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GAP Analysis Update

GAP Analysis Update. Alliance Meeting 2014 Steamboat Springs. Carol Meredith Corry Robinson Marijo Rymer On behalf of The GAP Analysis Steering Committee. Gap Analysis Background.

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GAP Analysis Update

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  1. GAP Analysis Update Alliance Meeting 2014 Steamboat Springs Carol Meredith Corry Robinson MarijoRymer On behalf of The GAP Analysis Steering Committee

  2. Gap Analysis Background • “Gap Analysis” regarding Cross System Crisis Intervention Program (CSCIP) for Colorado children, youth, and adults with co-occurring Developmental Disabilities and Mental Health and Behavioral Disorders.

  3. Gap Analysis Background • Access to mental health services difficult for this population • Community Centered Boards and Mental Health Centers have developed various agreements, but intervention around mental health or behavioral crises problematic

  4. Gap Analysis Background • 2008 Colorado Autism Commission developed 10 year Strategic Plan • Recommendation 14. Increased access to quality mental health services for individuals with Autism and other NeurodevelopmentalDisabilities • Focus on the Future endorsed this approach under the Develop Increased Capacity for Behavioral Supports

  5. Gap Analysis Background • Medical Mental Health subcommittee identified START (Systematic, Therapeutic Assessment, Respite and Treatment) Model to pursue as an evidenced practice model for crisis intervention for individuals with dual diagnosis • JBC authorized $50,000 through a contract to JFK/CU-SOM to explore development of a Colorado CSCIP • CLAG - WS

  6. Gap Analysis Background Elements to the Gap Analysis • Hold 11 Regional Meetings co-hosted by CCB’s, Mental Health Centers, and BHO’s; • Establish a web portal with surveys to be completed by interested stakeholder groups; https://redcap.ucdenver.edu/surveys/?s=9UMnVv • Analyze relevant statutes, policy and regulation documents

  7. Gap Analysis Background Elements to the Gap Analysis • Develop and implement a protocol for analyzing comprehensive costs for 40 individuals with dual diagnosis; • Convene a statewide meeting to report findings; • Develop a comprehensive report.

  8. Colorado Dual Diagnosis Gap Analysis Surveys Methods: A survey regarding experiences and services for individuals with a dual diagnosis. CHC ED Follow-up: Survey sent to caregivers of individuals with a dual diagnosis (ages 8-18) who had been seen in the CHC Emergency Department (ED). Response by mail or secure web link. (COMIRB #13-1751) GAP Analysis: Publically available survey via a secure web link was circulated among local advocacy groups. Surveys for Caregivers, Providers, and Adults receiving services are available. (https://redcap.ucdenver.edu/surveys/?s=9UMnVv)

  9. Colorado Dual Diagnosis Gap Analysis Survey Of note: • The following results are descriptive only. • Results from 47 individuals who did not meet the criteria of a dual diagnosis were excluded. • Results from 46 respondents identifying as “Other” have not been incorporated into these results. Examples include probation officers, advocates, and child protection services . • Results from 5 adults receiving services are not included in these results.

  10. Demographics CHC ED Follow-up (N=101) Public Survey (N=104)

  11. Developmental Diagnoses *Respondents could select more than one option* CHC ED Follow-up (N=101) Public Survey (N=104)

  12. Psychiatric Diagnoses*Respondents could select more than one option* CHC ED Follow-up (N=101) Public Survey (N=104)

  13. Main reasons for ED visits*Respondents could select more than one option* CHC ED Follow-up (N=101) Public Survey (N=104) Respondents having used ED (%) • ‘Other’ responses • Acute medical needs • Management of chronic medical needs due to behavior • Run Away

  14. IQ Distribution CHC ED Follow-up (N=101) Public Survey (N=104)

  15. Insurance type for individuals with IQ < 70 Public Survey (N=41) CHC ED Follow-up (N=25) Primary Insurance Mental Health Insurance *Respondents could select more than one option*

  16. Insurance type for individuals with IQ 71+ CHC ED Follow-up (N=51) GAP Analysis (N=39) Primary Insurance Mental Health Insurance *Respondents could select more than one option*

  17. Services Received CHC ED Follow-up (N=25) CHC ED Follow-up (N=51) Public Survey (N=41) Public Survey (N=39) IQ ≤ 70 Receiving services (%) IQ ≥ 71 Receiving services (%)

  18. Recurring comments for needed services • Wrap-around care/support • Many families receiving services/therapies state that any one service meets their child’s needs “a little” or “somewhat” (data not shown). • Access to needed care - regardless if diagnoses or lack thereof • Support for the entire family unit • Day Camp; Longer term camps • Respite care with trained staff • Family therapy/classes • Living options for transitioning adults • Living/other supports for higher-functioning individuals • Need for provider training/more options for crises

  19. GAP Analysis Provider Data Provider Practice Setting

  20. GAP Analysis Provider Data Years in Practice Have you had PREVIOUS TRAINING in caring for this population?

  21. GAP Analysis Provider Data Have you ever had to turn down seeing an individual from this patient population? • Most common reasons for refusal: • Presenting problem not covered by Medicaid/insurance • No insurance/lack of funding • Already had full caseloads

  22. GAP Analysis Study The State of Colorado is supporting a cross-systems analysis of crisis intervention services. This analysis will look at the capacity to serve all individuals with dual diagnoses of an Intellectual or Developmental Disability and a Mental Health or Behavioral Disorder. This population includes individuals with Autism, Asperger’s Syndrome or PDD-NOS who have co-occurring Mental Health or Behavioral Disorders. We are also interested in individuals with Developmental Disabilities who, for psychiatric or behavioral reasons, have used Emergency Medical Services or been hospitalized. We want to hear the perspectives of people in these situations even if they do not technically have a Mental Health or Behavioral Disorder. We invite you to take our survey online at https://redcap.ucdenver.edu/surveys/?s=9UMnVv. The results of this survey will be reported as a summary and no one will know which responses are yours. Please feel free to pass the survey link onto anyone you think might be interested in responding. Our hope is that, with your help, we will be able to provide recommendations on how to better meet the needs of this population. We will post the results of the survey on the Colorado CANDO and JFK Partners websites. We appreciate you sharing your experiences. Please know that every voice is heard. Thank you for your participation!

  23. Themes Identified at Community Meetings • System design and funding • Inter-system coordination • Support for families and caregivers • Knowledge and expertise AAIDD Annual Meeting June 2014

  24. Gap Barriers Identified • Limited access to appropriate treatment, especially inpatient psychiatry for individuals with concurrent physical health issues. • Lack of utility of diagnosis as etiology.

  25. Gap Barriers Identified • Conflicts within existing requirements. • if a person who has ongoing behavioral support staff through a Medicaid waiver is hospitalized, that same knowledgeable staff person could not be paid to consult or provide those behavioral supports in the hospital setting for continuity of service. These types of regulations create difficulty in providing continuity of care across systems when services are covered under different funding streams.

  26. Gap Barriers Identified • Adequacy of funding. • Workforce capacity.

  27. Gap Policy and Funding Recommendations • People with neurodevelopmental disabilities should have appropriate access to mental health services in parity with the general population.

  28. Gap Policy and Funding Recommendations • The state should develop a reimbursement system that fully includes people with co-occurring diagnosis in the capitated managed care system for mental health services.

  29. Gap Policy and Funding Recommendations • Care Coordination should have the authority to operate across systems for neurodevelopmental disabilities services, mental health services, primary care services, and long-term care services and supports.

  30. Gap Policy and Funding Recommendations • Supports and services should consider the holistic needs of the individual and his or her community-based support system.

  31. Gap Policy and Funding Recommendations • An integrated system of monitoring should be developed to ensure the desired outcomes are ultimately achieved at the individual and systems level.

  32. Gap Policy and Funding Recommendations • Specialized cross-training should be provided to increase the effectiveness of assessment, prevention, intervention and crisis response.

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