here - IntraCare North Hospital
Transcription
here - IntraCare North Hospital
IntraCare Hospital North Community Health Needs Assessment 2013 MISSION STATEMENT In This Place: Courtesy Governs Interaction Dignity Can Be Found Hope Grows Who Cares? I Care ICH North CHNA 2013 IntraCare Hospital North Community Health Needs Assessment 2013 Table of Contents I. Executive Summary …………………………………………………………………………………………………………………………….4 A. Background…………………………………………………….………………………………………………………………………5 B. Assessment Methodology…………………………………….………………………………………………………………..5 C. Findings……………..……………………..……………………………………………………………………………………………7 II. IntraCare Hospital North Biography……………….…………………………………………………………………………………..9 III. Assessment Methodology ……………………………..………………….……………………………………………………………10 A. Analytic Methods………………….……………………………………………………………………………………………10 B. Data Sources..…………………….………………………………………………………………………………………………10 C. Information Gaps …………………………………………………………………………………………………………..….12 D. Collaboration Organization ……………………………………………………………………………………………….12 IV. Definition of Community Assessed……………………..…………………………………………………………………………….13 Figure 1. Primary Service Area: Harris County Zip Code Map…………………………..13 V. Secondary Data Assessment……………………………………………………………..……………………………………………….15 A. Demographics………………………………………………………….………………………………………………………..…15 1. Primary Service Area (Harris County)………………………………………………………………………15 2. Secondary Service Area (other Counties)……………….……………………………………………….18 B. Economic Indicators of Health………………………………………………………………………………………………18 1. Family Income………………………………..……………………………………………………………………….18 2. Poverty………………………….………………………………………………………………………………………..19 3. Unemployment…………….…………………………………………………………………………………………19 4. Education……………………….……………………………………………………………………………………….20 5. Homelessness………………….………………………………………………………………………………………20 Figure 2. Harris County: What Triggers Homelessness?......................................20 6. Uninsured Population..…………………………………………………………………………….…………….21 C. Behavioral Health Indicators……………..………………………………………………………………………………….21 1. Leading Causes of Death ……..…………………………………………………………..……………………..21 Table 1. Leading Causes of Death, 2011…………..………………………………………………21 2. Youth Risk Behaviors…….………….………………………………………………………………………………22 3. Other Significant Health Behaviors…..………………………………………………………………………23 4. Mental Illness Prevalence……….….…………………………………………………………………………….24 D. Behavioral Health Underserved Population…………………….……………………………………………………25 1. Budget/Funding………..……………………………..………………………………………………………………25 2. Behavioral Health Professional Shortage .………………………………………………………………26 E. Existing Behavioral Health Facilities………………………………………………………………………………………26 F. Summary…………………………………………………………………..………………………………………………………….27 VI. Inpatient Data…………………………………………………………………………………………………………………………………..28 A. Demographics………………………………………………………………………………………………………………………28 B. Diagnosis Data……………………..………………………………………………………………………………………………29 1. Primary Diagnosis……………………………………………………………………………………………………30 2. Secondary Diagnosis….……………………………………………………………………………………………30 C. Insurance & Reimbursement Rates……….………..……………………………………………………………………32 D. Collaboration……………………………………………………………………………………………………………………….33 1. Intake Referrals………………………………………………………………………………………………………33 2. Inpatient Services…………………………………………………………………………………………………..34 2 ICH North CHNA 2013 3. Discharge Referrals…..……………………………………………………………………………………………34 VII. Primary Data Assessment………………………..………………………………………………………………………………………36 A. Findings Summary…….………….………………………………………………………………………………………………36 B. Community Input………………………….………………………………………………………………………………………36 Part One: Area of Experience………..……..…………………………………………………………………..36 1. Behavioral Health Experts ……………………………………………………………………….. 36 2. Community Agencies……………………………..…………………………………………………….38 3. ICH North Social Services Staff.…………………………………………………………………….41 4. Community Residents……..…………………………………………………………………………..44 Part Two: Behavioral Health Specific Needs…….………………………………………………………..48 Part Three: General Community Problems/Issues………………………………………………………49 VIII. Prioritization Process and Criteria…………………………………..………………………………………………………………50 IX. Assessment Summary…………………………………………………….…………………………………………………………………51 References…………………………………………………………………….………………………………………………………………………53 Appendix A: Community Resource List………………………………………..………………………………………………………..55 Appendix B: Complete List of Community Problems/Issues According to Resident Participants…...……..62 3 ICH North CHNA 2013 I. Executive Summary Harris County is located in Region 6 Source: Texas Department State Health Service, Health Service Regions Thirteen Service Area Counties: Brazoria, Brazos, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, Polk, Tyler, Walker, Waller, and Washington Primary Service Area: 87% of Service Community resides in Harris County Harris County Population Total 2010: 4.092 million Population Growth 2000-2010: Harris County 20.35%, Texas 20.59%, U.S. 9.71% Poverty: Harris County and Texas (17%), U.S. (14.3%) from 2007-2011 Harris County Race: White 40%, Hispanic 29%, and Black 14% Uninsured Rate: Harris County 27.9%, Texas 23.7%, U. S. 15.5% Mental Health Prevalence: U.S. population affected by mental illness annually 78.6% Findings: Increased access, availability, and funding for resources; collaboration among providers; diversity training; chemical dependency and health issues 4 ICH North CHNA 2013 A. Background This is the first assessment completed for IntraCare Hospital North (ICH North) and multiple data sources were utilized to gather information regarding the needs/issues of the behavioral health community served by ICH North, including secondary data (demographics, diagnosis, and referrals for care), census and community databases, and primary data (surveys of community residents, social services staff, behavioral health experts, and community agencies). Standard resources of data utilized included, but are not limited to, U.S. Census, United Way, and Harris County Health Department. This Community Health Needs Assessment (CHNA) was designed in accordance with the federal Patient Protection and Affordable Care Act (PPACA) passed in 2010, requiring all hospitals to report additional information regarding community needs, financial assistance policies, charges, billing and collections. The objectives of the CHNA are to: Meet Federal Government and regulatory requirements Research and report on the demographics and health status of the study area including a review of state and regional data Gather input, data and opinions from persons who represent the broad interest of the community Analyze the quantitative and qualitative data gathered and communicate results via a final comprehensive report on the needs of the communities served by ICH North Prioritize the needs of the community served by ICH North Create an Implementation Plan that addresses the prioritized needs An implementation strategy was developed to explain the best way to use limited charitable resources to best address or refer community members’ needs/issues. B. Assessment Methodology The following research was conducted by ICH North Administrative Staff: Demographic analysis of study area, utilizing data from the U.S. Census Bureau of Statistics and other sources Summarization of most recent behavioral health data available Conducted focus groups with social services staff providing services at ICH North Developed and analyzed questionnaires distributed to behavioral health experts via Survey Monkey, community residents, hospital inpatients, and patients at outpatient clinics, and community agencies/offices by the ICH North Community Education Department Facilitated the prioritization process during board meetings Analyzed data from discharged charts regarding referral sources most commonly used Methodology for each component is summarized below: ICH North Biography and Study Area Definition and Demographics 5 ICH North CHNA 2013 o Background information about ICH North was taken from the website and internal documents o The study area was based on hospital inpatient admission data from April 2010 to April 2013 o Population demographics include comparisons by race, age, ethnicity, average and median income, unemployment and economic statistics in the study area from, but not limited to, the U.S. Census Bureau and the U.S. Bureau of Labor Statistics Behavioral Health Data Collection Process o Multiple sources, listed in the reference section of this report, were utilized for behavioral health data collection o Behavioral health data sources include, but are not limited to, the Texas Department of State Health Services and the Behavioral Risk Factor Surveillance System Focus Group Methodology o Social services data was collected in the June 2013 monthly meeting (focus group) over an hour period of time o Data was entered and analyzed to report opinions of social services staff about the needs of the patients they serve and the behavioral health community as a whole o Focus groups with social services staff at ICH North explored discharge planning, referral processes, and ideas for ways to improve collaboration with outside agencies o Staff identified challenges/barriers to completing discharge plans, ease of access to referral sources, and common agency referrals used o The process of creating and executing a discharge plan as well as the positives and negatives of the process were shared Expert Questionnaire Data Collection (August 2013) o A ten question online questionnaire was emailed out to members of the Network of Behavioral Health Providers and 37 agency administrators across the Greater Houston area for completion o Behavioral health experts in the field were asked for opinions on service shortages and innovative collaboration techniques for improving service delivery Residential Community Questionnaire Data Collection (June 17-August 23, 2013) o Questionnaires were collected from several areas including inpatients, PHP/IOP patients, outpatients and their families o Questionnaires asked about the needs of services and services currently available, used, or needed but not accessible over this year, last year, five years ago and longer than five years ago o Part two listed reasons a service might have been needed but not accessed; community residents were asked to check all reasons that applied to each situation. Agency/Office Provider Questionnaire Data Collection (June 17-August 23, 2013) o Agencies/Offices associated with ICH North were asked by the Community Education Department to provide clientele and families an opportunity to complete the survey (i.e., 6 ICH North CHNA 2013 parents at schools, outpatients and families in psychiatrists’ offices, residential treatment center staff) Agency/Office Questionnaire Data Collection (June 17-August 23, 2013) o A three page questionnaire was distributed by the Community Education Department o Community agencies/offices were asked to provide service information and how collaboration with ICH North occurs and how often o Opinions about the needs of the clientele served from a professional assessment perspective o Questionnaires reportedly took about 20 minutes to fill out when piloted Discharge Plan Data Collection Methods (July 2013) o Discharge plans from closed charts were examined to determine the most common referral sources used for patients at discharge o Data was pulled from 4/2010 to 4/2013 service timeframe Prioritization Strategy o Eight significant needs were determined by assessing the primary service community data collected combined with the secondary data from national and local statistics o Priorities were determined by the frequency they appeared in the secondary and primary data o During a hospital Board meeting, it was determined which priorities ICH North will address within the capacity of the hospital and through referral and collaboration C. Findings Challenging social, economic, environmental, and behavioral factors combined with a lack of access to care can result in poor community health status. Improving quality of life in communities includes addressing basic needs and may reduce mortality and morbidity. A. Priority Needs in Primary Service Area - Harris County 1. 2. 3. 4. 5. 6. 7. 8. Access to services (transportation and offering local resources) Increased availability of mental health professionals and services Funding increases are needed at both state and federal levels Diversity Professional Training/Education of Community Chemical Dependency Services Collaboration/Integration of Services Cost of Providers/Reimbursement Rates Health Issues According to secondary, primary, and existing data and Community Health Needs Assessment analysis, an effective way to address the abovementioned needs include: Integrated Models of Service – collaboration among agencies and professionals Research Publications – collecting data and publishing results for funding purposes 7 ICH North CHNA 2013 Local Service Delivery – utilizing outreach departments or community education teams and projects to reach clients where they live 8 ICH North CHNA 2013 II. IntraCare Hospital North Biography IntraCare Hospital North (ICH North) is a not-for-profit private psychiatric hospital and has provided behavioral health services to residents of the greater Houston area for over 20 years. ICH North is licensed by the Texas Department of State Health Services (TDSHS) and accredited by The Joint Commission (Commission). ICH North offers mental health and chemical dependency services to children, adolescents, and adults. Services offered include assessments and evaluations, crisis stabilization, medical management, nursing services, social and therapy services, activities therapy, comprehensive individualized treatment and discharge planning, detoxification, and relapse prevention. Adult Inpatient Treatment Program services are available for those who require 24 hour care in a highly structured environment. The focus of treatment is on crisis intervention, stabilization and assessment of the patient’s needs. The treatment team, led by a psychiatrist, provides services that may include individual, family and group therapies, education groups, recreational therapy, relapse prevention and discharge planning. The Adult Partial Hospitalization Program (PHP) provides six to eight hours of programming per day. Services may include individual, family and group therapies, education groups, relapse prevention and process groups. It is more structured than traditional outpatient therapy and may be used as an alternative to hospitalization or as a step-down program upon discharge from the hospital. Intensive Outpatient Program (IOP) programming is similar to that of PHP, but provides services an average of 10 to 15 hours per week. ICH North offers a full range of psychiatric and substance abuse services for adolescents, with the ability to accommodate the individual programming needs of adolescents (ages 13-17) and their families. Any program may be the point of entry or a transition from another level of care. The Inpatient Program offers 24 hour intensive care in a highly structured environment focused on crisis intervention, stabilization and assessment of needs, addiction education and relapse prevention, and individual, group and family counseling. The Adolescent Partial Hospitalization Program (PHP) consists of 6-8 hours per day and is available 5 days per week. PHP utilizes a social/behavioral model of treatment with a focus on positive peer community and encourages an active commitment by family to support their adolescent's program at home in the evenings and/or weekends. ICH North children’s services (inpatient and outpatient) offer structured and intensive care for children ages 6-12 experiencing emotional and behavioral problems that interfere with daily life, family, and/or school. Family participation is highly encouraged. The treatment program offers opportunities for children to practice communication and problem solving skills, and enhances self-esteem. The goals of the programs are reinforced through modalities such as individual therapy, family therapy, expressive arts, goals group, and therapeutic recreation. The program encourages active participation by members of the family. Inpatient care is provided for children who are in need of 24-hour hospitalization. Day treatment care is provided for children who need intensive care, but do not require overnight care. The day treatment program may be adapted to morning, afternoon, or partial week. 9 ICH North CHNA 2013 III. Assessment Methodology The topics and data assessed in this report meet the CHNA requirements for ICH North’s service community identified by geographic location and population and include: Demographics (numbers and locations of vulnerable people); Economic issues (poverty, unemployment rates, homelessness); Harris County Behavioral Health Indicators (crime, drug use, obesity); Behavioral Health Status Indicators (prevalence, uninsured); Behavioral Health Access Indicators (budget, behavioral health professional shortage); Collaboration (needs met by ICH North and others); and Existing Behavioral Health Facilities and Resources. A. Analytic Methods Communities (counties and zip codes) served by ICH North are identified in the beginning of this report. Results of qualitative and quantitative data analysis are discussed, and other behavioral health needs assessments from recent years were reviewed. Information is described from four behavioral health community perspectives including experts, agencies/offices, ICH North staff, and community residents of the behavioral health community. Focus groups and questionnaires were distributed and collected from May 2013 to August of 2013. Findings are summarized from all qualitative and quantitative data collected. Inpatient data collected daily from the Intake Department was also analyzed to describe the community served at ICH North. Demographics, diagnosis, insurance, referral source, and zip code upon admission are reported. Inpatient data was compared to data available at the county and state levels and findings are discussed. Behavioral health status and access indicators were analyzed and compared to state-wide and national statistics. Multiple data sources and stakeholder views are essential to assessing the level of consensus regarding community behavioral health needs. When opinions are similar to alternate data sources, confidence is high in reporting the results as a fair assessment of community needs. B. Data Sources Secondary data was collected from an existing intake database at ICH North to describe patients served by age, gender, race/ethnicity, and diagnosis. Data is collected daily on all inpatient hospital admissions and entered into an existing database. For this community health needs assessment, data was pulled from the past three years (April 2010 - April 2013) to determine the service community of ICH North. The definition of the service area is based on 80% of patients served over the 3 year period leading up to assessment. 10 ICH North CHNA 2013 Data provided for quantitative analysis included: Demographic, diagnosis, referral source, admission, discharge, and insurance coverage data for 4/2010-4/2013 from ICH North Intake Department Discharge data collected from closed charts located at ICH North Discharge planning was examined to determine the availability of services in the community in regards to follow up services after hospitalization Unemployment data from the U.S. Bureau of Labor Statistics Health professional shortage information published by Methodist Health Care and Hogg Foundation in 2011 Findings of other needs assessments published from 2005-2012 that analyzed ICH North’s service area in part or in full Behavioral health status and access indicators available from: o County Health Rankings 2013; o Texas State Health Department, 2010; o U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), 2002-2010; and o U.S. Census for general public demographics, Poverty and Economic Data, 2010. Additionally, primary data was collected for additional perspectives of the community health needs assessment information. Community questionnaires were created for the purposes of this community health needs assessment. Four areas were targeted for primary data collection. The goal was to understand several perspectives of the behavioral health community including behavioral health experts in the field, behavioral health agencies/offices, ICH North social services and therapy staff, and community residents of the service community. Data were collected from June-August 2013. 1. Experts’ Questionnaire First of all, behavioral health experts in the field were asked for opinions on service shortages and innovative collaboration techniques for improving service delivery. A ten question online questionnaire was emailed out to members of the Network of Behavioral Health Providers and 37 agency administrators across the Greater Houston area for completion. Behavioral health experts were asked to provide professional opinions about the mental health community and ways to improve current limitations/gaps in service delivery. Experts offered historical perspectives as well as future innovative ideas for improvement. 2. Agency/Office An agency survey was distributed by the ICH North Community Education Department to understand the types of agencies/offices with which ICH North currently collaborates. A three page survey collected demographics on the type of agency/office (i.e., population served, services provided) as well as impressions and experiences interacting with ICH North in the community. Additionally, current needs of the behavioral health community were reported per agency/office staff based on interactions with 11 ICH North CHNA 2013 clientele. Surveys reportedly took about 20 minutes to fill out when piloted. Results are discussed with a focus on mental health services and support. Most surveys were dropped off for completion at the participant’s leisure and picked up at a later date by ICH North Community Education staff. Opportunity for questions and/or clarification was offered to each participating agency/office at initiation and collection of surveys. 3. Social Services Staff Social services data was collected in a monthly meeting (focus group) over an hour period of time from the ICH North Social Services Department staff members. Each question was reviewed and answered as a group, but recorded on individual questionnaires for accurate reporting. Data was entered and analyzed to report opinions of social services staff about the needs of the patients they serve and the behavioral health community as a whole. Areas explored included discharge planning, referral processes, and ideas for ways to improve collaboration with outside agencies. Staff identified challenges/barriers to completing discharge plans, ease of access to referral sources, and common agency referrals used. The process of creating and executing a discharge plan as well as the positives and negatives of the process were shared. 4. Resident Questionnaire Resident questionnaires were collected from several areas including inpatients, PHP/IOP patients, and outpatients and their families. Agencies/Offices associated with ICH North were asked by the Community Education Department to provide clientele and families an opportunity to complete the survey (i.e., parents at schools, outpatients and families in psychiatrists’ offices, residential treatment center staff). Questionnaire reportedly took 20 minutes to complete when piloted. Community residents were asked to fill out a questionnaire asking about what services were used or needed but not accessible over this year, last year, five years ago and longer than five years ago. This questionnaire provided insight as to what the behavioral health community needs have been over time. Part two listed reasons a service might have been needed but not accessed. Community residents were asked to check all reasons that applied to each situation. C. Information Gaps ICH North believes there are no information gaps affecting the ability to reach reasonable conclusions regarding community behavioral health needs. D. Collaboration Organization IntraCare Hospital North administrative staff collaborated with former staff of IntraCare Hospital Medical Center, which closed January 31, 2012, for this community needs assessment report. 12 ICH North CHNA 2013 IV. Definition of Community Assessed This section identifies the community assessed by ICH North. Eighty percent of the total patients served over three years (April 2010 to April 2013) were sorted by zip code of the patient at admission. Within the 80% examined, 87% of patients resided in Harris County. Figure 1: Primary Service Area: Harris County Zip Code Map Source: http://www.trendite.net/2008/09/11/city-of-houston-and-harris-county-evacuation-zones-zip-code-maps-and-other-resources/ ICH North is located in Houston (Harris County) and the service area extends to 30 additional cities in the Greater Houston area. The assessment service area is comprised of 118 zip codes that extend into and overlap with 13 counties: Brazoria, Brazos, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, Polk, Tyler, Walker, Waller, and Washington. 13 ICH North CHNA 2013 IntraCare Hospital Service Area 4/2010-4/2013 Other Counties 13% Harris County 87% From 4/2010-4/2013, the Primary Service Area (PSA) consisted of 87% of patients from Harris County with a population of 4.29 million people. The Secondary Service Area (SSA) consisted of 5% or less of patients served in each additional county with a combined population of approximately 2.16 million persons for a total service population of 6.25 million persons. Although ICH North services are farreaching, the following assessment will focus on the PSA of Harris County. 14 ICH North CHNA 2013 V. Secondary Data Assessment This section assesses secondary data regarding community health needs of Harris County. The population is continuing to grow in numbers and diversity. Economic strain is affecting physical health through behavioral health indicators, and a need for additional mental health professionals is apparent through assessments from many sources. A. Demographics Population changes over time and plays a key role in the types of behavioral health services communities’ need. Overall the population of the region served by ICH North continues to increase. Harris County has the largest population of Texas residents with 4.25 million (16%) residents compared to 26 million in the state of Texas (U.S. Census Estimates, 2012). Dallas County follows with 2.5 million, almost half. Population Growth 2000-2010 Percentage 25.00% 20.00% 15.00% 10.00% 20.35% 5.00% 20.59% 7.46% 0.00% 9.71% Houston Harris County Texas U.S. Source: U.S. Census Estimates, 2012 As of 2010, Houston’s population was 2,099,451, which was a 7.46% increase since 2000. The growth rate for Houston is much less than Texas (20.59%) and the national growth rate (9.71%); however, Harris County in which Houston is located, continues to grow at a much higher rate. In 2010, Harris County’s population was 4,092,459, which had grown 20.35% since 2000. Harris County had a similar population growth rate as Texas and was much higher than the national average (USA.com, 2010). 1. Primary Service Area The primary service area includes Harris County with 4,538 (87%) patients served. ICH North served patients from 90 of the 309 zip codes located in Harris County from 4/2010-4/2013. Zip codes not included were mostly affluent, industrial, or served by other local psychiatric hospitals. 15 ICH North CHNA 2013 Population by Age, 2010 100% 8.16% 10.34% 90% 13.04% 80% 70% 60.95% 60% 59.34% 59.99% 65+ 50% 19-64 years 40% Under 18 years 30% 20% 30.89% 30.32% 10% 26.97% 0% Harris County Texas U.S. Source: U.S. Census Population Data, 2010 Most residents are 19-64 years old (Harris County 60.95%, Texas 59.34%; U.S. 59.99%) and female (about 50% each for Harris County, Texas and U.S.). Population by Gender 2010 100 80 50.22 50.4 60 50.84 Female 40 20 49.78 49.6 Male 49.16 0 Harris County Texas U.S. Source: U.S. Census Population Data, 2010 Harris County residents are mostly White alone (40%), Hispanic or Latino (29%) or Black (14%) compared to Texans who are mostly White (51%) alone, Hispanic or Latino (27%) or Black (9%). The national composition is quite different with more White residents (62%), followed by Hispanic (14%) and Black (11%). 16 ICH North CHNA 2013 Population by Race, 2010 3.21 Two or more Race 2.7 14.26 One Race Other 0.75 Native 2.92 10.45 0.77 6.19 1.12 Harris County 6.18 Asian Hispanic 40.84 Black 18.95 56.65 White 0% 20% 3.84 4.75 37.62 11.85 70.4 40% Texas 16.35 U.S. 12.61 72.41 60% 80% 100% Source: U.S. Census Population Data, 2010 The diverse population of Harris County continues to grow in ethnic composition. It is becoming essential to be bilingual in order to serve this diverse population; specifically, use of the Spanish language has grown at a faster rate in Harris County (30.73%) than Texas (28.03%) or the U.S. (11.46%). Languages Spoken at Home, 2010 100% 80% 9.75% 30.73% 6.12% 28.03% 8.75% 11.46% Other 60% 40% Spanish 59.52% 65.85% 79.79% English 20% 0% Harris County Texas U.S. Source: U.S. Census Population Data, 2010 17 ICH North CHNA 2013 2. Secondary Service Area The secondary service area includes counties with less than 5% of patients served from each county. The remaining 12 counties served include Montgomery (4%), Walker (3.07%), Brazos (1.12%), and each with less than one percent from Chambers, Brazoria, Fort Bend, Galveston, Liberty, Polk, Tyler, Waller, and Washington Counties served over three years. This shows that ICH North serves a diversified community with far reaching capabilities. Secondary Service Area 5% 4.40% 4% 3% 2% 1% 0% 3.07% 0.93% 1.12% 0.38% 0.62% 0.36% 0.99% 0.44% 0.50% 0.42% 0.50% Source: U.S. Census Population Data, 2010 B. Economic Indicators of Health (Harris County) 1. Family Income In 2010, the median family income for Harris County residents ($56,319) was comparable to Texans ($56,575) but lower than the national median ($60,609). However, the average income in Harris County ($80,338) exceeded both the Texas ($75,506) and national ($79,338) averages. Family Income, 2010 $90,000 $70,000 Median Mean $50,000 Harris County Texas U.S. Source: U.S. Census Population Data, 2010 18 ICH North CHNA 2013 2. Poverty About 17% of persons were living below the poverty level for both Harris County and Texas, which was higher than the national average (14.3%) from 2007-2011. Poverty Rate Estimates, 2007-2011 17.3% 18% 17.0% 16% 14.3% 14% 12% 10% Harris County Texas United States Source: U.S. Census Population Data, 2010 3. Unemployment Rates The unemployment rate for Harris County (6.5%) in July 2013 was slightly lower than Texas (6.7%) and the U.S. (7.9%). In Texas, the unemployment rate for individuals with serious mental illness is 90% (United Way Denton County, 2013). Unemployment Rates Jan 2008-2013 10% 9% 8% Harris County 7% Texas 6% United States 5% 2010 2011 2012 2013 Source: U.S. Census Population Data, 2010 19 ICH North CHNA 2013 The National Institute of Mental Health (2008) reported that the lost earnings associated with major mental health disorders totaled at least $193 billion annually in the U.S. In 2007, persons diagnosed with serious mental illness were found to have annual earnings averaging $16,000 less than the general population. In Houston alone, $5.6 billion in earnings is lost annually as a result of severe mental illness (Methodist Health Care and Hogg Foundation, 2011). 4. Education Harris County is comparable to Texas and the U.S. in higher education, however, Harris County has fewer people with a high school diploma and more persons in the “less than a high school” category. 100% 80% 9.77% 18.03% 60% 26.83% 40% 23.40% 20% 21.97% 0% Harris County 8.61% 17.33% 29.16% 25.57% 19.33% Texas 10.44% Education for Over 25 Years Old 2010 17.74% Master, Doctorate, or Professional Degree 28.89% Bachelor Degree 28.50% Some College or Associate Degree 14.42% U.S. High School Graduate Less Than High School Source: U.S. Census Population Data, 2010 5. Homelessness According to the Coalition for the Homeless, in the Houston area, 8,700 people are without a home on a given night due to loss of job (35%), followed by having bills (15%), sick/disabled/mental illness (10%), change in family status (10%), or drugs/alcohol (9%). The homeless population was reported as one of the most at risk populations by respondents in the Harris County service area (Memorial Hermann, 2013). Figure 2. Harris County: What triggers homelessness? Source: Coalition for Homeless http://www.homelesshouston.org/homelessness-101/ 20 ICH North CHNA 2013 6. Uninsured (Harris County) According to the U. S. Census, the percent of uninsured in Harris County (27.9%) was compared to Texas (23.7%) and the U.S. (15.5%). Uninsured Population, 2010 30% 20% 27.90% 23.70% 10% 15.50% 0% Harris County Texas United States Source: U.S. Census Population Data, 2010 C. Behavioral Health Indicators In May 2013, the Memorial Hermann Health System reported the following behavioral health concerns in a CHNA that included Harris County: Respondents (71%) ranked mental health as the number one most important health problem in the community, with access to mental/behavioral healthcare services for low income residents as difficult/very difficult (85%), and inadequate/very inadequate mental health screenings available (80%). Barriers included inadequacies of limited number of beds and substance abuse intervention and rehabilitation programs (Memorial Hermann, 2013). 1. Leading Causes of Death The top two leading causes of death were the same for Harris County and Texas (Heart Disease and Cancer). Stroke was the third leading cause of death in Harris County compared to Texas which was 4th. The fourth leading cause of death for Harris County was accidents compared to Texas which was 5th. Diabetes was higher on the list for Harris County (6th) than for Texas (7th) and are all considered preventable diseases. Most causes of death are considered preventable, and decrease among persons exhibiting healthy behaviors. 1 2 3 4 5 6 7 Table 1. Leading Causes of Death, 2011 Harris County (mortality rate*) Heart Disease (196.1) Cancer (177.3) Stroke (49.5) Accidents (41.1) Chronic Lower Respiratory Disease (36.2) Diabetes Kidney Disease Texas (mortality rate*) Heart Disease (181.1) Cancer (165.9) Chronic Lower Respiratory Disease (43) Stroke (44.4) Accidents (39) Alzheimer's Diabetes 21 ICH North CHNA 2013 Table 1 (contd.) Leading Causes of Death Harris County (mortality rate*) 8 Septicemia 9 Alzheimer’s 10 Influenza and Pneumonia Texas (mortality rate*) Kidney Disease Influenza and Pneumonia Suicide *Deaths per 100,000 persons, age-adjusted to the 2000 Standard population. Source: Texas Department of State Health Services, Center for Health Statistics Suicide was ranked as the 11th cause of death for Harris County (10th in Texas) and had increased from 2007-2009. Intentional self-harm, i.e. suicide, was 5.2 per 100,000 adolescents in 2008 placing suicide as the 3rd leading cause of death in this age group. Eighty percent of adolescent suicide deaths occurred among males. Suicide Rates per 100,000 12 11.6 11.5 11 11.4 Harris County 11 Texas 10.5 10.7 10.5 10 2007 2008 2009 Source: Texas Department of State Health Services, Center for Health Statistics 2. Youth Risk Behaviors Houston youth are more likely to engage in 14 different risky behaviors in the following 6 categories than Texas youth: o o o o o o Physical violence Purchasing cigarettes Sexual intercourse before age 13 Never taught in school about AIDS or HIV infection Do not eat vegetables Do not engage in enough physical activity (<60 minutes per day) Source: Center for Disease Control and Prevention, Adolescent and School Health, Youth Risk Behavior Survey ‐ Houston and Texas 2011 22 ICH North CHNA 2013 3. Other Significant Health Behaviors: Harris County vs. Texas Texans and Harris County residents are compared below on multiple behavioral health indicators. Indicators with remarkable statistics are reported according to County Health Rankings. Behavioral Health Indicators, 2013 834 1000 800 600 400 200 0 483 545 476 Harris County Texas Violent Crime Sexually Transmitted Infections Source: Harris County Health Rankings, 2013 Violent crimes are almost twice as prevalent in Harris County (834) compared to Texas (483). Sexually transmitted diseases are slightly higher in Harris County (545) than those in Texas (476) as a whole. Behavioral Health Indicators, 2013 60% 50% 40% 30% 20% 10% 0% Harris County Texas Adult Smoking 16% Excessive Drinking 17% Teen Birth Rate 60% Adult Obesity 18% 16% 60% 29% 29% Source: Harris County Health Rankings, 2013 Harris County residents are equivalent to Texans overall on teen birth rate (60%) and adult obesity (29%). More adult Texans (18%) report smoking compared to Harris County Residents (16%). More Harris County residents (17%) report excessive drinking to Texas (16%) overall. Texas is ranked 10th in the country for highest obesity rate (30.4%), which contributes to three of the top ten leading causes of death (heart disease, cancer, and diabetes) (F is Fat, 2011). 23 ICH North CHNA 2013 4. Mental Illness Prevalence One in four adults in the U.S. experience a diagnosable mental illness in a given year, six percent have a serious mental illness, and nearly half of all adults in the U.S. will have a diagnosable mental condition in their life time (Methodist Health Care and Hogg Foundation, 2011). There is hope for those that suffer and their families as long as there are essential services and support available. Persons with mental illness can live productive and contributory lives in the community; however, without adequate services; this population fills the streets, homeless shelters, and hospital emergency rooms daily. Percent of U.S. Adult Population, 2010 50% 40% 30% 20% 10% 0% 46.6% 26.2% 5.8% Mental Illness in Mental Illness Lifetime Annually Serious Mental Illness Annually Source: Methodist Health Care & Hogg Foundation, 2010 The Texas Department of Mental Health and Mental Retardation (2005), reported the lifetime prevalence of diagnoses for participants 18 years and older. The most common were Anxiety Disorders (28.80%) followed by Impulse-Control Disorders (24.80%), Mood Disorders (20.80%), and Substance Use Disorders (14.60%). Lifetime Diagnosis Prevalence, 2005 28.80% 24.80% 30% 20.80% 25% 20% 14.60% 15% 10% Anxiety disorders Mood Disorders Impulse-control Substance use disorders disorders Source: Texas Department of Mental Health and Mental Retardation, 2005 24 ICH North CHNA 2013 D. Behavioral Health Underserved Population The following findings were reported by the Public Consulting Group’s analysis of the Texas Public Behavioral Health System in 2011: (http://www.publicconsultinggroup.com) Funding: Texas was ranked 51st (including Washington, D.C.) in mental health spending and 37th out of 45 states in spending on substance abuse Access and Quality: Texas Behavioral Health System was not providing access to needed services; therefore, persons were seeking help in emergency rooms or receiving treatment as inmates in jails, prisons, or juvenile detention centers across the state Transparency: DSHS collects multiple types of data from mental health and substance abuse contractors; however, data is not published in a manner that allows the public to understand it and that makes it difficult to hold providers accountable when deficiencies are found Integration: Individuals with mental illness have comorbid physical health conditions that often go untreated. Nationally, approximately 25% of people with mental illness also suffer from co-occurring substance abuse disorders. In Texas, some efforts have been made to provide integrated services, but not state wide. 1. State Budget Texas currently ranks 51st in the U.S. for mental health spending on mental health (per capita). From 2010 to 2012, Texas spent $38.99 to $16.25 per capita respectively, a 58.3% reduction in mental health funding across the state (United Way Denton County, 2013). Mental Health Expenditures (per capita) 2010 $150.00 $126.56 $100.00 $38.99 $50.00 $0.00 Texas U.S. Source: United Way Denton County, 2010 25 ICH North CHNA 2013 2. Behavioral Health Professional Shortage As the composition of Texas residents’ increases, ages, and shifts ethnic composition, a growing number of people are increasingly suffering from multiple medical conditions. There is an increased need for medical professionals and the number is not growing to accommodate the need. This shortage is well known and is more critically severe in mental health services. Texas ranks far below the national average in the number of mental health professionals per 100,000 residents (Center for Health Statistics Health Professionals Resource Center, 2010). While the need for mental health professionals has increased, the number of psychologists and social workers has remained flat, creating an increase in the ratio of mentally ill persons to professionals (Methodist Health Care and Hogg Foundation, 2011). In Texas, the need will go unmet due to several factors: an aging workforce beginning to retire, training and recruiting challenges for mental health, lack of internship training sites, inadequate pay and reimbursement rates, and lack of cultural and linguistic diversity, limiting the knowledge, skills, and training of existing professionals from serving those that speak a language other than English or of racial and ethnic diversity The need for holistic care is more apparent now than ever. Research indicates that mental health and physical health are linked; however, services are usually provided separately often creating overlap or split use of funds. Collaboration and working with interdisciplinary teams is essential in the cost effective treatment of the mentally ill population. E. Existing Behavioral Health Facilities Below is a list of existing behavioral health care facilities located in the Houston area and in ICH North’s service area. See Appendix A for a list of resources often utilized by ICH North social services staff, as well as age and need specifications. Other Houston Area Inpatient Psychiatric Facilities The Methodist Hospital Harris County Psychiatric Center The Neuropsychiatric Center‐ MHMRA West Oaks Cypress Creek Kingwood Pines Menninger Clinic Behavioral Hospital of Bellaire St. Joseph Medical Center Behavioral Health Address 6565 Fannin 2800 South McGregor Way 1502 Taub Loop 6500 Hornwood 17750 Cali Dr. 123 McClellan Rd. 12301 S. Main St. 5314 Dashwood Dr. 1401 St. Joseph Parkway City Houston Houston Houston Houston Houston Kingwood Houston Houston Houston Source: Adapted from Menninger Clinic Community Needs Assessment, 2013 26 ICH North CHNA 2013 F. Summary of Secondary Data According to secondary data collected for this CHNA, Harris County is the primary service area of ICH North. Compared to state and national statistics, Harris County appears to rank equal to or in greater need of intervention in the following issues: Economic strain Behavioral health affecting physical health outcomes Underserved Mentally Ill Population Following this section, the demographic data of the ICH North inpatient population for comparison and then primary data from community residents are reported. 27 ICH North CHNA 2013 VI. Inpatient Utilization Data From April 2010 to April 2013, ICH North served a total of 8,065 patients (80% analyzed = 6,256). Annual trends indicate a decrease in service from April 2010 (1,962) to April 2012 (1,840), then an increase from April 2013 (2,454). The large increase after January 31, 2012 is largely due to the accommodation of patients previously served by IntraCare Medical Center Hospital, which closed in January 2012. Inpatient Population by Year Served 2500 2300 2100 1900 1700 1500 2010-2011 2011-2012 2012-2013 A. Demographics The ICH North population is similar to Harris County and Texas regarding age and gender. However, ICH North differs greatly on inpatient ethnicity by serving a higher percentage of Black and Hispanic patients compared to Harris County, Texas, and the U.S. Female Inpatient Population by Age 59% 41% 29% 12% 18+ Male 13-17 65% 59% 0% 20% 40% 19% 60% 80% 16% 4-12 years 100% Mostly male (59%), patients served were over 18 years of age (65%), followed by 13-17 year olds (19%) and 4-12 year olds (16%) and females were over the age of 18 (59%) followed by 13-17 year olds (29%), and 4-12 year olds (12%). Patient age ranged from 18-82 years (60%), 13-17 years (24%), and 4-12 years (16%). ICH North serves mostly White or Black (42% each), followed by Hispanic (14%), other (2%) and Asian. (0.4%) patients. 28 ICH North CHNA 2013 Inpatient Population by Ethnicity, 2010 2.40% 14% 42% 42% 0% 10% 20% Other Hispanic 30% Black 40% 50% White ICH North serves (42%) patients compared to much lower numbers for Harris County (18.95%), Texas (11.85%) and the U.S. population (12.61%). There are also a lower number of Hispanic (14%) patients served by ICH North compared to the overall populations of Harris County (40.8%), Texas (37.62%), and the U.S. (16.35%). B. Diagnosis Data Diagnoses were categorized, regardless of specifications, for example Bipolar I, Unspecified and Bipolar I, severe with psychotic features were both categorized as Bipolar Disorder for analysis. Annual trends of diagnoses were similar for all three years with only fluctuations in the number of patients served. For the first two years, the most common diagnosis was Schizoaffective Disorder (2011=32%, 2012=25%), followed by Bipolar Disorder (2011=25%, 2012=24%) and Depressive Disorder (2011=24%, 2012=25%). By the third year, the order changed but the top three were still the same with the most common diagnosis being Bipolar Disorder (29%) followed by Depressive Disorder (28%) and then Schizoaffective Disorder (14%). Psychosis was a close fourth (11%) in year three and had only slightly increased from 2011 (6%) and 2012 (7%). Inpatient Primary Diagnosis by Year 35% 30% Schizoaffective 25% Bipolar 20% Depressive 15% Mood 10% Psychosis Schizophrenia 5% 0% 2011 2012 2013 29 ICH North CHNA 2013 1. Primary Diagnosis Since ICH North provides services to children, adolescents, and adults, data is reported separately to show services provided for the unique populations. Children and adolescents showed to have similar diagnoses with few differences when compared to the adult population differences. Overall the population shared the most common diagnoses; however, substance dependence diagnoses with the need for withdrawal services were most commonly found in the adult population. Similarly, ADHD was most commonly found in children and adolescents served by ICH North. Overall the top 5 most common primary diagnoses from 4/2011-4/2013 were the same for children (412 years old) and adolescents (13-17 years old). Mood Disorder for children (53%) and adolescents (53%) was followed by Bipolar Disorder for children (28%) and adolescents (29%). The third most common diagnosis was Depressive Disorder for children (12%) and for adolescents (26%) followed by ADHD for children (3%) and adolescents (1%). Inpatient Primary Diagnosis by Age 2010-2013 Depressive Child 12% 28% 26% Adolescent 3% 28% 53% 3% 3% 53% 1% Bipolar Schizophrenia Schoaffective 29% Adult 0% 20% 25% 40% 14% 10% 10% 9% 4% 60% 80% 100% Psychosis Mood The most common primary diagnoses for adults were types of Depressive Disorder (29%) followed by types of Bipolar Disorder (25%), types of Schizophrenia (14%), Schizoaffective and Psychosis (10% each), then Mood Disorder (8.6%). Compared to adults (0.05%), children (2.8%) and adolescents (1%) received ADHD as a primary diagnosis more often. Adults (4%) received substance dependence disorders more often than children (0%) and adolescents (0.3%) over all. Comparison by individual year did not show any difference over time other than the fluctuation of total number of patients served. 2. Secondary Diagnosis Thirteen percent of patients served over three years had a secondary diagnosis. The most common secondary diagnoses include Substance Abuse/Dependence (47%), ADHD (11%), Depression (10%), Psychosis (8%), Bipolar (7%), and PTSD (4%). All other secondary diagnoses (i.e., Schizophrenia, Schizoaffective, Mood, Anxiety, and Conduct) represented 30 patients (4%) or less. 30 ICH North CHNA 2013 Inpatient Secondary Diagnosis, April 2010-April 2013 50% 40% 30% 47% 20% 10% 11% 10% 8% 7% 4% Bipolar PTSD 0% Substance ADHD Depression Psychosis Children and adolescents were both most commonly diagnosed secondarily with ADHD (44% and 34% respectively) followed by Psychosis (15% and 18% respectively). Children were secondarily diagnosed with Depression (14%), Bipolar and Impulse Disorders (6% each) and less than 5% with other diagnoses. Following ADHD and Psychosis (abovementioned) adolescents were mostly secondarily diagnosed with substance related diagnoses (11%) and depression (9%). Less than 7% of patients were diagnosed secondarily with Conduct, Schizophrenia, Schizoaffective, Mood, Anxiety, PTSD, Bipolar, or other diagnosis. Inpatient Secondary Diagnosis by Age ADHD 44% Children 14% 6% 15% 4%6% Substance Depression 34% Adolescents 11% 9% 4% 18% 6%5% 7% Bipolar Psychosis PTSD 63% Adults 0% 20% 40% 10% 8% 5% 3% 3% 60% 80% 100% Schizophrenia Other Substance abuse (63%) is the most common secondary diagnosis for adults followed by Depression (10%) and Bipolar Disorder (8%). With less than 3% each, patients were secondarily diagnosed with other disorders including Schizoaffective, Mood, Anxiety, and ADHD. 31 ICH North CHNA 2013 C. Insurance & Reimbursement Rates ICH North serves mostly patients with managed care (44%), Medicare (35%), Medicaid (20%), or Commercial Indemnity coverage (1%). Percent of Patients Served by Insurance Commercial Indemnity 1% Medicare 35% Managed Care 44% Medicaid 20% Although the need for behavioral health services has increased, and the importance behavioral health effects on health has been shown in research, reimbursement rates for behavioral health services have actually decreased over time. Reimbursement rates for Medicaid, Medicare, and managed care have significantly been lower compared to Commercial Indemnity insurers. Reimbursement rates play a key role in the professional workforce. The majority of patients served by ICH North have managed care, which has the lowest reimbursement rate. IntraCare Reimbursement Rates by Year 850 800 750 700 Medicare 650 Medicaid 600 Manage Care 550 Commercial Indemnity 500 450 400 2009 2010 2011 2012 2013 32 ICH North CHNA 2013 D. Collaboration ICH North takes several steps in treating the whole patient from intake to discharge and aftercare. Collaboration is essential to holistic care of patients with behavioral health issues. 1. Intake Referrals ICH North worked with several referral sources including: Hospitals/Agencies Memorial Herman Health System Psych-Response Team o Team of therapists visit assigned ER to assess patients for inpatient psychiatric care (employed by Memorial Hermann Health System) Mobile Assessment Team (MAT) o Team of therapists visit contracted ERs to assess patients for inpatient psychiatric care (employed by West Oaks, Cypress Creek and Kingwood Pines Hospitals) Psychiatrists/Physicians Mental Health Mental Retardation Authority of Harris County (MHMRA) DAPA o Substance abuse treatment program Legal o Adult and youth probation departments, police departments o Constable offices, judges/courts) Child Protective Services Child Placement Agency (C.P.A.) o Work with foster parents and CPS caseworkers Social Network o Internet, Yellow Pages, Family Member, Friend Referral, ICH North Website Insurance Company Children are referred to ICH North from Residential Treatment Centers (RTC), Foster Parent/Foster Care/ C.P.A., Child Protective Services, and Schools with averages of 1-2 patients per week. There is also an increase in referrals of children when school is in session. Children Referrals by Source 1 School CPS Foster RTC 2 1 2 0 1 2 Average per Week 33 ICH North CHNA 2013 DAPA is the main referral source of adult patients with an average of 24 referrals per week followed by medical/surgical or psychiatric hospitals with an average of 12.8 and former patients returning for inpatient care with an average of 11.1 referrals per week. Secondary referral sources include psychiatrists with 7 patient referrals per week followed by the Social Network and Psych-Response Team from Memorial Hermann with an average of 6 patients per week each. The third most common referral sources include MHMRA and insurance companies with an average of 2-3 patient referrals per week. Other (average 1-2 per week) referrals include, but are not limited to, the MAT Team, Psychologist/Therapist, Legal, Physicians and Community Agencies. Average per Week Number of Referrals by Source 30 24 20 12.8 10 11.1 6.7 6.1 6.1 3.6 3.2 2.5 2.4 0 2. Inpatient Services ICH North offers medical evaluations on inpatient units to all patients. Physicians also discuss medications and treatment with treatment team members including, but not limited to, case managers, therapists, and the patient to assure efficient care. If a patient cannot be treated for a medical condition on the inpatient unit, ICH North collaborates with area medical hospitals for more in-depth medical assessment and stabilization prior to returning to ICH North for completion of mental health stabilization and treatment. ICH North is also a resource for medical hospitals to refer patients for mental health stabilization after medical treatment and stabilization. Chemical Dependency Unit ICH North offers a unit specifically for patients with a secondary diagnosis of chemical abuse or dependency. Patients are served by an experienced dual diagnosis treatment team. Patients are offered chemical abuse/dependency focused group therapy and assessments, as well as treatment by a psychiatrist specializing in co-occurring diagnosis and treatment. 3. Discharge Referrals Requirements of discharge plans include, but are not limited to, follow-up with outpatient psychiatrists, therapists, treatment programs and/or support groups. 34 ICH North CHNA 2013 Cases from the 3-year assessment timeframe were taken to examine the types of services ICH North utilizes for patients at the time of discharge. Ninety-eight percent of patients were referred for followup services; four patients refused assistance with discharge or signed out against medical advice (AMA). Patients accepted referrals for psychiatrists (92%), psychotherapists (86%), and/or treatment programs (46%). Most patients were referred to more than one service. Service Percent of Patient Discharge Referrals Treatment Program Psychotherapist Total Patients Psychiatrist AMA Followup Services 0% 20% 40% 60% 80% 100% Most patients (40%) made follow-up appointments with a psychiatrist associated with ICH North either at IntraCare Behavioral Health Clinic or in the psychiatrist’s private office. Patients were also referred to other outpatient psychiatrists (21%) followed by DAPA clinic (15%), and MHMRA (3%). The remaining patients (22%) were referred to a treatment program (PHP, IOP, RTC) with a psychiatrist and therapist on staff, or an outpatient private practice therapist. Treatment Program Referral 7% 43% 50% PHP IOP RTC Patients referred to a treatment program were most often referred to PHP (50%) and IOP (43%) with few referred to Residential Treatment Centers (7%). 35 ICH North CHNA 2013 VII. Primary Data Assessment A. Findings Summary The following is a summary of the primary data questionnaire created for the CHNA report. Experts, agencies/offices, social services staff, and community residents were surveyed. Most findings are consistent with those of secondary data sources indicating that this CHNA is a thorough assessment of the community served. Both individuals and the community at large are responsible for providing a healthy community that meets the needs of all members including, but not limited to, safety, quality education, access to resources and a sense of belonging without stigma. The population with the most need is the elderly population followed by poor adults that are uninsured, unemployed, and without transportation. The most common services provided to ICH North’s community are counseling and medication management, followed by crisis intervention and substance abuse services. Most patients utilize managed care benefits to get behavioral health needs met at ICH North and collaborating agencies/offices and are considered low income to middle class by providers. Collaboration, integration, and holistic care models are essential in meeting the growing needs of the behavioral health population. Most needed services are not utilized due to limited local access or availability of resources. Details of the questionnaire data collected from participants are reported below. B. Community Input Each group was given both specific questions about their area of experience (Part One) as well as general questions (Parts Two and Three) for comparison between groups. Experts were asked about funding opinions, social services staff was asked about discharge planning and treatment, agencies were asked about services provided, and community residents were asked about services utilized. Results are reported with Part One questions first followed by Parts Two and Three. Part One: Area of Experience 1. Behavioral Health Experts Eleven mental health professionals responded to the Experts’ Questionnaire. All but one expert (RN) held a post-graduate degree in their field of expertise. Licenses held by experts included LPC (12.5%), LMSW (37.5%), LCSW (12.5%), LCDC, MD, and RN. Respondents’ areas of expertise included administration, mental health, developmental disabilities, and chemical dependency. Experts had an average of 16 years of experience with a range of 10-35 with one person having only 4 years of experience. . 36 ICH North CHNA 2013 Behavioral Health Expert Participants 13% Area of Expertise Chemical Dependency Developmental Disabilities 7% 27% Clinical 40% Mental Health Professional 13% License Administration RN 12.5% MD 12.5% LCDC 12.5% LCSW 12.5% 37.5% Edu LMSW LPC 12.5% MD 7% RN 7% 86% Masters 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Experts provided the following answers to open-ended questions about the behavioral health community needs: Individuals have some power in contributing to a healthy community by making healthy physical and mental health choices The community is responsible for meeting the needs of its members by providing a healthy community that includes: o Safety o Fair and adequate wages o Access to resources o Communication and collaboration between services to provide holistic care o Community events and support for individuals o A sense of belonging without mental health stigma o Quality education both formal and knowledge of resources Most common barriers to providing healthy communities for its members are: o High costs and limited availability of resources o Presence of mental health stigma due to the lack of education o Transportation o Collaboration among resources o Federal and state financial support The population with the most difficulties is older adults, followed by poor adults who are mostly ineligible for enrollment in Medicaid in Texas. Other populations our experts determined are currently struggling included chronically mentally ill, indigent, working poor, minority groups, Spanish speaking groups, persons with special needs and children. The best ways to address community needs include: o Educating communities of available resources 37 ICH North CHNA 2013 o Increased government funding for program creation and expansion o Collaboration o Bringing services to the needy communities o Lowering costs o More acute and long-term hospital beds o Therapeutic group homes Areas currently being addressed well include the “bring back unused medications” program, collaboration programs are lowering mental health stigma, and education/training of law enforcement. Specific agencies are best meeting the needs of the community by providing multiple types of services through integrated models including Family Services of Greater Houston, United Way, and others providing holistic care for clients and families. Experts believe funds are most needed for (in order of importance): 1. Services for seniors 2. Skills/well-paying jobs 3. Quality child care 4. Juvenile delinquency/gang services 5. Domestic violence 6. Crisis intervention services 7. Substance abuse services More than half of respondents believe the positive attributes of living in the Greater Houston Area are: o Friendly o The Texas Medical Center o Diversity o Affordability o Cost of living o Job opportunities 2. Community Agencies/Offices Ninety-two agencies completed questionnaires regarding services provided to the community, collaboration efforts with ICH North, and perspectives on behavioral health community needs. Participating agencies were categorized by state agency (38%), clinics (25%), psychiatrists’ offices (9%), and others with less than four percent each were Residential Treatment Centers (RTC), Veterans Administration (VA), hospitals, outreach, adoption agency, schools, county services, law enforcement, pharmacy and the teen crisis hotline. 38 ICH North CHNA 2013 Agency Questionnaire Participants 40% 35% 30% 25% 20% 15% 10% 5% 0% Some agencies offered specific detail about the populations they serve. Most agencies (28.26%) reported serving all populations, incomes, genders, and classes. Children (27.17%) were the next most commonly specified population served followed by 0-18 years old and adolescents (16.03% each), adults (14.13%), veterans and their families and all families (4.34% each), 0-21 years old (2.17%), and females only (1.08%). Age Served Service Population Agency Questionnaire Service Population Eating DO Pregnancy Acute Psych Abuse Longterm Medication Mgmt Chemical Dependency Females 0-21 Families Veterans & Families Adults Adolescents 0-18 years Children All Categories 0% 5% 10% 15% 20% 25% 30% 35% 39 ICH North CHNA 2013 Some agencies gave specific details about the service provided to its population served as well as the income requirements and insurance accepted. Most agencies provided more than one service and accepted multiple insurances. The most common services provided were counseling/therapy (38%) and medication management (23%) followed by crisis intervention (10%), substance abuse services (7%), IOP (6%), education (4%), case management, housing, and residential (3% each), job assistance (2%) and transportation (1%). Agency Questionnaire Services Provided 3% Counseling 2% 1% 3% 3% Medication Mgmt 4% Crisis 38% 6% Substance Abuse 7% IOP Education 10% Case Mgmt 23% Housing Residential Job Assistance Transportation Most agencies/offices served persons with managed care (71.42%) followed by self-pay (21.42%) and Medicaid (7.14%). Only two agencies reported providing income based services. Of those that specified incomes most often served, most reported low income followed by middle or upper middle class served by the agency/office. Fourteen agencies specified the care coverage accepted for services. Income Served Insurance Served Agency Questionnaire Income & Insurance medicaid self pay managed care lower middle class upper middle class income based low income middle class 0% 10% 20% 30% 40% 50% 60% 70% 80% 40 ICH North CHNA 2013 When asked about services needed to better serve the behavioral health community, agency providers reported more local inpatient hospital beds (22%) followed by services for non-resourced persons (11%), mental health professionals (10%), chemical dependency services and parenting skills (8%), behavioral health funding and awareness (10%), education, jobs, and transportation (4% each). More local services and access to those services was the most common theme to all comments in this section. Agency Questionnaire Services Needed Outreach IOP Housing Basic Needs Aftercare Veterans Hosp Beds Children/Youth Svcs Access Transportation Jobs Education Funding Awareness Parenting Skills Chemical Dependency MH Professionals Non-Resourced Local Inpatient Beds 0% 5% 10% 15% 20% 25% 3. ICH North Social Services Staff Twenty-four social services staff members participated in focus groups to collect data regarding discharge planning processes and a different perspective of the community’s needs. The duties of social services staff range from assessment, treatment and discharge planning, and case management to individual, group, and family therapy. Additionally, ICH North offers court liaison services for inpatients and psychiatrists. Staff reported that daily referrals are most often made by phone (89%), fax (36%) or email (less than 10%). 41 ICH North CHNA 2013 Social Services Discharge Planning 100% 50% 0% Phone Fax Email Staff shared that discharge planning includes, but is not limited to: Medication Management Appointment Verification of Housing Individual Therapy Referrals Group Therapy Referrals Family Therapy Referrals Support Group Referrals Not all patients are referred for all services listed above. Discharge planning is individualized to meet the needs of each patient. Patients are referred to several aftercare resources including psychiatrists (80.5%), MHMRA (27.5%), PHP/IOP (50%), wraparound services (7%), CPS/APS (less than 10%), Personal Care Homes (PCH) (29%), Residential Treatment Centers (RTC) (13%), and support groups (89%). 42 ICH North CHNA 2013 Groups Phyicians Aftercare Inpatient Follow-up Referral Resources RTC PCH CPS/APS Wrap Around Service PHP/IOP MHMRA Psychiatrist Only Other Private Treatment Program DAPA MHMRA IntraCare Associated Support Groups Family Therapy Group Therapy Individual Therapy 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Patients are most commonly referred back to the referring physician for follow-up care. However, patients often forget contact information, are not allowed to return due to too many missed appointments, or an appointment is not available during the 7 day required timeframe. Patients are referred to ICH North associated psychiatrists (54%), MHMRA (24%), DAPA (59%), treatment program psychiatrist (31%), or other private MD (38%). Recommended services that vary by patient may include individual (56%), group (29%), and/or family (34%) therapy in a private or PHP/IOP setting. About 98% of patients are referred to support groups focused on mental illness or substance abuse, and/or case management services. Social Services Disharge Challenges Safe/Affordable Housing Insurance Timeframe Access/Transportation Pt Resistance/Limited Insight 0% 10% 20% 30% 40% 50% 43 ICH North CHNA 2013 Most common challenges for discharge planning include patient resistance or limited insight (50%), limited resources in patient areas or transportation to service (46%), completing discharge plan or obtaining follow-up appointments in the required 7 day timeframe (34%), finding insurance approved services available (25%), limited availability of safe, affordable and/or patient preferred housing (17%). 4. Community Residents One hundred fifty-two participants completed the community resident questionnaire at ICH North partial hospital program/intensive outpatient program (PHP/IOP) (53%), IntraCare Clinic (18%), pilot cases (14%), ICH North Inpatient Unit (12%), and ICH North Community Education Department (3%). Resident Questionnaire Participants Inpatient Unit Pilot 5% PHP Pilot 9% Outpatient Clinic 18% Community Education Deparment 3% Inpatient Unit 12% PHP/IOP 53% Resident respondents were mostly male (54%) and white (49%), followed by black (36%), Hispanic (11%), and other (5%). Respondents were mostly age 30-49 years old (47%), followed by 50-64 (38%), 18-29 (9%), 65+ (7%). 44 ICH North CHNA 2013 Resident Questionnaire Participants Age 65+ 50-64 30-49 18-29 Ethnicity Other Hispanic White Gender Black Male Female 0% 10% 20% 30% 40% 50% 60% Most residents lived with one other adult (34%) followed by those living alone (33%), and those with three (22%) or four (8%) adults living in their home. Finally, there were a few living with five or more (7%) adults. Community residents reported children living in the home as well with most having one child (41%), followed by two (30%), three (22%) and four (8%). Adults Children Resident Questionnaire Home Occupants Four Three Two One Five or more Four Three Two One 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Overall community residents reported using mostly counseling (22%) and substance abuse services (12%), followed by financial, education and health services (11% each), basic needs (7%), housing and job training (6% each), prisoner reentry and elderly services (4% each), and parent/prenatal services and youth development (3%). 45 ICH North CHNA 2013 Prisoner Reentry 4% Job Training 6% Percent of Resident Service Use Prenatal/Parenting 3% Substance 12% Elderly Services 4% Basic Needs 7% Housing 6% Financial 11% Education 11% Counseling 22% Health 11% Youth Development 3% Community residents reported the most commonly used services in the community this year, last year, five years ago or six or more years ago. There was a greater number of services reported used this year and six or more years ago. The most common services used this year were health care (82%), counseling (79%), elderly services (74%), basic needs and substance abuse services (64% each), and financial assistance (61%). All other services were used less often (33-57%). Six or more years ago the most common services used were job training (44%), prisoner reentry (41%), and education (40%). All other services reported as used six or more years ago were reported less often (8%-33%). 46 ICH North CHNA 2013 Frequency of Service Use Prenatal/Parenting Prisoner Reentry Job Training Elderly Services Financial This Year Education Last Year Health 5 Years Ago Youth Development 6+ Years Ago Counseling Housing Basic Needs Substance 0% 20% 40% 60% 80% 100% Community residents were asked and also reported reasons services were needed, but not accessed. Seven to eight percent of residents were not able to access all services. The most common reasons included “not able to pay” (15%), “lack of transportation” (13%), “no insurance” or “couldn’t find it” (12% each). Barriers to Access 16% 14% 12% 10% 8% 6% 4% 2% 0% 47 ICH North CHNA 2013 Part Two: Behavioral Health Specific Needs Community Behavioral Health Needs Questions were given to social services staff and agencies/offices to determine opinions about the behavioral health community’s overall needs. Scale: 1-10 (1-3=least need, 4-6=moderate need, 7-10=greatest need) Question 1. Participants rated the behavioral health community’s needs based on experience providing services. On average, agency providers believe that homeless services and professional development are the least needed, and all other services listed are the most needed. Behavioral Health Specific Service Needs 20 15 10 5 0 Staff Agency Social services staff believes the greatest needs of the behavioral health community are access to health care, substance abuse, and behavioral health services. Moderate needs included case management, homeless services, transportation and basic needs. Finally, the least needed services included employment opportunities, job skills, parenting skills, and professional development. Question 2. Participants were asked to rate the most needed services among those specific to the behavioral health community. Both agency/office staff and social services staff agreed that the most needed behavioral health service is more psychiatrists and psychotherapists. 48 ICH North CHNA 2013 Behavioral Health Service Needs 20 15 10 5 Staff 0 Agency Agency provider staff report “all” as the most needed regarding psychiatric services. Social services staff believes that all other services were rated as minor needs of the community including group therapy, PHP/IOP, wrap around services and case management services, crisis/ER and inpatient services and chemical dependency support groups (NA/AA). Part Three: General Community Problems/Issues The General Community Survey Questions were given to all four areas surveyed and results are reported here. The top three “serious problems” were alcohol/drug use (59%), lack of programs for mentally ill (46%) and child abuse (40%). Most common “moderate problems” were safety (25%), access to health care and lack of afterschool care (23% each), and uncertainty where to go (21%). Finally, minor problems reported included gambling (26%), transportation and lack of recreational programs (20% each). See full list of rankings (Appendix B). Serious Moderate Minor Top Ranked Community Problems Lack of Recreation Programs Transportation Gambling Uncertainty Where to Go Access to Health Care Lack of Afterschool Care Safety Lack of Programs for Mentally Ill Alcohol/Drug Use Child Abuse 0% 10% 20% 30% 40% 50% 60% 49 ICH North CHNA 2013 VIII. Prioritization Process and Criteria Secondary and primary data were examined to determine the need of the behavioral health community served by ICH North. A list was made of all needs found through both secondary and primary data sources. Needs were prioritized by the frequency of appearance in the data. For example, transportation was discussed as access to service in secondary data and reported by all surveyed groups (Experts, Agencies/Offices, Social Services Staff, and Community Residents). The priority list was determined as seen below: 1. Access to services (transportation and offering local resources) 2. Increased availability of behavioral health professionals and services 3. Funding increases are needed at both state and federal levels 4. Diversity Professional Training/Education of Community 5. Chemical Dependency Services 6. Collaboration/Integration of Services 7. Cost of Providers/Reimbursement Rates 8. Health Issues 50 ICH North CHNA 2013 IX. Assessment Summary ICH North assessed the health needs of the community it serves; mostly Harris County residents. Multiple data sources were examined including secondary data (demographics, health status and behavioral health status and access to services), assessments conducted by other agencies in recent years about Harris County and surrounding areas, and primary data through focus groups and questionnaires with a broad audience including those with experience in behavioral health. The following summarizes the findings of this CHNA: ICH North service area is comprised of 118 zip codes, 31 cities, and 13 counties that in 2010 were home to 6.25 million persons. Harris County is the primary service area and the secondary service area includes Brazoria, Brazos, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, Polk, Tyler, Walker, Waller, and Washington Counties. Harris County has the largest population of Texas residents, followed by Dallas County with about half the population of Harris County. Harris County’s population growth is similar to Texas and higher than the national average with a larger Hispanic, Spanish-speaking population. Harris County and Texas share the poverty rate, which is higher than the national average. Harris County has a higher number of uninsured persons than Texas or the U.S. In 2010, Harris County families’ median income was $56,319, which is comparable to the median in Texas, but lower than the national median Unemployment rates for Harris County are lower than Texas and the U.S.; however in Texas, unemployment is at 90% for persons with a mental illness. Harris County is comparable to Texas and the U.S. in higher education, but has a greater number of persons with less than a high school diploma and less high school and college graduates than both Texas and the U.S. Homelessness in Harris County is high due to several social and economic triggers including loss of job and having bills higher than earnings Available health status data indicates the following concerns affected by behavior and vice versa: o Leading causes of death including Heart Disease, Cancer, and Stroke are preventable with proper diet and exercise; however, surveys of the community indicate that even Harris County youth are not eating healthy or exercising the minimum recommended daily amounts o Suicide is ranked the 11th leading cause of death in Harris county and 10th in Texas; rates have increased from 2007-2009 o Violent crime, sexually transmitted infections, smoking, drinking, teen birth rate, and obesity are other significant behavior health indicators for both Harris County and Texas ICH North serves the mental health population, which affects more than 75% of Americans annually; however, state funding and reimbursement rates for services has continually decreased over time at a steady rate 51 ICH North CHNA 2013 There are nine major hospitals offering inpatient psychiatric services for the Harris County and Greater Houston Area in addition to ICH North Primary data collection indicated the following issues exist for ICH North’s primary service area: o The most common services used include inpatient hospitalization for stabilization, counseling, support groups, substance abuse services, and medication management o The most common reason services were not used when needed include access and availability, limited transportation, service did not exist/could not be found o Behavioral health professionals are much needed including psychiatrists and psychologists o The most needed services reported include an increase in local inpatient hospital beds, services for non-resourced persons, and behavioral health funding and resources Participants suggested both individuals and the community at large are responsible for creating a healthy community environment. Education about resources and behavioral health needs in the community was suggested to increase awareness and reduce negative stigma. Participants suggested that collaboration/integration models of service delivery are currently working best to deliver much needed services. It is suggested that integration models be used to best meet the needs of the community. 52 ICH North CHNA 2013 References U.S. Census (2010). Population Data and Statistics. Retrieved on June 15, 2013 from http://quickfacts.census.gov/qfd/index.html World Media Group (2010). Population Growth Harris County. Retrieved on June 15, 2013 from http://www.usa.com/harris-county-tx.htm Trendite (2008). City of Houston and Harris County Evacuation Zones Zip Code Map. Retrieved on June 30, 2013 from http://www.trendite.net/2008/09/11/city-of-houston-and-harris-county-evacuationzones-zip-code-maps-and-other-resources/ United Way of the Greater Houston Area (2012). Community Needs Assessment http://www.unitedwayhouston.org/ NIMH (2008). Mental Disorders Cost Society Billions in Unearned Income retrieved on September 2, 2013 from http://www.nimh.nih.gov/news/science-news/2008/mental-disorders-cost-society-billionsin-unearned-income.shtml Texas Health Department (2012). Houston and Harris County Report: The State of Health retrieved on September 2, 2013 from http://houstonstateofhealth.org/soh_doc/ United Way of Denton County (2013). Community Health Needs Assessment retrieved on August 15, 2013 from http://www.unitedwaydenton.org/ The Meadows Foundation (2011). Meadows foundation strategic plan for mental health, 2011 – 2020. Texas: The Meadows Foundation. Harris Health System (2010). Health of Houston Survey. Retrieved on August 15, 2013 from https://www.harrishealth.org/en/our-community/pages/community-assessment.aspx Coalition for Homeless (2013). Homelessness 101. Retrieved on August 26, 2013 from http://www.homelesshouston.org/homelessness-101/ Memorial Hermann (2013). Community Heath Needs Assessment. Retrieved on August 26, 2013 from http://www.memorialhermann.org/locations/texas-medical-center/community-health-needsassessment-tmc/ Texas Department of State Health Services: Center for Health Statistics (2011). Leading Causes of Death. Retrieved on August 3, 2013 from http://www.dshs.state.tx.us/CHS/VSTAT/latest/nmortal.shtm Harris County Health Public Health & Environmental Services (2011). Leading Causes of Death. Retrieved on August 22, 2013 from http://www.hcphes.org/LeadingCausesofDeath.pdf 53 ICH North CHNA 2013 Center for Disease Control & Prevention (2011). Adolescent& School Health, Youth Risk Behavior Survey- Houston & Texas. Retrieved on September 19, 2013 from http://www.cdc.gov/HealthyYouth/yrbs/index.htm County Health Rankings (2010). Harris County Health Rankings. Retrieved on September 15, 2013 from http://www.countyhealthrankings.org/app#/texas/2013/rankings/outcomes/overall/by-rank Methodist Health Care & Hogg Foundation (2011). Crisis Point: Mental Health Workforce Shortages in Texas. National Institute of Mental Health (2010). Mental Illness Statistics. Retrieved on September 1, 2013 from www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml Menninger Health Clinic (2013). Community Health Needs Assessment. Harris County Psychiatric Center (2013). UT Community Resources Lists. Retrieved on July 1, 2013 from http://www.uth.tmc.edu/uth_orgs/hcpc/local_mental_health_info.htm Trust for America’s Health (2011). F is Fat. Retrieved on June 15, 2013 from http://healthyamericans.org/report/108/ Texas Department of Mental Health & Mental Retardation (2005). Adult Mental Health Prevalence/Priority Population Data. Public Consulting Group (2011). State of Texas Health and Human Services Commission Department of State Health Services: Analysis of the Texas Public Behavioral Health System: Recommendations for System Redesign. Texas Department of State Health Services (2010). Health Service Regions. Retrieved on July 15, 2013 from http://www.dshs.state.tx.us/regions/state.shtm 54 ICH North CHNA 2013 Appendix A Community Resource List The Harris County Psychiatric Center of the University of Texas provides area resource lists most commonly used by inpatient social services staff at ICH and can be found at http://www.uth.tmc.edu/uth_orgs/hcpc/local_mental_health_info.htm. Below is the Adult and Family Services reference list in its entirety for the purposes of this CHNA report. Houston Area Mental Health Information Adult and Family Services Name Phone National Alliance for the Mentally III (NAMI) Services Provided Family Support, Education & Referral. African American (713) 673-4834 Bay Area (281) 424-4360 Fort Bend (281) 491-6707 Golden Triangle (409) 899-1990 Gulf Coast (281) 585-3100 Houston (713) 729-1242 Humble (281) 459-1518 Montgomery County (281) 367-2314 Tomball (281) 376-5368 West Houston (281) 579-3750 http://namiwesthouston.org Arc of Greater Houston (713) 957-1600 Support, Information & Referral. Associated Catholic Charities (713) 526-4611 Counseling. Baylor Psychiatry Clinic (713) 798-4857 Counseling, Evaluation. Bay Area Turning Point (281) 286-5133 Homeless shelter. Bay Area Women's Center (281) 422-2292 24-hour Hotline, Shelter, Counseling. Ben Taub General Hospital (713) 793-2000 Medical Hospital, Psychiatric Hospital. The Bridge (713) 473-2801 Hotline. Cancer Counseling, Inc. (713) 520-9873 Counseling, Education. Catholic Charities (713) 526-4611 Counseling, Adoption. Immigration Services Bay Area (281) 335-7066 Counseling. Center for Counseling (281) 487-3864 Counseling, Education. Center for Creative Resources (713) 461-7599 Counseling. Chicano Family Center (713) 923-2316 Counseling. Crisis Intervention of HoustonHotline (713) 228-1505 24-hour Telephone crisis counseling. 55 ICH North CHNA 2013 Bay Area (281) 461-9992 24-hour Telephone crisis counseling. Depressive/Manic Depressive Assoc. (713) 528-1546 Self-help support groups. Information & referral. Domestic Violence Hotline (713) 528-2121 Information & Referral, Shelter Escape Family Resource Center (713) 942-9500 Parenting classes, parent aides. Family Services of Greater Houston (713) 861-4849 Counseling. Support groups, Parent education. Bay Area (281) 335-7025 Baytown (713) 861-4849 El Centro de Familiar (713) 861-4849 Ft Bend County (281) 261-1830 Montgomery County (713) 756-6640 WaIler (281) 375-5110 Gay and Lesbian Switchboard of Houston (713) 529-3211 Telephone counseling. Gathering Place (713) 729-3499 Social support day programs. Vocation skills. Harris County Psychiatric Center (713) 741-5000 (Switchboard) Hospitalization. Houston Area Women's Center (713) 528-6798 Administrative office. Houston Council on Sexual Dependency Recovery (713) 683-2797 Support, Information & Referral. Houston Health Department (713) 794-9200 Health Services. Houston Psychiatry Society (Harris County Medical Society) (713) 524-4267 Information & Referral, Administrative office. Houston Psychological Association (713) 621-0131 Information & Referral, Speaker's Bureau. Houston Rape Crisis Hotline (713) 528-RAPE (528-7273 ) 24hr.Information & Referral, Victim assistance, support groups. Innovative Alternatives (281) 282-6023 Anger management. Interface-Samaritan Counseling Center (281) 3768006/08 (713) 626-7990 Counseling. Counseling. Jewish Family Service Lutheran Social Services (713) 667-9336 Information & Referral Counseling. Mental Health Association of Greater Houston (713) 521-0110 Counseling, Adoption, Immigration services. Mental Health Mental Retardation Authority (MHMRA) (713) 522-5161 Information & Referral, Education, Advocacy. Administration (713) 970-7000 Administration Offices. Access Center (713) 970-7070 Adult mental health services. Mental Retardation (713) 970-8200 Mental retardation services. Children's Services (713) 970-4400 Children's mental health services. Crisis Clinic (713) 970-4600 24hr Emergency Clinic. Homeless Services (713) 970-3300 Homeless services. Montrose Counseling Center (713) 529-0037 Counseling, HIV support. NAM Family Violence Center (281) 583-5656 (5600) Women's & children's counseling. 56 ICH North CHNA 2013 Obsessive-Compulsive Recovery (800) 639-7462 Support, Information & Referral. Planned Parenthood (713) 522-6363 Family planning, Education, Support groups, 24hr Helpline, Shelter. Texas Council on Problem and Compulsive Gambling (800) 742-0443 Support, Information & Referral. University of Houston/Clear Lake (281) 283-3330 Counseling, Evaluation, Assessment. U of H Psychological Research/Service Center (713) 743-8600 Counseling, Evaluation. University of Texas Psychiatric Services (713) 500-2525 Counseling, Evaluation, Subst. abuse. Veterans' Administration Hospital (713) 791-1414 Services to veterans. Children's Mental Health Services Name Phone Services Provided Attention DeficitHyperactive Disorder Assoc. (281) 897-0982 Support, Information & Referral. Bo's Place (713) 942-8339 Grief support, Information & Referral. Casa De Enperanza de los Ninos (713) 529-0639 Residential care for abused/HI children under 6 years. Child Builders (713) 783-8470 Support, Information & Referral. Children's Assessment Center (713) 986-3300 Counseling Assessment. Children's Protective Services (713) 664-5701 Child abuse investigation, Placement. Chimney Rock Center (713) 664-5701 Emergency shelter. Community Youth Services (713) 664-5701 Information & Referral, Counseling. 1-800-999-9999 (713) 523-2231 Shelter for youth under 21 years, Counseling, Vocational aid. DePelchin Children's Center Memorial Drive (713) 730-2335 Counseling Evaluation DePelchin Children's Center (Baytown, Fort Bend, Clear Lake, Montgomery County) (281) 730-2335 Outpatient Counseling, Evaluation. DePelchin Children's Center - Bay Area (281) 282-6062 Counseling, Evaluation. Family Outreach Centers (713) 748-7409 Child abuse prevention services. Hope Center for Youth (713) 526-4673, (713) 526-0919 Counseling, Residential care. Interface-Samaritan Counseling Center (281) 376-8006; (713) 626-7990 Counseling. Interfaith Ministries of Greater Houston (713) 522-3955 Education, Advocacy. Juvenile Probation (713) 512-4100 Covenant House 57 ICH North CHNA 2013 Department MHMRA Children's Mental Health Services (713) 970-7000 Assessment, Counseling, Evaluation, School-based, First-time offenders’ services. Runaway Hotline 1-800-392-3352 Shelter, Referral, Messages relayed, Information & Referral Teen Crisis Hotline (713) 529-8336 Crisis intervention. University of Texas Mental Sciences Institute Child/Adolescent Intake and Referral (713) 500-2800 Treatment services, Information & Referral. Services to the Elderly Name Phone Services Provided Abuse and Neglect Hotline 1-800-2525400 Report abuse and neglect cases. Adult Protective Services-Aged and Disabled (713) 767-2700 Investigate abuse/neglect. Alzheimer s Association (713) 266-6400 Information & Referral, Support. Career & Recovery Resources, Inc. (713) 754-7000 Employment counseling & training. Catholic Charities SAFE Program (713) 874-6590 Counseling, Case management, Information & Referral. Center for Counseling (713) 943-3864 Counseling. City of Houston Dept. of Health/Office on Aging (713) 794-9001 Support, Information & Referral. Family Service Center (Admin) (713) 861-4849 Counseling, Homecare. Houston Junior Forum, Sr. Guidance Program (713) 529-9991 Information & Referral 10:00am 2:00pm. Interfaith Ministries for Houston (713) 522-3955 Meals on Wheels, Shelter, Refugee aid. Jewish Family Service (713) 667-9336 Counseling, Social Activities. Lutheran Social Services (713) 521-0110 Counseling. MHMRA Mid-City Clinic (713) 970-4400 Evaluation, Psychiatric care. Seven Acres Jewish Senior Case Services (713) 778-5700 Day care, Full geriatric center. Sheltering Arms Senior Services (713) 956-1888 Information & Referral, Counseling, Respite & Day Care. University of Texas Psychiatric Services (713) 500-2525 Counseling, Evaluation. Veterans Administration (713) 791-1414 Services to Veterans. Visiting Nurse Association (713) 520-8115 Home Health Care. 58 ICH North CHNA 2013 Social and Related Services Name Phone Services Provided Advocacy. Inc. (713) 974-7691 Investigate abuse/neglect, Legal aid. Aid to Victims of Domestic Abuse (AVDA) (713) 224-9911 Protective orders, Divorces for victims. AIDS Foundation of Houston (713) 623-6796 Hotline Information & Referral. (713) 526-8300 Disaster assistance Transportation, Military & Social Services. Career & Recovery Resources, Inc./ United Way Agency (713) 754-7000 Employment counseling & training. Center for the Retarded, Inc. (CIR) (713) 525-8400 Workshops, Residential, Day Care. Consumer Credit Counseling Services/Money Management International (713) 923-2227 Financial counseling. Dispute Resolution Center (713) 755-8274 Mediation. Family Service Center (713) 961-4849 HIV / AIDS support services. Goodwill Industries of Houston (713) 692-6221 Job placement, Employment. Gulf Coast Community Services Association (713) 393-4700 Social Services. Gulf Coast Legal Foundation (713) 652-0077 Legal assistance. Harris County Attorney’s Office (713) 741-6016 Legal Services/Commitments. Harris County Public Health & Environment Services (713) 439-6000 Health services. Harris County Medical Society (713) 524-4267 Information & Referral. Harris County Probate Court (713) 741-6020 Legal Services/Commitments. Harris County Social Services (713) 696-7900 Food, Shelter Utilities. Hear-Say (713) 917-0062 Information & Referral, Education for hearing impaired. Houston Health Department (713) 794-9320 Health services. Houston Housing Authority (713) 260-0500 Federally subsidized housing. Houston Police Department-Jail (713) 247-5400 Emergency detention. Houston Public Library (713) 236-1313 Information, Reference desk. Interfaith Ministries for Houston (713) 522-3955 Meals so Wheels, Refugee Services, Information & Referral Lutheran Social Services (713) 521-0110 Refugee services. Mayor's Citizens Assistance Office (713) 247-1888 Information & Referral of city agencies. Planned Parenthood (713) 522-6363 Information & Referral American Red Cross 59 ICH North CHNA 2013 Education. Alliance for Multicultural Community Service (713) 776-4700 Information & Referral, Refugee services. Social Security Administration 1-800-772-1213 Social security benefits. TDHS (713) 767-2000 Info on Medicaid and AFDC. Texas Department of Protective and Regulatory Service -Abuse Hotline (800) 252-5400 Legal Services/Commitments. Texas Rehabilitation Commission (713) 862-5294 Job training & placement. United Way (713) 957-HELP (957-4357) Information & Referral Bay Area (281) 333-9700 Brazoria County (281) 331-6101 Ft. Bend County (281) 499-5681 WaIler County (281) 375-5110 Alcohol and Drug Services Name Phone Services Provided Al-Anon (713) 683-7227 Support to families. Alcoholics Anonymous Intergroup Assoc. (713) 686-6300 (713) 683-7227 Support to alcoholics. Association for the Advancement of Mexican Americans (AAMA) (713) 926-4756 (713) 926-5464 Counseling, Education, Support. Bay Area Council or Drugs & Alcohol (281)280-0800 Information & Referral, Education, Counseling. Bay House (281) 470-2710 Men's Treatment Program. Better Way (713) 524-0838 Men's Treatment Program. Career & Recovery Resources, Inc. (713) 754-7082 Counseling for paroles, Probationers. Chicano Family Center (713) 923-2316 Counseling, Outpatient care. Cocaine Anonymous (713) 668-6822 Information & Referral, Support groups. DePelchin Children's Center (713) 526-3232 Adolescent counseling. Door to Recovery (713) 688-3700 Men's/ Women's Treatment Program. Extended Aftercare (713) 695-8403 Men's Treatment Program. Family Service Center (713)861-4849 Supportive outpatient care for Hispanics. Harbor Light (713) 224-9200 Men's Treatment Center. 60 ICH North CHNA 2013 Houston Aftercare (713) 529-2270 Men's Treatment Program. Houston Council on Alcoholism & Drug Abase (713) 942-4100 Information & Referral, Education, Counseling. Houston Recovery Campus (713) 331-2500 ln /Outpatient substance abuse treatment. Montrose Counseling Center (713) 529-0037 Counseling Narcotics Anonymous (713) 661-4200 Support to Drug Abuse. New Directions (713) 691-0314 Residential care for ex-offenders, counseling. Odyssey House Texas (713) 726-0922 Residential care for 13-17 year olds. Palmer Drug Abuse Program (713) 668-0133 Support, Counseling. Recovery Houston Institute (713) 692-4000 Shelter program for indigent males. Salvation Army (713) 869-3551 Shelter, Counseling. Santa Mario Hostel (713) 228-0125 Women's treatment program. Star of Hope (713) 748-0700 Shelter, Counseling. Texas Commission on Alcohol & Drug Abuse (512) 867-8700 Information & Referral. University of Texas Psychiatric Services (713) 500-2525 Counseling, Education. Veteran's Administration (713) 791-1414 Counseling (veterans). Volunteers of America (713) 692-8190 Women's residential care. Women's Christian Home (713) 521-3429 Women's treatment program. Emergency/Crisis Services Name Phone Services Provided AIDS Foundation (713) 623-6796 fax: (713) 623-4029 Support, Information & Referral. Alcohol Abuse Emergency/Treatment Inpatient (800) 252-6465 Support, Information & Referral. Ben Taub Emergency Psychiatric (713) 793-2631 Phone is answered 24 hrs/day. Crisis Hotline (713)228-1505 Phone is answered 24 hrs/day. Mental Health Mental Retardation Crisis Center (713) 970-4600 Phone is answered 24 hrs/day. Police/Ambulance 911, (713) 461-9992 Phone is answered 24 hrs/day. Suicide Prevention Hotline (713) 228-1505 Support, Information & Referral 61 ICH North CHNA 2013 Appendix B Complete List of Community Problems/Issues According to Resident Participants Community Problems/Issues Uncertainty Where to Go for Help Lack of Programs for Physically Handicapped Lack of Programs for Mentally Ill Children/Teens with Behavioral/Emotional Problems Lack of Help and/or Special Care for Elderly Shortage of Recreation Programs Inadequate Housing Discrimination Lack of Afterschool Care Safety Access to Healthcare Not a Problem Family/Domestic Violence Minor Shortage of Daycare Moderate Transportation Serious Gambling Quality Education Sexual Assault Alcohol/Drug Use Drunk Driving Teen Pregnancy Adolescent Crime Juvenile Crime Hunger Runaway Youth Child Abuse 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 62 ICH North CHNA 2013 63