2012 county gaps analysis surveys summary of results kari benson, todd stump, jennifer strei, jill...
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Background Gaps Analysis in statute since 2001 Consists primarily of survey of counties In 2012, expanded to include people with disabilities, children and youth with mental health conditions and adults living with mental illnesses 2013 process included survey of counties and broader stakeholder input processTRANSCRIPT
2012 County Gaps Analysis Surveys Summary of Results
Kari Benson, Todd Stump, Jennifer Strei, Jill Johnson and Tom Witheridge
MN Department of Human ServicesHCBS Partners Panel Meeting
September 27, 2013
Outline of Presentation• Overview and Background• Survey Results– Aging and Adult Services– Disability Services– Children’s Mental Health Services– Adult Mental Health Services
• Discussion
Background
• Gaps Analysis in statute since 2001• Consists primarily of survey of counties• In 2012, expanded to include people with
disabilities, children and youth with mental health conditions and adults living with mental illnesses
• 2013 process included survey of counties and broader stakeholder input process
Methodology
• Separate surveys were conducted for each of the four populations
• All counties received links to the online surveys
• Approximately 80 responses were received for each of the four surveys
• For aging services, health plans and county based purchasing entities reviewed the county results and provided their comments
Focus of the Survey – Services for Older Adults
• Home and community-based services (HCBS)– change in capacity since January 2011– current HCBS capacity as of December 2012
• Housing • Nursing facility specialty beds/services • Relocation assistance
Changes in HCBS Capacity – More Available
• health promotion activities (42% of counties reporting this service as more available)
• customized living (35%)• technology (34%)• end-of-life/hospice/palliative care (31%)• personal care assistance (23%)
Changes in HCBS Capacity – Less Available
• transportation (20%)• chore service (17%)• companion service (17%)• non-medical transportation (16%)• homemaker service (14%)
Current HCBS Capacity – Meets or Exceeds Demand
• Long Term Care Consultation/ community assessment (98%)
• end-of-life / hospice / palliative care (96%)• relocation service coordination (93%)• supplies and equipment (90%)• skilled home nursing care (89%)
Current HCBS Capacity – Gaps
A “gap” is determined if a service is listed as available but limited or not available• chore service (65%)• companion service (64%)• transportation, non-medical (60%)• transportation, medical (58%)• adult day care (57%)
Changes in Reported Gaps for Aging Services 2003-2012
• top service gaps for 2012 are consistent with previous years
• Percent of counties reporting gaps have increased
• chore services, companion services and transportation reported as top gaps since 2007
Preparation for Culturally-Competent Care to Diverse Communities
• 16% believe providers are very prepared to deliver care that is culturally competent to racial and ethnic minority communities (16%)
• 7% for new American, immigrant and refugee communities (7%)
• 12% for gay, lesbian, bisexual and transgender (GLBT) communities (12%).
• 22% report provider network is not at all prepared fornew American, immigrant and refugee communities.
MCO input
• Requested health plans’ opinion on county responses to gaps analysis
• counties and plans were in agreement on reimbursement rates and culturally-appropriate service availability
• one instance of county/plan disagreement: PCA availability (county saw them as more available than plan)
Outline
• Improvements in Service Availability• Most Common Service Gaps• Barriers to Service Access• Cultural Competence• Housing Options and Transitions• Employment• Strategies for Improvement
Improvements in Service Availability
• Establishing a baseline for future surveys• Counties reported trends since 2011• Survey asked about 42 services paid through
waivers and home care that support people with disabilities in the community
• Over 80% reported increase in one or more service areas
Services – New or Expanded
• Services most commonly reported as either added/new or expanded/improved:– Assistive technology– Consumer-directed community supports (CDCS)– 24-hour customized living– Adult Day Care– 24-hour emergency assistance
Common Service Gaps
• Counties indicated services with insufficient capacity to meet the needs of people with disabilities in their area
• Combined numbers of “unavailable” and “available but limited”
• The top ten services reported as gaps were reported by half or more of all participating respondents
Top Services Reported as Gaps
1. Transportation (67%)2. Crisis Respite3. Specialist Services4. Chore Service5. Respite6. Night Supervision
Services
7. Housing Access Coordination
8. Behavioral Programming / Support
9. Adult Day Care, Bath10. Adult Day Care (51%)
Barriers to Service Access
• Critical issues to overcome to ensure people have access to options for home and community-based services:– Transportation for non-medical needs (80%)– Recruiting and maintaining staff (77%)– Affordable housing with services options (76%)– Distance / isolation (65%)
Cultural Competence
• Counties assessed their provider network’s preparation for working with specific cultural communities.
• Approximately 80% of respondents believe providers are “somewhat prepared” in cultural competence across the specific groups:– Racial / ethnic minority– New American / immigrant / refugee– Gay, lesbian, bisexual, and transgender
Cultural Competence continued
• Counties with experience in this area emphasized collaborations as a strength
• A frequently cited barrier was a lack of qualified interpreters and bilingual workforce
• Most counties are optimistic that when a need emerges providers will seek out resources to provide culturally appropriate care
Housing
• Largest gap reported was waiver funding• Within subsidized housing options the largest
gaps were reported in: – Subsidized rental apartments with
supervision/health care services (82%)– Subsidized rental apartments with support
services only (76%)– Subsidized adult family foster care (66%)
Moving to Own Home
Yes51%
No17%
Unsure32%
Could move if supports available
Yes42%
No31%
Unsure27%
Systematic strategy to re-locate?
Barriers to Employment
• Access to transportation (83%)• Job market fluctuations (77%)• Person does not want to work, or believes
they cannot work (75%)• Employment history (59%)• Fear of impact on benefits (57%)• Lack of employment supports (56%)
Strategies for Improvement
• Work closely with public health• Partnerships with neighboring counties• Collaborations with providers• Person-centered planning• Setting specific goals for contracted providers
to achieve• Using available resources (e.g. MA-EPD,
Disability Benefits 101, Disability Linkage Line)
Most Common Gaps
• Evidence-Based Practices (EBP)• Mental Health Behavioral Aide (MHBA)• Residential Treatment• Complex Needs– Brain Injuries– Neuro-psychological Services
• Inpatient Psychiatry• Psychiatric Consult to Primary Care
Service Access Barriers
• Workforce• Training• Geography/Population• Transportation
Barriers to Return to Community
• Lack of Community Based Resources– Intensive community supports (day treatment,
mentors, etc.)– Mobile crisis response
• Lack of supports for Families– Respite– Mentors– Support groups
County Priorities
• Workforce Issues• School-based Services• Transportation• Crisis beds, respite, and stabilization• Specialized treatment
Cultural Competence
• Report not much diversity– 30% not at all prepared for new Americans or
immigrant populations– Focus on language/race– Transportation to culturally specific providers &
limited success with language line, etc.– Additional training needed
Recommendations
• Increase Technology• Service Development and Planning– Prevention & Early Intervention– Mental Health Parity– Affordable Care Act (ACA)
• Embrace Evidence Based Practices (EBP)• Improve Cultural Competence
Let’s start with the good news ─ services that expanded or
improved:• diagnostic assessment• dialectical behavior therapy (DBT)• adult rehabilitative mental health services
(ARMHS)• certified peer specialist services• crisis assessment and intervention
Confusing results ─some services both expanded and
contracted:• adult rehabilitative mental health services
(ARMHS)• medication management by psychiatrists
or advanced practice nurses• mental health services in jail
Special problems inrural and frontier settings:
• low population density• chronic professional workforce shortages• long driving distances (“windshield time”)
Rural and frontier examples:
• assertive community treatment (ACT)• inpatient psychiatric care• crisis intervention services• skilled nursing care with enhanced behavioral health
staffing• partial hospitalization• dialectical behavior therapy (DBT)
We need more of these:• mental health court• “Bridges” rental subsidies• permanent supportive housing• mental health services in jail• certified peer support and other
consumer-provided services• outreach to people experiencing
homelessness
Cultural gaps:Only a small percentage said that providers are “very prepared” to deliver culturally competent services to:• racial and ethnic minority communities• new American, immigrant, and refugee
communities• gay, lesbian, bisexual, and transgender
communities.
As one county respondent pointed out:
“We need more culturally specific
providers to meet the needs of specific
cultural populations.”
Our goal is:
A recovery-oriented service system for
all Minnesotans living with mental
illnesses.
To achieve that goal:
1. We need many more units of decent,
affordable housing with supports ─ in
which both the housing and the
supports are chosen by the
participants themselves.
2. We need better integration across the
service delivery “silos” ─ mental health,
chemical health, primary care, public
health, and the rest.
3. We need more sensitive and effective
outreach to cultural communities that are
often underserved or inappropriately
served.
4. We need to address our serious, statewide shortages of:
• psychiatric care providers• mental health services in jail• integrated services for co-occurring
mental health and substance use disorders
• supported employment services using state-of-the-art, evidence-based practices
5. We need many more certified peer specialists
working in our system – that is, current or
former service recipients who have
successfully completed a DHS-approved
training program and are ready to help their
peers make progress on the road to recovery.
Bottom line:
Much progress has been made, but
much work remains to be done – as
the Gaps Analysis has clearly revealed.