FRANKLIN COUNTY ADAMH SYSTEM NEEDS ASSESSMENT

Executive Summary

Purpose and Scope
This project updates and extends upon earlier efforts to assess the need among Franklin County residents for services offered by the Franklin County ADAMH Network of Providers. Updated quantitative estimates of need are based on methodological approaches that benefit from and build on prior efforts to assess need for ADAMH-funded services. Qualitative information about need and priorities for addressing need also were gathered from internal and external system stakeholders and through a document review process. Areas in which quantitative and qualitative views of need converge also are identified. Implications for potential action are offered. The ADAMH Board will engage in more detailed review of these findings in a series of strategic planning sessions. A final report then will be produced which includes policy recommendations and an action plan.

Findings

What Do The Numbers Tell Us About Need For Service?
The Population in Need: Residents of Franklin County most likely to use the services provided by the ADAMH Network of Providers are the economically disadvantaged who number about 235 thousand or 28% of the county's 1.1 million residents. Roughly one-third of these individuals or 70 thousand residents are estimated to potentially be in need of services funded through the ADAMH Board. This estimate is based on using a basic prevalence rate of 21% for mental illness and 10% for substance-related illnesses.

The Population that Received Service: Between July 1, 2000 and June 30, 2001 about 32 thousand of these 70 thousand economically disadvantaged people (45%) received treatment services. This penetration rate of 45% was obtained at a cost of 77 million treatment dollars, forty-million of which were spent on services for the most severely ill children and adults. A penetration rate of 62% was attained for the most severely mentally ill component of this population. The penetration rate was 23% for children and adults with severe substance abuse problems. Penetration rates for older adults and some groups of children also were lower than the overall rate. For example, penetration rates for the elderly with either mental or substance-related illness are both under 20%.

The ADAMH Network also provides prevention services. In fiscal year (FY) 2002, the Board's allocations are 5.26 million dollars for alcohol and other drug-related prevention activities and 1 million dollars for prevention activities focused on mental illness.

The ADAMH Network of Providers is reaching about half (45%) of the population expected to be in need of service and providers generally are doing a good job projecting the actual amount of service that will be delivered. In addition, there has been stability in the number of treatment units funded by ADAMH (about 1.1 million units per year) although total units of service provided system-wide has declined from 2 million units to 1.6 million units between FY 2000 and FY 2001.

What Do Stakeholders Say About Need And Service Priorities?

Need.

Internal and external stakeholders identified service-related needs spanning the consumer, service, provider organization, system, and inter-organization and inter-system levels. Stakeholder views about need also were gleaned from reports and documents. Although views varied, there were many areas of agreement.

Populations identified as needing increased attention include:

1. minority groups,
2. children and adolescents,
3. adults with co-occurring mental and substance-related illnesses (SAMI),
4. individuals with mental retardation and/or developmental disabilities, and
5. consumers released from the criminal justice system.

Needs were also identified related to service. The most common mentioned were:

1. more timely access to first-need services (not just emergency services),
2. crisis beds, especially for youth,
3. services for children,
4. wrap-around services,
5. integrated services for the SAMI population,
6. culturally-competent services,
7. more housing tailored to special groups,
8. employment-related services,
9. evidence-based practices,
10. AOD services built on the concepts of self-help and peer-support,
11. consumer-operated services and,
12. prevention services for emerging groups and emerging needs.

At the service provider level, there was strong agreement that a system-wide effort needs to be launched to attract, develop and retain staff with a particular focus on consumer support program (CSP) staff. In addition, efforts to streamline paperwork must continue in order to maximize direct-service time of staff.

A number of needs were noted which relate to the system as a whole:

1. communicate the system's vision for service to the public,
2. clarify priorities to facilitate intra- and inter- system planning,
3. continue to increase stakeholder involvement in system planning activities, and
4. increase overall support to clinical leaders in the ADAMH Network.

Finally, needs also were identified at the inter-organization and inter-system levels. Needs mentioned include:

1. identify opportunities to share resources,
2. improve coordination in service delivery,
3. communicate long range plans, and
4. identify mechanisms for effective inter-system and inter-organization planning.

Priorities and Principles.

Stakeholders suggested seven principles to guide decisions related to service delivery. The seven principles are:

1. give priority to those most in need,
2. pay more attention to consumers' views about need,
3. focus first on increasing the availability of services seen as being in very short supply (e.g., housing, crisis beds for kids),
4. expand prevention programming to address emerging and changing needs,
5. increase public awareness about mental and substance-related illnesses and related need for service,
6. increase the focus on recovery through support of employment-related services and evidence-based practices, and
7. create systems for tracking the rapidly changing demographics in the county and modify services to reflect these changes.

Do The Numbers And The Experts Say The Same Thing About Need?

There are several areas of convergence between the quantitative and qualitative assessments of need. Both approaches suggest:

1. demands on the ADAMH system exceed current capacity,
2. the system is functioning quite well given current capacity,
3. the need for ADAMH-funded services is expected to grow and to change,
4. strategies must be identified and implemented for increasing capacity to serve,
5. a need to examine and evaluate current subgroup penetration rates,
6. a need to examine service priorities in light of changing demographics and economics, changes in funding and public policy, and current levels of service to subgroups of the population likely to be need, and
7. a need to carefully consider implications of various future action strategies.

CONCLUSIONS AND RECOMMENDATIONS

The financial picture facing the ADAMH Network of Providers is uncertain. Changes and limitations in Federal and State programs continue to stress local behavioral healthcare systems including the Franklin County ADAMH system. In order for the network to continue to reach the economically disadvantaged population, changes in services will need to reflect the changing complexion of this group or county residents.

A number of recommendations related to potential action emerge from project findings. These recommendations, listed in no particular order of importance include:

• Pursue strategies to increase funding and explore non-traditional sources of funding.
• Increase public awareness of network services and educate the public about how far current dollars can stretch.
• Strive for consensus on service priorities and take action in accordance with those priorities.
• Continue to support the system's focus on recovery by supporting evidence-based practices and employment-related services and by maintaining a focus on outcomes. bullet Increase services seen as being in particularly short supply (e.g., housing, crisis beds for youth, culturally-competent services).
• Increase prevention programming in light of emerging and changing needs.
• Provide strong support to clinical leaders in the network.
• Refine data systems to expand the potential uses of data.
• Increase stakeholder involvement in ADAMH system planning activities.
• Increase efficiency and continuity of care through inter-organization and inter-system collaboration.

Disseminated on January 22, 2002 at the ADAMH Board of Franklin County