Chapter Eight, New York City DSRIP Region Needs Assessmentomh.ny.gov/omhweb/special-projects/dsrip/docs/chapter-8-nyc.pdfThis community needs assessment of the New York City DSRIP

Chapter Eight

New York City DSRIP Region Needs Assessment

New York State Office of Mental Health

Executive Summary This community needs assessment of the New York City DSRIP region summarizes specific health care service data to identify mental health and substance use disorder treatment needs in the region. The data included are intended to enable planners and others to identify service gaps and disparities and plan for improved service delivery.

Population Socioeconomic Characteristics The New York City (NYC) region includes Bronx, Kings, New York, Queens, and Richmond counties. The socioeconomic characteristics of the approximately 8.2 million people living in this major metropolitan area are more indicative of need than those in other DSRIP regions. The median household income of $55,476 in NYC is below the state median of $58,687. Twenty-one percent of the population live below the poverty level, 4% are on cash public assistance, 18% receive food stamps/SNAP benefits, and 21% of adults are without a high school diploma. The percentages of the NYC population living below the poverty level, receiving food stamps/SNAP benefits, and without a high school diploma are the highest percentages in any DSRIP region. Among all NYS counties, Bronx County has the lowest median household income ($34,396), and the highest percentages of population on cash public assistance (8%), receiving food stamps/SNAP benefits (33%) and without a high school diploma (30%).

The percentages of the NYC population on some type of public health insurance (39%), on Medicaid (44%), and with no health insurance coverage (12%) are the highest in any DSRIP region. The Bronx has the highest percentages of individuals on some type of public health insurance and Medicaid (60%) in any NYS county.

Special populations in the region include 10% that are disabled and 3% that are Veterans. Thirty-seven percent of the region’s population are foreign born, 49% speak a primary language other than English, and 23% speak English less than “very well”, which are the highest percentages in any DSRIP region.

Health Care Resources Maldistributions and shortages of health care providers in the NYC region are recognized by federal Health Resources and Services Administration (HRSA) health professional shortage area (HPSA) designations. All NYC counties have primary health care and mental health (MH) professional Medically Underserved Area/Population (MUA/P) designations. The Medicaid eligible populations in all NYC counties are designated primary care MUPs. The Medicaid populations in all counties, except Richmond, are designated MH professional MUPs. NYC has 33,498 licensed MH professionals or 39 per 10,000 population, which is the third highest ratio in any DSRIP region. Regional maldistributions include New York County having 98 licensed MH professionals per 10,000 population (the highest in any NYS county), while the Bronx has 20.

Total psychiatric bed capacity in the region is 65 per 100,000 adults (the highest in any DSRIP region) and 25 per 100,000 children. The total average daily census (ADC) per 100,000 adults is 62 (the highest in any DSRIP region), and the total ADC per 100,000 children is 30. All acute care hospitals in NYC have chemical dependence rehab and detox beds.

All counties in the region have inpatient SUD crisis programs (n=31), rehabilitation programs (n=12) and residential programs (n=66). These programs have a total capacity of seven per 10,000 and an average daily enrollment (ADE) of six per 10,000, which are the third highest rates in all DSRIP regions.

New York City DSRIP Region Needs Assessment –December 2016

407


Health Status Challenges Among all DSRIP regions, NYC has the highest: 1) Average case rates of HIV and AIDS. New York County’s HIV case rate and Bronx County’s AIDS

case rate are the highest in any NYS county. 2) Average death rates from AIDS and pneumonia. In Bronx County these rates are the highest in

any NYS county. 3) Average percentage of premature deaths among all DSRIP regions. Bronx County has the highest

percentage of premature deaths in any NYS county. 4) Hospitalization rates for cardiovascular disease, diabetes, asthma, and drug-related. In Bronx

County these rates are the highest in any NYS county. 5) Average percentage of adults who reported food insecurity, housing insecurity, and not receiving

medical care because of cost.

Behavioral Health Care Utilization Challenges Compared to all DSRIP regions, the New York City region has the highest percentages of Medicaid beneficiaries with: 1) Inpatient hospital admissions for schizophrenia. 2) Inpatient hospital admissions for cocaine use disorder. 3) ER visits for schizophrenia. 4) ER visits for alcohol use disorder.

Unmet Service Needs Measures of behavioral health medication management suggest unmet need in the region. Nearly two-thirds (61%) of adults with schizophrenia adhere to anti-psychotic medications (39% do not). Region-wide, 51% of individuals with major depression remain on anti-depressant medication during the entire acute treatment phase and 37% remain on these medications during continuation phase treatment (63% do not). Among all DSRIP regions, NYC has the second lowest adherence to antidepressants for the acute phase.

Nearly two-thirds (64%) of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication. Seventy-two percent of children with a new prescription for ADHD medication remain on the medication for seven months and/or have at least two follow-up visits in the nine month period after the initiation phase.

Follow-up care after hospitalization for mental illness and engagement in alcohol and other drug dependence (AOD) treatment also suggest unmet need. After hospitalization for mental illness, 40% of individuals have follow-up care within 7 days of discharge (60% do not) and 54% follow-up within 30 days. Nineteen percent of individuals engage in AOD treatment within 30 days after initiation (81% do not). With regard to physical health, NYC’s rates of potentially avoidable hospital admissions for diabetes long-term complications are the highest in any DSRIP region, and suggest a need for further outpatient resources.

Consumer and Provider Input New York City region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to prevention services are an issue that needs attention for the populations with mental health and/or chemical dependency concerns. Five clinics in the New York City region collected input from 443 consumers and 85 providers. The needs most frequently reported by both consumers and providers include: affordable housing; services provided at homeless shelters; assistance with finding and maintaining employment; treatment for co-occurring disorders; child and adolescent mental health and substance abuse detox/rehab services; peer support services; and assistance with paying for services.

New York City DSRIP Region Needs Assessment –December 2016

408


I. Description of Communities to Be Served

1. Geographic Service Area The New York City DSRIP region is located in southeastern New York State. The region is composed of five boroughs, each of which is a New York State county. Manhattan (New York County) and Staten Island (Richmond County) are islands, Brooklyn (Kings County) and Queens are geographically part of Long Island, and the Bronx is attached to the U.S. mainland.

Overall, more than 8 million people live in the New York City (NYC) region (Table 1). Estimated county populations range from a low of 466,569 in Richmond County to a high of nearly 2.5 million in Kings County. All of the region’s counties have been designated urban by the U.S. Office of Management and Budget (OMB).1 About one in every 36 people living in the U.S. resides in NYC.

The city's geography, with its scarce availability of land, is a contributing factor in making the NYC region the most densely populated DSRIP region and the most densely populated city in the U.S. Population density per square mile in the region ranges from a low of 7,993.3 in Richmond County to a high of 69,745.6 in New York County, which is the most densely populated county in New York State (NYS).

New York City DSRIP Region Needs Assessment – December 2016 409


Table 1. New York City Region: Population Size, Density and Urban/Rural County Designations

County US Census ACS 2010-2014 Est.

Population

Population Density per Square Mile

OMB Urban/Rural

Designation1

Bronx 1,379,211 32,760.4 Urban Kings 2,497,563 35,266.4 Urban New York 1,592,291 69,745.6 Urban Queens 2,223,182 20,484.5 Urban Richmond 466,569 7,993.3 Urban

Totals 8,158,817 26,957.9 Data is from the U.S. Department of Health and Human Services, Health Resources Services Administration Data Warehouse. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/ tools/analyzers/geo/Rural.aspx

2. Population Characteristics

A. Gender, Race, Ethnicity and Age In the NYC region slightly more than half (53%) of the population are female (Table 2).

Table 2. New York City Region: Gender, Race/Ethnicity and Age


Population

American Community Survey Data 2010-2014 Gender Race/Ethnicity Age

Male Female White African

American Asian Other*

Hispanic or Latino Ethnicity

19 and Under

65 and Over

Bronx 1,379,211 47% 53% 22% 34% 4% 40% 53% 30% 10% Kings 2,497,563 48% 53% 44% 34% 11% 11% 20% 26% 11% New York 1,592,291 47% 53% 57% 15% 11% 17% 26% 17% 13% Queens 2,223,182 49% 52% 42% 19% 23% 15% 27% 23% 12% Richmond 466,569 49% 52% 76% 10% 8% 6% 17% 26% 12%

Totals 8,158,817 48% 53% 44% 25% 13% 18% 29% 24% 12% *Other includes American Indian and Alaska Native, Native Hawaiian and other Pacific Islander, some other race, and two or more races

The region is the most racially and ethnically diverse DSRIP region and geographic area in NYS. It has the lowest percentage of Whites (44%) and highest percentages of African Americans (25%), Asians (13%), some other race (18%), and persons of Hispanic or Latino ethnicity (29%) in any DSRIP region. In NYC percentages of Whites vary from a low of 22% in the Bronx to a high of 76% in Richmond County. Percentages of African Americans vary from a low of 10% in Richmond County to a high of 34% each in Bronx and Kings counties. Percentages of Asians vary from a low of 4% in Bronx County to a high of 23% in Queens. Percentages of some other race vary from a low of



6% in Richmond County to a high of 40% in the Bronx. More than half of the population (53%) in the Bronx is of Hispanic or Latino ethnicity, which is the highest percentage in any NYS county.

A quarter of the NYC population are age 19 and under and 12% are age 65 and over. In the region, the Bronx has the largest percentage of persons age 19 and under (30%) and the lowest percentage of persons age 65 and over (10%). In contrast, New York County has the smallest percentage of persons age 19 and under (17%) and the highest percentage of persons age 65 and over (13%)

B. Income, Education, Unemployment and Poverty The median household income in the NYC region is $55,476 (Table 3). Median household incomes range from a low of $34,396 in the Bronx to a high of $72,789 in Richmond County. Bronx County has the lowest median household income of any NYS county.

Table 3. New York City Region: Income, Education, Unemployment and Poverty


Population

American Community Survey Data 2010-2014

Median Household

Income

Educational Attainment1 Unemployment and Indicators of Poverty

Less than High School

Bachelor's Degree or Higher Unemployed2 Below Poverty

Level On Cash Public

Assistance On Food Stamps/

SNAP Benefits

Bronx 1,379,211 34,396 30% 18% 8% 30% 8% 33% Kings 2,497,563 45,284 22% 31% 6% 23% 5% 22% New York 1,592,291 68,372 14% 58% 5% 18% 3% 13% Queens 2,223,182 56,538 20% 30% 5% 15% 3% 13% Richmond 466,569 72,789 12% 30% 6% 12% 3% 11%

Totals 8,158,817 55,476 21% 33% 6% 21% 4% 18% 1 Educational attainment are calculated based on population 25 years and older. 2 Unemployment data is the average for 2015 and is from the NYS Department of Labor.

Compared to all DSRIP regions, the NYC region has the largest percentage of individuals age 25 and older without a high school diploma (21%) and the third largest percentage with a bachelor’s degree or higher (33%). Educational attainment varies by county. Adults without a high school diploma range from a low of 12% in Richmond County to a high of 30% in the Bronx (the highest percentage in any NYS county). Adults with a bachelor’s degree or more range from a low of 18% in the Bronx to a high of 58% in New York County (the highest percentage in any NYS county).

The NYC region has a 6% unemployment rate. Twenty-one percent of the population live below the poverty level, 4% are on cash public assistance and 18% receive food stamps/SNAP benefits, which are the highest percentages in any DSRIP region. Among all NYS counties, the Bronx has the highest rate of poverty (30%) and the largest percentages of population on cash public assistance (8%) and receiving food stamps/SNAP benefits (33%).



C. Health Insurance Status In NYC, 39% of the population are on some type of public health insurance2 and 12% have no health insurance coverage (Table 4). These are the highest percentages in any DSRIP region. Percentages of the population on public health insurance range from a low of 30% in Richmond County to a high of 50% in the Bronx, which is the highest percentage in any NYS county. Those with no health insurance range from a low of 8% in Richmond County to a high of 17% in Queens.

Table 4. New York City Region: Health Insurance Status


Population

American Community Survey Data 2010-2014

Public Health

Insurance1

Coverage

No Health Insurance Coverage

Unemployed w/Public Health

Insurance

Unemployed w/No Health Insurance

Bronx 1,379,211 50% 15% 51% 32% Kings 2,497,563 42% 14% 41% 34% New York 1,592,291 31% 10% 34% 31% Queens 2,223,182 36% 17% 32% 37% Richmond 466,569 30% 8% 29% 25%

Totals 8,158,817 39% 12% 39% 33% 1 Public coverage includes Medicare, Medicaid and other federal medical assistance programs; VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans.

Among the region’s unemployed, 39% are on public health insurance (the highest percentage in any DSRIP region) and 33% have no health insurance. While the rates of the unemployed on public health insurance are comparable to those of the general population, the rates of the unemployed with no health insurance are nearly three times as high as those in the general population (33% compared to 12%).

Medicaid Population Among all DSRIP regions, New York City has the highest percentage of the estimated population that are Medicaid beneficiaries (44%). By county, Medicaid beneficiaries range from a low of 27% in Richmond County to a high of 60% in the Bronx (Table 5). Bronx County has the highest percentage of Medicaid beneficiaries in any NYS county.

Table 5. New York City Region: Medicaid Beneficiaries as Percentage of Total Population

County US Census

ACS 2010-2014 Est. Population

Total # Medicaid Beneficiaries

% Est. Population Receiving Medicaid

Bronx 1,379,211 821,339 60% Kings 2,497,563 1,237,587 50% New York 1,592,291 485,833 31% Queens 2,223,182 915,815 41% Richmond 466,569 127,533 27%

Totals 8,158,817 3,588,107 44% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About



In the region, 67% of Medicaid beneficiaries are adults and 33% are children (Table 6). By county, adult Medicaid beneficiaries range from a low of 64% in Bronx County to a high of 74% in New York County.

Medicaid beneficiaries include individuals that receive Medicaid only and dual-eligible individuals that receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes.3 In the New York City region, 87% of Medicaid beneficiaries receive Medicaid only (the highest percentage in any DSRIP region) and 13% are dual-eligible. Medicaid only beneficiaries range from a low of 81% in New York County to a high of 89% in Bronx County.

Table 6. New York City Region: Medicaid Beneficiaries by Population and Eligibility Type

County All Medicaid Beneficiaries

Medicaid Population Eligibility Type

Adults Children Medicaid Only Dual Medicaid and Medicare

# # % # % # % # % Bronx 821,339 523,010 64% 298,329 36% 728,015 89% 93,324 11% Kings 1,237,587 811,438 66% 426,149 34% 1,083,392 88% 154,195 12% New York 485,833 361,650 74% 124,183 26% 392,578 81% 93,255 19% Queens 915,815 626,845 68% 288,970 32% 806,730 88% 109,085 12% Richmond 127,533 84,181 66% 43,352 34% 109,643 86% 17,890 14%

Totals 3,588,107 2,407,124 67% 1,180,983 33% 3,120,358 87% 467,749 13% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

D. Special Populations, Foreign Born and Primary Language In NYC 10% of the population are disabled and 3% are Veterans (Table 7). Percentages of individuals with disabilities are 10% in all NYC counties, except for the Bronx, which has 14% disabled. The NYC region has the lowest percentage of Veterans in any DSRIP region. Veterans range from a low of 3% each in Kings, New York and Queens counties to a high of 6% in Richmond County.

Jail data is unavailable for the NYC region and foster care data is unavailable at the county level. In NYC more than 10,000 children aged 19 years and younger are in foster care, which is the largest number in any DSRIP region. More than a third (37%) of the NYC population are foreign born. The largest percentages of foreign born are in Queens (48%, the largest percentage in any NYS county) and Kings (37%) counties. NYC’s percentage of foreign born is the largest in any DSRIP region.



Table 7. New York City Region: Special Populations and Foreign Born


Population

American Community Survey Data 2010-2014 Special Populations

Foreign Born Disabled Veterans

In Foster

Care1 In Jail2

Bronx 1,379,211 14% 4% ─ ─ 33% Kings 2,497,563 10% 3% ─ ─ 37% New York 1,592,291 10% 3% ─ ─ 29% Queens 2,223,182 10% 3% ─ ─ 48% Richmond 466,569 10% 6% ─ ─ 21%

Totals 8,158,817 10% 3% 10,866 ─ 37% 1Foster care data for NYC is available only for the DSRIP region. Data is for 2014 calendar year and is from the NYS Office of Children and Families. 2 Jail population data is not available for New York City

Table 8 describes the primary languages spoken at home and those who speak English less than ”very well” in the population aged five years and older. In the NYC region, 51% of this population speak English as their primary language (the lowest percentage in any DSRIP region), 25% speak Spanish, 13% speak other Indo-European languages, 8% speak Asian and Pacific Islander languages, 2% speak some other language and 23% speak English less than “very well” (the highest percentage in any DSRIP region).

Table 8. New York City Region: Primary Language Spoken at Home

County

US Census ACS 2010-2014 Est. Population 5

Years and Older

American Community Survey Data 2010-2014 Language Spoken at Home

Speak English less than "very

well" English Spanish

Other Indo-European

Asian and Pacific

Islander Other

Bronx 1,282,640 43% 46% 5% 2% 3% 25% Kings 2,334,108 54% 17% 18% 8% 3% 24% New York 1,518,583 60% 23% 8% 8% 2% 17% Queens 2,101,228 44% 24% 16% 14% 2% 29% Richmond 439,725 70% 10% 12% 5% 2% 11%

Totals 7,676,284 51% 25% 13% 8% 2% 23%

Percentages of the population aged five and over that speak English as their primary language range from a low of 43% in Bronx County (the lowest percentage in any NYS county) to a high of 70% in Richmond. Those who speak English less than “very well” range from a low of 11% in Richmond County to a high of 29% in Queens (the highest percentage in any NYS county).

1 Urban areas (metro areas) are geographic entities defined by the U.S. Office of Management and Budget (OMB) for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. An urban area includes one or more counties containing a core urban area of 50,000 or more people, together with any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core. The OMB defines rural as all counties outside



metropolitan areas based on 2010 census data. There are currently 24 counties designated rural in New York State. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx 2 Public coverage includes the federal programs Medicare, Medicaid and other medical assistance programs, VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans. Retrieved April 14, 2016 from https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html3 In this analysis dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf


http://www.medpac.gov/documents/data-book/january

https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html

http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx


II. Physical and Behavioral Health Care Resources

This section describes physical and behavioral health care resources in the New York City DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

Physical Health Care Resources

1. Inpatient Physical Health Care Facilities The New York City (NYC) region has 59 acute care hospitals and 215 nursing homes that provide inpatient health care (Table 1).

Table 1. New York City Region: Inpatient Physical Health Care by Certified Beds

County

Acute Care Hospitals Nursing Homes

# Hospitals

# Certified Beds # Nursing

Homes

# Certified Beds Total # All Bed Types

Chemical Dependence

Rehab

Chemical Dependence

Detox Psychiatric Total Beds

BH Intervention Beds

Bronx 10 3,783 30 76 439 55 8,509 0 Kings 14 5,746 20 104 796 50 7,761 0 New York 21 9,707 66 112 930 22 5,915 0 Queens 9 3,863 0 62 595 72 7,032 0 Richmond 5 1,238 24 63 129 16 2,742 72

Totals 59 24,337 140 417 2,889 215 31,959 72 Acute care hospital data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Health-Facility-General-Information/vn5v-hh5r . Nursing home data is from the NYS Open Data Nursing Home Profile dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Nursing-Home-Profile/dypu-nabu

In the region, all counties have acute care hospitals, with the greatest concentration in New York County (n=21). The region has a total of 24,337 beds where physical health care is the primary type of care provided. Among those beds are 2,889 psychiatric beds, 140 chemical dependence rehab beds, and 417 chemical dependence detox beds.

The region’s 215 nursing homes have a total of 31,959 beds, which includes 72 behavioral health intervention beds in Richmond County.1 All counties in the region have nursing homes.

2. Outpatient Physical Health Care Facilities In the NYC region, home health care is provided in all counties (Table 2). All counties have certified home health care facilities (n=38) and long-term home health care facilities (n=18). All of the counties, except for Richmond, have ambulatory surgical centers (n=59).



Table 2. New York City Region: Outpatient Physical Health Care

County

Home Health Care Ambulatory

Surgical Centers

Primary Health Care

Certified Home Health

Long-term Home Health

School-based Health Centers

Diagnostic and Treatment Centers

Federally Qualified

Health Centers

# Facilities

Bronx 7 8 8 60 41 46 Kings 15 3 18 45 65 23 New York 12 4 19 59 71 29 Queens 3 2 14 10 35 17 Richmond 1 1 0 5 5 3

Totals 38 18 59 179 217 118 Ambulatory surgical center data is from the NYS HCRA Provider List dataset. Retrieved April 12, 2016 from https://www.health.ny.gov/regulations/hcra/provider/provamb.htm. Federally qualified HC data is from the HRSA Data Warehouse. Retrieved April 21, 2016 from http://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=60#. All other data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/ Health-Facility-General-Information/vn5v-hh5r .

There are three types of institutional providers that provide primary care: school-based health centers, diagnostic and treatment centers,2 and federally qualified health centers.3 All NYC counties have these primary health care centers. Collectively, the counties have 179 school-based health centers, 217 diagnostic and treatment centers, and 118 federally qualified health centers (46 are in the Bronx).

3. Physical Health Care Practitioners Physical health care providers include primary care providers, medical specialists, dentists, and physical rehabilitation specialists. Health practitioners in primary care and medical specialties include physicians, physician assistants, and nurse practitioners.

Primary Care Providers In the NYC region, family medicine providers include 3,616 physicians and a total of 1,091 nurse practitioners and physician assistants (Table 3). The number of family medicine providers of all types is lowest in Richmond County (n=143) and highest in Bronx County (n=1,329). Family medicine health care providers are the smallest group of primary care providers in the region.

Internal medicine providers include 14,440 physicians and a total of 626 nurse practitioners and physician assistants. The number of internal medicine physicians is highest in New York County (n=4,669) and lowest in Richmond (n=803). Internal medicine nurse practitioners and physician assistants are found in the greatest numbers in New York County (n=252) and the fewest are in Richmond (n=24).



Table 3. New York City Region: Primary Care Providers

County US Census


Family Medicine

Internal Medicine

Pediatrics Total

Total per 10,000

population MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA

Bronx 1,379,211 962 367 2,476 144 2,073 160 6,182 45 Kings 2,497,563 1,074 238 3,773 103 2,461 128 7,777 31 New York 1,592,291 821 335 4,669 252 2,588 149 8,814 55 Queens 2,223,182 668 99 2,719 103 1,566 39 5,194 23 Richmond 466,569 91 52 803 24 371 9 1,350 29

Totals 8,158,817 3,616 1,091 14,440 626 9,059 485 29,317 36 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/ medicaid/redesign/providernetwork/

Throughout the NYC region there are 9,059 physicians providing pediatric care and 485 pediatric nurse practitioners and physician assistants. The number of pediatric health providers is highest in New York County (n=2,737) and lowest in Richmond County (n=380).

The maldistribution of primary care providers in the NYC region is made clearer by looking at the number of providers per 10,000 population in the region’s counties. Queens County has 23 primary care providers per 10,000 population, while New York County has 55. The region’s 36 primary care providers per 10,000 population is the highest among all DSRIP regions.

These maldistributions are recognized by designations of county health professional shortage areas (HPSAs) made by the federal Health Resources and Services Administration (HRSA).4 In addition to county wide shortage area designations, HRSA also makes county census tract, special population, and health care facility shortage designations. Table 3a describes all of the HRSA primary care professional shortage designations for the counties in the NYC region.

Table 3a. New York City Region: HRSA Federal Primary Care Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Low Income Population

Bronx Yes Yes Kings Yes Yes New York Yes Yes Queens Yes Yes Richmond Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx



All counties in the NYC region have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in all counties have been designated primary care MUPs.

Physical Health Medical Specialists The NYC region has a total of 15,129 physical medical health specialists or 19 providers per 10,000 population, which is the highest concentration in any DSRIP region (Table 4).

Table 4. New York City Region: Physical Medical Specialists


Population

Allergy and Immunology

Cardiology and Other Cardiology

Specialties

Endocrinology and Other Endocrinology Related Specialties

Obstetrics and Gynecology

General Surgery Total

Total per 10,000

populationMD/DO NP/PA MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA MD/DO NP/PA

Bronx 1,379,211 76 1 628 7 90 0 936 27 578 11 2,354 17 Kings 2,497,563 126 0 1,198 3 150 1 1,539 49 1,075 8 4,149 17 New York 1,592,291 250 0 1,675 8 248 1 1,475 50 1,232 14 4,953 31 Queens 2,223,182 139 0 1,061 0 82 0 1,023 27 655 15 3,002 14 Richmond 466,569 19 0 191 0 24 1 213 1 221 1 671 14

Total 8,158,817 610 1 4,753 18 594 3 5,186 154 3,761 49 15,129 19 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

Allergy and immunology providers (n=611) and endocrinology providers (n=597) are in shortest supply, while those in obstetrics and gynecology (n=5,340) are most prevalent, followed by cardiology (n=4,771) and general surgery (n=3,810). The number of medical specialists is highest in New York County (n=4,953) and lowest in Richmond County (n=671). Queens and Richmond counties each has 14 physical medical specialists per 10,000 population, while New York County has 31, the highest concentration in any NYS county.

Dentists In the NYC region there is a total of 7,978 dentists serving approximately 8.2 million residents (Table 5). The number of dentists ranges from a low of 423 in Richmond County to a high of 2,493 in Kings. Region-wide there are ten dentists per 10,000 population, the highest rate in any DSRIP region.

Table 5. New York City Region: Dentists

County US Census


Number of Dentists Per 10,000 Population

General Dentist

Specialist Dentist

Total

Bronx 1,379,211 1,075 529 1,604 12 Kings 2,497,563 1,848 645 2,493 10 New York 1,592,291 1,103 570 1,673 11 Queens 2,223,182 1,356 429 1,785 8 Richmond 466,569 268 155 423 9

Totals 8,158,817 5,650 2,328 7,978 10 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

New York City DSRIP Region Needs Assessment – December 2016419


Physical Rehabilitation Specialists In the NYC region, there is a total of 7,028 physical rehabilitation specialists serving the population of approximately 8.2 million residents (Table 6).

Table 6. New York City Region: Physical Rehabilitation Specialists


Population

Occupational Therapy

Physical Therapy

Speech Therapy

Total Total per

10,000 population

Bronx 1,379,211 76 678 31 785 6 Kings 2,497,563 286 1,868 152 2,306 9 New York 1,592,291 147 2,247 138 2,532 16 Queens 2,223,182 98 992 65 1,155 5 Richmond 466,569 26 193 31 250 5

Totals 8,158,817 633 5,978 417 7,028 9 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

21, 2016 from

In the region, speech therapists (n=417) and occupational therapists (n=633) are in shortest supply, while physical therapists are most prevalent (n=5,978). The number of physical rehabilitation specialists ranges from a low of 250 in Richmond County to a high of 2,532 in New York County. Region-wide there are nine physical rehabilitation specialists per 10,000 population.

Behavioral Health Care Resources

4. Inpatient Behavioral Health Care Facilities and Programs The data presented in this section is by county of provider location, with the exception of psychiatric inpatient average daily census, which is by patient county of residence. Individuals may access services in a county other than the county in which they reside.

Mental Health Inpatient Facilities The NYC region has a total of 3,977 adult psychiatric beds and 491 psychiatric beds for children (Table 7).5 Adult and child psychiatric beds are located in all counties.

New York County has the largest number of adult psychiatric beds (n=1,235) and Richmond has the fewest (n=415). Queens County has the largest number of psychiatric beds for children (n=160) and Richmond has the fewest (n=22). Total psychiatric bed capacity in the region is 65 per 100,000 adults (the highest rate in all DSRIP regions) and 25 per 100,000 children.



Table 7. New York City Region: Total Psychiatric Inpatient Bed Capacity by Provider County and Average Daily Census by Patient County of Residence

County

- Adults - - Children -Total

Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC2,3

Total ADC

per 100,0004

Total Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC

Total ADC

per 100,0004

Bronx 570 59 651 68 119 29 208 50 Kings 902 49 1,046 57 78 12 123 19 New York 1,235 94 926 71 112 40 92 33 Queens 855 50 899 53 160 31 146 28 Richmond 415 121 292 85 22 18 27 22

Totals 3,977 65 3,815 62 491 25 595 30 Notes: 1. Includes General Hospital, Private Psychiatric Hospital and State Psychiatric Centers’ budgeted capacity for the county of the providers. Children’s capacity includes residential treatment facility (RTF) beds for the county of the providers. 2. Average Daily Census (ADC) covers General, Private Psychiatric, State Psychiatric hospital and RTF (children only). 3. ADC is shown for patient county of residence. 4. The ADC per 100,000 population of adults or children as indicated. Data Sources: Capacity -- General Hospital and Private Psychiatric Hospital current capacity: NYSOMH CONCERTS database, 10/2015. Current capacity includes all beds licensed for operation as of that date. State Psychiatric Center budgeted capacity: NYSOMH MHARS EHR, 10/2015. RTF capacity: NYSOMH CAIRS database, 10/2015. US Census 2014 Est. Populations. Average Daily Census -- General Hospital (Art. 28): SPARCS, CY 2014. Private Psychiatric Hospital (Art. 31): Medicaid, CY 2014. Institutional Cost Report (ICR), CY 2014: county distribution using the 2013 Patient Characteristics Survey (PCS). State Psychiatric Centers: MHARS, CY 2014. RTF: CAIRS, CY 2014. US Census 2014 estimates.

In the NYC region, the total inpatient average daily census (ADC) for adult beds is 3,815, and the ADC for child beds is 595, which is larger than the total number of child inpatient beds (n=491). Kings County has the highest total ADC for adults (n=1,046, the highest in any NYS county) and Richmond has the lowest (n=292). In contrast, Bronx County has the highest total ADC for children (n=208, the highest in any NYS county) and Richmond has the lowest (n=27).

In the region, the total psychiatric inpatient ADC per 100,000 adults is 62, which is the highest rate in any DSRIP region, and the total ADC per 100,000 children is 30. For adults the total ADC per 100,000 adults is highest for residents of Richmond County (n=85, the highest ADC in any NYS county) and lowest for residents of Queens County (n=53). In comparison, the total ADC per 100,000 children is highest for residents of Bronx County (n=50) and lowest for residents of Kings (n=19).

Substance Use Disorder Inpatient Programs In New York State, substance use disorder (SUD) inpatient programs include crisis, inpatient rehabilitation, and residential programs.6 In the NYC region (Table 8) there are SUD inpatient crisis programs (n=31), rehabilitation programs (n=12), and residential programs (n=66) located in all of the region’s counties.



Table 8. New York City Region: Substance Use Disorders Inpatient Program Capacity

County

US Census ACS 2010-2014 Est.

Population

Inpatient Programs Total

Capacity per 10,000

Crisis Inpatient

Rehabilitation* Residential Total

Capacity

# Programs Capacity # Programs Capacity # Programs Capacity

Bronx 1,379,211 5 90 3 86 17 1,309 1,485 11 Kings 2,497,563 6 106 2 80 16 811 997 4 New York 1,592,291 13 237 3 78 21 1,701 2,016 13 Queens 2,223,182 5 172 2 81 9 902 1,155 5 Richmond 466,569 2 71 2 54 3 89 214 5

Totals 8,158,817 31 676 12 379 66 4,812 5,867 7 Notes and Data Sources: *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016. More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps/state/CD_descriptions.cfm

The region’s crisis capacity is 676, inpatient rehabilitation capacity is 379 and its residential capacity is 4,812. The regional capacity per 10,000 for all SUD inpatient programs is seven, the third highest rate in all DSRIP regions. New York County has the highest capacity per 10,000 (n=13), while Kings County has the lowest (n=4).

Table 9 describes the average daily enrollment (ADE) in these programs. The ADE in the region for crisis is 540, inpatient rehabilitation is 342 and residential is 3,655. The regional ADE per 10,000 for these programs is six, the third highest rate in all DSRIP regions. New York County has the highest ADE per 10,000 (n=10) and Kings County has the lowest (n=3).

Table 9. New York City Region: Substance Use Disorders Inpatient Program Average Daily Enrollment

County


Population

Inpatient Programs

Crisis Inpatient

Rehabilitation* Residential

Total Avg. Daily

Total Avg. Daily

Enrollment

# Programs Avg. Daily Enrollment



Enrollment per 10,000

Bronx 1,379,211 5 49 3 79 17 962 1,090 8 Kings 2,497,563 6 51 2 72 16 697 820 3 New York 1,592,291 13 223 3 62 21 1,272 1,557 10 Queens 2,223,182 5 187 2 78 9 639 904 4 Richmond 466,569 2 29 2 50 3 86 165 4

Totals 8,158,817 31 540 12 342 66 3,655 4,537 6 *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.



5. Outpatient Behavioral Health Care Services The data presented here is by county of provider location. Individuals may access services in a county other than the county in which they reside.

Mental Health Outpatient and Clinic Programs

Adults Adult mental health outpatient programs include: assertive community treatment (ACT), clinic, continuing day treatment (CDT), intensive psychiatric rehabilitative treatment (IPRT), partial hospitalization (PH), and personalized recovery-oriented services (PROS). The NYC region’s capacity and service use in these programs are presented in Table 10.

Table 10. New York City Region: Adult Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, IPRT, CDT, PROS, ACT)

Clinics: Total Number of Adults

Locally Operated Clinics Recipients in

State-operated

Clinics4

Clinic Treatment per 100,000

Adults5Capacity1

(Slots)

Slots per 100,000

Adults5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Bronx 1,393 144 19,147 3,724 810 2,456 Kings 1,790 97 27,309 8,636 3,445 2,145 New York 1,807 138 26,526 13,060 1,813 3,162 Queens 1,479 87 16,549 10,680 1,742 1,700 Richmond 370 107 2,921 1,628 821 1,560

Totals 6,839 111 92,452 37,728 8,631 2,254 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of persons served annually. 1. Includes the total capacity for Partial Hospitalization (PH), Intensive Psychiatric Rehabilitative Treatment (IPRT), Continuing Day Treatment (CDT), Personalized Recovery-Oriented Services (PROS) and Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes adults and children enrolled in Medicaid and served annually in non-State clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of adults not receiving Medicaid and served in non-State clinics during the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes adults served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

In the region outpatient programs (other than clinic) are located in all counties. Outpatient program capacity is largest in New York County (n=1,807 slots) and smallest in Richmond County (n=370 slots). There are a total of 6,839 non-clinic outpatient program slots in the region or 111 slots per 100,000 adults.

Clinics may be locally- or state-operated. All counties in the NYC region have locally-operated clinics. These clinics served a total of 92,452 adult Medicaid recipients and 37,728 adult non-Medicaid recipients. The largest number of adult Medicaid recipients (n=27,309) was served in Kings County and the largest number of adult non-Medicaid recipients (n=13,060) was served in New York County. In comparison, the smallest numbers of adult Medicaid recipients (n=2,921) and adult non-Medicaid recipients (n=1,628) were served in Richmond County.



The NYC region has state-operated clinics in all counties which together served 8,631 adults.

In the region, 2,254 adults received clinic treatment per 100,000 adults. New York County’s rate of 3,162 adults per 100,000 adults is the highest in region. Richmond County’s service rate of 1,560 adults per 100,000 adults is the lowest.

Children Mental health outpatient programs that serve children include: assertive community treatment (ACT), clinic, day treatment (DT), and partial hospitalization (PH). The NYC region’s capacity and service use in these programs are presented in Table 11.

In the region, there are child outpatient programs (other than clinic) in all counties. Capacity is largest in Queens County (n=378 slots) and smallest in Richmond (n=186 slots). There are a total of 1,552 non-clinic outpatient program slots in the region or 78 slots per 100,000 children.

All counties in the NYC region have locally-operated clinics. These clinics served a total of 35,282 child Medicaid recipients and 11,652 child non-Medicaid recipients. The largest number of child Medicaid recipients (n=12,004) was served in Kings County and the smallest number (n=898) was served in Richmond. Similarly, the largest number of child non-Medicaid recipients (n=3,712) was served in Kings County and the smallest number (n=504) was served in Richmond.

Table 11. New York City Region: Child Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, DT, ACT)

Clinics: Total Number of Children

Locally Operated Clinics Recipients in

State-operated

Clinics4

Clinic Treatment per 100,000

Children5Capacity1

(Slots)

Slots per 100,000

Children5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Bronx 368 89 7,259 1,432 ─ 2,092 Kings 325 49 12,004 3,712 352 2,421 New York 295 106 8,218 2,924 58 4,040 Queens 378 73 6,903 3,080 108 1,951 Richmond 186 154 898 504 ─ 1,161

Totals 1,552 78 35,282 11,652 518 2,379 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of children served annually. 1. Includes the total capacity for Partial Hospitalizations (PH), Day Treatment (DT) and Children's Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes children enrolled in Medicaid and served annually in locally-operated (non-State) clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of children not receiving Medicaid and served in locally-operated (non-State) clinics during the week of the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes children served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.



The NYC region has state-operated clinics in Kings, New York, and Queens counties, which together served 518 children.

In the region, 2,379 children received clinic treatment per 100,000 children. New York County’s rate of 4,040 children per 100,000 children is the highest in the region, while Richmond County’s rate of 1,161 children per 100,000 children is the lowest.

Mental Health Emergency and Community Support Programs

Adults Table 12 describes the NYC region’s service use in adult mental health emergency and community support programs. A total of 1,807 adults were served in emergency programs located in all counties. New York County’s rate of 53 adults per 100,000 is the highest rate in any NYS county. In the region, 29 adults received emergency services per 100,000 adults, which is the second highest rate in any DSRIP region.

There are adult community support programs (e.g., vocational, self-help and care coordination) in each county in the NYC region which collectively served 10,094 adults. In the region, 164 adults per 100,000 adults received services from community support programs. In the counties service rates per 100,000 adults ranged from a low of 81 in Bronx County to a high of 349 in New York County.

Table 12. New York City Region: Adult Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs Community Support Programs

# Adults Served # Served per

100,000 Adults # Adults Served

# Served per 100,000 Adults

Bronx 363 34 862 81 Kings 366 18 1,823 91 New York 739 53 4,846 349 Queens 269 15 2,029 110 Richmond 70 19 534 145

Totals 1,807 29 10,094 164 Data Sources: Includes adults receiving emergency services and support services (e.g., vocational, self-help, care coordination) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Children The NYC region’s service use in child mental health emergency and community support programs is presented in Table 13. In the region, 356 children received emergency services and 18 children received emergency services per 100,000 children.



Table 13. New York City Region: Child Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs

Community Support Programs

# Children Served

# Served per 100,000 Children

# Children Served

# Served per 100,000 Children

Bronx 123 33 397 108 Kings 52 9 477 78 New York 91 37 507 204 Queens 63 13 374 79 Richmond 27 26 122 117

Totals 356 18 1,877 94 Data Sources: Includes children receiving emergency services and support services (e.g., vocational, home-based family treatment, residential treatment facility transition) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Community support programs for children (e.g., vocational, home-based family treatment, and residential treatment facility transition) are located in all counties in the NYC region and together served 1,877 children. These programs served 94 children per 100,000 children, which is the third lowest rate in any DSRIP region. In the counties, service rates per 100,000 children ranged from a low of 78 in Kings County to a high of 204 in New York County.

Behavioral Health Housing Programs

Adults In New York State, adult behavioral health housing services are provided in licensed beds in family care, congregate treatment and apartment treatment programs, and in unlicensed beds in housing support and supported housing programs. More information about these programs is available on the NYS Office of Mental Health web page at http://bi.omh.ny.gov/adult_housing/index.

These adult housing services in the NYC region are described in Table 14. In the region, licensed family care beds (n=520), congregate treatment beds (n=4,442) and apartment treatment beds (n=2,101) are located in all counties. Unlicensed housing support program beds (n=60) are located only in Kings County, and unlicensed supported housing beds (n=15,010) are available in all counties.

The housing capacity per 100,000 adults in the region is 359, which is the highest rate in any DSRIP region. In the counties housing capacity per 100,000 adults ranged from a low of 204 in Queens County to a high of 613 in Bronx County, which is the highest rate in any NYS county.


http://bi.omh.ny.gov/adult_housing/index


Table 14. New York City Region: Adult Behavioral Health Community-Based Housing Capacity by Provider County

County

Licensed Beds Unlicensed Beds Housing

Family Care

Congregate Treatment

Apartment Treatment

Housing Support

Programs

Supported Housing

Capacity per 100,000 Adults

Bronx 207 1,169 280 ─ 4,259 613 Kings 89 1,169 499 60 4,065 320 New York 1 1,180 675 ─ 3,996 447 Queens 183 725 574 ─ 2,000 204 Richmond 40 199 73 ─ 690 291

Totals 520 4,442 2,101 60 15,010 359 Data Sources: Licensed and unlicensed beds: New York State Office of Mental Health CONCERTS database; data as of 10/2015. US Census ACS 2010-2014 Est. Population.

Children In New York State, child behavioral health housing services are provided in licensed beds in teaching family homes and child and youth community residences, and in home and community-based services (HCBS). These child housing services in the NYC region are described in Table 15. The region has no teaching family home beds. Licensed child and youth community residence beds (n=120) are located in all counties, except for New York County. The region has a capacity of six child and youth community residence beds per 100,000 children, which is the third lowest rate in any DSRIP region.

Table 15. New York City Region: Child Behavioral Health Community-Based Housing Capacity and Home & Community-Based Services (HCBS) Slots by Provider County

County

Number of Licensed Housing Beds HCBS Slots

Teaching Family Home

Child & Youth Community Residence

Capacity per 100,000

Children

Number of Slots

Slots per 100,000 Children

Bronx ─ 24 6 156 38 Kings ─ 48 7 192 29 New York ─ ─ ─ 138 50 Queens ─ 40 8 120 23 Richmond ─ 8 7 36 30

Totals ─ 120 6 642 32 Data Sources: New York State Office of Mental Health databases. Licensed housing capacity: CONCERTS, 10/2015. Home & Community-based Services (HCBS): CAIRS, CY 2014. US Census ACS 2010-2014 Est. Population.



All NYC counties have HCBS slots (n=642), ranging from a high of 192 in Kings to a low of 36 in Richmond County. The region’s HCBS slots serve 32 children per 100,000 children, which is the second lowest rate in any DSRIP region. In the counties, HCBS slots per 100,000 children ranged from a low of 23 in Queens County to a high of 50 in New York County.

Substance Use Disorder Outpatient Programs New York State has a variety of substance use disorder (SUD) outpatient programs including clinic and rehabilitation. In the NYC region, all counties have SUD outpatient programs. The average daily enrollment (ADE) in these programs (n=16,909) is described in Table 16.

Table 16. New York City Region: Substance Use Disorders Outpatient Program Average Daily Enrollment

County US Census ACS

2010-2014 Est. Population

Outpatient Avg. Daily Enrollment

Total Per 10,000

Bronx 1,379,211 2,888 21 Kings 2,497,563 4,150 17 New York 1,592,291 5,959 37 Queens 2,223,182 2,828 13 Richmond 466,569 1,084 23

Totals 8,158,817 16,909 21 Notes and Data Sources: Outpatient programs (OP) include Medically Supervised Outpatient, Outpatient Rehabilitation, Specialized OP – Traumatic Brain Injury, Outpatient Chemical Dependency for Youth, Specialized OP – Mobile, and Specialized Services OP Rehabilitation. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

In the region, New York County has the highest ADE (n=5,959) and Richmond has the lowest (n=1,084). Region-wide these SUD programs have an ADE of 21 per 10,000, which is the lowest rate in any DSRIP region. In the counties, ADE per 10,000 range from a low of 13 in Queens County to a high of 37 in New York County.

New York State also has outpatient opioid treatment programs (Table 17). The NYC region has 70 opioid treatment programs that are located in all counties. These programs have a combined capacity of 31,716 and an ADE of 29,453. Region-wide the programs have a capacity of 39 per 10,000 and an ADE of 36 per 10,000, which are the highest rates in any DSRIP region. Among all NYS counties, New York County has the highest opioid treatment program capacity (79 per 10,000) and ADE (72 per 10,000).



Table 17. New York City Region: Substance Use Disorders Outpatient Opioid Treatment Program Capacity and Average Daily Enrollment

County US Census


Number of Programs

Opioid Treatment (Methadone) Capacity Avg. Daily Enrollment

Total Per 10,000 Total Per 10,000

Bronx 1,379,211 15 9,905 72 8,874 64 Kings 2,497,563 14 7,350 29 6,598 26 New York 1,592,291 34 12,579 79 11,473 72 Queens 2,223,182 4 1,112 5 1,789 8 Richmond 466,569 3 770 17 719 15

Totals 8,158,817 70 31,716 39 29,453 36 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

6. Care Coordination New York State’s Medicaid health home initiative is designed to expand and improve care management for beneficiaries with intensive, high-cost service needs. The health home model provides the basis for unified systems of care to coordinate and integrate physical and behavioral health care, and social services provided to health home members. In the NYC region, there are 12 Health Home providers (Table 18).

Table 18. New York City Region: Health Homes Serving Medicaid Enrollees by County

County Total # Health Homes

Serving Region # Health Homes Serving County

Bronx

12

5 Kings 4 New York 6 Queens 3 Richmond 1 Data is from the NYS Department of Health Designated Health Homes Web page. Retrieved May 4, 2016 from https://www.health.ny.gov/health_care/ medicaid/program/medicaid_health_homes/contact_information/list_by_county.htm #clinton

The number of providers serving each county varies from a high of six in New York County to a low of one provider serving Richmond County.

7. Behavioral Health Care Practitioners

Licensed Mental Health Professionals In New York State, the licensed mental health (MH) workforce includes psychiatrists, psychologists, clinical or master level social workers, nurse practitioners–psychiatry, marriage and family therapists, mental health counselors, psychoanalysts, and creative arts therapists.7 The number and distribution of these practitioners in the NYC region is presented in Table 19.



Table 19. New York City Region: Licensed Mental Health Professionals

County


Population

Psychiatrists Psychologists LCSWs LMSWs Mental Health

Counseling

Nurse Practitioner -

Psychiatry *Other Total Per 10,000

Bronx 1,379,211 200 205 810 1,417 130 30 44 2,836 21 Kings 2,497,563 398 872 2,396 3,404 442 73 367 7,952 32 New York 1,592,291 2,650 3,254 4,970 3,564 548 108 865 15,959 100 Queens 2,223,182 362 528 1,624 2,328 398 57 188 5,485 25 Richmond 466,569 81 120 469 467 90 20 19 1,266 27

Totals 8,158,817 3,691 4,979 10,269 11,180 1,608 288 1,483 33,498 41

Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. *Other category includes marriage and family therapists, psychoanalysts, and creative arts therapists.

The NYC region has a total of 33,498 licensed MH professionals or 41 per 10,000 population, which is the third highest rate in any DSRIP region. There are maldistributions of MH professionals across the region’s counties. Bronx County has the lowest county distribution of licensed MH professionals ─ 21 per 10,000 compared to New York County which has the highest ─ 100 per 10,000, which is the highest rate in any NYS county.

MH Professional Shortage Designations The maldistribution of licensed MH professionals in the NYC region is recognized by federally designated health professional shortage areas (HPSAs). HPSAs are designated on the county level by the federal Health Resources and Services Administration (HRSA). HPSAs are designated using several criteria, including population-to-clinician ratios. This ratio is usually 6,000 to 1 for mental health care.

In the NYC region (Table 19a) all counties have a census tract, population or facility designated as a MH Medically Underserved Area/Population (MUA/P). The Medicaid eligible populations in all counties, except Richmond, have been designated MH MUPs.

Table 19a. New York City Region: HRSA Federal Mental Health Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Bronx Yes Yes Kings Yes Yes New York Yes Yes Queens Yes Yes Richmond Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx



Certified and Credentialed Substance Use Disorder Professionals In New York State, the certified and credentialed substance use disorder (SUD) workforce includes physicians and counselors. The number and distribution of these practitioners in the NYC region is presented in Table 20. All counties in the region have SUD professionals.

Table 20. New York City Region: Certified and Credentialed Substance Use Disorder Professionals

County US Census


Physicians Counselors

Total Per 10,000 PopulationBoard Certified

Addiction Medicine

Authorized for Buprenorphine

Prescription

Credentialed Alcoholism and Substance Abuse

Certified Rehabilitation

Bronx 1,379,211 13 210 512 35 757 5 Kings 2,497,563 16 311 591 55 957 4 New York 1,592,291 76 853 459 56 1,368 9 Queens 2,223,182 17 247 506 93 846 4 Richmond 466,569 5 88 170 19 277 6

Totals 8,158,817 127 1,709 2,238 258 4,205 5 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Human Resources Office and is as of May 13, 2016.

SUD physicians include those board certified in addiction medicine and those authorized to prescribe buprenorphine to treat opioid addiction. In the NYC region there are 127 physicians certified in addiction medicine, but only five in Richmond County. All counties have physicians authorized to prescribe buprenorphine.

SUD counselors include those credentialed in alcoholism and substance abuse and those certified in rehabilitation. All counties in the region have both alcoholism and substance abuse counselors and rehabilitation counselors.

Overall, the NYC region has a total of 4,205 certified and credentialed SUD professionals or five per 10,000 population. Kings and Queens have the lowest county distributions of SUD professionals ─ four per 10,000 each, compared to the highest in New York County ─ nine per 10,000, which is the third highest rate in any NYS county.

While there are no HPSA shortage designations for SUD professionals, an area will be considered to have unusually high needs for mental health services if: 1) there is a high prevalence of alcoholism in the population, as indicated by prevalence data showing the area's alcoholism rates to be in the worst quartile of the nation, region, or State; or 2) there is a high degree of substance abuse in the area, as indicated by prevalence data showing the area's substance abuse to be in the worst quartile of the nation, region, or State.8



1 NYS Nursing Home Behavioral Intervention Services: This program must include a discrete unit with a planned combination of services with staffing, equipment and physical facilities designed to serve individuals whose severe behavior cannot be managed in a less restrictive setting. The program’s services are directed at attaining or maintaining the individual at the highest practicable level of physical, affective, behavioral and cognitive functioning. Retrieved April 21, 2016 from https://www.health.ny.gov/facilities/nursing/all_services.htm . 2 Diagnostic and Treatment Centers provide a comprehensive range of primary health care outpatient services to a population that includes uninsured individuals.3 Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, and provide comprehensive services. 4 A primary care HPSA is a collection of census tracts that has been designated as having a shortage of primary care health professionals. HRSA uses two methodologies to determine whether there are adequate health care resources for specific geographical areas. Aggregate ZIP codes or census tracts can be designated as a Medically Underserved Area/Population (MUA/P) based on an analysis of four criteria: the ratio of primary care medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over. A medically underserved population faces economic barriers (e.g. low-income or Medicaid-eligible populations), or cultural and/or linguistic access barriers to primary medical care services, and population specific information is assessed according to the above criteria to achieve MUP designation. 5 In this report adults are individuals aged 20 and older and children are individuals aged 19 and younger. 6 More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps /state/CD_descriptions.cfm 7 Licensed Mental Health Workforce Data Sources and Limitations: Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. Licensees must be registered in order to practice and use a professional title in NYS; being registered, however, does not necessarily mean the licensee is actively engaged in practice. In addition, NYS licensing data show only “nurse practitioners-psychiatry” as a BH-psychiatric nurse specialty. All other nursing specialties that contribute to the licensed BH workforce are combined in the general category of “nurse” in the NYS licensing data and are not counted in the licensed BH workforce described here. This limitation also extends to other data sources such as professional nursing organizations, which also combine a l l nursing specialties in a general category of “nurse” in their data collection processes.8 HRSA Guidelines for Mental Health HPSA Designation. Retrieved May 24, 2016 from http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html


http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html

https://application.abpn.com/verifycert/verifycert.asp

http://www.oasas.ny.gov/hps

https://www.health.ny.gov/facilities/nursing/all_services.htm


III. Health Status

This section describes the health status of individuals in the New York City DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

1. Disease Prevalence Chronic Health Conditions Compared to all other DSRIP regions, the New York City (NYC) region has the lowest average percentage of adults with asthma (6%) and the second lowest average percentage of adults that are overweight or obese (59%).

Table 1. New York City Region: Prevalence of Chronic Health Conditions Among Adults

County

Age-adjusted Percentage of Adults

With physician diagnosed diabetes

With physician diagnosed

angina, heart attack or stroke

Ever told they have high

blood pressure

Overweight or obese

(BMI 25 or higher)

With current asthma

Bronx 11 * 33 68 8 Kings 11 * 30 59 4 New York 6 * 24 49 6 Queens 11 * 30 56 5 Richmond 9 * 27 65 5 Region Average 9 * 29 59 6 *Suppressed due to small sample size. Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

In the region, Bronx County has the highest percentages of adults that have high blood pressure (33%), are overweight or obese (68%), and with asthma (8%) (Table 1). New York County has the lowest percentages of adults with diabetes (6%, the lowest percentage in any NYS county), high blood pressure (24%), and that are overweight or obese (49%, the lowest percentage in any NYS county). Kings County has the lowest percentage of adults with asthma (4%) in any NYS county.

HIV, AIDS and Cancer Among all DSRIP regions, the NYC region has the highest case rates per 100,000 of HIV (n=30) and AIDS (n=24). The case rate of HIV is highest in New York County (n=44, the highest of any NYS county) and lowest in Richmond (n=9) (Table 2). The AIDS case rate per 100,000 ranges from 9 in Richmond County to 41 in Bronx County, which is the highest rate among all NYS counties.



Table 2. New York City Region: Rates of HIV, AIDS, and Cancer

County

Age-adjusted case rate per 100,000

Age-adjusted all cancers incidence rate per

100,000 HIV AIDS

Bronx 42 41 464 Kings 32 26 460 New York 44 29 472 Queens 22 14 445 Richmond 9 9 522

Region Average 30 24 473 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

In contrast, the NYC region has the lowest cancer incidence rate per 100,000 (n=473) among all DSRIP regions. The cancer incidence rate is lowest in Queens County (n=445, the lowest rate in any NYS county) and highest in Richmond County (n=522).

2. Health Behaviors and Risk Factors For self-reported health behaviors and risk factors, data for the NYC region is available only at the region level (Table 3). Among all DSRIP regions, the NYC region has the highest percentage of adults that reported food insecurity (37%) and housing insecurity (52%) in the past 12 months, and that reported not receiving medical care because of cost (16%) in the past 12 months. The region has the lowest percentage of adults that reported smoking (13%) in all DSRIP regions.

Table 3. New York City Region: Adult Self-Reported Health Behaviors and Risk Factors

Region Survey

Sample Size

Percentage of Adults Who Self-Reported: Binge

drinking during past

month

Food insecurity in

past 12 months

Housing insecurity in

past 12 months

Poor health Current smoker

Did not receive medical care

because of cost in past 12 mos

Poor mental health for 14 or more days in last month

Cigarette smoking among those who report poor mental

health

NYC Totals* 6,369 18% 37% 52% 5% 13% 16% 11% 28% *Data is not available for NYC on the county/borough level. Data is from the CDC Expanded Behavioral Risk Factor Surveillance System (BRFSS) 2013-14 Survey. Retrieved April 27, 2016 from https://health.data.ny.gov/Health/Expanded-Behavioral-Risk-Factor-Surveillance-Surve/jsy7-eb4n?_sm_au_=iVVnMrPRnsfs8P5M



3. Hospitalization Rates by Disease or Cause Among all DSRIP regions, the NYC region has the highest hospitalization rates per 10,000 for cardiovascular disease (n=168), diabetes (n=25), asthma (n=30), and drug-related (n=36). The region has the lowest hospitalization rate for self-inflicted injury (n=4) among all regions.

Table 4. New York City Region: Hospitalization Rates by Disease or Cause

County

Age-adjusted hospitalization rate per 10,000 Newborn drug-related diagnosis rate per 10,000

newborn discharges

Total hospitalizations

Cardiovascular disease

Cerebrovascular disease (stroke)

Diabetes (primary

diagnosis) Asthma

Self-inflicted injury

Drug-related

Bronx 1,663 201 29 40 58 5 53 127 Kings 1,362 183 27 29 30 4 26 46 New York 1,168 133 20 18 24 4 40 60 Queens 1,178 153 23 19 18 3 12 50 Richmond 1,414 168 24 21 20 6 49 52 Region Average 1,357 168 24 25 30 4 36 67

Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

In the NYC region, Bronx County has the highest hospitalization rate for all listed conditions except self-inflicted injury, which is highest in Richmond County (n=6) (Table 4). In the Bronx, the hospitalization rates per 10,000 for cardiovascular disease (n=201), diabetes (n=40), asthma (n=58) and drug-related (n=53) are the highest in any NYS county.

In contrast, New York County has the lowest hospitalization rates in the region for cardiovascular disease (n=133), stroke (n=20) and diabetes (n=18). Queens County has the lowest hospitalization rates in the region for asthma (n=18), self-inflicted injury (n=3, the lowest in any NYS county) and drug-related (n=12). Kings County has the lowest rate in the region for newborn drug-related diagnosis (n=46).

4. Mortality Rates Premature Mortality Among all DSRIP regions, the NYC region has the highest average percentage of premature deaths (45%) and the lowest rate per 100,000 of alcohol related motor vehicle injuries and deaths (n=19).

In the region, the Bronx has the highest percentage of premature deaths (52%, the highest in any NYS county) and Queens County has the lowest percentage (40%) (Table 5). Bronx County also has the highest premature death rates for cardiovascular disease (n=135) and stroke (n=14) in the region. In comparison, New York County has the lowest premature death rate for cardiovascular disease (n=79) and Richmond County has the lowest rate for stroke (n=7).



Table 5. New York City Region: Percentage and Rates of Premature Death and Alcohol Related Motor Vehicle Injuries and Deaths

County

Percentage premature deaths (aged less than 75

years)

Rate per 100,000

Premature Death (aged 35-64 years) Alcohol related motor vehicle injuries and

deaths Cardiovascular

disease Cerebrovascular disease (stroke)

Bronx 52 135 14 17 Kings 46 119 13 18 New York 41 79 8 16 Queens 40 91 11 18 Richmond 45 102 7 25 Average % or Rate 45 105 10 19

Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

Alcohol related motor vehicle injuries and deaths rates per 100,000 vary from a low of 16 in New York County (the lowest in any NYS county) to a high of 25 in Richmond.

Top Ten Causes of Death Among all DSRIP regions, the NYC region has the highest average death rates per 100,000 for AIDS (n=6) and pneumonia (n=23), and the lowest average death rates for cerebrovascular disease (n=20), chronic lower respiratory disease (n=22) and accidents (n=21).

Table 6. New York City Region: 2014 Top Ten Causes of Death — Rates* per 100,000 Population by Resident County

County Heart Disease

Malignant Neoplasms

Cerebrovascular Disease (Stroke)

AIDS Pneumonia

Chronic Lower

Respiratory Disease

Accidents Diabetes Mellitus

Homicide or Legal

Intervention

Cirrhosis of Liver

Suicide

Bronx 203 156 23 11 27 24 20 23 8 9 5 Kings 183 141 20 6 26 18 20 25 5 5 5 New York 138 133 18 6 17 19 19 15 2 5 8 Queens 172 128 21 2 24 19 17 16 3 6 6 Richmond 235 150 16 3 22 28 29 18 4 6 6 Region Average 186 141 20 6 23 22 21 19 4 6 6 Data is from the NYS Department of Health. Retrieved April 26, 2016 from https://www.health.ny.gov/statistics/vital_statistics/2014/table40.htm *Age-Sex adjusted rates are directly standardized using the age-sex distribution for the United States 2000 Census.

Heart disease is the leading cause of death in all NYC counties (Table 6). Heart disease death rates per 100,000 varied from a low of 138 in New York County to a high of 235 in Richmond County. Richmond County also has the highest death rates in the region from chronic lower respiratory disease (n=28) and accidents (n=29). Kings County has the lowest death rate from chronic lower respiratory disease (n=18) in any NYS county.



New York County also has the lowest death rates in the region from cerebrovascular disease (n=18), pneumonia (n=17) and diabetes (n=15), but the highest death rate from suicide (n=8).

Bronx County has the highest death rates in the region from malignant neoplasms (n=156), cerebrovascular disease (n=23), AIDS (n=11), pneumonia (n=27), and cirrhosis of the liver (n=9). The Bronx County death rates from AIDS and pneumonia are the highest in any NYS county. Queens County has the lowest death rate in the region from malignant neoplasms (n=128).

5. Patients in the Public Mental Health System Every other year, the NYS Office of Mental Health (OMH) collects information about patients served over a one week period in NYSOMH funded or licensed outpatient and inpatient facilities. Tables 7 and 8 report the chronic health conditions and behavioral health diagnoses of those served in 2015.

Chronic Health Conditions Overall, smoking (25%) and high blood pressure (21%) are the leading chronic health conditions for the public mental health population in the NYC region (Table 7).

Table 7. New York City Region: Chronic Health Conditions Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served with Chronic Health Conditions

Current Smokers

Diabetes Obesity High Blood Pressure

Hyperlipidemia Had a Heart

Attack Had a Stroke

Under 21 3 1 6 1 1 0 0 21-64 33 14 15 23 14 1 1 65+ 18 24 11 48 28 3 3 Total Average 25 13 13 21 13 1 1 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the NYC region has the highest percentages of patients with diabetes (13%) and high blood pressure (21%), and the lowest percentages of patients that smoke (25%) and with obesity (13%).

Among patients under the age of 21, the region has the lowest percentage that are current smokers (3%) in all DSRIP regions.

Among patients ages 21-64, the region has the highest percentage with diabetes (14%) and the lowest percentages that are current smokers (33%) and with obesity (15%) in all DSRIP regions.



For patients ages 65 and older, the NYC region has the highest percentage with high blood pressure (48%) and the lowest percentage with obesity (11%) in all DSRIP regions.

Behavioral Health Diagnoses Overall, depressive disorders (29%), schizophrenia and other psychotic disorders (28%) and co-occurring disorder (18%) are the leading behavioral health diagnoses for the public mental health population in the region (Table 8).

Table 8. New York City Region: Behavioral Health Diagnoses Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served by Diagnostic Category

Anxiety Disorder

Bipolar and related Disorders

Depressive Disorders

Disruptive Impulse Conduct Disorder

Neurodevelop-mental

Disorders

Schizophrenia Spectrum & other

Psychotic Disorders

Trauma Stress or Adjustment

Not a Mental Illness

With a Co-Occuring Disorder

Under 21 11 7 18 10 30 3 15 2 3 21-64 8 16 30 0 1 35 6 3 23 65+ 9 10 41 0 0 29 4 4 12 Total Average 9 13 29 2 7 28 7 3 18 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the NYC region has the lowest percentage of patients served with bipolar and related disorders (13%) and the second highest percentages with depressive disorders (29%) and schizophrenia and other psychotic disorders (28%).

Among patients under the age of 21, the region has the highest percentage of those with a neurodevelopmental disorder (30%), the second highest percentage of those with disruptive impulse conduct disorder (10%), and the second lowest percentage of those with bipolar and related disorders (7%) in all DSRIP regions.

Among patients ages 21-64, the region has the second highest percentage of those with schizophrenia and other psychotic disorders (35%), and the lowest percentage of those with bipolar and related disorders (16%) in all DSRIP regions.

For patients ages 65 and older, the NYC region has the highest percentage of those with depressive disorder (41%), and the lowest percentage of those with bipolar and related disorders (10%) in all DSRIP regions.



IV. Behavioral Health Care Utilization

This section describes behavioral health care utilization in hospitals and emergency rooms by Medicaid beneficiaries in the New York City DSRIP region. Its findings should be considered with those in Sections V and VI of this report, which describe unmet service need by DSRIP region.

1. Medicaid Beneficiaries with Mental Health Diagnoses

Mental Health Diagnosis Inpatient Admissions Table 1 describes the number of Medicaid beneficiaries in the New York City region with inpatient hospital admissions (n=227,203) by mental health diagnosis. By county, admissions ranged from a high of 68,617 in Kings to a low of 10,640 in Richmond. Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (44%), followed by other mental health diagnoses (17%), schizophrenia (16%), bipolar disorder and chronic stress and anxiety diagnoses (10% each), and PTSD (2%).

Table 1. New York City Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Mental Health Diagnosis

County

Bi-Polar Disorder Depressive Disorders

Schizophrenia Chronic Stress and Anxiety Diagnoses

Post Traumatic Stress Disorder

Other Mental Health Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries MH Inpatient

N % N % N % N % N % N % Admission

Bronx 6,480 10% 28,208 45% 9,668 16% 6,117 10% 1,383 2% 10,250 17% 62,106 Kings 7,195 10% 29,710 43% 10,581 15% 7,285 11% 1,372 2% 12,474 18% 68,617 New York 5,000 11% 20,039 44% 7,305 16% 4,280 9% 1,050 2% 7,918 17% 45,592 Queens 3,891 10% 17,792 44% 6,806 17% 4,492 11% 536 1% 6,731 17% 40,248 Richmond 1,060 10% 4,786 45% 1,597 15% 1,513 14% 187 2% 1,497 14% 10,640

Totals 23,626 10% 100,535 44% 35,957 16% 23,687 10% 4,528 2% 38,870 17% 227,203 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

In the region, the percentages of Medicaid beneficiaries hospitalized for mental health diagnoses were highest by diagnosis in the following counties: depressive disorders in Bronx and Richmond counties (45% each), schizophrenia in Queens County (17%), chronic stress and anxiety diagnoses in Richmond County (14%), and other mental health diagnoses in Kings County (18%). Percentages of Medicaid beneficiaries hospitalized for bipolar disorder and PTSD were consistent across counties.

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries with hospital admissions for schizophrenia (16%).

Table 2 describes the number of Medicaid inpatient hospital admissions in the New York City region (n=553,159) by mental health diagnosis. By county, admissions ranged from a high of 162,865 in Queens County to a low of 24,656 in Richmond.



Table 2. New York City Region: Number of Medicaid Inpatient Hospital Admissions by Mental Health Diagnosis

County Bi-Polar Disorder


Schizophrenia Chronic Stress

and Anxiety Diagnoses


Other Mental Health

Diagnoses

Total Number of

MH

Number of Admissions Admissions

Bronx 18,073 66,035 23,285 13,698 3,755 26,379 151,225 Kings 20,052 66,848 25,231 15,117 3,743 31,874 162,865 New York 16,682 53,468 19,774 10,249 3,318 23,566 127,057 Queens 9,524 36,916 14,420 8,957 1,348 16,191 87,356 Richmond 2,747 10,818 3,408 3,257 535 3,891 24,656

Totals 67,078 234,085 86,118 51,278 12,699 101,901 553,159 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Depressive disorders accounted for the largest number of inpatient admissions in all counties and were highest in Kings (n=66,848). Across counties, admissions were highest in Kings County for all diagnoses, except PTSD, which were highest in the Bronx (n=3,755).

Mental Health Diagnosis Emergency Room Visits Table 3 describes the total number of Medicaid beneficiaries in the New York City region with emergency room visits (n=305,171) by mental health diagnosis. By county, ER visits ranged from a high of 89,653 in the Bronx to a low of 14,660 in Richmond.

Table 3. New York City Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Mental Health Diagnosis



Schizophrenia Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses Total Medicaid

Beneficiari Number/Percentage of Medicaid Beneficiaries

es with MH ER Visit

# % # % # % # % # % # % Bronx 8,276 9% 38,110 43% 13,898 16% 10,722 12% 2,410 3% 16,237 18% 89,653 Kings 7,878 9% 34,106 40% 13,085 15% 10,764 13% 2,533 3% 16,934 20% 85,300 New York 6,059 10% 26,049 41% 9,588 15% 7,527 12% 1,839 3% 11,824 19% 62,886 Queens 4,710 9% 21,094 40% 8,180 16% 7,068 13% 1,133 2% 10,487 20% 52,672 Richmond 1,284 9% 5,758 39% 2,249 15% 2,437 17% 310 2% 2,622 18% 14,660

Totals 28,207 9% 125,117 41% 47,000 15% 38,518 13% 8,225 3% 58,104 19% 305,171 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (41%), followed by other mental health diagnoses (19%), schizophrenia (15%), chronic stress and anxiety diagnoses (13%), bi-polar disorder (9%), and PTSD (3%).



In the region, the percentages of Medicaid beneficiaries with ER visits were highest by diagnosis in the following counties: depressive disorders in Bronx County (43%), chronic stress and anxiety diagnoses in Richmond County (17%), and other mental health diagnoses in Kings and Queens counties (20% each). The percentages of Medicaid beneficiaries with ER visits for bipolar disorder, schizophrenia and PTSD were consistent across counties.

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries with ER visits for schizophrenia (15%).

Table 4 describes the total number of Medicaid ER visits in the New York City region (n=912,586) by mental health diagnosis. By county, ER visits ranged from a high of 256,135 in Bronx County to a low of 43,662 in Richmond.

Table 4. New York City Region: Number of Medicaid Emergency Room Visits by Mental Health Diagnosis


Depressive Disorders Schizophrenia

Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses

Total Number of ER Visits

Number of ER Visits

Bronx 27,967 105,438 40,624 28,120 7,507 46,478 256,134 Kings 28,930 98,992 40,675 28,191 7,682 50,657 255,127 New York 24,412 84,585 33,512 22,010 6,095 41,125 211,739 Queens 15,914 54,899 23,872 18,109 3,260 29,870 145,924 Richmond 4,560 16,908 6,520 6,788 964 7,922 43,662

Totals 101,783 360,822 145,203 103,218 25,508 176,052 912,586Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Depressive disorders accounted for the largest number of ER visits in all counties and were highest in the Bronx (n=105,438). Across counties, ER visits were highest in Kings County for all diagnoses, except depression.

Medicaid Mental Health Beneficiaries Compared to All Medicaid Beneficiaries Table 5 describes Medicaid mental health beneficiaries compared to all Medicaid beneficiaries in the New York City region. In the region, 6% of all Medicaid beneficiaries had a mental health inpatient hospital admission and 9% had a mental health ER visit. By county, New York had the highest percentage of Medicaid beneficiaries with a mental health inpatient admission (9%), while Queens had the lowest (4%). Similarly, New York County had the highest percentage of Medicaid beneficiaries with a mental health ER visit (13%) and Queens had the lowest (6%).



Table 5. New York City Region: Percentage of Medicaid Population with Mental Health Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with MH Inpatient Admission

Medicaid Beneficiaries with MH ER Visit

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Bronx 821,339 62,106 8% 89,653 11% Kings 1,237,587 68,617 6% 85,300 7% New York 485,833 45,592 9% 62,886 13% Queens 915,815 40,248 4% 52,672 6% Richmond 127,533 10,640 8% 14,660 11%

Totals 3,588,107 227,203 6% 305,171 9% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

2. Medicaid Beneficiaries with Substance Use Disorders

Substance Use Disorder Inpatient Admissions Table 6 describes the total number of Medicaid beneficiaries in the New York City region with inpatient hospital admissions (n=144,503) by substance use disorder (SUD). By county, admissions ranged from a high of 44,191 in the Bronx to a low of 6,826 in Richmond. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (29%), followed by opioid use disorder (21%), cocaine use disorder (19%), and drug abuse: cannabis/NOS/NEC and other SUD diagnoses (16% each).

Table 6. New York City Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder

Drug Abuse: Cannabis/ NOS/NEC

Other SUD Diagnoses

Total Medicaid Beneficiaries with

SUD Inpatient Number/Percentage of Medicaid Beneficiaries Admission

# % # % # % # % # %

Bronx 9,093 21% 11,807 27% 9,825 22% 7,319 17% 6,147 14% 44,191 Kings 7,206 18% 12,161 30% 8,057 20% 6,560 16% 6,720 17% 40,704 New York 7,717 21% 10,549 29% 7,488 20% 5,214 14% 5,996 16% 36,964 Queens 2,274 14% 5,864 37% 3,063 19% 2,385 15% 2,232 14% 15,818 Richmond 820 12% 1,760 26% 1,916 28% 1,020 15% 1,310 19% 6,826

Totals 27,110 19% 42,141 29% 30,349 21% 22,498 16% 22,405 16% 144,503 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

In the region, the percentages of Medicaid beneficiaries hospitalized for SUDs were highest by disorder in the following counties: alcohol use disorder in Queens (37%), opioid use disorder (28%) and other SUD diagnoses (19%) in Richmond County, cocaine use disorder in Bronx and New York counties (21% each, the highest in any



NYS county), and drug abuse: cannabis/ NOS/NEC in Bronx County (17%). Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries hospitalized with cocaine use disorder (19%).

Table 7 describes the number of Medicaid inpatient hospital admissions in the New York City region (n=516,891) by substance use disorder. By county, admissions ranged from a high of 154,459 in Bronx County to a low of 20,811 in Richmond.

Table 7. New York City Region: Number of Medicaid Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of SUD

Admissions Number of Admissions

Bronx 9,093 11,807 9,825 7,319 6,147 154,459 Kings 7,206 12,161 8,057 6,560 6,720 140,976 New York 7,717 10,549 7,488 5,214 5,996 149,452 Queens 2,274 5,864 3,063 2,385 2,232 51,193 Richmond 820 1,760 1,916 1,020 1,310 20,811

Totals 27,110 42,141 30,349 22,498 22,405 516,891 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Alcohol use disorder accounted for the largest number of inpatient admissions in all counties except Richmond, and were highest in the Kings County (n=12,161). Across counties, admissions for cocaine use disorder, opioid use disorder and drug abuse: cannabis/ NOS/NEC were highest in the Bronx. Admissions for other SUD diagnoses were also highest in Kings County.

Substance Use Disorder Emergency Room Visits Table 8 describes the total number of Medicaid beneficiaries in the New York City region with emergency room (ER) visits (n=137,107) by substance use disorder. By county, ER visits ranged from a high of 40,278 in the Bronx to a low of 6,670 in Richmond. Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (26%), followed by drug abuse: cannabis/ NOS/NEC (22%), opioid use disorder (18%), and alcohol use disorder and other SUD diagnoses (17% each).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by disorder in the following counties: cocaine use disorder in Queens County (30%), alcohol use disorder in New York County (19%, the highest in any NYS county), opioid use disorder in the Bronx (19%), drug abuse: cannabis/NOS/NEC (27%) and other SUD diagnoses (22%) in Richmond County.

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries with ER visits for alcohol use disorder (17%).



Table 8. New York City Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder


Other SUD Diagnoses

Total Medicaid

Beneficiaries with SUD ER

Visit

Number/Percentage of Medicaid Beneficiaries

# % # % # % # % # %

Bronx 9,766 24% 7,356 18% 7,708 19% 9,393 23% 6,055 15% 40,278 Kings 10,002 26% 6,338 17% 7,012 18% 8,128 21% 6,833 18% 38,313 New York 9,021 26% 6,725 19% 5,739 16% 7,217 21% 6,355 18% 35,057 Queens 5,114 30% 2,512 15% 2,885 17% 3,417 20% 2,861 17% 16,789 Richmond 1,524 23% 749 11% 1,133 17% 1,804 27% 1,460 22% 6,670

Totals 35,427 26% 23,680 17% 24,477 18% 29,959 22% 23,564 17% 137,107

Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Table 9 describes the number of Medicaid ER visits in the New York City region (n=595,318) by substance use disorder. By county, ER visits ranged from a high of 173,256 in New York County to a low of 25,886 in Richmond. Cocaine use disorder accounted for the largest number of ER visits in all counties, and were highest in New York County (n=49,116). Across counties, ER visits for cocaine use disorder, alcohol use disorder, and other SUD diagnoses were highest in New York County. ER visits for opioid use disorder and drug abuse: cannabis/NOS/NEC were highest in Kings County.

Table 9. New York City Region: Number of Medicaid Emergency Room Visits by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of ER Visits

Number of ER Visits

Bronx 40,559 29,034 28,220 32,881 27,306 158,000 Kings 47,046 29,606 28,986 33,504 32,494 171,636 New York 49,116 32,266 26,363 31,086 34,425 173,256 Queens 21,047 10,100 10,919 12,378 12,096 66,540 Richmond 6,711 3,252 4,462 6,027 5,434 25,886

Totals 164,479 104,258 98,950 115,876 111,755 595,318 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Medicaid Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Table 10 describes Medicaid SUD beneficiaries compared to all Medicaid beneficiaries in the New York City region. In the region, 4% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 4% had a SUD ER visit. By county, New York County had the highest percentage of Medicaid beneficiaries with a SUD inpatient admission



(8%, the highest in any NYS county), while Queens had the lowest (2%). Similarly, New York County had the highest percentage of Medicaid beneficiaries with a SUD ER visit (7%) and Queens had the lowest (2%).

Table 10. New York City Region: Percentage of Medicaid Population with Substance Use Disorder Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with SUD Inpatient Admission

Medicaid Beneficiaries with SUD ER Visit

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Bronx 821,339 44,191 5% 40,278 5% Kings 1,237,587 40,704 3% 38,313 3% New York 485,833 36,964 8% 35,057 7% Queens 915,815 15,818 2% 16,789 2% Richmond 127,533 6,826 5% 6,670 5%

Totals 3,588,107 144,503 4% 137,107 4% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

3. Medicaid Beneficiary Hospital Inpatient Admissions and Emergency Room Visits

Medicaid Beneficiaries by Eligibility Type In the New York City region 44% of the estimated population are Medicaid beneficiaries (Table 11). By county, Medicaid beneficiaries range from a high of 60% of the estimated population in the Bronx (the highest percentage in any NYS county) to a low of 27% of the estimated population in Richmond.

Table 11. New York City Region: Medicaid Beneficiaries by Eligibility Type

County


Population

Total Medicaid Beneficiaries

Medicaid Only Dual Medicaid and Medicare

# %

Total Pop # % Total Medicaid

Bene. #

% Total Medicaid

Bene.

Bronx 1,379,211 821,339 60% 728,015 89% 93,324 11% Kings 2,497,563 1,237,587 50% 1,083,392 88% 154,195 12% New York 1,592,291 485,833 31% 392,578 81% 93,255 19% Queens 2,223,182 915,815 41% 806,730 88% 109,085 12% Richmond 466,569 127,533 27% 109,643 86% 17,890 14%

Totals 8,158,817 3,588,107 44% 3,120,358 87% 467,749 13%

Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid beneficiaries include individuals that receive only Medicaid and individuals that are dually-eligible for Medicare and Medicaid benefits because of their age or disability



and low incomes.1 In the New York City region, 87% of Medicaid beneficiaries receive Medicaid only and 13% are dual-eligible. Medicaid only beneficiaries range from a low of 81% in New York County to a high of 89% in the Bronx.

Compared to all other DSRIP regions, the New York City region had the largest percentage of its population that are Medicaid beneficiaries (44%), and the largest percentage of those beneficiaries that are Medicaid only (87%).

Medicaid Beneficiary Hospital Inpatient Admissions Medicaid beneficiary hospital inpatient admissions in the New York City region are described in Table 12.2 In the region, 10% of Medicaid only beneficiaries and 19% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Table 12. New York City Region: Total Medicaid Inpatient Hospital Admissions by Type of Beneficiary

County

Number of BeneficiariesNumber of Beneficiaries

with Inpatient Admissions Total Inpatient

Hospital Admissions

Medicaid Only

Dual Medicaid and Medicare


Medicaid Only


# # # % # % # #

Bronx 728,015 93,324 81,065 11% 19,664 21% 123,162 28,491 Kings 1,083,392 154,195 107,766 10% 29,889 19% 153,965 41,764 New York 392,578 93,255 41,628 11% 16,860 18% 72,647 23,565 Queens 806,730 109,085 73,179 9% 19,326 18% 100,780 26,832 Richmond 109,643 17,890 11,494 10% 3,354 19% 17,451 4,706

Totals 3,120,358 467,749 315,132 10% 89,093 19% 468,005 125,358 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Percentages of Medicaid only beneficiaries with hospital inpatient admissions ranged from a low of 9% in Queens County to a high of 11% each Bronx and New York counties. In comparison, hospital inpatient admissions in the dual-eligible Medicaid/Medicare population ranged from a low of 18% each in New York and Queens counties to a high of 21% (the highest in any NYS county) in the Bronx.

Compared to all other DSRIP regions, the New York City region had the largest percentage of dual-eligible Medicaid/Medicare beneficiaries with inpatient admissions (19%).

Medicaid Beneficiary Emergency Room Visits Emergency room (ER) visits among Medicaid beneficiaries in the New York City region are described in Table 13.3 In the region, 25% of Medicaid only beneficiaries and 14% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

Percentages of Medicaid only beneficiaries with ER visits ranged from a low of 22% each in Kings and Queens counties to a high of 31% in the Bronx. In comparison, ER



visits for the Medicaid/Medicare dual-eligible population ranged from a low of 12% in Queens County to a high of 17% each in Bronx and New York counties.

Table 13. New York City Region: Medicaid Emergency Room Visits by Beneficiary Type

County

Number of Beneficiaries Number of Beneficiaries

with ER Visits Total ER Visits



Medicaid Only


# # # % # % # #

Bronx 728,015 93,324 222,950 31% 15,860 17% 429,368 27,029 Kings 1,083,392 154,195 233,134 22% 19,999 13% 432,836 33,722 New York 392,578 93,255 110,705 28% 15,527 17% 236,845 29,320 Queens 806,730 109,085 177,128 22% 13,274 12% 314,951 22,075 Richmond 109,643 17,890 29,562 27% 2,839 16% 56,587 5,494

Totals 3,120,358 467,749 773,479 25% 67,499 14% 1,470,587 117,640 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

In conclusion, in the New York City region the Medicaid only population had a higher percentage of ER visits than the Medicaid/Medicare dual-eligible population, while the Medicaid/Medicare dual-eligible population had a higher percentage of hospital inpatient admissions than the Medicaid only population.

1 In this analysis, dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf 2 In this analysis, inpatient utilization was based on all Medicaid inpatient admissions. To avoid duplication, admissions are counted per Medicaid beneficiary, per hospital, per admission. 3 Emergency room utilization was based on all Medicaid fee-for-service and managed care emergency room visits. To avoid duplication with multiple provider claims on a single ER visit for a Medicaid beneficiary, visits were counted per unique recipient per day.


http://www.medpac.gov/documents/data-book/january


V. Unmet Service Needs

Access to an adequate amount of outpatient care and community resources can reduce hospitalizations and emergency room (ER) visits for both behavioral and physical health problems. For example, high rates of potentially avoidable ER visits and hospital admissions suggest a need for further outpatient resources in the community. This section describes the unmet service needs of individuals in the New York City DSRIP region.

Quality indicators are one of several ways to measure the unmet needs of a community. Unmet service need is reported here using measures of initiation and engagement in behavioral health treatment and measures of potentially avoidable hospitalizations and ER visits. Further information about these measures is included below. Additional information about unmet need in the New York City (NYC) DSRIP region from needs assessments of local issues conducted by counties in the region is also included.

1. Behavioral Health Treatment Mental Health Medication Adherence and Management Adherence to Antipsychotic Medications for Individuals with Schizophrenia, and Antidepressant Medication Management are two Healthcare Effectiveness Data and Information Set (HEDIS)/New York State Quality Assurance Reporting Requirement (QARR) measures collected by Performing Provider Systems in the DSRIP program.

Adherence to Antipsychotic Medications for Individuals with Schizophrenia refers to the percentage of members, ages 19 to 64 years, with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.

Antidepressant Medication Management Effective Acute Phase Treatment refers to the percentage of members who remained on antidepressant medication during the entire 12-week acute treatment phase.

Antidepressant Medication Management Effective Continuation Phase Treatment refers to the percentage of members who remained on antidepressant medication for at least six months.

For adults with schizophrenia in the NYC region, 61% adhere to antipsychotic medications (39% do not). In the region, the percentage with adherence to antipsychotic medications ranges from a low of 58% in Kings County to a high of 69% in Richmond (Table 1).

In the region, 51% of individuals remain on antidepressant medication during the acute phase and 37% remain on antidepressant medication during the continuation phase (63% do not). Among all DSRIP regions, the NYC region has the second lowest adherence to antidepressants for the acute phase. Adherence to antidepressants is lowest in Queens County for both the acute (49%) and the continuation (35%) phases. In comparison, the highest rates of adherence are found in Bronx County (52%, acute phase) and New York County (38%, continuation phase).



Table 1. New York City Region: Mental Health Medication Adherence and Management

County Adherence to Antipsychotic

Medications for Individuals with Schizophrenia

Antidepressant Medication Management

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

Bronx 59% 52% 37% Kings 58% 51% 37% New York 60% 51% 38% Queens 67% 49% 35% Richmond 69% 49% 37%

Region Avg. % 61% 51% 37% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

Mental Health Follow-up Care This section presents HEDIS/QARR measures related to mental health follow-up care.

Follow-up after Hospitalization for Mental Illness within 7 Days refers to the percentage of members who were seen on an ambulatory basis or who were in intermediate treatment with a mental health provider within 7 days of hospital discharge.

Follow-up after Hospitalization for Mental Illness within 30 Days refers to the percentage of members who were seen within 30 days of hospital discharge.

Follow-Up Care for Children Prescribed ADHD Medication Initiation Phase refers to the percentage of children with a new prescription for ADHD medication who had one follow-up visit with a practitioner within the 30 days after starting the medication.

Follow-Up Care for Children Prescribed ADHD Medication Continuation & Maintenance Phase refers to the percentage of children with a new prescription for ADHD medication who remained on the medication for 7 months and who, in addition to the visit in the Initiation Phase, had at least 2 follow-up visits in the 9-month period after the initiation phase ended.

In the NYC region, 40% of individuals follow-up after hospitalization for mental illness within seven days (60% do not) and 54% follow-up within 30 days (Table 2). In the region, New York County has both the lowest seven day follow-up percentage after hospitalization for mental illness (36%) and 30 day follow-up percentage (50%). Richmond County has both the highest seven day follow-up (53%) and 30 day follow-up (63%) percentages.



Table 2. New York City Region: Mental Health Follow-Up Care

County

Follow-up After Hospitalization for Mental Illness

Follow-Up Care for Children Prescribed ADHD Medication

Within 7 Days Within 30 Days Initiation Phase Continuation Phase

Bronx 41% 57% 67% 73% Kings 40% 54% 64% 72% New York 36% 50% 67% 73% Queens 42% 55% 60% 72% Richmond 53% 63% 59% 67%

Region Avg. % 40% 54% 64% 72% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

In the NYC region, 64% of children prescribed ADHD medication have follow-up care during the initiation phase and 72% have follow-up care during the continuation phase. Among all DSRIP regions, NYC has the highest percentages of follow-up care for children prescribed ADHD medication for both the initiation and continuation phases.

The percentage of children prescribed ADHD medication with follow-up care is lowest in Richmond County for both the initiation (59%) and continuation (67%) phases. It is highest in Bronx and New York counties for both the initiation (67% each) and continuation (73% each) phases.

Alcohol and Other Drug Dependence Initiation and Engagement in Treatment Performing Provider Systems in the DSRIP program also collect two Alcohol and Other Drug (AOD) Dependence Treatment HEDIS/QARR measures: Initiation and Engagement in treatment.

The Initiation measure is the percentage of members who initiate treatment within 14 days of the diagnosis of AOD dependence. The Engagement measure is the percentage of members who engage in

treatment within 30 days after initiation.

In the NYC region, 49% of individuals initiate AOD treatment within 14 days of diagnosis and 19% of individuals engage in AOD treatment within 30 days after initiation (81% do not) (Table 3). Among all DSRIP regions, NYC has the second lowest percentage for AOD engagement.

In the region, Queens County has the lowest percentage for both AOD initiation (46%) and engagement (17%) in treatment. In contrast, Bronx and Richmond counties have the highest percentage for AOD initiation (51% each), and Richmond has the highest percentage for AOD engagement (24%).



Table 3. New York City Region: Alcohol and Other Drug Dependence Treatment

County Alcohol and Other Drug Dependence Treatment

Initiation Engagement

Bronx 51% 18% Kings 49% 19% New York 49% 20% Queens 46% 17% Richmond 51% 24%

Region Avg. % 49% 19% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2013 data.

2. Potentially Avoidable Hospitalizations The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population-based measures that can be used with hospital inpatient discharge data to identify conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications. PQIs provide a good starting point for assessing quality of health services in the community.

All PQIs apply only to adult populations (individuals over the age of 18 years). The Observed Rate (per 100,000 people) is the number of PQI discharges

divided by the population, multiplied by 100,000. The Expected Rate (per 100,000 people) is the number of PQI discharges

adjusted by age group, gender and race/ethnicity divided by the population, multiplied by 100,000. Lower ratios of observed to expected rates represent better results.

Diabetes Chronic Conditions In the NYC region’s Medicaid only population, Bronx County has the highest observed to expected ratios for both diabetes short-term complications (160/130) and long-term complications (241/170) (Table 4a). Queens County has the lowest observed to expected ratios for both diabetes short-term complications (71/100) and long-term complications (106/133).



Table 4a. New York City Region: Diabetes Short and Long-Term Complications Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Diabetes Short-term Complications Diabetes Long-term Complications



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected

Bronx 160 130 179 130 241 170 708 498 Kings 114 124 86 104 151 146 488 405 New York 138 127 97 107 183 178 434 443 Queens 71 100 83 91 106 133 362 377 Richmond 90 119 93 105 195 138 335 334

Totals 115 120 108 107 175 153 465 411 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual population, Bronx County also has the highest observed to expected ratios for both diabetes short-term complications (179/130) and long-term complications (708/498). Kings County has the lowest observed to expected ratios for diabetes short-term complications (86/104) and Queens County has the lowest ratio for long-term complications (362/377).

Among all DSRIP regions, the NYC region has the highest observed to expected ratios for diabetes long-term complications in the Medicaid only (175/153) and dual (465/411) populations.

Table 4b describes uncontrolled diabetes and lower-extremity amputation rates among patients with diabetes. In the Medicaid only population, Richmond County has the highest observed to expected ratio for uncontrolled diabetes (35/25) and Queens County has the lowest (20/26). For lower-extremity amputations in this population, Bronx County has the highest observed to expected ratio (26/16) and Queens County has the lowest (8/13).



Table 4b. New York City Region: Diabetes Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Uncontrolled Diabetes Lower-Extremity Amputation

among Patients with Diabetes



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected

Bronx 43 32 98 72 26 16 105 62 Kings 30 29 77 57 14 15 61 54 New York 32 33 51 63 18 18 49 55 Queens 20 26 39 52 8 13 32 47 Richmond 35 25 41 47 10 15 15 45

Totals 32 29 61 58 15 15 52 53 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual population, Bronx County has the highest observed to expected ratio for uncontrolled diabetes (98/72) and Queens County has the lowest (39/52). Bronx County also has the highest ratio for lower-extremity amputation among patients with diabetes (105/62) and Richmond County has the lowest (15/45).

Cardiac Chronic Conditions In the Medicaid only population in the NYC region (Table 5a), Richmond County has the highest observed to expected ratios for hypertension (99/67) and Bronx County has the highest ratios for both heart failure (243/207) and angina without procedure (31/21). In this population, Queens County has the lowest observed to expected ratios for both hypertension (56/74) and heart failure (149/179), and Richmond County has the lowest ratio for angina without procedure (15/18).

In the dual Medicaid and Medicare population, Bronx County has the highest observed to expected ratio for hypertension (306/215) and Richmond County has the lowest ratio (98/129). In this population, Kings County has the highest ratios for both heart failure (1,222/952) and angina without procedure (44/34), and Richmond County has the lowest ratios for both conditions (571/764 and 10/29 respectively).

Among all DSRIP regions, the NYC region has the highest observed to expected ratio for hypertension in dual Medicaid and Medicare population (191/177).



Table 5a. New York City Region: Cardiac Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Hypertension Heart Failure Angina Without Procedure




Rate per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected Observed Expected Observed Expected

Bronx 122 84 306 215 243 207 1,225 980 31 21 43 39 Kings 73 77 213 177 214 196 1,222 952 19 19 44 34 New York 80 87 193 198 228 229 804 948 27 24 41 36 Queens 56 74 147 166 149 179 801 863 19 20 36 32 Richmond 99 67 98 129 160 173 571 764 15 18 10 29

Total 86 78 191 177 199 197 925 901 22 20 35 34 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

Asthma Chronic Conditions Asthma chronic conditions are described in Table 5b. Bronx County has the highest observed to expected ratios for asthma in younger adults in both the Medicaid only population (304/145) and dual population (808/419). Queens County has the lowest ratios for both populations (64/113 and 208/317 respectively).

Table 5b. New York City Region: Asthma Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Asthma in Younger Adults


Rate per 100,000

Observed Expected Observed Expected

Bronx 304 145 808 419 Kings 101 118 476 347 New York 150 132 371 361 Queens 64 113 208 317 Richmond 160 112 356 264

Total 156 124 444 342 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



Composite PQIs Tables 6 and 7 report observed and expected composite PQIs by county in the NYC region.

The Chronic Composite PQI includes: Diabetes Short-Term and Long-Term Complications Admission Rates, the Asthma in Younger and Older Adults Admission Rates, the Hypertension Admission Rate, the Congestive Heart Failure (CHF) Admission Rate, the Angina without Procedure Admission Rate, the Uncontrolled Diabetes Admission Rate, and the Rate of Lower-Extremity Amputation among Patients with Diabetes.

The Acute Composite includes: the Dehydration Admission Rate, the Bacterial Pneumonia Admission Rate, and the Urinary Tract Infection Admission Rate.

The Overall Composite PQI refers to all PQI measures within the Chronic and Acute Composites.

In the NYC region’s Medicaid only population, Bronx County has the highest observed to expected ratios for the overall composite (1,984/1,436, the highest ratio in any NYS county), acute composite (456/336) and chronic composite (1,527/1,100, the highest ratio in any NYS county) indicators. The lowest ratios for these indicators are in Queens County (overall composite, 871/1,171, acute composite, 236/296 and chronic composite, 635/875).

Table 6. New York City Region: Prevention Quality Overall, Acute, and Chronic Composite Indicators by Medicaid Eligibility

County

Overall Composite Acute Composite Chronic Composite




Rate per 100,000


Bronx 1,984 1,436 5,840 4,438 456 336 1,605 1,330 1,527 1,100 4,237 3,108 Kings 1,219 1,273 4,573 4,099 254 301 1,416 1,333 965 972 3,157 2,766 New York 1,547 1,487 4,138 4,248 354 344 1,471 1,364 1,193 1,143 2,668 2,884 Queens 871 1,171 3,420 3,811 236 296 1,187 1,277 635 875 2,232 2,535 Richmond 1,344 1,228 2,821 3,562 256 313 932 1,235 1,088 915 1,889 2,327

Totals 1,393 1,319 4,158 4,032 312 318 1,322 1,308 1,082 1,001 2,837 2,724Notes and Data Source: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the NYC region’s dual population, Bronx County has the highest observed to expected ratios for all of these indicators: overall composite (5,840/4,438), acute composite (1,605/1,330) and chronic composite (4,237/3,108, the highest ratio in any NYS county). In the dual population, the lowest ratios for these indicators are in Richmond County (overall composite, 2,821/3,562, acute composite, 932/1,235 and chronic composite, 1,889/2,327).



Table 7 describes the all diabetes, circulatory and respiratory composite indicators. In the NYC region’s Medicaid only population, Bronx County has the highest observed to expected ratios for the all diabetes composite (470/348), all circulatory composite (395/312) and all respiratory composite (674/448, the highest ratio in any NYS county) indicators. The lowest ratios for these indicators are in Queens County (all diabetes composite, 205/273, all circulatory composite, 223/272 and all respiratory composite, 211/336).

Table 7. New York City Region: Prevention Quality All Diabetes, Circulatory, and Respiratory Composite Indicators by Medicaid Eligibility

County

All Diabetes Composite All Circulatory Composite All Respiratory Composite




Rate per 100,000


Bronx 470 348 1,090 761 395 312 1,574 1,234 674 448 1,618 1,137 Kings 308 313 712 621 306 292 1,479 1,162 358 374 989 1,004 New York 371 356 632 667 335 340 1,038 1,182 496 456 1,018 1,057 Queens 205 273 516 566 223 272 985 1,061 211 336 746 926 Richmond 330 297 484 531 275 258 679 922 486 367 731 892

Total 337 317 687 629 307 295 1,151 1,112 445 396 1,020 1,003 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the NYC region’s dual population, Bronx County also has the highest observed to expected ratios for the all diabetes composite (1,090/761, the highest ratio in any NYS county), all circulatory composite (1,574/1,234, the highest ratio in any NYS county) and all respiratory composite (1,618/1,137) indicators. Queens County has the lowest ratios for the all diabetes (516/566) and all respiratory composites (746/926), while Richmond County has the lowest ratio for the all circulatory composite (679/922). Among all DSRIP regions, the NYC region has the highest all diabetes composite observed to expected ratio (687/629) in the dual population.

3. Potentially Avoidable Emergency Room Visits In the NYC region, Bronx County has the highest observed to expected ratio (41/32) of potentially preventable ER visits (Table 8). Kings (24/27) and Queens (23/26) counties have the lowest ratios.



Table 8. New York City Region: All Payers Potentially Preventable Emergency Room Visits

County ER Discharges 2013: Rate per 100,000

Observed Expected

Bronx 41 32 Kings 24 27 New York 25 24 Queens 23 26 Richmond 23 21

Total 27 26 Notes and Data Sources: Data is from the NYS Department of Health All Payer Potentially Preventable Emergency Visit (PPV) database. Rates by patient county, SPARCS data 2013. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/All-Payer-Potentially-Preventable-Emergency-Visit-/f8ue-xzy3#About

4. Local Assessment of Need by New York City Region Counties New York State Mental Hygiene Law requires the Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) to guide and facilitate the process of local planning. As part of the planning process, New York State counties and New York City (local governmental units [LGUs]) conduct a needs assessment of local issues impacting populations with mental illness and chemical dependency. These issues include prevention, treatment, and recovery support service needs, including other individualized person-centered supports and services. The issues of workforce retention and recruitment and coordination/integration with other systems are also included.

Table 9 summarizes the results of the LGUs’ needs assessments for the New York City (NYC) region. The data were collected from LGUs from March 1, 2015 through June 1, 2015. For each need issue listed, the LGUs indicated the extent to which it is an area of need at the local level for each population by identifying high, moderate or low need.

Mental Illness Population High Needs In the NYC region mental illness population, for adults (21+) the area of highest need is access to prevention and crisis services and to supported housing.

Chemical Dependency Population High Needs In the NYC region chemical dependency population, the largest rates of high need vary by age group. For all age groups the area of highest need is access to prevention services. For adults (21+) the areas of highest need also include access to treatment services.



Table 9. New York City Region: Assessment of Needs by Population and Issue Assessment of Local Need

Youth (<21) Adults (21+) High Need

Moderate Need

Low Need

Missing High Need

Moderate Need

Low Need

Missing

Selected Issues Mental Illness Population Access to Prevention Services 0% 0% 0% 100% 100% 0% 0% 0% Access to Crisis Services 0% 0% 0% 100% 100% 0% 0% 0% Access to Treatment Services 0% 0% 0% 100% 0% 100% 0% 0% Access to Supported Housing 0% 0% 0% 100% 100% 0% 0% 0% Access to Transportation 0% 0% 0% 100% 0% 0% 100% 0% Access to Home/Community-based Services 0% 0% 0% 100% 0% 100% 0% 0% Access to Other Support Services 0% 0% 0% 100% 0% 100% 0% 0% Workforce Recruitment and Retention 0% 0% 0% 100% 0% 100% 0% 0% Coordination/Integration with Other Systems 0% 0% 0% 100% 0% 0% 100% 0% Selected Issues Chemical Dependency Population Access to Prevention Services 100% 0% 0% 0% 100% 0% 0% 0% Access to Crisis Services 0% 100% 0% 0% 0% 100% 0% 0% Access to Treatment Services 0% 100% 0% 0% 100% 0% 0% 0% Access to Supported Housing 0% 0% 0% 100% 0% 0% 100% 0% Access to Transportation 0% 0% 0% 100% 0% 0% 100% 0% Access to Home/Community-based Services 0% 100% 0% 0% 0% 0% 100% 0% Access to Other Support Services 0% 0% 0% 100% 0% 0% 100% 0% Workforce Recruitment and Retention 0% 0% 0% 100% 0% 0% 100% 0% Coordination/Integration with Other Systems 0% 0% 0% 100% 0% 0% 100% 0%



VI. Consumer and Provider Input

This section summarizes the NYC region consumer and provider input regarding community behavioral health needs. Input for this region was collected by five clinics. The clinics and counties they serve are listed in Table 1.

Table 1. New York City Region: Clinics that Submitted Consumer and Provider Input

Clinic Counties Served in Region New Horizon Counseling Center (NHCC) Queens The Puerto Rican Organization to Motivate, Enlighten, and Serve Addicts, Inc. (Promesa) All NYC counties Richmond University Medical Center (RUMC) Richmond Samaritan Daytop Village (SDV) South Bronx

Services for the UnderServed, Inc. (SUS)

Morrisania (Bronx County), Kings County, and East

Harlem (New York County)

Methods To collect data, clinics used focus group templates and/or anonymous surveys created by NYSOMH. These instruments are included in Appendix IV. Collectively, these data collection instruments focus on behavioral health concerns, available programming and services, potential disparities in service access and use, evidence-based practices, trauma-informed services, and recommendations regarding strategies to promote improved community health.

Participating clinics utilized the instruments to collect consumer, family, caregiver and provider input. Once collected, the clinics aggregated and submitted the consumer and provider input to NYSOMH. The consumer survey was made available in English and Spanish.

Participating clinics were asked to gather input from consumers and providers in and outside of the clinic, including:

Clinic consumers ages 15 and older; parents or guardians of consumers younger than 15; and family members or caregivers of consumers. Consumer information was also collected from Veterans and individuals in foster care or homeless shelters who receive services from secondary related agencies that make referrals to behavioral health services.

Provider surveys were administered to and focus groups were conducted with both participating clinics and secondary related agency providers.



When reporting survey multiple choice item results to NYSOMH, participating clinics recorded the frequency for each response option. The percentages reported in the tables below are based on those numbers as indicated. For open-ended questions, the clinics recorded the most frequently occurring responses or “themes”. All responses to open-ended survey questions are stated as they were submitted to NYSOMH by the clinics, and include response frequencies. A complete list of open-ended responses is included in Appendix B.

Participant Descriptions and Demographics Three clinics used only surveys for consumer and provider data collection, one used only focus groups, and the fifth used both methods. Demographics and information about participating consumers and providers are described in Tables 2a and 2b respectively.

Table 2a. New York City Region: Consumer Input – Consumer Demographics

Category NHCC (n=39)

Promesa (n=172)

RUMC (n=113)

SDV (n=103)

SUS (n=16)

Participant Information % Survey Participants 100% 100% 85% 100% 0% Focus Group Participants 0% 0% 15% 0% 100% Not patients at the Clinic 5% 0% 0% 0% 0% Live in the Clinic county 100% 92% 100% 77% 88% Age n=76 Under 18 5% 0% 3% 0% 0% 18-64 77% 94% 95% 95% 100% 65 or older 18% 6% 3% 5% 0% Gender n=165 n=98 Male 41% 55% 36% 62% 94% Female 59% 45% 64% 38% 6% Race/Ethnicity* n=96 n=98 White 26% 8% 38% 13% * Black/African-American 46% 34% 16% 35% * Asian 0% 0% 1% 1% * Native-American 0% 0% 0% 0% * Other Race 0% 0% 6% 0% * Hispanic/Latino Ethnicity 26% 56% 40% 57% * *The race/ethnicity question was asked only in the survey, not in the focus groups. Participants were instructed to select all that apply. Percentage is the number within each group divided by the number who responded to the question.

Three of the five clinics surveyed over 100 consumer participants for a total of 443 consumer participants in the NYC region. Consumer participants were patients at four of the five clinics. At all clinics, the majority of consumer respondents were 18-64 years of



age. Two sites included youth and four sites included elderly participants in their consumer sample. At three of the clinics, the largest percentages of consumer respondents are Black/African American.

Only one clinic surveyed more than 20 providers and a total 85 provider participants provided input at the clinics (Table 2b). Three of the five sites included several providers that do not practice at the clinic.

Table 2b. New York City Region: Provider Input

Provider Information NHCC (n=18)

Promesa (n=32)

RUMC (n=12)

SDV (n=13)

SUS (n=10)

% Questionnaire Participants 100% 100% 100% 100% 0% Focus Group Participants 0% 0% 0% 0% 100% Do not practice at the Clinic 0% 0% 83% 100% 30% Practice within the Clinic county 100% 100% 100% 92% 100% Have a Master’s degree or higher 78% 71% 83% 62% 100%

Findings The consumer and provider input is organized into five domains:

1. Service Utilization, Perceived Service Needs, Barriers to Access, and Disparities in Access

2. Scope of Services in Treatment 3. Provider Training Needs 4. Participants Feel Welcome where they Receive Services 5. General Suggestions for Improvement

1. Service Utilization, Perceived Service Needs, Barriers to Access, and Disparities in Access

A. Service Utilization Table 3 shows the distribution of behavioral health services that consumers reported using (question 6, consumer survey). Across the four clinics, the most frequently reported services received are outpatient mental health services (range from 55% to 95%) and medication for mental health problems (range from 28% to 70%). At three of the four clinics, the services case managers who meet outside of the agency and education about mental health and substance use issues were also frequently reported.

Across the four clinics, the percentage of consumers who received outpatient SUD services ranged from five percent to 45%. The least frequently reported services received are: SUD residential treatment (range from zero to 22%); and SUD inpatient rehabilitation and SUD detoxification (range from three percent to 20% each).



Table 3. New York City Region: Consumer Survey Input – Behavioral Health Services Used

Service Category NHCC (n=39)

Promesa (n=172)

RUMC (n=96)

SDV (n=103)

Mental Health Services % a. Outpatient mental health services - (e.g., outpatient clinic) 95% 67% 55% 65% b. Inpatient treatment 10% 32% 14% 31% c. Medication for mental health problems 67% 70% 28% 55% d. Residential treatment 10% 30% 6% 22% Substance Use Disorder Services e. Outpatient substance use disorder services (e.g., outpatient clinic) 5% 29% 9% 45% f. Inpatient rehabilitation 3% 16% 5% 20% g. Detoxification 3% 17% 5% 20% h. Residential treatment 0% 22% 4% 20% i. Medication for substance use problems (e.g., methadone or buprenorphine to treat opioid addiction) 5% 22% 4% 34% Other Services j. Case managers or providers who will meet individuals outside of an agency setting (e.g., in the home, church, school, homeless shelter, foster care setting, ER, recreational facility, jail) if necessary 41% 43% 8% 33% k. Providers who will meet with patients via phone or webcam 5% 26% 3% 19% l. Help with finding or maintaining employment 15% 24% 13% 17% m. Help with advancing education or seeking job training 8% 27% 3% 20% n. Help with finding, maintaining, or improving housing 8% 30% 2% 28% o. Education about mental health and substance use issues 44% 40% 6% 33% p. 24-hour crisis phone line 3% 30% 2% 29% q. 24-hour mobile crisis teams 0% 27% 3% 29% r. Peer delivered services (services provided by people who have experienced behavioral health problems and who work to help others with behavioral health problems; e.g., self-help groups, warmlines, and peer specialist services) 5% 37% 1% 25% s. Education and supports (e.g., support groups) for families of individuals in behavioral health treatment 10% 34% 10% 18%

B. Perceived Service Needs Across all clinics, the majority of consumer respondents reported that they have access to behavioral health services (consumer survey, question 9; focus group, question 1). Unmet service needs that consumers reported include the following:

Services are more than a one hour drive away (n=6 at RUMC ODT and MICA) Very difficult to receive services unless a child has Medicaid. Many hospitals/

programs/doctors do not accept private insurance (n=1) Wanted but unable to access “help with job and housing” (n=1) Many SUS outpatient SUD consumers reported they want mental health services

available to them alongside their substance use treatment since accessing psychiatric services in the community is difficult. A strong consistent request was assistance in transitioning to the community once they complete treatment. This includes finding



housing, support groups and employment. Participants discussed the fears of returning to the community without support and would like to have a case manager to assist them.

Providers identified service needs that include the following (provider survey, question 7; focus group, question 1):

Co-occurring mental health and substance use services Child and adolescent mental health services and substance abuse detox/rehab services Peer support services Access to all services for undocumented individuals, and homeless individuals with SMI,

e.g., provide BH services at the shelter

C. Barriers to Access Table 4a presents the percentages of consumers and providers surveyed that reported barriers to accessing behavioral health treatment (consumer survey, question 7; provider survey, question 4).

Table 4a. New York City Region: Consumer and Provider Survey Input -- Barriers to Behavioral Health Treatment

Perceived Barrier

NHCC Promesa RUMC SDV Consumers

(n=39) Providers

(n=18) Consumers

(n=172) Providers

(n=32) Consumers

(n=96) Providers

(n=12) Consumers

(n=103) Providers

(n=13)

Percentage that selected barrier

Problems with transportation 10% 6% 24% 94% 2% 58% 12% 54% Took too long to get an appointment 5% 6% 22% 88% 7% 75% 16% 77% Problems paying for services 5% 6% 11% 31% 1% 75% 10% 46% Provider hours are not convenient 3% 0% 8% 9% 2% 25% 12% 54% Service providers don’t speak my (or the patient’s) preferred language 3% 6% 6% 16% 3% 42% 6% 23% Nearest service provider is too far away 3% 0% 9% 19% 1% 25% 8% 38% Services were not accessible to people with disabilities 0% 0% 7% 22% 1% 25% 11% 23% Service providers are not sensitive to other cultures 0% 0% 8% 3% 0% 8% 9% 23% No service provider in the area 0% 0% 11% 0% 2% 8% 9% 15% Local provider does not serve individuals with these particular problems 0% * 5% * 2% * 11% * Services were not available to children or the elderly 0% * 7% * 0% * 10% * Services were not available to Veterans or members of the armed forces 0% * 4% * 0% * 9% * Other 0% 0% 6% 0% 3% 25% 6% 15% *Provider responses to questions about access for particular demographic groups are reported in Table 4b

Across the four clinics, the most frequently reported barriers by both providers and consumers are: problems with transportation, having to wait too long to get an appointment, problems paying for services, and inconvenient provider hours. Providers also reported service providers not speaking patient’s preferred language as a barrier. Responses to open-ended questions were consistent with survey findings. In addition to the barriers listed above, consumers and providers noted the following barriers



(consumer survey, question 7m; provider survey question 5j; consumer and provider focus groups, question 2):

Wait time for a psychiatrist is too long No evening hours Lack of transportation Shortage of affordable housing, and the regulations guiding eligibility and the

documentation required, present serious barriers. The definition of chronic homelessness, a key factor in eligibility, was cited as a major barrier to treatment. Many individuals will desperately try to stay out of the shelters by couch surfing, sleeping outside etc. By doing this, they do not meet the criteria for chronic homelessness and do not qualify for affordable housing.

D. Disparities in Access Table 4b describes disparities in access to behavioral health services reported by providers (provider survey, question 5).

Table 4b. New York City Region: Provider Input -- Access to Behavioral Health Services by Special Populations

Special Population

NHCC Promesa RUMC SDV

Total # Respondents

% Answered

"No"* Total #

Respondents

% Answered

"No"* Total #

Respondents

% Answered

"No"* Total #

Respondents

% Answered

"No"*

Veterans or members of the armed forces 18 0% 32 0% 2 0% 12 17% Children 18 0% 32 13% 6 17% 12 8% Children in foster care 18 0% 31 13% 6 17% 12 17% Elderly 18 0% 32 3% 3 0% 12 8% Homeless 18 0% 32 6% 4 25% 13 23% Incarcerated 18 89% 32 100% 4 50% 11 36% *Percentage is the number who responded "No" divided by the number of respondents.

The most frequently reported groups for whom services are not available are incarcerated individuals (range from 36% to 100%) and homeless individuals (range from zero percent to 25%). Responses to the open-ended questions on access disparities (consumer focus group, question 5; provider focus group, question 4) include:

“Recovery is unlikely if you’re homeless” There are limited behavioral healthcare services in the community due to a shortage of

psychiatrists and psychiatric nurse practitioners. Positions can sometimes go unfilled for more than a year. The group strongly felt that there needs to be incentive programs developed for doctors so that they will be willing to work with not for profit organizations.

2. Scope of Services in Treatment Consumer Survey Responses Table 5 describes consumers’ experiences with evidence-based services, care coordination, and integrated care while receiving care from behavioral or physical health providers (consumer survey, question 8).



Table 5. New York City Region: Consumer Survey Input -- Scope of Services in Treatment

Provider Service

NHCC Promesa RUMC SDV

Total # Respondents

% Answered

"Yes"* Total #

Respondents

% Answered

"Yes"* Total #

Respondents

% Answered

"Yes"* Total #

Respondents

% Answered

"Yes"*

a. Screen for history of traumatic life events or abuse? 33 94% 143 69% 48 35% 82 66% b. Screen for depression, anxiety, substance abuse, or another behavioral health problem? 8 38% 134 85% 60 63% 88 82% c. Screen for physical health problems? 34 91% 151 83% 56 55% 86 78% d. Assess your strengths, abilities, preferences, and goals? 37 92% 145 83% 51 49% 84 69% e. Talk with other providers about your care? 33 67% 122 75% 57 51% 85 76% f. Talk to you about the relationship between thoughts, behaviors, and feelings? 35 100% 150 87% 56 64% 86 77% g. Provide clear information about:

i. How to get treatment for mental health and substance use issues? 36 100% 146 90% 53 60% 88 78%

ii. How to cope with mental health and substance use issues? 35 94% 144 96% 50 54% 87 77% iii. Crisis management? 36 92% 134 78% 49 49% 85 69%

h. Met all of your health care needs? 30 77% 150 84% 53 66% 86 78% *Percentage is the number who responded "Yes" divided by the total number of respondents.

Across the four clinics, consumers reported the most frequently provided services are talking about the relationship between thoughts, behaviors, and feelings (range from 64% to 100%) and how to get treatment for mental health and substance use issues (range from 60% to 100%).

Consumers reported the least frequently provided services are screening for history of traumatic life events or abuse (range from 35% to 94%), screening for depression, anxiety, substance abuse or another behavioral health problem (range from 38% to 85%), and talking with providers about your care (range from 51% to 76%).

Focus Group Responses In their open-ended responses pertaining to scope of services (consumer focus group, question 3), the majority of consumers responded that providers do talk with them about feelings, moods, history of trauma, strengths and goals. However, some consumers at SUS also reported:

Staff turnover, vacant positions, and limited individual time are a concern. The majority of the group agreed that housing was the most important and urgent need

for them. They wanted to get information about housing in a timely manner and to feel that they can compete with the vast numbers who apply.

With regard to use of EBPs and trauma-informed services (provider focus group, question 3), SUS providers responded:



Criminal Justice requires one of three EBPs: Thinking for Change; Ready, Set, Work; and Journaling for Change. Some programs use Wellness Self-Management and Seeking Safety, though these require extensive training and supervision to maintain fidelity. Motivational Interviewing is also used at many sites. The consensus of the group was that evidenced based practice is often just a buzz word, not an actuality.

One member suggested following up on the Assessment and Referral Team (ART), an EBP that is used by HRA-HRSA.

There was general agreement that we need to incorporate trauma informed care throughout our services. SUS has completed participation in a yearlong Trauma Informed Learning Collaborative and is about to roll out a data driven initiative for the whole organization.

Participants were united in their belief that training staff in EBP's needs to begin in professional schools. Some social work schools include Motivational Interviewing in the curriculum, so new workers coming into the field are familiar with the model.

3. Provider Training Needs Regarding provider reported training needs (provider survey, question 7), providers reported the need for training in both EBPs and trauma-informed care, as well as treating co-occurring mental health and substance use, and working with Veterans and adolescents. Providers at RUMC reported that additional training in both evidence-based and trauma-informed practices are needed to address drug use and drug overdoses in Richmond County.

4. Participants Feel Welcome where they Receive Services The percentage of consumers who reported not feeling welcome in the places where they receive behavioral health services (consumer survey, question 10) is low across all programs (Table 6).

Table 6. New York City Region: Consumer Input --Feeling Welcome where you Receive Behavioral Health Services

Clinic Total #

Respondents % Answered

"No"*

NHCC 36 3% Promesa 152 4% RUMC 82 0% SDV 81 5% *Percentage is the number who responded "No" divided by the number of respondents.

With regard to things that make consumers feel welcome (consumer survey question 11; consumer focus group, question 4), several consumers reported that they feel welcome when: clinicians and the staff who first greet them are friendly/smiling; counselors are professional, kind, respectful, supportive, caring, and helpful; the doctor knows and takes time with the patient; the environment is pleasing, hospitable, and



safe; there are group meetings, peer support is available, and there is camaraderie with peers; and food or tea is available.

5. General Suggestions for Improvement With regard to suggestions for improving behavioral health treatment in the community (consumer and provider focus group questions 6 and 5 respectively), SUS consumers and providers suggested the need for:

Housing More medical and clinical providers, and self-help groups. Vocational assistance to both MH and SUD patients. SUS providers noted that

individuals with substance use disorders have more pressure on them to get a job. Yet, once on the job, they do not have access to case management and supportive services that would help them to remain on the job.

Additionally, expanding transitional and supportive employment to help individuals with substance use disorders transition from jail, or shelters will help motivation to remain out of those facilities.

Communication among providers. The general opinion among SUS providers was that organizations are spending a lot of money on EHR's that are not able to talk with each other. Health Homes that were developed to help providers share information and build a continuity of care apparently are not working well. Individuals receiving services do not understand what being in a Health Home means, and case managers do not seem to know their role in the model. The recommendation was to educate consumer and provider, particularly in regards to the value of collaboration, then establish paths for communication.

Summary The five clinics in the New York City region collected input from 443 consumers and 85 providers. Only one of the sites obtained feedback from consumers outside of the clinic, but nearly one third of the participating providers practice outside of the clinics. Across these consumer and provider groups, the most frequently reported needs included:

Affordable housing Services provided at a homeless shelter Assistance with finding and maintaining employment, for both MH and SUD

patients Treatment for co-occurring disorders Child and adolescent mental health and substance abuse detox/rehab services Peer support services Reduced wait time, especially for providers who are able to prescribe medication Transportation Assistance with paying for services Evening and weekend hours Communication among providers



Appendix A. Highlights of New York City Region Needs Assessment Findings

Appendix A summarizes needs assessment findings that may impact providers meeting the health care service needs of the target consumer population in the New York City region.

I. Population Characteristics Summary Highlights

New York City Region: Population Characteristics Characteristic Region Region/County Comparison Median household $55,476 The New York City region’s median household income income is below the state median of $58,687.

Bronx County has the lowest median household income ($34,396) of any NYS county.

Education 21% of adults in region are without a high school diploma and 33% have a bachelor’s degree or higher.

Compared to other DSRIP regions, the NYC region has the largest percentage of adults without a high school diploma.

Bronx County has the highest percentage (30%) of adults without a high school diploma of all NYS counties.

New York County has the highest percentage (58%) of adults with a bachelor’s degree or more of any NYS county.

Poverty 21% of region’s population live below poverty level

NYC has the highest percentage living below the poverty level of any DSRIP region.

4% of the region’s population are on cash public assistance and 18% receive food stamps/SNAP benefits (the highest percentage in any DSRIP region).

Bronx County has the highest percentages of individuals on cash public assistance (8%) and that receive food stamps/SNAP benefits (33%) of any NYS county.

Public Health Insurance/ 39% of region’s population The NYC population percentages on some type of Medicaid/ Beneficiaries/ are on public health public health insurance and with no health insurance No Health Insurance insurance, 42% are Medicaid

beneficiaries and 12% have no health insurance.

coverage are the highest across DSRIP regions. Bronx County has the highest percentage of

individuals on public health insurance of any NYS county.

Of all DSRIP regions, New York City has the highest percentage of the estimated population that are Medicaid beneficiaries.

Bronx County has the highest percentage of Medicaid beneficiaries of any NYS county.

Special Populations 10% of the region’s population are disabled and 3% are Veterans.

The NYC region has the lowest percentage of Veterans in any DSRIP region.

Foreign Born 37% of the population are foreign born.

The NYC percentage of foreign born is the largest in any DSRIP region.

Primary Language other 49% of the region’s The NYC percentage of those with a primary language than English population speak a primary

language other than English. other than English is the largest in any DSRIP region.

In NYC 23% speak English less than “very well” (the highest percentage in any DSRIP region).




II. Health Care Resources Summary Highlights A. New York City Region: Health Care Professional Supply and Shortages Domain Region/County Region/County Comparison Supply of Primary Health Care Providers

1. The region has 29,317 primary care providers or 35 per 10,000 population.

1. Highest rate in any NYS DSRIP region. However, there is a mal-distribution of these providers (see HPSAs below)

Supply of Physical Health Care Specialists

1. The region has 15,128 physical medical health specialists or 18 providers per 10,000 population.

1. The highest concentration of any DSRIP region.

Supply of Licensed Mental Health (MH) Professionals

1. The region has 33,498 licensed MH professionals or 39 per 10,000 population.

1. This is the 3rd highest rate in any DSRIP region. There is a mal-distribution of these providers (see HPSAs below).

Substance Use Disorder (SUD) Professionals

1. The region has a total of 4,205 cert i f ied and credentialed SUD professionals or five per 10,000 population.

1. NY County has the 3rd highest rate of SUD professionals of all NYS counties.

Region’s HPSA County Designations Federal Health Primary Health Care: Professional Shortage All counties in the region have primary care Medically Underserved Area/Populations Areas (HPSAs) (MUA/Ps). In addition, all the counties’ Medicaid eligible populations have been designated

primary care MUPs. Mental Health Professionals: In the region, all counties have MH Medically Underserved Areas/Populations (MUAs/P). In addition, the Medicaid eligible populations in all counties except Richmond have been designated MH MUPs.

B. New York City Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region/County Comparison Physical Health Acute Care Hospitals

1. The region’s nursing homes have 72 behavioral health intervention beds located in Richmond County.

2. Queens County acute care hospitals have no chemical dependence rehab beds.

Mental Health Inpatient Facilities

1. Total psychiatric bed capacity in the region is 65 per 100,000 adults and 25 per 100,000 children.

1. Psychiatric bed capacity for adults is highest among all DSRIP regions.

2. In the region, the total psychiatric inpatient ADC per 100,000 adults is 62, which is the highest rate in any NYS DSRIP region. The total ADC per 100,000 children is 30.

3. Richmond County’s psychiatric inpatient ADC per 100,000 adults is highest of any NYS county (n=85).

Substance Use Disorder (SUD) Inpatient Programs

1. In the New York City region, there are SUD inpatient crisis programs (n=31), rehabilitation programs (n=12), and residential programs (n=66) located in all the region’s counties.

1. The total capacity per 10,000 for all SUD inpatient programs is 7, the 3rd

highest rate in NYS DSRIP regions. 2. The total ADE per 10,000 for these

programs is six, the 3rd highest rate in NYS DSRIP regions.

Mental Health Outpatient and Clinic Programs

1. Adult outpatient programs (other than clinic) are in all counties. There is a total of 6,839 non-clinic outpatient



Appendix A. Highlights of New York City Region Needs Assessment Findings B. New York City Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region/County Comparison

program slots in the region or 111 slots per 100,000 adults.

2. In addition to locally-operated clinics in all counties, the region has state-operated clinics in all counties serving adults and state-operated clinics in Kings, New York and Queens counties serving children.

3. In the region, only all counties have child outpatient programs other than clinic. These programs have a capacity of 1,552 slots or 78 slots per 100,000 children region wide.

MH Emergency and Community Support Programs

1. In the region emergency programs are in all counties. In the region, 29 adults received emergency services per 100,000 adults.

2. In addition, 18 children received emergency services per 100,000 children.

3. In the region, 164 adults per 100,000 received services from community support programs.

4. Community support programs in the region served 94 children per 100,000.

1. The adult emergency services rate is the 2nd highest in any DSRIP region.

4. The child community support program service rate is the 3rd lowest in any DSRIP region.

SUD Outpatient Programs

1. In the region, all counties have SUD outpatient programs. The average daily enrollment (ADE) is 21 per 10,000.

2. The region has 70 opioid treatment programs located in all counties.

1. The region’s SUD ADE rate is the lowest in any NYS DSRIP region.

2. Region-wide the opioid programs have a capacity of 39 per 10,000 and an ADE of 36 per 10,000, which are the highest rates in any DSRIP region.

III. Health Status New York City Region: Health Status Challenges/Strengths Domain Region/County Comparison Disease Prevalence Among all DSRIP regions, the region has the highest case rates of HIV and AIDS. Chronic Health The case rate of HIV in New York County is the highest of any NYS county.Conditions Bronx County has the highest AIDS case rate among all NYS counties.

The region has the lowest cancer incidence rate per all DSRIP regions. The cancer incidence rate in Queens County is the lowest rate in any NYS county.

Health Behaviors and Among all DSRIP regions, the region has the highest percentage of adults that reported Risk Factors food insecurity and housing insecurity and that reported not receiving medical care

because of cost. The region has the lowest percentage of adults that reported smoking compared to all

other DSRIP regions. Hospitalization Rates by Among all DSRIP regions, the region has the highest hospitalization rates per 10,000 Disease or Cause for cardiovascular disease, diabetes, asthma, and drug-related.

The region has the lowest hospitalization rate for self-inflicted injury among all DSRIP regions.

Bronx County’s hospitalization rates per 10,000 for cardiovascular disease, diabetes, asthma and drug-related are the highest rates in any NYS county.

Premature Among all NYS DSRIP regions the region has the highest average percentage of



Appendix A. Highlights of New York City Region Needs Assessment Findings New York City Region: Health Status Challenges/Strengths Domain Region/County Comparison Deaths/Mortality premature deaths and the lowest rate per 100,000 of alcohol related motor vehicle

injuries and deaths. Bronx has the highest percentage of premature deaths of all NYS counties. Among all NYS DSRIP regions, the region has the highest average death rates per

100,000 for AIDS and pneumonia and the lowest average death rates for cerebrovascular disease, chronic lower respiratory disease and accidents.

Bronx County death rates from AIDS and pneumonia are the highest in any NYS county.

Patients in the Public Chronic Health Conditions: Among all NYS DSRIP regions, the region has the highest Mental Health System percentages of patients with diabetes and high blood pressure, and the lowest percentages

of patients that smoke and with obesity. Behavioral Health Diagnoses: Among all NYS DSRIP regions, the region has the lowest percentage of patients served with bipolar and related disorders and the 2nd highest percentages with depressive disorders and schizophrenia and other psychotic disorders.

IV. Behavioral Health Care Utilization A. New York City Region: Medicaid Beneficiary Health Care Utilization by Behavioral Health Diagnosis Domain Utilization by Diagnosis Region

Medicaid Inpatient Admissions

Mental Health Diagnosis Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (44%), followed by other mental health diagnoses (17%), schizophrenia (16%), bipolar disorder and chronic stress and anxiety diagnoses (10% each), and PTSD (2%).

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries with hospital admissions for schizophrenia (16%).

Substance Use Disorder Region-wide, the largest percentages of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (29%), followed by opioid use disorder (21%), cocaine use disorder (19%), and drug abuse: cannabis/NOS /NEC and other SUD diagnoses (16% each).

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries hospitalized with cocaine use disorder (19%).

Medicaid Emergency Room Visits

Mental Health Diagnosis Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (41%), followed by other mental health diagnoses (19%), schizophrenia (15%), chronic stress and anxiety diagnoses (13%), bi-polar disorder (9%), and PTSD (3%).

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries with ER visits for schizophrenia (15%).

Substance Use Disorder Region-wide, the largest percentages of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (26%), followed by drug abuse: cannabis/ NOS/NEC (22%), opioid use disorder (18%), and alcohol use disorder and other SUD diagnoses (17% each).

Compared to all other DSRIP regions, the New York City region had the largest percentage of Medicaid beneficiaries with ER visits for alcohol use disorder (17%).




B. New York City Region: Medicaid Mental Health and Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Domain Utilization MH Medicaid In the region, 6% of all Medicaid

beneficiaries had a mental health inpatient hospital admission and 9% had a mental health ER visit.

SUD Medicaid In the region, 4% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 4% had a SUD ER visit.

C. New York City Region: Medicaid Beneficiary Health Care Utilization by Eligibility Type Domain Utilization by Eligibility Medicaid Inpatient Admissions

In the region 10% of Medicaid only beneficiaries and 19% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Medicaid Emergency Room Visits

In the region 25% of Medicaid only beneficiaries and 14% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

V. Unmet Service Needs New York City Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

Mental Health Medication Adherence and Management

1. Adherence to antipsychotic medications for individuals with schizophrenia for at least 80% of their treatment period.

1. Region-wide, 61% of individuals with schizophrenia adhere to antipsychotic medications (39% do not).

2. Antidepressant medication management effective acute phase treatment.

2. Region-wide 51% of individuals remain on their medication during the entire acute treatment phase.

Among all DSRIP regions, the NYC region has the 2nd lowest adherence to antidepressants for the acute phase.

3. Antidepressant medication management effective continuation phase treatment.

3. Region-wide 37% of individuals remain on their medication during continuation phase treatment (63% do not).

1. Follow-up care after hospitalization for mental illness within 7 or 30 days of hospital discharge.

1. Region-wide, 40% of individuals follow-up after hospitalization for mental illness within seven days (60% do not) and 54% follow-up within 30 days.

2. Follow-up care for children 2. Region-wide 64% of children prescribed ADHD Mental Health Follow-up Care

prescribed ADHD medication initiation phase.

medication have one follow-up visit with a practitioner within 30 days after starting the medication.

Among all DSRIP regions, the region has the highest percentage of follow-up care for children prescribed ADHD medication for the initiation phase.

3. Follow-up care for children prescribed ADHD medication

3. Region-wide 72% of children with a new prescription for ADHD medication remain on the medication for 7



Appendix A. Highlights of New York City Region Needs Assessment Findings New York City Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

continuation and months and/or have at least 2 follow-up visits in the maintenance phase. 9-month period after the initiation phase.

Among all DSRIP regions, the region has the highest percentage of follow-up care for children prescribed ADHD medication for the continuation phase.

Alcohol and other Drug Dependence (AOD) Initiation and Engagement Treatment

1. AOD Initiation 1. Region-wide 49% of individuals initiate AOD treatment within 14 days of diagnosis.

2. AOD Engagement 2. Region-wide 19% of individuals engage in AOD treatment within 30 days after initiation (81% do not).

Among all DSRIP regions, the New York City region has the second lowest percentage for AOD engagement.

Potentially Avoidable Hospitalizations (Conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications)

1. Diabetes Long-Term Complications

1. Among all DSRIP regions, the region has the highest observed to expected ratios for diabetes long-term complications in the Medicaid only population (175/153) and the dual population (465/411).

2. Chronic Cardiac Conditions: Hypertension

2. Among all DSRIP regions, the NYC region has the highest observed to expected ratio for hypertension in dual Medicaid and Medicare population (191/177).

VI. Consumer and Provider Input New York City region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to prevention services are an issue that needs attention for the populations with mental health and/or chemical dependency concerns.

Five clinics in the New York City region collected input from 443 consumers and 85 providers. The needs most frequently reported by both consumers and providers include: affordable housing; services provided at homeless shelters; assistance with finding and maintaining employment; treatment for co-occurring disorders; child and adolescent mental health and substance abuse detox/rehab services; peer support services; and assistance with paying for services.



Appendix B: New York City Region Survey/Focus Group Responses to Open Ended Questions

Appendix B contains comprehensive lists of responses to the open-ended questions posed to consumers and providers during surveys and focus groups conducted by clinics in the NYC region. Responses are organized first by question, and then by clinic. Surveys and focus group forms can be found in Appendix IV.

Consumer questionnaire #9: Are there particular behavioral health services that you (or anyone you know) want but are unable to access within a one hour drive of where you live? Please explain

Consumer focus group #1: Are there behavioral health services to which individuals with mental health and/or substance abuse problems do NOT have access within a one hour drive (e.g., individual or group psychotherapy, medications, peer delivered, family supports, crisis services, employment supports)?

Promesa mental health clinic: Of the 133 participants completing the survey, 15 responded reporting “No” with

no further explanation.

RUMC questionnaire respondents: None (25 responses) Very difficult to receive services unless child has Medicaid. Many

hospitals/programs/doctors do not accept private insurance (One response)

RUMC Staten Island ODT and MICA respondents: Eleven participants have access within a one hour drive, six participants have

more than one hour.

SDV: Only one client responded that they wanted but were unable to access “help with

job and housing.”

SUS: Participants in this group are consumers at the outpatient substance use disorder

treatment service who may live in a recovery oriented community residence or in one of the many homeless shelters we operate. Based on their housing status, they did not respond strongly to the idea of accessibility to services based on distance, but on their ability to get a Metro card to get them to treatment. Many of the participants want mental health services available to them alongside their substance use treatment since accessing psychiatric services in the community is difficult. A strong consistent request was assistance in transitioning to the community once they complete treatment. This includes finding housing, support groups and employment. Participants discussed the fears of returning to the community without support and would like to have a case manager to assist them.




Provider questionnaire #7 and focus group #1: Are there specific types of behavioral health services that are not currently available in your community that your community would benefit from (e.g., particular program types, prescribers, substance services, peer delivered, family supports, crisis services, employment supports)? Please explain

RUMC/Staten Island MH Society, Inc. questionnaire The Richmond County community would benefit from additional peer support

services to strengthen, enhance and boost the work of providers in the community.

Yes, a program that is able to provide evidence-based therapy and substance abuse would be extremely beneficial.

Child and adolescent substance abuse detox/rehab services. Children with commercial insurance cannot access mental health or substance

abuse services – rates are too low and providers cannot afford to provide these services.

There are very few behavioral health services for children and adolescents, especially on the South Shore of Staten Island.

SDV questionnaire: “Respondent felt that the Bronx community would most benefit from the following services: Increased co-occurring mental health and substance use services (5

respondents), Services targeted towards youths and young adults (2 respondents), Trauma-based services and treatment (1 respondent), Assistance with housing (1 respondent), Services for parents including extended hours and on-site child care (1

respondent), LGBT treatment services including psychosocial supports (1 respondent), Peer-driven Recovery Center (1 respondent), and Services related to gambling addiction (1 respondent).

Promesa Acacia Network primary health care center questionnaire: Need more MICA programs (n=1) Child and adolescent behavioral health (n=1)

Promesa Chemical Dependence Outpatient Program (CDOP) questionnaire: Yes (n=2) No (n=3)

NHCC questionnaire: 11 individuals indicated that there are no gaps in services in the community. 2 individuals indicated that child day treatment are not available. 2 individuals indicated that child partial hospitalization programs are not

available.




3 individual indicated that there are no/a lack of inpatient psychiatric child beds in the immediate community.

4 indicated that there were no gaps.

SUS focus group: “The group response was that there are behavioral health services that are not available and that there are particular populations that are not permitted to access existing services.

Undocumented individuals are ineligible for entitlements, and are prevented from getting employment, housing and other benefits due to their illegal status. Often, Family Care (Adult Foster Care) which is reported to be a very poorly regulated service may be their only recourse to homelessness.

Homeless Veterans - The Rapid Housing mandate for homeless veterans is often significantly slowed by the lack of available behavioral health professionals licensed to do an initial assessment. Without the initial assessment, the veteran may end up lingering in the shelter, or being placed expeditiously in the wrong level of care. Increasing behavioral healthcare clinicians on-site at the shelter and or through outreach services would provide the support needed for rapid "appropriate" housing.

Homeless with Serious Mental Illness - Often an individual may have problems that are too severe to be managed at a shelter, even if it is one for mental health problems. Currently there is a proposal from OMH & OASAS that will permit licensed clinicians to go on-site to the shelter (as well as other designated spaces) to do an assessment. This service will be billable, therefore making it more feasible for mental health programs to participate. Allowing behavioral healthcare services to be offered in an unrestricted manner is certainly in line with the approach being promoted through the clinic.

Primary Care- FQHC's are restricted to having primary care as their main focus with coordination/collaboration around behavioral health problems being ancillary. The suggestion was made to let FQHC's (where needed) to have behavioral health as their primary focus.

Provider questionnaire #5j: Please indicate which barriers to behavioral health treatment exist in your community. Select all that apply. Other (please explain)

Too few providers Youth services are scarce Not taking commercial insurance

Consumer focus group #2: Are there identifiable barriers to treatment (e.g., service doesn’t exist, transportation, no evening or weekend hours, wait time to treatment is too long, language barriers, payment difficulties)?




RUMC: Friends need to know where to go and who to call to get services. Blood work needs to be done on-site at South Avenue. Members are very worried that Medicaid/Medicare will discontinue payment for

treatment. They do not believe that insurance companies (Medicaid, Medicare and Commercial Insurances) understand time and effort needed to make changes or to sustain functioning.

The group identified several barriers: no evening hours and wait time to treatment is too long; i.e., wait for psychiatrist.

SUS: Transportation and food are often barriers to treatment. Participants may have

difficulty getting a Metro card for transportation and if they have multiple appointments in a day, may not have any means of getting food, hence the request for lunch.

Most participants would like more individual counseling and consistency in staff. They voiced concern about opening up to a counselor and then having them leave.

A large number in the group requested more self-help groups and wanted them available at their treatment facility. They were very receptive to the idea of expanding services at the treatment site to include acupuncture, yoga, and other traditional and non-traditional approaches to wellness. Again, assistance finding and keeping a job was important.

It is difficult getting approved for Medicaid and once approved group members state they don't always get notices sent to them and then are taken off the roles.

Provider focus group #2: Are there identifiable barriers to treatment (e.g., service doesn’t exist, transportation, no evening or weekend hours, wait time to treatment is too long, language barriers, payment difficulties)?

SUS: There was general consensus among group members that housing was the most

critical issue, yet the shortage of affordable housing, the regulations guiding eligibility and the documentation required, present serious barriers. The definition of chronic homelessness, a key factor in eligibility, was cited as a major barrier to treatment. Many individuals will desperately try to stay out of the shelters by couch surfing, sleeping outside etc. By doing this, they do not meet the criteria for chronic homelessness and do not qualify for affordable housing. Individuals are required to provide proof of homelessness while at the same time they are expected to produce an original social security card, this seems like an oxymoron.

Transportation and access to a Metro card was cited as necessary for engaging individuals in treatment.




Although employment is certainly encouraged, there are limited resources and long delays in accessing assistance from the state agency. SUS is trying to compensate by starting and expanding its own internal vocational resources through an SUS Vocational Network.

Accessible hours e.g. evenings and week-ends are rare, though are needed by individuals particularly if they have family and /or work and go to school.

The loss of Medicaid upon employment serves as a dis-incentive to work for individuals who are dependent on the receiving medication and medical care with entitlements. Most treatment services require payment and/or Medicaid. Entitlement applications take a long time to be approved, therefore delaying the individual's access to behavioral healthcare.

Consumer focus group #5 and Provider focus group #4: Are the behavioral health services in your community accessible to everyone?

SUS consumers: The primary request was to be included in housing opportunities and that

recovery is unlikely if you are homeless.

RUMC consumers: Group members felt that behavioral health services are accessible to everyone in

the community. I would refer my friends to CDT, some of them do not know about the program. Participants thought that friends should have opportunity to visit the program first

and they would welcome opportunity to show friends the CDT program and/or accompany them to E & R.

Yes, as far as they know.

SUS Providers: There are limited behavioral healthcare services in the community due to a

shortage of psychiatrists and psychiatric nurse practitioners. Positions can sometimes go unfilled for more than a year. The group strongly felt that there needs to be incentive programs developed for doctors so that they will be willing to work with not for profit organizations. As noted earlier, the lack of behavioral healthcare specialists can seriously affect an individual’s ability to access other services like housing, employment and entitlements. Other professional groups such as nurses, social workers and counselors would benefit from incentives that would encourage them to pursue their education and career.

Consumer focus group #3: Do providers talk with you about your feelings, moods, history of trauma, strengths and goals?

SUS: Overall, the participants felt that their individual counselors listened to their

concerns and responded.




Again, staff turnover, vacant positions, and limited individual time were all concerns they spoke about.

The majority of the group agreed that housing was the most important and urgent need for them. They wanted to get information about housing in a timely manner and to feel that they can compete with the vast numbers who apply.

RUMC: Yes, all therapists and doctors are very involved with patient care. The group spoke affirmatively for all categories of this question. The group members felt that their providers talk with them about feelings, moods,

history of trauma and strengths and goals.

Provider focus group #3: To your knowledge, do providers use evidence-based practices (EBPs) and trauma informed services? Which EBPs are you using?

SUS providers: Criminal Justice requires one of three EBPs: Thinking for Change; Ready, Set,

Work; and Journaling for Change. Some programs use Wellness Self-Management and Seeking Safety, though these require extensive training and supervision to maintain fidelity. Motivational Interviewing is also used at many sites. The consensus of the group was that evidenced based practice is often just a buzz word, not an actuality.

One member suggested following up on the Assessment and Referral Team (ART), an EBP that is used by HRA-HRSA.

There was general agreement that we need to incorporate trauma informed care throughout our services. SUS has completed participation in a year long Trauma Informed Learning Collaborative and is about to roll out a data driven initiative for the whole organization.

Participants were united in their belief that training staff in EBP's needs to begin in the professional schools. Some social work schools include Motivational Interviewing in the curriculum, so new workers coming into the field are familiar with the model.

Provider questionnaire #7: “Would behavioral health providers in your community benefit from additional training e.g., evidence-based or trauma-informed practices? Please explain”

RUMC: CBT, motivational interviewing Yes, additional training in both evidence-based and trauma-informed practices

are needed in this community with Richmond County leading not only with drug use but drug overdoses as well. Many of the substance users also have mental wellness challenges, creating the need to be better informed and prepared to service this population.




Yes, child welfare is moving in the direction of providing evidence-based trauma focused therapy for clients.

Yes, many topics of training that could be offered to providers on Staten Island would be helpful.

The behavioral health providers would benefit from SBIRT training, motivational interviewing and formal training in trauma informed care. This is not standard in all agencies.

SDV: All respondents agreed that BH providers would benefit from additional training.

Providers felt the following trainings would be most beneficial to the Bronx community: co-occurring mental health and substance use (4 respondents), trauma-informed care (3 respondents), evidence-based parenting programs (1 respondents), working with veterans (1 respondent), and working with adolescents (1 respondent).

Promesa mental health clinic: Responders to the survey want more training or the continuation of training in

order to continue providing excellent services to the people in our community

Promesa Acacia Network primary health care clinic: Substance Abuse (n=2) Trauma Informed (n=2) Medication management (n=1) CBT and DBT (n=1)

Promesa CDOP: Yes (n=3)

NHCC: 12 participants indicated that additional training in evidence-based and trauma-

informed practices would be beneficial. Participants who explained their answers further indicated that additional training is always beneficial.

Consumer questionnaire #11: What makes (or would make) you feel welcome?

Promesa mental health clinic Of the 133 participants, 34 reported “Staff is polite making you feel welcomed,

good service, and great hospitality.”

Promesa Acacia Network primary health care clinic Direct eye contact (n=1) Friendly, professional services offered (n=1) Very kind, helpful people (n=1)




Coffee while waiting (n=1) People smiling (n=1) Don’t know (n=1)

Promesa CDOP: The program is fine overall. They should continue to support, care, listen,

respect, and understand the client.

RUMC: Friendly greetings (7 responses) Hospitable environment (7 responses) Counselors are good professionals (6 responses) Courtesy, friendliness, professionalism, excellent customer service (5 responses) Friendliness and helpful advice (4 responses) Group Meetings (3 responses) Kindness (3 responses) Counselors are friendly (2 responses) Staff and patients are friendly and understanding (2 responses) Safe Place and comradery (2 responses) A cup of tea, food (2 responses) People have the same problems and experiences (1 response) Down to earth staff, good services, non-judgmental (1 response) Therapists and staff make it comfortable to seek treatment (1response) Nice people, kind respectful (1response) Call back in timely fashion (1response) A consistent psychiatrist (1 response) If depression gets better, I will feel better and more welcome (1 response)

SDV: Of the 52 clients who responded to this question, 35 mentioned the level of

respect, safety, and support they felt from program staff as the primary reason they feel welcome in the places they receive behavioral health services and 3 respondents commented that peer support at the program makes them feel welcome.

NHCC: The most frequent responses/themes about what makes you feel welcome:

o 23 indicated friendly/caring/smiling/respectful office staff. o 25 indicated caring/responsive clinical staff. o 5 indicated the confirmation and outreach calls they receive. o 7 indicated that the environment was pleasing and comfortable (including

TV/reading materials). 1 respondent said that coffee service would make him/her feel more welcome. 3 surveys were unanswered.




Consumer focus group #4: Do you feel welcome in the places where you receive behavioral health services? What makes you feel welcome?

SUS: Most group members felt comfortable, and as noted earlier, voiced concern

about returning to the community with the same triggers that got them in treatment in the first place. Participants felt their clinicians listened to them and addressed their concerns.

Would like more access to mental health services. Getting good medical care is a challenge, though participants varied in opinion.

Dental care became a topic of the conversation where one recipient had a great experience three years ago, and the other recipient felt he was being played with and did not get good care.

RUMC The group members agreed that they feel welcome in the place where they

receive behavioral health services because 1) staff acknowledges them; 2) peers recognize them; 3) friendly front desk; and 4) they know they can get help.

All eight group members felt relaxed and welcomed where they receive behavioral health services. Staff and peer relationships, the ability to make friends and help one another were major factors. Especially the time and thoroughness of the doctor was very important because 1) doctor always remembers what they last spoke about; 2) doctor spent over an hour on the hone getting approval for a medication that was needed; 3) does not just write scripts but is dedicated to the program and patients and spends time with them; 4) they always have the same doctor who they know and who knows them.

Yes, because staff greets them each day, is considerate of their needs. They work hard and learn a lot during the day. They can develop friendships and are like a family.

Consumer and provider focus group #6 and 5 respectively: Do you have suggestions for improving behavioral health treatment in your community?

SUS consumers: To summarize some of the previous points, housing, housing and housing. Consistency and additional medical and clinical personnel was a strong request. Make the application to Medicaid easier and ensure that any notifications from

them is received before they are removed from the program. Vocational assistance that includes supportive employment, job training and job

finding. Increase availability of self-help groups and mental health services.

SUS providers: Establishing clear communication between providers was a strong

recommendation.




The general opinion was that organizations are spending a lot of money on EHR's that are not able to talk with each other. Even with the development of the RIO's, it is reported that they are not able to adequately share information. Health Homes that were developed to help providers share information and build a continuity of care apparently are not working well. Individuals receiving services do not understand what being in a health home means, and case managers do not seem to know their role in the model. The recommendation was to educate consumer and provider, particularly in regards to the value of collaboration, then establish paths for communication.

The group would like to see the range of vocational services provided to individuals with a mental health problem, extended to individuals with substance use disorders. More specifically, job coaches and mentors are only permitted for individuals with a mental health diagnosis. The group noted that individuals with substance use disorders have more pressure on them to get a job. Yet, once on the job, they do not have access to case management and supportive services that would help them to remain on the job.

Additionally, expanding transitional and supportive employment to help individuals with substance use disorders transition from the jail, or the shelter will help motivation to remain out of those facilities.


Documents

Chapter Eight, New York City DSRIP Region Needs Assessmentomh.ny.gov/omhweb/special-projects/dsrip/docs/chapter-8-nyc.pdfThis community needs assessment of the New York City DSRIP