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Version 2.4
Table of Contents
I. BACKGROUND.......................................................................................................................3
II. FLORIDA POPULATION.......................................................................................................3
III. METHODOLOGY....................................................................................................................4
IV. APPLICATION........................................................................................................................ 5
V. NEXT STEPS........................................................................................................................... 9
VI. CONCLUSION .......................................................................................................................10
4. Behavioral Health Advisory Workgroup Report
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Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied without
permission from the Department of Children and Families (DCF), Office of Substance Abuse and Mental
Health Programs. However, citing the source provides credibility and reliability of the information
presented. This publication may not be reproduced or distributed for a fee without the specific, written
authorization of the DCF Office of Substance Abuse and Mental Health Program.
Prepared by:
Jennifer Evans, LMHC
Kathleen Roberts, MS
Florida Department of Children and Families
Substance Abuse and Mental Health
1317 Winewood Boulevard, Building 6
Tallahassee, Florida 32399-0700
Completion Date:
January 8, 2014
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I. Background
The Behavioral Health Advisory Workgroup (BHAW) is being convened by the Department of Children
and Families Substance Abuse and Mental Health Program Office (SAMH) to assist with the development
of a predictive estimation of potential service utilization using prevalence data related to behavioral health
conditions in Florida and estimates of the population in the range of 19% to 138% of the federal poverty
level guidelines. Information from this model will be used to support SAMH planning efforts that will
ultimately improve the quality of health and behavioral health care in the State of Florida.
The BHAW is comprised of researchers, statisticians and epidemiologists. Participant’s role on the
BHAW is to:
Provide leadership in the identification, development and validation of an estimated pool of
eligible population;
Identify appropriate data sources and indicators for a predictive model;
Assist in the analysis and interpretation of results; and
Provide recommendations for meeting current and future demands for behavioral health services
in Florida.
II. Florida Population
To determine need, the Department must first establish the potential population that could receive this
safety net of funding services. The Florida Office of Economic and Demographic Research (EDR) provide
annual population estimates for legislative planning. At the February 2013 Demographic Estimating
Conference, EDR estimated the population in Florida to be 19,259,543.1 For the purposes of establishing
population for the determination of need, the Department has made the following assumptions in relation
to the reported population:
Persons 65 and older are majorly covered by Medicare, this creates rates that are unstable;
The Affordable Care Act provides insurance exchanges to persons residing at 138% to 400% of
federal poverty guidelines; and
To impute a population estimate for each age range within the safety net, the Department applied
the poverty and insurance status distribution from the American Community Survey2 to the
aggregated 2013 population estimate of Florida.
The result of these assumptions is that the Department estimates 1,137,601 people could be eligible to
receive safety net services from SAMH program funding based on insurance status and poverty level. In
addition, the Department looked at all potential service utilization to estimate affect of behavioral health
service provision. The Department estimates 4,314,138 persons could utilize treatment in the coming
year.
1
This estimating conference was selected because itincluded the mostrecenttotal county population estimate from
EDR. See http://edr.state.fl.us/Content/population-demographics/data/CountyPopulation.pdf (site accessed,
December 19,2013).
2 The United State Census Bureau developed the American CommunitySurvey as ongoing statistical surveyto
sample small percentages ofpopulation every year. Population estimates help inform need for planning and investing
for services in communities. See https://www.census.gov/acs/www/data_documentation/data_via_ftp/ (site accessed
December 30,2013).
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III. Methodology
The following steps outline the approach for calculating the projection estimate for numbers served:
Step 1- 2010 age distribution was applied to the EDR 2013 county-level population estimate.3
Step 2- Multiply Step 1 by the Distribution of persons within the 19% to 138% poverty level (FPL).4
Step 3- Multiply the result of Step 2 by the percent of persons without insurance status within FPL.5
Step 4- Multiply Step 3 by the rates identified by Florida’s National Survey of Drug Use and Health
(NSDUH) for substance abuse and mental health treatment.
Step5- County numbers were aggregated into regions and then summed for total Florida estimates.
Data was examined based on the following inclusion criteria:
Residence;
Population data was broken down by county and aggregated up to regional and state
outputs.
NSDUH data was filtered by state for either specifically to Florida only or by all states, to
pick up Florida data.
American Community Survey data was also broken down by household size and income
to obtain FPL estimates.
Behavioral Health Service;
Using the NSDUH codebook, only measures of behavioral health utilization were
considered.
Poverty Level; and
NSDUH data was controlled for poverty level. Behavioral health utilization rates were
identified controlling for 19-138% FPL.
Age.
NSDUH data was filtered by age range. Ranges included: (0-17), (18-64), (65+).
American Community Survey and EDR population estimates were also broken down in
the same manner to account for children, adult, and Medicare populations.
Data exclusion is based on availability of data from the NSDUH survey. NSDUH collects information from
residents of households and non-institutional group quarters (e.g., shelters, rooming houses, dormitories)
and from civilians living on military bases. The survey excludes homeless persons who do not live in
shelters, military personnel on active duty, and residents of institutional group quarters such as jails and
hospitals. In addition, the online system used for analytic data runs is limited to displaying numbers of
observations below a certain threshold. To preserve confidentiality, tables cannot be displayed when the
number of observations in any cell in the table is too low. Data was excluded when it was unable to be
displayed for this reason.
To review data input and steps in further detail, see attachment A, Behavioral Health Needs Spreadsheet.
3 2010 Decennial Census provides age distribution of population broken down into three age ranges, 0-
18, 18-64, and 65+.
4 Distribution was obtained from the American Community Survey (ACS)
5
Ibid
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IV. APPLICATION
The Department estimates approximately 3,520,690 people are within 19% to 138% of federal poverty level. Of this population, approximately
1,137,601 individuals do not have insurance. Table 1 provides a breakdown by region for the total utilization estimates for the state. Tables 2, 3,
and 4 breakdown this utilization estimate by age group: 0-18, 18-64, and 65+, respectively.
Table 1. State Overview of Substance Abuse and Mental Health Need for Treatment by Region
Region
Total
Population
19%-138*
Illicit Drug or
Alcohol Abuse
or
Dependence
(A x 10%)
Received
Any
Treatment
for Illicit
Drugs or
Alcohol
(A x 2.2%)
Received Any
Mental Health
Treatment in
Past Year
(A x 12.9%)
Receipt of
Any Inpatient
Mental
Health
Treatment
( A x 2%)
Receipt of Any
Outpatient
Mental Health
Treatment
( A x 6.7%)
Receipt of Any
Prescription
Medication
for Mental
Health
Treatment
( A x 11.1%)
A B C D E F G
Central
262,223 24,911 5,769 33,827 5,244 17,569 24,911
Northeast
137,153 13,029 3,017 17,693 2,743 9,189 13,029
Northwest
72,988 6,934 1,606 9,415 1,460 4,890 6,934
Southeast
255,107 24,235 5,612 32,909 5,102 17,092 24,235
Southern
194,984 18,523 4,290 25,153 3,900 13,064 18,523
Suncoast
215,148 20,439 4,733 27,754 4,303 14,415 20,439
1,137,601 108,072 25,027 146,751 22,752 76,219 108,072
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Table 2. Age 0-18 Population Estimate by Region
Region
0-18 Population
19%-138% Poverty
Line
Illicit Drug or
Alcohol
Abuse or
Dependence
Received Any Illicit
Drugs or Alcohol
Treatment
Received
Any Mental
Health
Treatment
in Past Year
Receipt of
Any
Inpatient
Mental
Health
Treatment*
Receipt of
Any
Outpatient
Mental
Health
Treatment*
Central
43,989 3,255 572 2,683 880 2,947
Northeast
16,881 1,249 219 1,030 338 1,131
Northwest
12,957 959 168 790 259 868
Southeast
42,088 3,115 547 2,567 842 2,820
Southern
28,945 2,142 376 1,766 579 1,939
Suncoast
29,953 2,217 389 1,827 599 2,007
TOTAL
174,813 12,936 2,273 10,664 3,496 11,712
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Table 3. Age 18-64 Population Estimate by Region
Region
18-64 Population 19%-
138% Poverty Line
Illicit Drug or
Alcohol Abuse
or Dependence
Received Any
Treatment for
Illicit Drugs or
Alcohol
Received Any
Mental
Health
Treatment in
Past Year
Receipt of
Any
Inpatient
Mental
Health
Treatment
Receipt of
Any
Outpatient
Mental
Health
Treatment
Central 2,585,573 315,440 74,982 351,638 56,883 196,504
Northeast 1,635,472 199,528 47,429 222,424 35,980 124,296
Northwest 907,595 110,727 26,320 123,433 19,967 68,977
Southeast 2,254,221 275,015 65,372 306,574 49,593 171,321
Southern 1,703,668 207,848 49,406 231,699 37,481 129,479
Suncoast 2,735,802 333,768 79,338 372,069 60,188 207,921
11,822,332 1,442,324 342,848 1,607,837 260,091 898,497
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Table 4. Age 65+ Population Estimate by Region
Region
65+ Population19%-
138% Poverty Line
IllicitDrug or
Alcohol
Abuse or
Dependence*
ReceivedAny
Treatment for
IllicitDrugs or
Alcohol*
ReceivedAny
Mental
Health
Treatment in
Past Year*
Receiptof
Any Inpatient
Mental
Health
Treatment*
Central 1,052 18 2 114 5
Northeast 264 5 1 29 4
Northwest 272 5 1 29 4
Southeast 2,660 46 6 288 38
Southern 2,007 34 4 217 28
Suncoast 1,526 26 3 165 22
7,781 133 17 842 110
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V. Next Steps
The Behavioral Health Advisory Workgroup (BHAW) will review methodology in comparison with the SAMHSA toolkit and provide
recommendations for:
Other possible Florida-linked data sources
Additional or New variables
Comparing against other data sources
Identifying methods to improve the process and provide greater accuracy in estimation
The BHAW is currently reviewing the following sources utilizing the SAMHSA toolkit methodology:
Florida Agency for Healthcare Administration (AHCA) – Medicaid
Florida Criminal Justice
Department of Juvenile Justice
Department of Corrections
Florida Department of Health
All agency data is housed in its own database. Through data sharing agreements the Department is able to access data sources through county
level aggregates. A new database will be created to summarize all data sources by county with recoded variables related to:
Substance abuse or dependence;
Mental health; and
Behavioral health.
These recoded variables will become the basket of measures in which rates will be identified. Agency level data accessible to the Department is
not linked with household income or federal poverty level identifiers, therefore, rates are applied to state population estimate. Once state level
estimates are found, federal poverty level will then be applied to define the doughnut hole of service applicable to the Department. Further this will
be compared against the NSDUH estimations for similarities and identify a range for Florida behavioral health utilization rates.
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VI. Conclusion
As indicated, many individuals who may need behavioral health services do not access them due to lack of health care coverage. However, health
reform will significantly reduce this barrier to behavioral health services. It is estimated that approximately 11 million of the individuals who will
have access to coverage beginning in 2014 will have mental and/or substance use disorders and will have access to care with the continued
implementation of health reform (SAMHSA, 2011). This increase is expected to strain an already thinly stretched workforce. ”
The issue of workforce development in the field of behavioral health has long been a critical one. With the advent of health care reform and parity,
workforce issues have taken on a greater sense of urgency (SAMHSA, 2013). According to the Annapolis Coalition (2007), there is evidence that
the behavioral health workforce is not equipped in skill or in numbers to respond adequately to the changing needs of the American population and
the evolving healthcare landscape. Behavioral health professionals who have been trained to provide behavioral health prevention and
intervention have not kept pace with current trends in the field, which have been shifting toward strengths-based and resilience-oriented models, a
systems-of-care approach, and the use of evidence-based practices. These deficiencies become even more problematic with increasing demands
for integration of primary care, increasing focus on improving quality of care, and improved outcomes (SAMHSA, 2013). This determination of
need is based on prevalence estimates and predicted rates of use. The Department plans to follow this research with the following to enhance
effectiveness of services and improve quality of care:
Environmental Scan of behavioral health services;
Consumer evaluation on service provision and accessibility;
Continued collaborative building through Florida Learning System Managing Entity Workgroups;
Epidemiological profiles;
Evaluation;
Utilization management;
Training and Capacity build series; and
A data management system to track and record behavioral health outcomes and relevant variables.
