Colorado Gap Analysis Survey - 10-9-13

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Colorado Gap Analysis Survey presentation by Cordelia Robinson Rosenberg, PhD, RN, Director, and Angela Rachubinski, PhD, JFK Partners.

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Colorado Gap Analysis Survey - 10-9-13

  1. 1. Colorado Dual Diagnosis Gap Analysis Surveys Cordelia Robinson, PhD, RN Angela Rachubinski, PhD Zia Choudhury, Medical Student Erin Hickey, Medical Student Sterling Mclaren, Medical Student Shamita Punjabi, Medical Student Cordelia.Rosenberg@ucdenver.edu 303-724-7680 19/20/2013
  2. 2. 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) Colorado Dual Diagnosis Gap Analysis Surveys 29/20/2013
  3. 3. Demographics 76 16 1 54 27 Male Female No answer 40 30 23 0 0 0 19 8 17 27 6 4 Age 8-12 Age13-15 Age 16-18 Age 19-22 Age 23-30 Age 31+ CHC ED Follow-up (N=93) GAP Analysis (N=81) 39/20/2013
  4. 4. 66 40 24 0 6 23 0 51 26 29 5 6 15 4 Autism Spectrum Disorder Developmental Delay Intellectual Disability Down syndrome Cerebral Palsy Other Developmental Disability I don't know CHC ED Follow-up (N=93) GAP Analysis (N=81) Developmental Diagnoses *Respondents could select more than one option* 49/20/2013
  5. 5. Psychiatric Diagnoses *Respondents could select more than one option* 29 51 24 39 48 4 0 32 0 29 52 23 20 32 9 2 23 2 Depression Anxiety Bipolar Disorder Other Mood Disorder ADD/ADHD Psychotic Disorder Substance Abuse/Addiction Other psychiatric diagnosis I don't know CHC ED Follow-up (N=93) GAP Analysis (N=81) 59/20/2013
  6. 6. Main reasons for ER visits *Respondents could select more than one option* ‘Other’ responses • Medical needs • “We needed a break” • “Needed medical evaluation and surveillance” • “My child has medical problems that sometimes cannot be managed at home due to behavior - IE, refusing to allow treatment …” 39 33 61 0 30 29 16 38 4 10 Self-injury Thoughts of Suicide Threat to others/property Medication refill Other CHC ED Follow-up (N=93) GAP Analysis (N=81) 69/20/2013
  7. 7. IQ 70 and Below 35 71 and Above 29 Don't know/No answer 17 GAP Analysis N=81 IQ 70 and Below 23 71 and Above 47 Don't know/No answer 23 CHC ED Follow-up N=93 79/20/2013
  8. 8. IQ Insurance type for individuals with IQ < 70 35%61% 4% Public (Medicare, Medic aid, CHP+) Private (Private, Tricare) Other 54%43% 3% Primary Insurance Mental Health Insurance *Respondents could select more than one option* CHC ED Follow-up (N=23) GAP Analysis (N=35) 25% 42% 33% Public Private Other (Other, Out of Pocket) Does not receive MH services 50% 14% 24% 12% 89/20/2013
  9. 9. 29% 39% 30% 2% 44%54% 2% Primary Insurance Mental Health Insurance *Respondents could select more than one option* CHC ED Follow-up (N=47) GAP Analysis (N=29) Insurance type for individuals with IQ 71+ 45%48% 4% 3% Public (Medicare, Medicai d, CHP+) Private (Private, Tricare) Other 34% 25% 29% 12%Public Private Other (Other, Out of Pocket) Does not receive MH services 99/20/2013
  10. 10. Services received for individuals with IQ < 70 Yes 43% No 57% Yes 80% No 17% No answer 3% Yes 39%No 61% Yes 74% No 22% No answer 4% Yes 23% No 77% Yes 31%No 66% No answer 3% CCB Services CHC ED Follow-up (N=23) Community Mental Health Center School Mental Health Services GAP Analysis (N=35) 109/20/2013
  11. 11. Services received for individuals with IQ 71+ CCB Services CHC ED Follow-up (N=47) Community Mental Health Center School Mental Health Services GAP Analysis (N=29) Yes 17% No 77% No answer 6% Yes 38%No 62% Yes 60% No 40% Yes 53% No 41% No answer 6% Yes 28% No 72% Yes 28% No 72% 119/20/2013
  12. 12. 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 129/20/2013
  13. 13. Other comments of note • “A child's needs for services and support can change quickly.” • “HOLISTIC approach to mental wellness is team effort, communicate effectively in a way that honors family and they can understand. “ • “Options in metro Denver and within schools seem limited. The current private options for school are very costly and very limited. CHC is doing a fine job with the acute care phase, but after that working with the schools is very difficult and lacking in collaboration. Improved information to families about 911 services and how they can be helpful in a crisis involving a child with ASD mental health. What happens after age 18? THAT is a scary thought.” • “Provide continuous follow up with family • “In my experience it is near impossible to get help with low cognition and behavior problems. Parents are left to feel desperate for help with no options for relief if the child doesn't qualify for admission.” • “There needs to be an option. ER is not the answer. Population misunderstood. Develop programs to allow more family and in home crisis management. Take approach that brings needed interventions together.” 139/20/2013
  14. 14. GAP Analysis Provider Data Private Practice 13% Hospital 14% Mental Health Center 22% School 7% Direct Service Provider (DSP) 26% Other 18% N=61 *Providers able to select more than one type of practice setting* Provider Practice Setting 149/20/2013
  15. 15. GAP Analysis Provider Data Have you had PREVIOUS TRAINING in caring for this population? Yes 59% No 36% No answer 5% 9 15 9 10 17 1 0-5 years 6-10 years 11-15 years 16-20 years More than 20 years No answer Years Practicing in Current Field (N=61) 159/20/2013
  16. 16. 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 Yes 56% No 41% No answer 3% 169/20/2013
  17. 17. Providers thoughts on barriers to serving this population • Lack of skilled providers • Low re-imbursement • Too high of caseload/burn-out from emotional investment GAP Analysis Provider Data 179/20/2013
  18. 18. 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! 189/20/2013
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