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MIDD Background

Program Development, Implementation, and Sustainability of Locally Funded Behavioral Health Programming August 26, 2019. MIDD Background. What is midd ?. OR. Funding gaps in local behavioral health care system 2005 state law allowed counties to collect sales tax

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MIDD Background

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  1. Program Development, Implementation, and Sustainability of Locally Funded Behavioral Health Programming August 26, 2019

  2. MIDD Background

  3. What is midd? OR • Funding gaps in local behavioral health care system • 2005 state law allowed counties to collect sales tax • 1/10th of one percent to address mental health and substance use disorder service gaps and needs • King County ordinance required evaluation of all MIDD-funded programs

  4. MIDD Background

  5. Original Midd policy goals • Reduce jail use and jail recycling • Reduce emergency department use • Reduce psychiatric inpatient hospitalizations • Reduce incidence and severity of behavioral health symptoms • Link with other countywide initiatives Added in 2017: Reduce crisis events, improve health, increase cultural awareness

  6. Midd I strategies and programs Youth-Focused • School-based services • Suicideprevention trainings • Juvenile justice assessments • Wraparound • Children’s crisis outreach • Drug courts • Domestic violence prevention Diversion • CIT training for first responders • Adult crisis diversion with respite beds & mobile crisis teams • Jail liaisons • Mental health courts • Education classes • Hospital respite beds • Intensive case management Community-Based • Mental health and substance use disorder treatment • Outreach • Screening + • Next day appointments • Workforce development • Family support • Supported housing & employment • Special populations

  7. SEQUENTIAL INTERCEPT MODEL

  8. MIDD 2 • In August 2016, King County Council unanimously extended the MIDD behavioral health sales tax through 2025.* • The second generation of MIDD services (2017-25) known as “MIDD 2.” • MIDD 2 investments/evaluation guided by Council-approved plans: • Service Improvement Plan • Implementation Plan • Evaluation Plan * Ordinance 18333

  9. MIDD 2: Updated MIDD Policy Goals*

  10. Ongoing Role for Council in MIDD Decision-Making

  11. Context for MIDDImplementation in 2017

  12. Implementation in 2017 45 Initiatives operating or launched (85%) • 30 initiatives continued • 15 new initiatives launched • 8 initiatives deferred or delayed • Some programs initiated in 2018 • Others slated for 2019-20 startup

  13. MIDD 2Evaluation and Reporting

  14. Why evaluate?

  15. Ways evaluators can help

  16. *This data is fictitious

  17. 2010 Census Race and Ethnic Categories:Non-Hispanic White: 1 ,251,300 64.8% Hispanic or Latino: 172,378 8.9%Black or African American: 1 16,326 6.0% Two or more race: 79,529 4.1%Asian and Pacific Islander: 2 94,097 15.2%Native American and other: 1 7,619 0.9%

  18. MIDD Reporting HighlightsMultiple Kinds of Progress • Performance measures and outcome analysis to assess and demonstrate results of MIDD investments • Accomplishments including program implementation highlights. • Stories of lives changed by MIDD services, going beyond the statistics to show how individuals are better off.

  19. Outcomes analysis process Data from participants allows analysis of changes in system utilization and/or symptoms over time. Patterns suggest relationships between measured variables without implying causation. Outcomes eligibility for a given time period depends on strategy participation, start date, passage of time, and matching within jail, hospital, and other data sources. To prevent bias toward showing either reductions or increases in system use, buffers may be applied.

  20. longitudinal outcomes The pre period (Pre) is the year-long interval before an individual’s first MIDD start date per strategy. The first post period (Post 1) is the one-year span after their MIDD start date or release from their “buffered” event. The second post period (Post 2) is the year after the first anniversary of MIDD service initiation. The third post period (Post 3) is the year following the second anniversary of a person’s MIDD start date. The MIDD tracks outcomes up to 5 years!

  21. General Population Statistics 1.9% 2010 Population: P = 521,883 Average Annual MIDD: M = 9,890 Seattle P = 505,244 M = 4,573 East 1.3% 0.9% 1.2% P = 162,877 M = 1,958 North P = 696,915 M = 8,950 South

  22. Estimated Poverty Statistics 13% 2010 Estimated Population Living Below Poverty Level: PP = 75,673 Average Annual MIDD: M = 9,890 Seattle PP = 40,420 M = 4,573 East 15% 7% 11% PP = 13,030 M = 1,958 PP = 125,445 M = 8,950 North South

  23. Longitudinal MIDD Outcomes

  24. MIDD Time Periods Pre Period (Baseline) First Post Period Second Post Period MIDD “Start” Marker Third Post Period

  25. Outcomes Sampling Total Sample Size 0 Year 1 Year 2 Year 3 Year 4 25,205 35,262 10,970 The size of each sub-sample analyzed depends on three factors: 1.) outcome type by strategy 2.) match found in outcome data 3.) passage of time eligibility.

  26. Initial Jail Outcomes Post One Post Two Post Three 2,060 2,654 3,355 Jail use reduced for EVERY relevant strategy by the second post Six of ten strategies with third year post results reduced jail use by more than 40% Average jail use reduced by 23% with all strategies combined Reported in 2012 Reported in 2013 Reported in 2011

  27. Recent Outcomes for Inpatient Community Psychiatric Hospitals Post Two Post Three Post One 1,364 1,129 537 Only 3 of 7 strategies had average reductions in the first post Average days decreased by 48% from 13.4 (Pre) to 7.0 (Post 3) 5 of 7 strategies showed reduced hospital days by the second post Reported in 2013

  28. Harborview’s Emergency Department Utilization Post One Post Two Post Three 8,102 3,619 11,040 One strategy reduced average ED visits by 70% from 12.8 (Pre) to 3.83 (Post 3) 10 of 11 strategies showed reduced ED visits by the second post 7 of 11 strategies had average reductions in the first post Reported in 2013

  29. So What?? OPPORTUNITY!!

  30. Who Does MIDD Serve?28,780 King County residents in 2017

  31. Location of People Served by MIDD

  32. Overall Long-term System Use Outcomes Reduced use in third year after MIDD services started (compared to use in the year prior to service start)

  33. Initiative SnapshotReducing Emergency Department Use Reduced use in third year after MIDD services started compared to use in the year prior to service start. Includes eligible individuals served in 2014 through 2016.

  34. Health and Wellness Improvements • Reduced Depression and Anxiety • Reduced Substance Use • Strengthened and Empowered Families • Employment

  35. Initiative SnapshotPeople Recovering ThroughSupported Employment One in three Supported Employment participants attained a new job in 2017. The 90-day job retention rate was 70 percent in Supported Employment.

  36. Initiative SnapshotReducing Depression andAnxiety for Older Adults Includes eligible individuals served with outcome measures.

  37. Other MIDD AnnualReport Components

  38. What’s Happening Next?

  39. Questions? For more information: www.kingcounty.gov/midd Susan Schoeld Crisis Triage Administrator King County Behavioral Health and Recovery Division Susan.Schoeld@kingcounty.gov (206) 263-8967

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