11-47 yrs of age)
Education:
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45% did not graduate from high school
10% still in high school
Symptom Focus:
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Depression
Sexual abuse history
Domestic violence
16.8%
16%
5%
History of depression (factor in PPD): 59%
Insurance:
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Medicaid
67%
HMO (job, parent or spouse) 19%
Findings
 Prenatal Care:
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92% received prenatal care
6% received late prenatal care
2% did not received care
 Birth Outcomes on 135 women:
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Birth weight ranged from 1 pound to 10.10 pounds with average weight of 6
pounds)
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14% premature births
16% had very low to low-birth weights (under 2500 grams or 5 lb. 8 oz.)
8 women had twins (weight ranging from 3.12 to 7.30 lbs.)
2% miscarried
5% infant deaths
 Treatment completion:
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Average length of sessions
3
Completed with symptom improvement
Could not be contacted for follow up
Referred for additional services
Declined further services
40%
36%
12%
10%
Findings
 Number of sessions and healthy birth outcomes.
 Advocate for more finances and staff to provide counseling
sessions before and after delivery to impact high infant
mortality rates.
Women who declined services at 16.5%, scored the highest
on the Edinburgh test. Women who completed the sessions
at 13.29%, scored the lowest. Although this was not
statistically significant it was concluded that those who
declined services are more depressed.
The majority of the women indicated that they cannot
financially support themselves alone.
Future Program Plans
The program is in the process of setting up more program
evaluation with DCHD’s Health, Policy and Evaluation
Research Department.
DCHD recently added on the Department of Institutional
Medicine in 2006.
Medical and Behavioral Health Services are provided to
inmates.
An additional need was identified to provide inmates and
their families counseling to assist with the transition of
inmates back to the community.
An additional licensed mental health professional is being
hired to provide these services.