Hazelette Crosby-Robinson, LLMSW Katie Kettner, LLMSW Florence Roberson Khalila King

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H a z e l e t t e C r o s b y - R o b i n s o n , L L M S W

K a t i e K e t t n e r, L L M S W

F l o r e n c e R o b e r s o n

K h a l i l a K i n g

Outreach & Engagement in Physical Health Care Services

For Racially, Ethnically & Socially Disadvantaged Populations with Mental Health Problems

Slides property of WCHO Community Organization & Development Team

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Workshop Objectives

Participants will be able to:

Identify the health disparities that affect racially, ethnically and socially disadvantaged populations

Describe how a community-based method can improve health outcomes for racially, ethnically and socially disadvantaged populations

List at least 3 outreach methods used to reach and inform minority populations who have physical and mental health care needs


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WHAT YOU SHOULD KNOW ABOUT US…

Washtenaw Community Health Organization


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Washtenaw Community Health Organization

Community Mental Health Services Program (CMHSP) for Washtenaw County

Member of the Community Mental Health Partnership of Southeast Michigan Prepaid Inpatient Health Plan (PIHP) with Lenawee, Livingston & Monroe Counties

Designated Substance Abuse Coordinating Agency for Lenawee, Livingston and Washtenaw counties


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Washtenaw County Demographics

2010 Population – 344, 291

2 large cities and several towns & villages Ann Arbor Ypsilanti Chelsea Saline Milan Dexter Manchester

2 major universities & 1 community college University of Michigan Eastern Michigan University Washtenaw Community College

2 large health systems University of Michigan Health System St. Joseph Mercy Hospital


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Washtenaw County Health & Income Disparities

Profound disparities exist in lifespan for Washtenaw County residents.

There is over a 15 year gap between the shortest and longest average lifespan

across Washtenaw County cities, townships and villages.


Data Source: Adreanne Waller, MPH – Project Epidemiologist, Washtenaw County Public Health

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Washtenaw County Health & Income Disparities

Washtenaw County adults with health insurance who have less education have higher diabetes rates than more educated adults with health insurance

Regardless of overweight status, Washtenaw County adults who have more education are much less likely to have heart attacks

African-American/Black population have worst diabetes rate in Washtenaw County – 7.3%

The poorest Washtenaw County African American adults are 3 to 4 times more likely to have diabetes than the poorest Washtenaw County white adults

African American/Black population have worst Infant Mortality rate in Washtenaw County – 11.5 per 1,000 (compared to 4.4 per 1,000 for White population)

The wealthiest 20% of Washtenaw County residents possess 50% of the total income in the County. The poorest 20% possess only 2.9% of the total income

There is a disproportionate share of minorities on Medicaid and they do not receive access to services as they need (local and national issue)

Data Source: Adreanne Waller, MPH – Project Epidemiologist, Washtenaw County Public Health


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Mental Health Disparities

Racial and ethnic minorities have less access to and less availability of mental health care; are less likely to receive needed services; and often receive poorer quality mental health care.

Additional studies have identified the role of socioeconomic disadvantage in exacerbating disparities in mental health.

Source: Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md, US Department of Health and Human Services, US Public Health Service, 2001


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Project History


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Project History: The Issue

Startling info revealed in 2010 at a WCHO Board meeting: 50% of inpatient psychiatric admissions for

Washtenaw Co. were coming from 2 zip code areas of Ypsilanti – 48197 & 48198

Zip code

# Hosp Adm

% Hosp Adm

# Inpatients

% Inpatients

# Male

# Female

# CMH

# Non-CMH

48197 299 29% 234 30% 108 115 60 176

48198 223 22% 170 22% 68 96 42 132

48103 113 11% 89 11% 39 46 30 64

48108 71 7% 52 7% 26 26 12 43

48104 63 6% 43 6% 23 19 11 33


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Why was this a problem? Community members are seeking emergency

care as first line alternative when in need of mental health care

48197 & 48198 hold just 20% of the County’s population

WCHO has clinical & administrative offices located in the 48198 zip code area

Extremely costly for our organization


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48197 & 48198 zip code areas:

Lie within the City of Ypsilanti

Are subject to cumulative social disadvantages; have high rates of poverty, social disadvantage & racial/ethnic minority residents

Have the highest rates of high school dropouts – 20.1% in Willow Run district (compared to 2.8% in Manchester)

Have the highest rates of poverty – 15.6% in City of Ypsilanti (compared to .8% in Lima Township)

Hold 67% of Washtenaw County’s Black/African American population


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INITIATING THE MEDICAID MATCH PROJECT

Addressing the Issue


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Addressing the Issue

WCHO applied for and received a Medicaid Match grant to identify and remedy perceptions and practices that might inhibit access and utilization of Medicaid mental health services within the population of interest


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Outreach & Engagement with Racial & Ethnic Socially Disadvantaged Populations

Goal: Partner with community members & community

agencies in efforts to remove & reduce access barriers for beneficiaries in target areas who are eligible for/need mental health & substance abuse services Contracted with a Community Organizer

Secret Shopper Street outreach

Faith-Based Outreach Focus groups


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Focus Groups

Held 11 focus groups to collect feedback/opinions of internal staff & external human service providers, community members, and primary/secondary consumers

We have learned that potential consumers in the 48197 & 48198 zip codes here in Ypsilanti are more likely to receive inpatient psychiatric treatment than to come in to see us. As someone working with the consumers we want to engage, what are some of the reasons that you think potential consumers don’t get services from us?

Hired an independent focus group facilitator to encourage honest responses from participants

Reported results back to internal staff

Utilized results for Community Outreach and Engagement plan as part of the Medicaid Match project


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Focus Group Responses

Structural Issues Lobby is a cold environment

When clients have to face a bank-like security glass, it makes one wonder if mental health = criminality

Close proximity to DHS is problematic

Limited human interaction and no welcoming triage system; clients are told to call Access from a pay phone in the lobby rather than talking to someone at the front desk


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Cultural Factors There is a stigma of mental illness as being different than other illnesses; issues of

responsibility & blame

There are various issues which arise within a number of ethnic, racial, cultural groups on mental health issues and their treatment; mistrust of authorities

Some tension exists around treatment within the intersection of faith & science

Many African Americans lean first to family, friends, and pastors before turning to professionals

There needs to be an ongoing, stronger dialogue between the faith and professional mental health communities to explore how best to work together, and when to hand-off

Starting in schools, African American/Black males have often been the targets of diagnosis and medication

Culturally, there are many who cannot accept that they could face mental illness


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Systemic Issues There should be a ‘no wrong door’ policy

Access is regarded as the ‘Just Say No’ agency

We must improve our service model and move beyond lip service

Branding and marketing are problematic; is WCHO health or mental health? No name recognition and not ‘on the radar’

There is a general lack of good information on mental health in the hands of consumers

Public transportation, telephones, and access to computers/the web are not equally distributed across the current and/or potential client base

“We need to go where they are”


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Suggestions for Improvement Resolve the branding issue by ensuring that WCHO’s info can be found and accessed

Focus on making service center more inviting

Build a closer relationship and dialogue with the faith community

Work more closely with other human service organizations on mental health issues

Articulate an ‘outer-county’ strategy to reach outer edges of County

Work on making the intake system more client-friendly

Ensure that clients can always talk to a person

Consider alternative concerning hours of operation to accommodate working adults


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“WE NEED TO GO WHERE THEY ARE”

Addressing the Issue – Year Two


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Addressing the Issue – Year Two

Goal: Identify and develop specific interventions that seek

to minimize/eliminate identified barriers to access in the 48197 and 48198 zip codes


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Addressing Structural Issues

Lobby issues Community organizer spent time in lobby with refreshments

Better signage posted

Eliminated pay-phone process; people are now able to speak face-to-face with Access staff after very short wait time

Computer kiosks with security screens installed by Community Support and Treatment Services (CSTS) so consumers can access their medical record and view Individual Plan of Service


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Addressing Systemic Issues

Improvements to CSTS Access System made by Access staff:

Reviewed and rewrote Access eligibility criteria; removed outdated and inappropriate criteria for services

Implemented a presumptive eligibility model

Individuals may call one single Access number and will be triaged, assessed and/or referred to services; educated on options

Access expanded in 02/13 to include 24/7 Mandated Functions for 4 County Affiliates

Moved Mandated Functions out of U of M Psychiatric Emergency Services; individuals no longer directed towards Emergency Room for after hours mental health crises


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Addressing Branding & Marketing Issues

Outreach and Engagement campaign to 48197 & 48198 zip code areas

Purchased and distributed WCHO products to all ages and populations

Street-level outreach

Utilization of local printing company that’s recognizable to community and experienced in reaching community of interest

Direct mail campaign

Heavy involvement in coalitions, and planning/participating in community events

6 week “Building Healthy Communities” curriculum at Willow Run Youth Summer Camp

Collaborated with other Human Service Organizations


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Addressing Cultural Factors

Efforts to reduce stigma of mental illness

Faith-based outreach Working individually with faith-based organizations Church fans

Building trust and rapport with community members and stakeholders

Working with African American/Black male youth Ballin’ In the Boulevard Camp outreach


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HOW OUR WORK HAS PAID OFF

2nd Year Results


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Number of Community Hospital AdmissionsFiscal Years 11, 12 & 13 (through July 2013)

FY 11 FY 12 FY 130

100

200

300

400

500

600

700

800

If current admission trend continues, approximately 490 admissions are anticipated resulting in a 22% decrease in admissions from FY 12


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Number of Walk-Ins to 48198 Service Center (through July, 2013)

FY 11 FY 12 FY 130

50

100

150

200

250

300 Walk-ins to the Towner service center in the 48198 zip code area have increased by about 40% since FY 11


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2nd Year Results

Willow Run Summer Camp survey results indicated curriculum was effective in increasing knowledge about the WCHO and the importance of mental/physical health

Community Support and Treatment Services (CSTS) created 39 positions to keep up with increased service demand

WCHO administrative staff moved to new location to create more room for direct care providers at 48198 service center

Increased recognition, trust building and networking with community members and stakeholders

Gained ideas and experience for outreach and engagement expansion


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ADDING PRIMARY HEALTH CARE COMPONENT

Addressing the Issue – Year 3


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WCHO learned that disadvantaged individuals with mental health issues in the 48197/48198 zip codes in Ypsilanti do not have regular primary care providers and may be seeking emergency care rather than seeking ongoing preventive care and regular follow-up

Americans with major mental illness die 14 to 32 years earlier than the general population as they are more likely to suffer from chronic diseases, obesity and poverty and they may suffer the adverse health consequences earlier


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Goals: Survey community members to assess barriers to

primary health services

Develop & implement education and outreach program to improve access to physical health care in this underserved area

Share our findings with others


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Creation and distribution of Community Health Survey Likert Scale for satisfaction of healthcare systems and

resources in the community

Questions regarding barriers to access, what prevents community members from seeking services, where people receive health services when needed, and familiarity with WCHO

Distributed in Spanish and made available via Survey Monkey


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Survey Results 260 respondents

Majority reported adult and child dental care is difficult to receive in the county; other health care services that are difficult to receive include: Counseling Vision care Substance Use

63% reported that having no regular source of health care keeps people from getting healthcare they need; other prevalent barriers to healthcare include: lack of trust in doctors/clinics Childcare Fear lack of evening and weekend services Transportation high co-pay or deductible don’t know what type of services are available


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Survey Results, continued 57% reported that most people in our county likely

receive their healthcare in the ER

48% reported that they were previously aware of the WCHO and the services they provide; 23% have heard of the WCHO, but not of their services

The majority reported they are satisfied with the quality of life, healthcare systems, and networks of support within Washtenaw County

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Outreach Activities

Primary health-focused outreach and event, coalition participation

Parkridge Community Center Youth Summer Camp Building Healthy Communities curriculum presentation

Primary health-related WCHO product distribution


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OUTREACH VIDEO

Outreach Events


https://www.youtube.com/watch?v=QvcIQjBTxvM&feature=youtu.be

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Behavioral Health and Wellness Symposium

Medicaid Match project capstone event created to inform community members and human service organizations of the efforts being made locally and state-wide to integrate behavioral and physical health care

Featured keynote presentation by Senator Rebekah Warren and panel including State Representative David E. Rutledge and WCHO Board members, County Commissioner, and WCHO Executive Staff and Medical Director


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Sharing our work with the community and receiving recognition

Poster presentation at the University of Michigan Dept. of Psychiatry 24th Annual Albert J. Silverman Research conference

2013 WCHO Behavioral Health and Wellness Symposium

2013 MACMHB Conference – Building Culturally Competent and Diverse Organizations and Systems of Care

WCHO staff and Board meetings

Substance Abuse Coordinating Agency Town Hall

Newsletters

Formal reports


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NEXT STEPS

Conclusion


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WCHO Community Development & Organization

Success of program has allowed us to create a Community Development & Organization team within the WCHO

Expanding outreach efforts Expanding our team Extending outreach and engagement efforts to entire

county Additional focus on opiate use issue Continue to share our work and findings with others Consideration regarding how our work has improved

health outcomes for our community


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COMMENTS?

QUESTIONS?

GROUP DISCUSSION

Thank You!


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References

Agency for Health Care Research and Policy. National Health Care Disparities Report, 2003 http://archive.ahrq.gov/qual/nhdr03/fullreport/index.html

Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md, US Department of Health and Human Services, US Public Health Service, 2001

McGuire TG, Miranda J: New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Affairs 27: 393-403, 2008

National Healthcare Disparities Report, 2004. Rockville, Md, Agency for Healthcare Research and Quality, 2004National Institute of Mental Health

Smedley BD, Stith AY, Nelson AR: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC, Institute of Medicine, National Academies Press, 2003

Snowden LR, Hu TW, Jerrell JM. Emergency care avoidance: Ethnic matching and participation in minority-serving programs. Community Mental Health Journal, 31(5), 463-473, 1995.

Waller, A. Ten Things to Know About Health Equity in Washtenaw County. 2010

Waller, A. Opening the Window of Opportunity to Health for All. 2012


http://archive.ahrq.gov/qual/nhdr03/fullreport/index.html

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Hazelette Crosby-Robinson, LLMSW Katie Kettner, LLMSW Florence Roberson Khalila King

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