Health Planning and Community Organizing : Its what we do every day World Café Summary Report Department of Children and Families, Circuit 4 Substance.

Health Planning and Community Organizing: It’s what we do every day

World Café Summary ReportDepartment of Children and Families, Circuit 4

Substance Abuse and Mental Health Office

Prepared by the

Health Planning Council of Northeast Florida

June 30, 2009


Table of Contents

Who is the Health Planning Council of Northeast Florida 3

World Café Assessment Introduction and Background 8

Assessment Methodology 10

Summary of Findings by County 12

Circuit Wide Comparisons 25

Debrief Summaries by County 30


Who is the Health Planning Council?• One of 11 Local Health Councils created by state statute 408.033 in 1982

• Manage the Certificate of Need process for hospitals and nursing homes located in Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties

• The only health planning organization to collect, analyze, and warehouse real-time health care utilization data submitted by hospitals and nursing homes in the 7 county northeast Florida region

• The only non-partisan / non-profit planning organization mandated to dedicate resources and expertise to regional health planning and community organizing on health disparities and healthcare issues (State Statute 408.033)

• Trained to execute cultural competent health planning models such as the World Cafe’, Community Based Participatory Research (CBPR), Community Based Participatory Marketing (CBPM), Social Marketing, Empowerment Evaluation, Strategic Framework Prevention (SPF), Mobilizing for Action through Planning and Partnerships (MAPP), Planned Approach to Community Health (PATCH) * Competency within these models are highly recommended by all major federal and state funding agencies

• Conducts SPSS data analysis for reliable health planning analysis

• HPCNEF reviews and provides input on Development of Regional Impact pre-applications via the Northeast Florida Planning Council


Health Planning

Collects monthly hospital utilization statistics, monthly emergency department statistics, and quarterly nursing home utilization statistics from the providers in the seven counties of northeast Florida (over 100 providers) for Agency of Health Care Administration (AHCA)

Provides subscription-driven hospital data clearinghouse

Develops annual county profiles and regional health plans on hospital utilization rates, health disparities, health care work force capacity, regional development impact studies, health care funding equity

Performs theory-based community health needs assessments

Facilitates community organizing and convening activities to discuss health disparities and healthcare issues

What We Do


Advocacy

Facilitates community forums on Medicaid Reform and Florida KidCare

Provides leadership and advocacy for the uninsured and underinsured

Contributes to the development of the Jacksonville and Northeast Florida Healthcare Guide (the green pages)

Develops the Guide to Assisted Living Facilities in Northeast Florida

Develops influencing plans for the health advocates and coalitions

Serve on many regional Boards and Advisory council to advocate for cultural competent health planning and health care advocacy

What We Do



What We DoHealth Promotion and Evaluation

Provides flu, pneumonia and hepatitis vaccinations to high risk, minority populations thru churches, community centers, and homeless shelters in Duval County

Conducts social marketing training to regional community based organizations

Administers and serves as an AIDS Insurance Continuation Program enrollment site

Supports the St. Johns River Rural Health Network’s diabetes disease management program for Baker, Clay, Nassau, Bradford and Union counties

Conducts program evaluation for small community based organizations


Non-Profit and Coalition Support

Provides fiscal and administrative support to the local non-profits and coalitions including the St. Johns River Rural Health Network and the Healthy Start Coalition of Northeast Florida.

Provides fiscal and administrative support for Ryan White Title II, general revenue funded HIV/AIDS Network in for Volusia and Flagler counties,

Provides fiscal and administrative support for Housing Opportunities for People with AIDS (HOPWA) for Volusia and Flagler counties

Provides staff support and technical assistance to the Duval County Immunization Task Force

What We Do


Assessment Introduction and BackgroundThe Department of Children and Families (DCF), Circuit 4 (Clay, Duval, and Nassau counties) is reviewing its strategic plan for the long term future and success of the Circuit. As part of the process, leaders from Circuit 4 contracted with the Health Planning Council of Northeast Florida (HPC) to plan, coordinate, facilitate four World Café dialog meetings in each county located within the Circuit:

Clay County- 31 people in attendanceHilltop Country Club- Orange Park

Thursday May 21, 2009 2:00 PM - 5:00 PM

Duval County- 34 people in attendanceThree Layers Cake- Downtown Jacksonville Friday May 22, 2009 9:00 AM -12:00 PM

Nassau County- 9 people in attendanceHampton Inn and Suites- Fernandina Beach

Friday May 22, 2009 2:00 PM - 5:00 PM

Nassau County- 3 RSVP’s – meeting cancelledCounty Inn and Suites- Yulee

Thursday, June 18, 2009 2:00 PM – 5:00 PM


1. How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders?

2. Prioritize our Circuits services. 3. Assess the effectiveness and quality of our system of care. 4. If additional dollars come into Circuit 4, what substance abuse and mental health

services would you like to see expanded or created? In other words, where would you like the money to go?

5. How do we integrate our substance abuse and mental health services into our child welfare system?

The purpose of the World Café was to engage community stakeholders and provide them an opportunity to share their thoughts on the effectiveness of the system of care (infrastructure and service delivery) within the substance abuse and mental health services, offer ideas for integrating our services, and to help the Circuit prioritize substance abuse and mental health services.

*Over 70 individuals attended one of the three World Cafés meetings where they were asked to discuss the following five questions:

At the end of each meeting, all participants were asked to debrief about their experience in a “Town Hall” setting

Assessment Introduction and Background


Three weeks prior to the scheduled World Café meeting dates, the HPC sent electronic invitations to community leaders, advocates, providers, the judicial system, law enforcement, school board members, academic institutions, and elected officials.

Recipients of the electronic invitation were encouraged to forward their electronic invitation to other constituents who would see value in attending.

Each of the four World Café meetings were held in Circuit 4’s respective counties eliminating the participants from having to drive more than 15-20 miles from their service area to attend a meeting. By request, a forth World Café meeting in Nassau County was added to provide west Nassau County stakeholders a closer venue. This venue was cancelled due to the low number of RSVPs (3).

World Café locations (Hilltop Country Club, Three Layers, Hampton Inn and Suites, and Country Inn and Suites) were selected because of their café style environments. This relaxing and inviting environment is one of the pillars of the World Café dialog model.

RSVP lists for each of the four meetings were managed by using a computer based polling program called doodle.com.

Assessment Methodology


Attendees participating in each World Café meeting were presented with the same *five questions in order to capture consistent data from each of the three World Café meetings.

It is important to recognize that each person had the opportunity to give multipleresponses to each question. Notes recorded on table-top paper were also included in the analysis.

The HPC collected all of the data from each World Café meeting and synthesized the data according to each county. Major themes emerged in the responses to each question, and they, along with un-coded responses are reported in the summary of findings by county and then by Circuit.

Themes are presented in the order of magnitude. Rounding is used in the display of percentages, so totals may fall within +/- 1% of 100.

* Due to World Café requirements, the attendees participating in the Nassau County World Café’ in Fernandina Beach were presented with three questions rather than five questions. Low attendance (20 RSVPs; 9 people in attendance) restricted the HPC from introducing additional meaningful questions. An additional meeting was scheduled in Nassau county (Yulee) however, due to low RSVP numbers, this meeting was cancelled.

Assessment Methodology


Summary of Findings By County- ClayQuestion 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders?

4 major themes emerged from a total of 29 responses.

Collaboration and integration of services 52%

Education and cross training of providers 24%

Innovation, electronic medical records and data sharing 7%

Develop social change awareness 9%

Creative funding, demand evidence-based intervention

1 response each


Summary of Findings By County- DuvalQuestion 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders?




Prevention and early intervention 14%

Provide choice of services 14%

Improve funding 9%

Develop social change awareness 9%

Improve communications among providers 1 response


Summary of Findings by County- NassauQuestion 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders?



Innovation / electronic medical records 8%

Improved funding 8%

Enhanced professional workforce 8%


Improved communications among providers 5%

Commitment / ownership of issues at all levels, HIPPA / FERPA issues, Annual community assessments

1 response each


Question 2: Prioritize the Circuit’s services

7 major themes emerged from a total of 22 responses

Integration of services and care coordination 18%

Self directed care 14%

Improve funding streams 9%

Prevention, education and early intervention 9%

Housing 9%

Community education and social change 9%

Demand evidence-based intervention, needs assessments and data 9%

Transportation, medication, access to insurance and homeless

1 response each

Summary of Findings By County- Clay




Centralized access, mental health authority, instant access, integration of services & coordination 19%

Self directed care 17%

Improve funding streams- “braiding” 11%

Family services 11%

Transportation 6%

24 hour helpline 6%

Housing 6%

Discharge planning/ safe placement 6%

Early intervention, medication, school based programs, data sharing

1 response each

Summary of Findings By County- Duval




Transportation 19%

Emergency psychiatric services 16%

Housing 14%

Centralized assessment / linkage/ integrated services 12%

Early intervention / prevention 7%

Residential substance abuse 5%

School based services 5%

Outpatient services 5%

Medication, policy, HIPPA, indigent, aftercare and home based care

1 response each

Summary of Findings by County- Nassau


Question 3: Assess the effectiveness and quality of our systems of care


Fragmentation / lack of integration of services 38%

Poor housing options 19%

Fragmented funding streams 10%

Lack of awareness in community, no money for medication, all parallel counseling, poor professional workforce, no evidence based treatment

1 response each





Fragmentation / lack of integration of services/ data sharing 25%

Treatment inadequacies (i.e. access, waiting list etc…) 23%

Prevention starts too late 14%

Limited transportation 11%

Professional training is poor 7%

Funding is poor, parent engagement needs to improve and better community stewardship is needed

1 response each





Services and treatment inadequacies (i.e. access, waiting list etc…) 30%

Limited transportation 13%

Location of services is challenging 13%

Professional training is poor 13%

Funding is poor 13%

Physical care and effectiveness is good 6%

Need to improve collaboration 6%

More local control, gaps in housing, no socialization

1 response each

Summary of Findings by County- Nassau


Question 4: If additional dollars came into Circuit 4, what substance abuse and mental health services would you like to see expanded or created?


Expand to the underserved 22%

Expand self directed care 17%

Improve access to care via better transportation 15%

Mental health court 8%

Medications 8%

Evidence based services 8%

School based programs, housing, family support, expand awareness

1 response each



Question 4: If additional dollars came into Circuit 4, what substance abuse and mental health services would you like to see expanded or created?


Central access/ integration of services 12%

Self directed care, peer support, Club House, consumer choice 12%

24 hour emergency service 12%

Treatment (i.e. detox, case management, counseling) 10%

Employment opportunities for clients 10%

Expand to underserved 8%

Increase awareness and education 8%

Housing 8%

Increase salaries, medication, respit, prevention, recreation services, standards,

1 or 2 responses

only



Question 5: How do we integrate our substance abuse and mental health services into our child welfare system?


Access schools 38%

Service integration 31%

Evidenced based, family preservation, cross training, improved workforce, mentoring, incentives and FIS

1 response only



Question 5: How do we integrate our substance abuse and mental health services into our child welfare system?


Access schools 29%

Service integration 23%

Evidence-based only 14%

Cross training 9%

Access, discharge, standards, leverage funding, awareness

1 response each



Circuit Wide ComparisonQuestion 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders?

Clay Duval Nassau

1Collaboration and integration of services

Education and cross training of providers

Collaboration and integration of services

2Education and cross training of providers

Collaboration and integration of services

Innovation / electronic medical records

3Innovation, electronic medical records and data sharing

Prevention and early intervention

Improved funding

4Develop social change awareness

Provide choice of services Enhanced professional workforce

5 Improve funding Education and cross training of providers


Circuit Wide ComparisonQuestion 2 : Prioritize the Circuit’s services

Clay Duval Nassau

1Integration of services and care coordination

Centralized access, mental health authority, instant access, integration of services & coordination

Transportation

2 Self directed care Self directed care Emergency psychiatric services

3Improve funding streams Improve funding streams-

“braiding”Housing

4Prevention, education and early intervention

Family services Centralized assessment, linkage, integrated services

5 Housing Transportation Early intervention, prevention


Circuit Wide ComparisonQuestion 3 : Assess the effectiveness and quality of our systems of care

Clay Duval Nassau

1Fragmentation / lack of integration of services

Fragmentation / lack of integration of services/ data sharing

Services and treatment inadequacies (i.e. access, waiting list etc…)

2Poor housing options Treatment inadequacies

(i.e. access, waiting list etc…)

Limited transportation

3Fragmented funding streams

Prevention starts too late Location of services is challenging

4Limited transportation Professional training is

poor

5Professional training is poor Funding is poor


Circuit Wide ComparisonQuestion 4 : If additional dollars came into Circuit 4, what substance abuse and mental health services would you like to see expanded or created?

Clay Duval Nassau

1Expand to the underserved Central access/ integration of

services

2Expand self directed care Self directed care, peer

support, Club House, consumer choice

3Improve access to care via better transportation

24 hour emergency service

4Mental health court Treatment (i.e. detox, case

management, counseling)

5Medications Employment opportunities

for clients


Circuit Wide ComparisonQuestion 5 : How do we integrate our substance abuse and mental health services into our child welfare system?

Clay Duval Nassau

1 Access schools Access schools

2 Service integration Service integration

3 Evidence-based only

4 Cross training


Debriefing- Clay•More specific training is needed for staff, CBC’s, teachers etc…•Align Baker Act and Marchman Act with each other better•Lack of continuity of care•Silo’s in funding•Fragmentation of system•Transportation- rural communities have unique needs•Education the community on services available•There is a lot of duplicated people•Prevention education is needed•Gaps in services•Develop the concept of “no wrong door”•Work better with the criminal justice system•Staff retention is awful •Share! Share! Share!


Debriefing- Duval •A lot of work to be done•Need more community engagement•There is no community ownership•Consistent training and standards are needed•Streamline processes•Centralized assessments are necessary•Need a quality work force•There is a willingness and desire to work together•24/7 services•Combine physical heath and behavior health•Self directed care works


Debriefing- Nassau•Transportation is a big issue•Services do not match the treatment needed•Very positive results in providing intervention and prevention in Nassau county schools•Surprised to hear about the great work being done in the schools•Surprised to hear about how the female gangs are outnumbering the male gangs•Substance Abuse Prevention Coalition is working


World Café FindingsThis report is intended to provide an executive level overview of the findings from the three World Café meetings. Copies of the hand written synthesis and illustrations of the collapsing process of the data is available by written request. All information contained in this report is owned by the Health Planning Council of Northeast and can not be reproduced without their permission. Furthermore, any of the findings listed in this report must be cited and or referenced in all public documents including web site postings.

For further information, please contact Dawn Emerick, Executive Director of the Health Planning Council of Northeast Florida. 904-723-2162

Health Planning and Community Organizing : Its what we do every day World Café Summary Report Department of Children and Families, Circuit 4 Substance.

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