HomeMy WebLinkAboutAgenda - 12-05-2016-13-6 - Information Item - Access to Mental Health Services Assessment INFORMATION ITEM
Abe." „so,
ORANGE COUNTY
HEALTH DEPARTMENT
Improving health. Inspiring change.
MEMORANDUM
To: Bonnie Hammersley, Orange County Manager
Orange County Board of County Commissioners
From: Colleen Bridger, Orange County Health Director
Date: December 5, 2016
Re: Access to Mental Health Services Assessment
This fall, Health Department staff, with the help of an UNC Public Administration intern, initiated an assessment
of the barriers Orange County mental health professionals face as they seek to refer county residents 0-25
years old to mental health and substance abuse treatment services. The Health Department sought a clearer
understanding of access to resources for prevention and early intervention, as well as follow-up care and other
support systems for recovery. Simultaneously, we sought to identify the areas where these services could be
improved by pinpointing significant barriers to treatment. We interviewed and surveyed members of the mental
health community, k-12 education area, judicial system, law enforcement representatives, immigrant and
refugee advocates, and community advocates.
Attached are the results of this assessment for your review. Next we take these results back to key
stakeholders to prioritize the gaps we found and create a plan to bridge those gaps through potential services
and programs in the community. We will have that plan complete by February 15th
I look forward to sharing the results of the stakeholder meetings and our proposed plans to better meet the
mental health and substance abuse treatment needs of our community at a future meeting.
919 245 2400 ) 300 West Tryon Street ) Hillsborough, NC 27278 ) orangecountync.gov
/01116'
ALoc lip. ASSESSMENT OF ORANGE COUNTY
HD MENTAL HEALTH AND SUBSTANCE
ABUSE SERVICES
AN ASSESSMENT OF COMMUNITY ASSETS AND NEEDS IN ORANGE COUNTY, NC
BACKGROUND
The North Carolina Institute of Medicine (NCIOM) stated in an October 2016 publication
that"mental health and substance use are at the forefront of health policy issues today,
both at the national and state levels, due to rising visibility of the costs of not addressing
mental health and substance use treatment needs" (NCIOM, 2016). North Carolina's
transition to a managed care system 15 years ago brought fresh challenges for local
officials seeking to implement comprehensive, coordinated community-based prevention,
treatment, and recovery services to meet the needs of their residents. Though progress is
evident in some areas, NCIOM reported that this level of care "remains an elusive goal for
many North Carolinians with mental health and substance use disorders."
Like the rest of North Carolina, Orange County struggles to meet the need for mental health
and substance abuse services for residents, especially those ages 0-25. This assessment
was initiated by the Orange County Health Department (OCHD) to determine what barriers
professionals face as they seek to refer county residents to mental health and substance
abuse treatment services. The results of this assessment will be shared with the Board of
County Commissioners prior to their strategic planning session in January 2017.
According to the U.S. Department of Health and Human Services, the majority of
adolescents in North Carolina with mental health and substance use needs do not receive
treatment services. Orange County is home to more than 141,000 residents, including up to
2,200 residents aged 3-17 that are currently being treated for these conditions through the
managed care organization Cardinal Innovations. In Orange County, hospitalization records
from 2009-2015 demonstrate the percentage of visits due to mental health for youth 0-24
years is increasing as a proportion of all mental health visits (an increase from around 18%
to 24% of all mental health visits). Data from the same period show that between 27% and
31% of all mental health visits for 0-24 year olds are a result of mental and behavioral
disorders due to psychoactive substance abuse.
OCHD sought a clearer understanding of the extent patients in the 0-25 age group have
access to resources for prevention and early intervention, as well as follow-up care and
other support systems for recovery. Simultaneously,we sought to identify the areas where
these services could be improved by pinpointing significant barriers to treatment. UNC
Master of Public Administration student Sabrina Willard conducted the assessment from
August to November 2016. Ms. Willard interviewed ten prominent figures in the mental
health community, surveyed more than 150 individuals based in the fields of healthcare,
social services, criminal justice,behavioral therapy, K-12 education, and others, and
analyzed UNC Chapel Hill Emergency Department records.
BARRIERS TO ACCESSING TREATMENT
The primary findings of the assessment showed that existing levels of service do not
adequately address the needs of this population although there are many examples of
successful collaborations taking place across the county in an attempt to address the gaps.
Responses from key opinion leaders around the barriers to accessing treatment for mental
health and substance abuse helped to inform the findings included in the below table.
These common themes were also incorporated into the survey questionnaire as a method
for confirming their validity with a larger group.
BARRIERS TO MENTAL HEALTH (MH)AND SUBSTANCE ABUSE (SA)
TREATMENT AND RESOURCES
Theme D$scription
Affordability- #1 Gap The#1 gap in the OC mental health system is
affordability. Many low-income residents
either do not have insurance or find their
coverage inadequately covers treatment
services for MH and SA(e.g.must meet a high
deductible before any coverage is provided,
lack of reimbursement options,restricted to a
low maximum number of appointments, etc.).
This issue is exacerbated when adolescents age
out of the Medicaid system at 18.There are
very few sliding scale or pro bono options to fill
this gap. Children and adolescents have
difficulty with recovery if parents with mental
health issues aren't treated as well,but parents
run into these same issues with affordability.
Transportation was ranked as the 2nd largest
Location/Transportation - #2 Gap barrier to MH/SA services in Orange County.
Services are especially scarce in the northern
part of the county(i.e. Hillsborough and
unincorporated areas). Public transportation
helps somewhat with the older patients in the
southern sector,but the younger ones still have
unmet needs.This dilemma emphasizes the
need for more accessible treatment centers and
in/near-school care,especially when parents
are unable to take their children to necessary
appointments due to busy work schedules or
other conflicts.
Language/Cultural-#3 Gap For the most part, services for non-English
speaking patients are either difficult to obtain
or virtually inaccessible. 60%of respondents
said it was difficult for non-English speaking
residents to access services for any of the
listed disorders (Major Depressive, Generalized
Anxiety, Bipolar, Personality, Eating, Substance
Language/Cultural-#3 Gap (cont'd) Abuse, or Schizophrenia Spectrum),making
this the #3 gap identified in the survey. There
is need for more diversity in the languages MH
and SA services are offered in (i.e. Spanish,
Burmese/Karen...etc.), as well as cultural
competency training to help providers better
understand how to work with
refugee/undocumented populations.
Culturally-relevant practices that provide
support for LGBTQ teens are also needed.
Education to combat stigma (adolescent Awareness initiatives in the community are
and family) -#4 helping combat the stigma associated with MH
conditions. More could be done to continue the
dialogue encouraging people to seek
appropriate treatment. Parents also need to be
educated about the importance of ensuring
their child gets the help they need. Barriers
exist where parents are either unaware of the
importance of taking their child to
appointments or have busy schedules that
conflict with their ability to do so. Knowing
how to navigate the Cardinal system and
properly enroll their child in MH and SA
services is a barrier to accessing treatment.
Post-diagnosis maintenance of care -#5 Non-emergency treatment options are non-
existent or scarce. Psychiatric care in particular
is a critical need for adolescents yet this type of
therapy is largely unavailable to this
population,especially if uninsured. In general,
there is a need for more varied types of
therapy(i.e. cognitive behavioral therapy,
other types of counseling), as well as therapists
trained to do trauma work both in the school
systems and in the community.
Preventive/Early intervention care-#6 Preliminary efforts to incorporate MH services
into the school system are showing success.
More robust systems for identifying issues
earlier within the primary care and school
settings are still needed.There is also a need
for more variety of screening tools.
Citizenship status-barrier identified Cardinal Innovations does not provide
through stakeholder interviews and survey behavioral health services to residents without
responses proof of US citizenship.Undocumented
immigrants have to rely on the scarce services
provided by other community organizations.
Inpatient Care Usage/Access-barrier 2009-2015 UNC Hospital data obtained shows
identified through stakeholder interviews that after an initial decline in mental health-
and survey responses related Emergency Department(ED)visits
Inpatient Care Usage/Access-barrier between 2009 and 2012,we have begun to see
identified through stakeholder interviews a large increase in visits for patients 0-24
and survey responses (cont'd) (51/%).This increase supports reports of ED
overcrowding we've received from UNC
Hospitals. The percentage increase of youth
mental health ED visits is also increasing at a
faster rate than overall mental health ED visits
(25%compared to 18%.) In the case of
substance abuse, 29%of all mental health ED
visits for 0-24 year olds are substance abuse
related.
Disorder/Diagnosis Type -barrier Survey data indicates that generalized anxiety
identified through stakeholder interviews disorder and major depressive disorder are the
and survey responses two mental illnesses that most frequently affect
residents aged 0-25 in Orange County(93%
and 89%respectively) and are also the easiest
to refer for treatment. Drug and alcohol abuse
were also frequent diagnoses (80%of
respondents for both) however, only 39%of
respondents found them easy to refer for
treatment. Schizophrenia spectrum and other
psychotic disorders were deemed the most
difficult to refer for treatment(25%) and
treatment for eating disorders was said to be
the most inaccessible (11%).
CONCLUSION
The most common barriers for people in Orange County aged 0-25 who need mental health
and/or substance abuse treatment services were affordability and accessibility.
Affordability
One of the biggest barriers to accessing services, even when they are available, is the lack of
services that are provided based on a person's ability to pay.Any improvement to the
mental health system in Orange County will need to address the affordability of these
services.
Accessibility
We found that the ability to access services depends on a variety of factors (service type,
location, eligibility and cultural/linguistic appropriateness) all of which have gaps. Certain
types of services such as substance abuse treatment and psychiatric care are hard to find.
The location of mental health services in the population centers makes them difficult for
this age group to access. Restrictions on who can receive services (e.g., age, citizenship,
diagnosis) results in decreased access. Finally,the inability to provide needed mental
health services in a linguistically and culturally appropriate manner significantly limits
access.
Next Steps:
The Health Department will convene a group of stakeholders to review the detailed results
of this gap analysis (survey results attached). This group will prioritize which specific gaps
to address first and identify potential programs and services to meet those prioritized
needs by February 15, 2017.
ACKNOWLEDGEMENTS
Thank you to all of the participants who generously gave their time to this assessment.
Special thanks to: Orange County Criminal Justice Resource Office (Caitlin Fenhagen)
Orange County Health Department (Allison Young, Juliet Sheridan, Coby Austin, Jennifer
Sharpe, and Karen Kyes) I Freedom House (Trish Hussey) I El Futuro (Luke Smith and
Karla Siu) I Cardinal Innovations (Debra Farrington) I UNC Healthcare (Tammie Stanton)
UNC Pediatric Psychiatry (Jack Naftel) I UNC School of Social Work(Josh Henson).
Orange County Mental Health Gap Analysis Survey
Q. How do you serve Orange County
residents 0-25 with conditions related
to mental illness and/or substance abuse?
Check all that apply.
knswered:143 Skipped:8
lama
healthcare...
I work in the
K-12 school...
I am a
behavioral...
Iama
caregiver
I work in '
childcare
I work in the
Health...
I work in the
Department o...
I work in law
enforcement...
Other(please
specify)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
I am a healthcare provider 8.39% 12
I work in the K-12 school system 40.56% 58
I am a behavioral therapist and/or counselor 9.79% 14
I am a caregiver 0.70% 1
I work in childcare 3.50% 5
I work in the Health Department 11.89% 17
I work in the Department of Social Services 9.09% 13
I work in law enforcement or the judicial system 13.99% 20
Other(please specify) 18.88% 27
Total Respondents: 143 I
20 /48
Orange County Mental Health Gap Analysis Survey
Other(please specify) I Date
1 I work with juvenile's between ages of 6 to 15 or 16 and 17 if undisciplined 11/3/2016 3:46 PM
2 School Social Worker 10/31/2016 6:58 PM
3 I am school nurse for middle and high school students 10/31/2016 2:39 PM
4 early childhood mental health specialist 10/21/2016 6:08 PM
5 pre-k 10/20/2016 1:26 PM
6 We provide programming at a youth development program 10/20/2016 11:20 AM
7 We are the company which coordinates and has oversight for management and delivery of care for individuals with 10/19/2016 10:13 AM
mental illness and/or substance abuse
8 I'm a student 10/18/2016 10:51 PM
9 NAMI provides support,education and advocacy for individuals and families with mental illness 10/18/2016 8:58 PM
10 I am a 1st year MSW student that provides mental health services through UNC's Refugee Wellness Initiative 10/18/2016 7:45 PM
11 I am a student in East Chapel Hill High School 10/18/2016 3:12 PM
12 I work at a non-profit social service organization 10/18/2016 11:34 AM
13 The Durham CDSA serves young children with social emotional difficulties,as well as developmental delays.There is 10/18/2016 10:25 AM
a need for more evidence-based intervention for very young children.
14 I am the Director of the Durham CDSA,which services for infants and toddlers with or at risk for developmental delays 10/18/2016 9:07 AM
and disabilities through the NC Infant-Toddler Program.
15 psychiatrist 10/17/2016 7:00 PM
16 Migrant Health Program Coordinator/Community Health Center 10/17/2016 5:16 PM
17 I am a care manager at a community health center 10/17/2016 2:57 PM
18 I work in the church and am the director of small groups for our church as well as 11th and 12th grade boys group 10/17/2016 2:10 PM
leader.
19 private non-profit 10/17/2016 1:56 PM
20 Program Coordinator and Public Health Educator 10/17/2016 1:07 PM
21 I work for NC Public Health--Statewide 10/17/2016 11:15 AM
22 Mental Health Substance Abuse prevention 10/17/2016 11:13 AM
23 I also coordinate Healthy Carolinians of Orange County that is a community coalition serving all ages and residents of 10/17/2016 10:32 AM
OC.
24 I work as an advocate 10/14/2016 4:00 PM
25 Orange County Head Start/Early Head Start 10/14/2016 3:13 PM
26 Juvenile Court Supervisor 10/14/2016 2:52 PM
27 I am a classroom behavior specialist with the Healthy Social Behaviors Initiative. 10/14/2016 2:06 PM
21 /48
Orange County Mental Health Gap Analysis Survey
Which age group within the Orange
County community do you work with
primarily?
Answered:143 Skipped:8
0-4
5-10
11-13
14-17
18-25
All of the
above
None of the '
above
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
0-4 16.08% 23
5-10 29.37% 42
11-13 18.18% 26
14-17 23.08% 33
18-25 18.88% 27
All of the above 31.47% 45
None of the above 2.80% 4
Total Respondents: 143
22 / 48
Orange County Mental Health Gap Analysis Survey
What percentage of the population you
serve is dealing with mental health issues?
Answered:132 Skipped:1c
# Responses Date
1 1-2%unsure of specific numbers. 11/4/2016 11:15 AM
2 0.3%(guess) 11/4/2016 11:10 AM
3 I am in a normal 3rd grade classroom.A small percentage of our kids are dealing with a significant mental health 11/4/2016 10:41 AM
issue.
4 5-10% 11/4/2016 10:29 AM
5 approx.15% 11/4/2016 9:56 AM
6 90% 11/3/2016 3:46 PM
7 unknown 11/3/2016 3:02 PM
8 25 11/2/2016 3:55 PM
9 25 11/2/2016 8:22 AM
10 10 11/2/2016 6:43 AM
11 20-50 students out of 400? 11/1/2016 5:21 PM
12 maybe 50% 11/1/2016 4:48 PM
13 75% 11/1/20162:17 PM
14 50% 11/1/2016 12:22 PM
15 10% 11/1/2016 12:02 PM
16 with actual diagnoses probably 20%,but struggling with mental health issues not yet identified or not quite at a 11/1/2016 11:18 AM
diagnostic level yet,I'd say closer to 30%
17 I do not know. 11/1/2016 11:08 AM
18 5-10% 11/1/2016 9:36 AM
19 10% 11/1/2016 9:12 AM
20 20 11/1/2016 8:05 AM
21 With actual diagnoses of childhood mental health disorders,I'd say at least 20%.If this means just dealing with mental 10/31/2016 8:59 PM
health issues but symptoms are not yet at a diagnostic level,I'd say significantly higher--closer to 30%.
22 25% 10/31/2016 6:58 PM
23 5-10% 10/31/2016 6:27 PM
24 25-30 10/31/2016 5:28 PM
25 8 10/31/2016 3:06 PM
26 40% 10/31/2016 2:39 PM
27 25% 10/31/2016 1:52 PM
28 75% 10/31/2016 12:45 PM
29 20% 10/31/2016 12:38 PM
30 25% 10/31/2016 12:36 PM
31 10%? 10/31/2016 12:17 PM
32 At least 15% 10/31/2016 12:14 PM
33 35% 10/31/2016 12:13 PM
23 /48
Orange County Mental Health Gap Analysis Survey
34 Hard to tell for certain but I would estimate around a quarter of the population 10/31/2016 11:48 AM
35 68% 10/31/2016 11:36 AM
36 15-25% 10/31/2016 11:28 AM
37 15% 10/31/2016 11:27 AM
38 Unclear but I would say about 20% 10/31/2016 8:49 AM
39 50% 10/30/2016 9:19 PM
40 90-95% 10/28/2016 4:29 PM
41 estimate:90% 10/28/2016 3:33 PM
42 100% 10/28/2016 11:06 AM
43 100 10/28/2016 10:57 AM
44 90 10/28/2016 10:52 AM
45 90% 10/28/2016 10:25 AM
46 80%-85% 10/28/2016 10:17 AM
47 at least half 10/28/2016 10:16 AM
48 80 10/28/2016 10:07 AM
49 at least 50% 10/28/2016 10:06 AM
50 75% 10/28/2016 10:05 AM
51 75%or more 10/28/2016 9:44 AM
52 N/A-not a direct service provider 10/28/2016 8:31 AM
53 1 percent 10/28/2016 6:37 AM
54 100% 10/26/2016 8:37 PM
55 estimate 50% 10/26/2016 10:33 AM
56 5 10/22/2016 8:09 AM
57 75% 10/21/2016 6:08 PM
58 30% 10/21/2016 1:05 PM
59 20 10/21/2016 9:28 AM
60 approx 20% 10/20/2016 10:21 PM
61 10% 10/20/2016 1:26 PM
62 I do not have an exact percentage,but it seems to be growing each year.I would love to learn about a way to assess 10/20/2016 1:24 PM
the needs at the school.
63 A high percentage of the student we serve are dealing with mental health issues. 10/20/2016 11:20 AM
64 ?25%would be my guess(counting family members of children enrolled) 10/20/2016 10:41 AM
65 30% 10/20/2016 10:37 AM
66 3-5% 10/20/2016 10:07 AM
67 seems like 12-15% 10/19/2016 9:43 PM
68 10% 10/19/2016 5:41 PM
69 10%estimate 10/19/2016 5:00 PM
70 5 10/19/2016 12:48 PM
71 70%-80% 10/19/2016 11:25 AM
72 Majority 10/19/2016 10:13 AM
24 /48
Orange County Mental Health Gap Analysis Survey
73 15 10/19/2016 2:48 AM
74 100%fam 10/18/2016 10:51 PM
75 100 10/18/2016 8:58 PM
76 unknown percentage. 10/18/2016 8:49 PM
77 I'm nut sure the percentage of people we screen that need mental health treatment,but close to 100%of those that 10/18/2016 7:45 PM
receive services are having mental health issues since that is the service we provide.
78 75% 10/18/2016 3:54 PM
79 No? 10/18/2016 3:12 PM
80 -10-15% 10/18/2016 1:51 PM
81 10-15 10/18/2016 1:01 PM
82 Unsure. 10/18/2016 11:34 AM
83 don't have data on this 10/18/2016 9:07 AM
84 25% 10/18/2016 8:47 AM
85 35%? 10/18/2016 8:40 AM
86 25%-30% 10/18/2016 8:32 AM
87 50%to 75% 10/18/2016 8:30 AM
88 10% 10/17/2016 11:09 PM
89 Children:-25%(varying degrees)Parents:-30%(varying degrees) 10/17/2016 7:08 PM
90 100% 10/17/2016 7:00 PM
91 approximately 10% 10/17/2016 5:16 PM
92 2/3 10/17/2016 4:10 PM
93 1 10/17/2016 3:20 PM
94 The majority-no specific percent 10/17/2016 3:05 PM
95 86% 10/17/2016 2:59 PM
96 99% 10/17/2016 2:57 PM
97 75% 10/17/2016 2:54 PM
98 95% 10/17/2016 2:50 PM
99 75%parents of my clients 10/17/2016 2:02 PM
100 unsure 10/17/2016 1:56 PM
101 I am not sure 10/17/2016 1:13 PM
102 It is hard to say with kids.However,many of the kids that I have to work with in the Trauma Center at UNC have a 10/17/2016 1:07 PM
parent or caregiver who is clearly dealing with a mental health issue most notably,substance abuse.
103 100% 10/17/2016 12:27 PM
104 NA 10/17/2016 11:13 AM
105 50 10/17/2016 10:59 AM
106 50% 10/17/2016 10:57 AM
107 at least 50% 10/17/2016 9:05 AM
108 15% 10/17/2016 2:01 AM
109 50% 10/16/2016 6:35 AM
110 90 10/15/2016 4:05 PM
111 30% 10/15/2016 3:48 AM
25 /48
Orange County Mental Health Gap Analysis Survey
112 85% 10/15/2016 3:44 AM
113 75% 10/14/2016 8:40 PM
114 60% 10/14/2016 7:18 PM
115 unknown 10/14/2016 6:43 PM
116 35-45 10/14/2016 6:13 PM
117 5% 10/14/2016 4:28 PM
118 Unknown. 10/14/2016 4:00 PM
119 20 10/14/2016 3:55 PM
120 We work with families who are living in poverty and many of our parents and children have mental health issues or 10/14/2016 3:13 PM
concerns.
121 30% 10/14/2016 3:09 PM
122 25% 10/14/2016 3:02 PM
123 75% 10/14/2016 2:52 PM
124 80% 10/14/2016 2:46 PM
125 85% 10/14/2016 2:41 PM
126 100 10/14/2016 2:27 PM
127 50 10/14/2016 2:10 PM
128 Unknown 10/14/2016 2:06 PM
129 25% 10/14/2016 2:01 PM
130 Guesstimate of 25%-50%depending on the day. 10/14/2016 2:01 PM
131 at least 50% 10/14/2016 12:54 PM
132 I don't know the percentage. 10/14/2016 12:25 PM
26 /48
Orange County Mental Health Gap Analysis Survey
Q5 What are the most frequent mental
illnesses affecting the population (ages 0-
25) you work with? Please rank in order of
frequency (1 = most frequent).
Answered:111 Skipped:40
Major
Depressive... Mk
Generalized
Anxiety...
Bipolar
Disorder
Personality IME
Disorders
Eating
Disorders
Alcohol Abuse
Drug Use
Other(please
specify in n...
0 1 2 3 4 5 6 7 8 9 10
1 2 4 6 7 8 N/A Total Score
Major Depressive Disorder 19.19% 33.33% 18.18% 12.12% 8.08% 4.04% 1.01% 0.00% 4.04%
19 33 18 12 8 4 1 0 4 99 6.28
Generalized Anxiety Disorder 28.16% 27.18% 11.65% 11.65% 6.80% 9.71% 0.97% 0.00% 3.88%
29 28 12 12 7 10 1 0 4 103 6.26
Bipolar Disorder 6.59% 5.49% 18.68% 17.58% 18.68% 13.19% 9.89% 2.20% 7.69%
6 5 17 16 17 12 9 2 7 91 4.63
Personality Disorders 4.49% 3.37% 11.24% 11.24% 19.10% 17.98% 13.48% 4.49% 14.61%
4 3 10 10 17 16 12 4 13 89 4.04
Eating Disorders 1.14% 3.41% 4.55% 6.82% 9.09% 17.05% 31.82% 10.23% 15.91%
1 3 4 6 8 15 28 9 14 88 3.04
Alcohol Abuse 8.99% 16.85% 13.48% 20.22% 8.99% 7.87% 5.62% 2.25% 15.73%
8 15 12 18 8 7 5 2 14 89 5.28
Drug Use 21.35% 10.11% 17.98% 12.36% 11.24% 7.87% 4.49% 0.00% 14.61%
19 9 16 11 10 7 4 0 13 89 5.72
Other(please specify in next 30.77% 4.62% 12.31% 6.15% 4.62% 3.08% 4.62% 16.92% 16.92%
question) 20 3 8 4 3 2 3 11 11 65 5.26
27 /48
Orange County Mental Health Gap Analysis Survey
(alb If you work with a mental health
issue that was not mentioned in the
previous question, please specify below.
Answered:55 Skipped:96
Responses Date
1 ADD and ADHD 11/4/2016 11:11 AM
2 ADHD 11/4/2016 9:57 AM
3 Trauma and traumatic events-PTSD 11/2/2016 8:28 AM
4 Attention Deficit Hyperactivity disorder,some childhood bipolar and PTSD/trauma 11/1/2016 5:23 PM
5 ADHD Trauma Related Issues ADD ODD 11/1/2016 4:52 PM
6 PTSD 11/1/2016 12:24 PM
7 ADHD and autism 11/1/2016 11:19 AM
8 ADD and ADHD 11/1/2016 9:39 AM
9 Neurodevelopmental Disorders such as ADD/ADHD;Autism Spectrum Disorder 11/1/2016 9:18 AM
10 ADHD,autism,ODD 10/31/2016 9:32 PM
11 Adjustment Disorders 10/31/2016 3:10 PM
12 ADHD,attachment disorders, 10/31/2016 12:52 PM
13 Trauma and PTSD 10/31/2016 12:41 PM
14 ADHD/ADD,Emotional Disturbance Disorder,PTSD,ODD 10/31/2016 12:17 PM
15 ODD and BED 10/31/2016 12:16 PM
16 ADHD;ODD 10/28/2016 4:32 PM
17 PTSD,Schizophrenia 10/28/2016 3:37 PM
18 PTSD 10/28/2016 10:55 AM
19 Schizophrenia 10/28/2016 10:07 AM
20 PTSD 10/26/2016 8:43 PM
21 PTSD 10/26/2016 10:35 AM
22 History of unaddressed trauma,toxic stress 10/25/2016 11:42 AM
23 Adjustment Disorder 10/23/2016 9:27 PM
24 PTSD,Adjustment disorders,ADHD 10/21/2016 1:08 PM
25 social emotional regulation issues,parenting, 10/20/2016 1:27 PM
26 One of the biggest issues for many of our youth can be substance issues but this is often a secondary issue because 10/20/2016 11:23 AM
they are dealing with experiences of trauma and other mental health issues like anxiety and depression.
27 ADHD/ASD 10/20/2016 10:41 AM
28 PTSD 10/20/2016 10:10 AM
29 OCD 10/19/2016 5:42 PM
30 Schizophrenia spectrum disorders 10/19/2016 10:18 AM
31 I do not work professionally but I would like to as a peer to provide basic support.(I understand with confidentiality I 10/18/2016 10:52 PM
can't work professionally)
32 schizophrenia 10/18/2016 9:00 PM
28 /48
Orange County Mental Health Gap Analysis Survey
33 schizophrenia 10/18/2016 8:51 PM
34 Schizophrenia 10/18/2016 3:55 PM
35 ADHD,Conduct Disorder,ODD 10/18/2016 1:53 PM
36 PTSD/adjustment;oppositional/defiant;ADHD/learning issues;parenting/behavioral management 10/18/2016 1:06 PM
37 young children with social emotional difficulties 10/18/2016 10:26 AM
38 Adjustment reaction with depressed or anxious mood 10/18/2016 8:33 AM
39 Generalized stress/trauma 10/17/2016 7:12 PM
40 Neurocognitive impairment(eg ADHD)Trauma(PTSD,etc.)Intellectual Developmental Delay(IDD)Autism 10/17/2016 7:04 PM
41 Depression.. 10/17/2016 5:18 PM
42 PTSD,trauma related disorders 10/17/2016 3:13 PM
43 2.Mild to moderate depression 5.Trauma 10/17/2016 3:08 PM
44 ADHD,PTSD 10/17/2016 3:01 PM
45 ptsd 10/17/2016 2:58 PM
46 Court referrals for behavior that has led to court involvement,behavioral issues,conduct disorders,ADHD 10/17/2016 12:39 PM
47 Postpartum depression 10/17/2016 11:14 AM
48 schizophrenia 10/17/2016 9:07 AM
49 adhd 10/16/2016 6:36 AM
50 Adjustment disorders,family stress,other v codes.ADHD,learning disorders,developmental disabilities. 10/15/2016 4:10 PM
51 N/A 10/14/2016 7:22 PM
52 Oppositional Defiant Disorder 10/14/2016 2:55 PM
53 Trauma 10/14/2016 2:43 PM
54 PTSD 10/14/2016 2:29 PM
55 Postpartum depression 10/14/2016 12:28 PM
29 /48
Orange County Mental Health Gap Analysis Survey
Q7 How difficult is it for you to refer English
speaking, Orange County residents ages 0-
25 to treatment for these disorders?
Answered:108 Skipped:43
Major
Depressive...
Generalized
Anxiety...
Bipolar
Disorder
Personality
Disorders
Eating
Disorders
Substance
Abuse...
Schizophrenia
Spectrum and...
0 1 2 3 4 5 6 7 8 9 10
Easy Moderately Difficult Difficult Inaccessible Total Weighted Average
Major Depressive Disorder 49.52% 40.00% 7.62% 2.86%
52 42 8 3 105 1.64
Generalized Anxiety Disorder 51.92% 35.58% 10.58% 1.92%
54 37 11 2 104 1.63
Bipolar Disorder 36.08% 40.21% 19.59% 4.12%
35 39 19 4 97 1.92
Personality Disorders 35.48% 34.41% 22.58% 7.53%
33 32 21 7 93 2.02
Eating Disorders 29.03% 36.56% 23.66% 10.75%
27 34 22 10 93 2.16
Substance Abuse(including alcohol abuse) 39.36% 31.91% 22.34% 6.38%
37 30 21 6 94 1.96
Schizophrenia Spectrum and other Psychotic Disorders 31.18% 35.48% 24.73% 8.60%
29 33 23 8 93 2.11
30 / 48
Orange County Mental Health Gap Analysis Survey
Q8 How difficult is it for you to refer non-
English speaking, Orange County residents
ages 0-25 to treatment for these disorders?
Answered:107 Skipped:44
Major
I
Depressive...
Generalized
Anxiety...
Bipolar
IIII
Disorder
Personality
Disorders
Eating
Disorders
Substance
Abuse...
Schizophrenia
Spectrum and...
0 1 2 3 4 5 6 7 8 9 10
Easy Moderately Difficult Difficult Inaccessible Total Weighted Average
Major Depressive Disorder 6.80% 24.27% 61.17% 7.77%
7 25 63 8 103 2.70
Generalized Anxiety Disorder 6.73% 25.00% I 60.58% 7.69%
7 26 63 8 104 2.69
Bipolar Disorder 6.32% 17.89% 62.11% 13.68%
6 17 59 13 95 2.83
Personality Disorders 5.21% 19.79% 61.46% 13.54%
5 19 59 13 96 2.83
Eating Disorders 5.32% 14.89% 60.64% 19.15%
5 14 57 18 94 2.94
Substance Abuse(including alcohol abuse) 7.45% 19.15% 55.32% 18.09%
7 18 52 17 94 2.84
Schizophrenia Spectrum and other Psychotic Disorders 5.43% 15.22% 60.87% 18.48%
5 14 56 17 92 2.92
31 /48
Orange County Mental Health Gap Analysis Survey
Please rank the following according to
how significant you perceive these barriers
to be in accessing mental health and
substance abuse treatment in Orange
County for residents ages 0-25. (1 = most
significant):
Answered:108 Skipped:43
Affordability
(i.e.no...
Transportation
(i.e.distan...
Language(i.e.
not enough...
Stigma
surrounding...
Maintenance of
care...
Preventive
care/early...
0 1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 I do Total Score
not
believe
this is
a
barrier
Affordability(i.e.no insurance,insurance doesn't cover 36.08% 26.80% 13.40% 12.37% 5.15% 3.09% 3.09%
mental health services) 35 26 13 12 5 3 3 97 4.69
Transportation(i.e.distance to services) 12.12% 24.24% 27.27% 8.08% 19.19% 6.06% 3.03%
12 24 27 8 I 19 6 3 99 3.83
Language(i.e.not enough services for non-English speaking 20.20% 13.13% 20.20% 21.21% 11.11% 9.09% 5.05%
patients) 20 13 20 21 11 9 5 99 3.82
Stigma surrounding mental health(i.e.lack of 12.50% 10.42% 14.58% 22.92% 14.58% 20.83% 4.17%
education/awareness is deterring people from seeking help) 12 10 14 22 14 20 4 96 3.17
Maintenance of care post-diagnosis(i.e.non- 11.46% 10.42% 14.58% 23.96% 21.88% 13.54% 4.17%
emergency treatment options are non-existent or scarce) 11 10 14 23 21 13 4 9L6 3.22
Preventive care/early intervention(i.e.more robust 12.50% 18.27% 14.42% 9.62% 18.27% 18.27% 8.65%
systems for identifying issues earlier on within the primary 13 19 15 10 19 19 9 104 3.37
care,school setting...etc.)
32 /48
Orange County Mental Health Gap Analysis Survey
.,t I Are there any barriers not already
included on this list that you would like to
see addressed within Orange County?
Please explain.
Answered:42 Skipped:109
Responses Date
1 I would say when a family is in crisis how can they access or be connected to someone that speaks their language 11/3/2016 3:50 PM
such as mobile crisis or police officer.
2 no 11/3/2016 3:10 PM
3 you covered them 11/2/2016 8:31 AM
4 need capacity for more school based mental health 11/1/2016 5:24 PM
5 culturally relevant practices specific support services for LGBTQ teens 11/1/2016 4:59 PM
6 I find it difficult to rank these barriers because almost all are very significant barriers.Even if we are able to identify 11/1/2016 11:52 AM
them early in elementary school,there are several factors that might inhibit a child in need of mental health services
from actually getting them--especially for our low income families.The most significant being transportation,parent
schedule,insurance,and language,but also the fact that mental health services and treatment for youth in OC is still
pretty limited and stretched thin.
7 Education for parents for the need. 11/1/2016 11:12 AM
8 What was not included on this survey are the barriers created through the MCO,Cardinal.The lack of appropriate 11/1/2016 9:20 AM
services and ease of access is a barrier to services.
9 I find it incredibly hard to rank these because most of these are very significant barriers and a ranking system doesn't 10/31/2016 9:39 PM
do it justice.Even if we identify mental health concerns at the elementary school level,there are so many barriers
keeping our families from following up with our referrals for mental health services for their children(especially low
income families with limited transportation,busy work schedules,and even more so for those that are Non-English
speakers)
10 This would relate to transportation but not enough services in Northern Orange County. 10/31/2016 7:03 PM
11 Lack of psychiatric care. 10/31/2016 3:12 PM
12 Parents not driving kids to their appointments so kids miss their appointments.Once you have missed enough 10/31/2016 12:54 PM
appointments,the provider often refuses to see you again.
13 Transportation and parent work schedule for low income families is a huge barrier,which is why in school mental 10/31/2016 12:19 PM
health services are so important but at this point,still very scarce/spread thin
14 Insurance that has POOR coverage for mental health services(i.e.must meet$500 deductible before any coverage is 10/31/2016 8:51 AM
given)
15 Lack of accessible,comprehensive substance abuse treatment for Spanish speaking,uninsured clients.Only option is 10/28/2016 11:11 AM
El Futuro and it is NOT a comprehensive substance abuse treatment center.
16 The primary barrier i see is lack of follow-up and follow-through from the agencies. 10/28/2016 11:10 AM
17 No 10/28/2016 6:40 AM
18 Childcare 10/26/2016 8:44 PM
19 awareness among human service staff and medical professionals about red flags in adults and children and how to 10/25/2016 11:44 AM
support someone in accessing mental health services
20 No 10/22/2016 8:17 AM
21 Services for undocumented people are virtually non existent 10/21/2016 1:10 PM
22 very limited spanish speaking or karen/burmese speaking therapists.and very few sliding scale options or pro bono 10/20/2016 1:29 PM
for those without insurance
33 /48
Orange County Mental Health Gap Analysis Survey
23 Relationship and trust with people in the system 10/20/2016 11:23 AM
24 Availablility of providers.Limited number of adolescent mental health care providers.Or,if they exist,knowing who 10/20/2016 10:48 AM
and where they are.A directory would be helpful.
25 Most significant barrier is finding available adolescent psychiatrists. 10/19/2016 9:51 PM
26 access to services in northern area of county i.e.Hillsborough 10/19/2016 10:20 AM
27 People know very little about mental illness and do not know to seek help because they just think the person is 10/18/2016 9:02 PM
behaving badly
28 the mental health system is a broken system.this focus on outpatient services does not work. 10/18/2016 8:53 PM
29 Cultural awareness/acknowledgement of Mental illness 10/18/2016 1:10 PM
30 Not enough therapists truly trained to do trauma work with clients. 10/18/2016 11:41 AM
31 There are barriers to type of therapy.For example,for adolescents with anxiety and depression it is clear that the 10/17/2016 11:13 PM
evidence supports manual-based cognitive behavioral therapy,but other types of'counseling'are either not studied or
limited efficacy.It is hard to find therapists who will commit to this modality or as a clinician you are so disconnected to
the actual therapist through the Ime that you have no idea what they are doing.I've had patients say they're getting
'sandbox therapy'and i have no idea what the heck is even happening there.
32 Cardinal Innovations-policy is not consistent with Federal statute to provide behavioral health services regardless of 10/17/2016 7:10 PM
citizenship status.This not only undercuts current providers but discourages development of new services that are
needed in our county.Services for IDD individuals age 18-25 are very inadequate;especially for non-English speaking.
33 I would like to say that 1-4 are almost equal barriers to care for our patients. 10/17/2016 3:27 PM
34 Lack of reimbursement for interpretation through Medicaid.Number of steps required to enroll in mental health 10/17/2016 3:10 PM
services.Lack of cultural competency training for providers.
35 Appropriate referrals for trauma informed care. 10/17/2016 2:01 PM
36 more variety of screening tools 10/17/2016 9:09 AM
37 n/a 10/16/2016 6:38 AM
38 Parents have less insurance,English language ability than kids.Kids can't really recover if parents aren't treated. 10/15/2016 4:12 PM
39 n/a 10/15/2016 3:50 AM
40 N/A 10/14/2016 7:24 PM
41 It would be an advantage to have a mental health liaison between Cardinal and the Justice system 10/14/2016 2:45 PM
42 people lose there care when they age out and lose their Medicaid at 18 10/14/2016 2:31 PM
34 /48
Orange County Mental Health Gap Analysis Survey
Do you provide services in languages
other than English?
Answered:46 Skipped:105
Yes
No
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Yes 56.52% 26
No 43.48% 20
Total 46
35 / 48
Orange County Mental Health Gap Analysis Survey
Q12 If yes, which languages do you use?
Answered:27 Skipped:12
Spanish ■
Burmese
Karen
Mandarin
Other(please
specify)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Spanish 59.26% 16
Burmese 0.00% 0
Karen 0.00% 0
Mandarin 3.70% 1
Other(please specify) 37.04% 10
Total ■ IIM
# Other(please specify) ■ Date
1 Spanish,Burmese,Karen,Rohingya(It wouldn't let me check more than one) 10/26/2016 8:45 PM
2 I am fortunate to have access to interpreters through the school district so that I can work with some non-English 10/21/2016 1:11 PM
speaking families
3 All lanuages with the assistance of Language Line 10/19/2016 11:29 AM
4 We use telephonic interpreter services 10/18/2016 3:56 PM
5 won't let me select more than one.we serve people who speak all of the above 10/18/2016 8:37 AM
6 we use language line to provide in any language---limited though as using an interpreter. 10/17/2016 11:14 PM
7 none 10/17/2016 2:14 PM
8 All of the above using interpreter services 10/17/2016 12:41 PM
9 Spanish,others through interpreter. 10/15/2016 4:13 PM
10 Use telephone interpreting 10/14/2016 2:59 PM
36 /48
Orange County Mental Health Gap Analysis Survey
Q13 How do the Orange County residents
ages 0-25 you serve pay for mental health
and substance abuse services? Check all
that apply.
Answered:46 Skipped:10
Medicaid or
Health Choice
No
insurance/pa...
No
insurance/re...
Private
insurance
Other(please
specify)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices _ ■ Responses
Medicaid or Health Choice 76.09% 35
No insurance/pay out-of-pocket for services 50.00% 23
No insurance/receive services pro-bono 52.17% 24
Private insurance 45.65% 21
Other(please specify) 23.91% 11
Total Respondents: 46 1.111 1
MIL Other(please specify) . Date NI
1 School system 11/4/2016 9:58 AM
2 Grant funding 11/1/2016 2:27 PM
3 grant funded services 10/25/2016 11:46 AM
4 No fees for the services provided in the unit 10/19/2016 11:29 AM
5 sTuDeNt 10/18/2016 10:53 PM
6 Not sure 10/18/2016 1:55 PM
7 state/federal IDEA/Part C funds 10/18/2016 10:27 AM
8 No insurance-we bill through Cardinal for indigent care if person is citizen,otherwise we receive county funding, 10/17/2016 7:12 PM
foundation grants,contributions,or block grant funding from Cardinal
9 Receive through school system 10/17/2016 3:11 PM
37 /48
Orange County Mental Health Gap Analysis Survey
10 No charge just encouragement 10/17/2016 2:14 PM
11 I have no idea 10/15/2016 3:51 AM
38 /48
Orange County Mental Health Gap Analysis Survey
Q14 Where does your funding come from
for mental health and substance abuse
services to Orange County residents ages
0-25? Check all that apply.
Answered:39 Skipped:112
County drops 1
ated dollars
State-appropria
ted dollars
Federally-appro
priated dollars
Donation-based
I.
Grant-based
For-profit
Other(please
specify)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
County-appropriated dollars 48.72% 19
State-appropriated dollars 61.54% 24
Federally-appropriated dollars 48.72% 19
Donation-based 33.33% 13
Grant-based 38.46% 15
For-profit 12.82% 5
Other(please specify) 23.08% 9
Total Respondents: 39
2. Other(please specify) Date
1 not sure 11/4/2016 11:12 AM
2 Parents/Gaurdians 10/31/2016 6:31 PM
3 I can't directly provide these services myself,aside from informal counseling etc 10/31/2016 12:24 PM
4 Small amount from the school system(because we provide school-based groups) 10/26/2016 8:48 PM
5 I do not know 10/22/2016 8:18 AM
6 school sytsem employee 10/19/2016 9:54 PM
39 /48
Orange County Mental Health Gap Analysis Survey
7 unknown 10/19/2016 2:52 AM
8 School System employee 10/18/2016 1:55 PM
9 I just help in the church I 10/17/2016 2:14 PM
40 /48
Orange County Mental Health Gap Analysis Survey
Q15 How important are collaborative
partnerships in achieving the levels of
service your organization provides to
Orange County residents?
Answered:47 Skipped:104
Not at all
important
Low importance
Neutral
Moderately
important
Very important
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Answer Choices Responses
Not at all important 0.00% 0
Low importance 0.00% 0
Neutral
I 2.13% 1
Moderately important 21.28% 10
I
Very important 76.60% 36
Total
# Please explain: Date
1 Local Collaboratives like Making Connections,Family Success Alliance,and the Orange County System of Care 11/1/2016 2:28 PM
Collaborative are essential in providing services to Orange County residents.
2 I can't provide direct mental health services in school,so we rely completely on local agencies and our partnership 10/31/2016 12:24 PM
with them for these referrals and services
3 Collaborative partnerships are integral to the success of our mental health work with refugees and immigrants.We 10/26/2016 8:48 PM
partner with the Durham and CHCCS school systems,the local managed care organization,UNC School of Social
Work,Church World Service,and many more to provide accessible mental health care,transportation,child care,and
interpreter services for our clients.
4 the siloing that exists in this community makes everything harder for staff trying to engage families and connect them 10/25/2016 11:51 AM
with services and for families trying to manage stress.Collaboration needs top be supported and expected by all to
increase access and awareness of needs and services.
5 With these partnerships,we are able to provide better services at a faster rate than before.Accessibility has increased 10/22/2016 8:18 AM
with these partnerships,along with great training.
41 / 48
Orange County Mental Health Gap Analysis Survey
6 These partnerships allow us to contract with outside agencies and providers to begin to meet the needs of students 10/21/2016 1:13 PM
7 We work with Faith Connections 10/18/2016 10:54 PM
8 The Infant Toddler Program provides an integrated coordination of care for the children and families in our program. 10/18/2016 10:29 AM
We work collaboratively with medical,developmental,educational,and family support services to ensure needs are
met.
9 Increasingly important but ultimately we are on the hook for generating the$required and that$is not very dependent 10/17/2016 7:14 PM
on collaborative partnerships(except with FSA/UWGT funding).The main place collaborations are important
practically speaking is with the referrals to and from.
10 Interagency collaboration and communication about services is critical for early identification and efficient referral. 10/17/2016 3:15 PM
11 Unfunded and unsupported collaborative partnerships are not as helpful because it is costly to attend meetings,etc. 10/17/2016 12:44 PM
There are some referrals that do come out of the collaboratives.Unfortunately,we are all struggling under funding
challenges and ways to meet consumer need with fewer resources.
12 No one organization can do it on its own. 10/16/2016 6:40 AM
42 /48
Orange County Mental Health Gap Analysis Survey
Q16 What is Orange County doing well in
addressing the needs of its residents ages
0-25 with mental health and/or substance
abuse conditions? Please comment below.
Answered:62 Skipped:89
# Responses Date
1 I feel there is so much that still needs to be done with being able to help all residents with getting accessible mental 11/3/2016 3:57 PM
health care.There are so many that fit into grey area and still don't qualify for IPRS funds or can access Pro-Bono
Counseling.
2 School based mental health 11/2/2016 8:34 AM
3 In school support is helpful but not enough. 11/2/2016 6:46 AM
4 I have had good experience with some clinicians/clinics,the fact that a pro bono network exists is important,that 11/1/2016 5:28 PM
school based mental health is available(though limited and not enough to meet the need),that art therapy is an
option,that we have a lot of providers in the area,the trainings the collaborative have offered recently have been
good,that the police crisis unit has social workers who can respond
5 There seems to be increased recognition of the fact that transportation is a significant issue in Orange County, 11/1/2016 12:37 PM
especially for low-income families,and a barrier to receiving mental health services.Several organizations have
expanded to Orange County which is encouraging to see.Having a school-based therapist this year is also a HUGE
win!
6 Community and Student Support in schools work well together to get needed care and see that it is accessible. 11/1/2016 9:43 AM
7 Orange County has identified that there is a need for services. 10/31/2016 7:06 PM
8 In school treatment from Carolina Outreach one day per week 10/31/2016 5:32 PM
9 I think Orange County is doing about the same as other counties in the state in addressing needs.In general I think 10/31/2016 3:15 PM
North Carolina is abysmal in helping those who are afflicted with mental heath issues.
10 New substance abuse treatment option 10/31/2016 3:02 PM
11 Trying to implement more Mental Health services in the school system. 10/31/2016 12:19 PM
12 The Crisis Unit is a great resource. 10/31/2016 11:55 AM
13 Currently,there is a mental health therapist in the school system.The only unfortunate piece,is that it is one person 10/31/2016 11:43 AM
serving all the schools,and it is difficult to get a student seen.There have been a couple new agency that are now
taking referrals which is great,but making sure that the parent follows through is something that I see as a problem.
Once it leaves the school,due to confidentiality,the school liaison is now out of the picture.
14 Providing some services in schools and recognition and training around mental health 10/31/2016 11:33 AM
15 Organizing around all age groups and having partnerships in the community. 10/28/2016 4:37 PM
16 We have a variety of MH and SA providers in Southern Orange County for English speaking residents.We have well 10/28/2016 3:42 PM
qualified professionals in the area and UNC Health system.
17 There are good residential,comprehensive,substance abuse treatment facilities available in Orange County. 10/28/2016 11:14 AM
18 Public transportation is awesome-clients can get to where they need to go if we help them with the bus schedule. 10/28/2016 11:11 AM
19 There is a need to have quicker response to children in crisis in providing services.This is especially true for children 10/28/2016 11:00 AM
in foster care to avoid a disruption.
20 -provider lists are accessible-IPRS funding available-some providers take Medicaid 10/28/2016 10:27 AM
21 There are lots of resources for people with insurance coverage.There are also a lot of providers that offer in-home 10/28/2016 10:12 AM
services for their clients which increases treatment compliance.
22 Quality providers;Orange County has resources and is genuinely concerned about the MH and SA needs of children 10/28/2016 10:02 AM
and parents.
43 /48
Orange County Mental Health Gap Analysis Survey
23 It could be better! 10/28/2016 6:42 AM
24 collaborative groups-learning and sharing community health centers 10/26/2016 10:38 AM
25 focusing on early childhood and prevention,strengthening Freedom House as a community mental health clinic 10/25/2016 11:56 AM
26 Education,information,and accessibility. 10/22/2016 8:19 AM
27 Promoting greater collaboration among agencies and providers. 10/21/2016 1:18 PM
28 outreach and education 10/20/2016 10:25 PM
29 Identifying and providing ways for service providers to collaborate.We do have a lot of services available to children 10/20/2016 11:30 AM
and families in Orange County.The public transportation system in Chapel Hill is helpful.
30 Not sure. 10/20/2016 10:50 AM
31 not sure 10/19/2016 9:58 PM
32 Having counselors and social workers in the schools. 10/19/2016 12:55 PM
33 Family Success Alliance Orange County Collaborative for Children Chapel Hill Carrboro City school evaluation of 10/19/2016 10:22 AM
school based mental health
34 You are starting this survey,which means something will be done.Recognizing the problem is the first step to solving 10/18/2016 10:56 PM
it.
35 I do not see any improvements.The focus on outpatient services is a revolving door.The continuous impact on 10/18/2016 8:56 PM
society is not being helped by the current methodology being implemented by mental health providers or specifically
substance abuse counselors.
36 Great job with crisis unit in Chapel Hill PD!! 10/18/2016 3:58 PM
37 Many school guidance departments have personnel who can help or refer 10/18/2016 1:15 PM
38 OCHD is now offering IBH services to their patients. 10/18/2016 8:52 AM
39 Family Success Alliance,Integrative Behavioral Health Services in OCHD 10/18/2016 8:38 AM
40 Good leadership in the Health Dept has helped alleviate the anemic leadership at Cardinal since 2012.Providers are 10/17/2016 7:19 PM
relatively strong in the network.
41 Aware of the magnitude of the problem and doing proactive planning(like this survey)to help direct future 10/17/2016 7:18 PM
programming options
42 I am not familiar with the programs Orange County Provide.I am responding according the effort our organization is 10/17/2016 5:23 PM
providing to assist the Community
43 We do have services available in Chapel Hill/Carrboro area,not as many in Northern Orange.The time frame to get 10/17/2016 4:17 PM
an appointment can be very long wait.
44 Freedom House has been a great resource in the community. 10/17/2016 4:14 PM
45 Good question!!We have some good early intervention programs such as the Family Success Alliance and Early 10/17/2016 3:32 PM
Head Start/Head Start.The problem is when issues are identified,there are not enough resources to refer community
members to
46 Art Therapy Institute is doing an excellent job of serving the needs of refugee students in our County.More support is 10/17/2016 3:17 PM
needed.
47 not sure 10/17/2016 3:02 PM
48 not sure I am not aware of all that it does.I do like the Orange Partnership and think that it is a great way for informing 10/17/2016 2:16 PM
people of the threats that are out there.As well as helping people understand how to prevent and seek help.
49 Mental health and substance use is a public health issue.Appreciate the LHD taking a lead in prevention and 10/17/2016 11:19 AM
intervention.Integration of mental health services in the school system.Drug courts?
50 For English speaking clients with insurance there are many services for most conditions(not Adolescent Substance 10/17/2016 11:05 AM
Abuse).
51 more variety of mental health services in the county 10/17/2016 9:11 AM
52 Not sure.Just recently moved here 10/16/2016 6:40 AM
53 Good specialist services,ex.Kidscope,teach,oasis,school support etc 10/15/2016 4:14 PM
44 /48
Orange County Mental Health Gap Analysis Survey
54 first recognizing that there is a need for this population 10/15/2016 3:54 AM
55 Hard to say what Orange County is doing well,since we deal with most mental health issues over and over again. 10/14/2016 7:30 PM
56 talking about it,increasing public awareness and training 10/14/2016 6:51 PM
57 little 10/14/2016 6:16 PM
58 For the most part yes when it comes to mental health.I see far more substance abuse. 10/14/2016 4:32 PM
59 well linked to services through the health department! 10/14/2016 2:48 PM
60 good in areas of early intervention also people with Medicaid have vastly more options than uninsured 10/14/2016 2:37 PM
61 Good services for pregnant women-HBI,UNC perinatal psych,Horizons 10/14/2016 2:11 PM
62 Naloxone program is great. 10/14/2016 2:02 PM
45 /48
Orange County Mental Health Gap Analysis Survey
. How could Orange County do a better
job of addressing the needs of its residents
ages 0-25 with mental health and/or
substance abuse issues? Please
comment below.
Answered:68 Skipped:83
# Responses Date
1 I feel there needs to be more Bi-Lingual providers in our area which that can work with youth and families in OPT, 11/3/2016 3:57 PM
IIHT,MST and High Fidelity Wrap;etc settings.We need to have workers of Spanish and other dialects that can
communicate with our parents in their native language to help them navigate system and get connected to supports for
their juvenile and family especially in a crisis after hours.
2 More mental health clinics for children and youth with therapist who speak different languages.More school based 11/2/2016 8:34 AM
mental health.
3 More services in and out of school for all languages,cultures 11/2/2016 6:46 AM
4 more spanish speaking availability;more school based mental health spaces;more options for burmese/karen 11/1/2016 5:28 PM
students;crisis services;people not waiting in ER for extended periods for a psy bed
5 Though not limited to Orange County,there is such a need for more low-cost/sliding scale mental health services 11/1/2016 12:37 PM
available for kids,especially with options for school-based or home based services.There is also a real need for more
Spanish speaking therapists in Orange County.
6 Better long term care. 11/1/2016 9:43 AM
7 Advocating for services located in rural communities and for transportation that provides an ease of access. 11/1/2016 9:27 AM
Advocating for services through the MCO that are evidence-based services to treat multiple disorders,not just a select
few.Behavioral therapy for children with ASD is nil in northern Orange.Services are offered in Chapel Hill,but
providers won't drive an additional 10-15 miles north to provide services.Strong advocacy and push back is needed.
8 Actually doing something that will breakdown the existing barriers. 10/31/2016 7:06 PM
9 Work within the school building with students. 10/31/2016 6:32 PM
10 services available at school regardless of medical plan 10/31/2016 5:32 PM
11 Provide transportation.Quality of provides,nothing out there but intensive family home care. 10/31/2016 3:15 PM
12 Don't know 10/31/2016 3:02 PM
13 More transportation and providers with flexible hours(after 5pm and on the weekends) 10/31/2016 12:54 PM
14 Providing more mental health therapist.They waiting list are long usually for our students to get the care that they 10/31/2016 12:19 PM
need.
15 More affordable and accessible mental health support.Families have difficulty taking off work to transport their children 10/31/2016 11:55 AM
and many do not have insurance.
16 Providing more mental health therapist within the schools.There are many of our children suffering with mental illness 10/31/2016 11:43 AM
and not only the children,but their parents.If there was any way that Orange County could assist the parents better,I
think that would definite assist the students.
17 Provide mere resources with in the school day 10/31/2016 11:33 AM
18 Keep an updated list and how to guide for navigation of resources. 10/28/2016 4:37 PM
19 We need more bilingual MH and SA professionals(Spanish and Burmese).Need more services in the northern part of 10/28/2016 3:42 PM
the county.More DBT trained professionals willing to see clients with Medicaid or without health insurance.More
appointment hours conducive to people who work first shift hours.Better education with providers about the role of the
courts with DSS involved children and families and the timelines we operate within.
20 Removing barriers to accessing treatment.Creating agreements with quality providers so they will serve Orange 10/28/2016 11:14 AM
County Medicaid clients(i.e AHB,CCFH)
46 /48
Orange County Mental Health Gap Analysis Survey
21 The difficulties I have are with specific agencies,and the difficulties are likely due to lack of funding and staff turnover. 10/28/2016 11:11 AM
22 Allow multiple services(front load)for a family to prevent a crisis versus waiting for the crisis to happen before 10/28/2016 11:00 AM
additional services can be used.
23 -transportation to appointments-more quality services through IPRS or Medicaid 10/28/2016 10:27 AM
24 I do not have any suggestions at this time. 10/28/2016 10:12 AM
25 Waiting list for services is too long. 10/28/2016 10:09 AM
26 Collaboration between providers and services. 10/28/2016 10:02 AM
27 Have easier accessibility! 10/28/2016 6:42 AM
28 Teenagers and young adults ages 18-25 are often lacking insurance,because their Medicaid/Healthchoice is no 10/26/2016 8:50 PM
longer valid.We then have to see these young adults pro-bono or use grant funding,and because of this lack of
insurance,many of them are slipping through the cracks,and not getting the mental health resources they need.
29 taking care of non-english speaking populations more work inside schools 10/26/2016 10:38 AM
30 more trauma screening in medical practices,more promotion of Stewards of Children child sexual abuse prevention 10/25/2016 11:56 AM
initiative.More black,Latino and Burmese/Karen therapists.More services offered through home visiting and services
embedded in schools and medical practices.More engagement with high risk populations and communities.More
awareness across all sectors-Mental Health First Aid for all!!!
31 Keep improving the same way that it has been.I do not see any major areas that need improvement. 10/22/2016 8:19 AM
32 Need for more facilities for uninsured and underinsured people to access care.Need for public health campaign to 10/21/2016 1:18 PM
address stigma and prevalence of mental health issues in the community.Need for greater funding in schools to
address variety of mental health issues and provide workshops to caregivers to address stigma and disseminate
resources.
33 provide more services for uninsured,spanish speaking and karen/burmese speaking,more sliding scale.and more 10/20/2016 1:35 PM
school based options,as many students cannot get to appointments in the community due to transportation issues,
parent schedules,etc.
34 We need more accessible SA services for all(undocumented,no insurance,insurance).While there are a lot of 10/20/2016 11:30 AM
services and providers know each other,families do not always know what is out there.Schools overall are not
positioned to respond to students with mental health issues beyond being reactive and punitive.Increasing support for
undocumented families is a specific need.
35 A comprehensive guide to available services with provider names,insurance,languages spoken,any specialty area 10/20/2016 10:50 AM
(i.e.child/adolescent/eating disorder/school avoidance,etc.)address,and contact information would help.
36 Adolescents often tell me how negative the UNC ER experience is when referred there for a crisis.I feel adolescents 10/19/2016 9:58 PM
seldom get the help they need--perhaps because they aren't ready to accept help yet,
37 Spanish language therapists,funding for undocumented people,flexible clinic hours-evenings and weekends,more 10/19/2016 5:45 PM
services in schools
38 More affordable assistance and help with language issues. 10/19/2016 12:55 PM
39 Reducing stigma by providing more education and exposure. 10/19/2016 11:30 AM
40 More public agency involvement in Orange County System of Care Collaborative 10/19/2016 10:22 AM
41 Making teachers and other professionals understand that there are no bad kids.No kid wants to have bad grades,no 10/18/2016 10:56 PM
kid wants to be labelled a misfit.It's just what happens when you are dealing with a mental health issue.Also there
should be free services for mental health just like for a physical injury
42 We need more school personnel educated about mental health and we need more providers for adolescents 10/18/2016 9:03 PM
43 provide more long term,intensive,supervised care. 10/18/2016 8:56 PM
44 Educate teachers,parents and students about different kinds of mental health problems,how to identify them and 10/18/2016 1:15 PM
provide resource information.Develop a few centralized outpatient service center facilities for the gamut of pediatric
MH problems-to simply access to MH care
45 Mental Health First Aid Training for all health department staff.More robust access for clients/citizens with urgent 10/18/2016 8:38 AM
mental health needs.More community collaboration with safety net providers and mental health providers,police,
UNC ED,UNC psychiatry.
46 Create a 10-20 year plan for growing and sustaining services(alas,the wildly unpredictable GA makes such an 10/17/2016 7:19 PM
endeavor fool hardy-let's hope for change at that level).But this gaps analysis is a good idea and important first step!
47 /48
Orange County Mental Health Gap Analysis Survey
47 Better coordination of various providers;updated resource book of providers;facilitate having more practitioners 10/17/2016 7:18 PM
provide"in kind"care to at least one person in need.
48 Promote the services with the schools,religion base organizations,Community Health centers, 10/17/2016 5:23 PM
49 We need more services for non-insured individuals.Reduce the wait time from when a call is made to see someone to 10/17/2016 4:17 PM
when a person is actually seen by someone.
50 More outreach assessment and prevention.More providers and free options for mental health care. 10/17/2016 4:14 PM
51 We need more mental health providers period.We need more therapist who speak Spanish and other languages,we 10/17/2016 3:32 PM
need more therapists that take Medicaid and health choice and sliding scale.We need mental health services
embedded in all our schools and community health centers.We need more alternate therapies,such as art,music and
equine therapy.We need more to support our fantastically diverse community who often come from war torn parts of
the world and have PTSD and trauma as a result of that.
52 Mental health services for undocumented immigrants continues to be a huge gap in services.In addition,the lack of 10/17/2016 3:17 PM
Medicaid reimbursement for interpreters services provides a serious barrier to care for refugee populations.
53 more Spanish speaking services for folks with medicaid or those with no insurance.get Cardinal replaced. 10/17/2016 3:02 PM
54 Not sure 10/17/2016 2:16 PM
55 Affordability.Accessibility.Acceptability. 10/17/2016 11:19 AM
56 Advocate for$for services for undocumented individuals and families.Advocate for additional quality in patient child 10/17/2016 11:05 AM
and adolescent in patient beds.Too many young people spending 4-5 days or more in UNC Psychiatric ER waiting for
beds and still being sent as far away as Greensboro or Wilmington.
57 Use a consistent screening tool for individuals under 5 and encourage all providers to screen and discuss MH issues 10/17/2016 10:41 AM
with parents as options.For those over 5,the need to reduce stigma is essential.
58 better screenings and that patients are screened often/early 10/17/2016 9:11 AM
59 Follow up with them more often. 10/16/2016 6:40 AM
60 We miss El Futuro in the county. 10/15/2016 4:14 PM
61 education 10/15/2016 3:54 AM
62 N/A 10/14/2016 7:30 PM
63 task forces on the street made up of EMS,social worker and LEO.making 24 hr referral easier.facilitating follow-up 10/14/2016 6:51 PM
(see task force)
64 more available services in timely manner 10/14/2016 6:16 PM
65 Unknown how to deal with substance abuse since patients rarely accept help when presented. 10/14/2016 4:32 PM
66 Cardinal could help professionals and all navigate the mental health system instead of trying NOT to serve clients. 10/14/2016 2:50 PM
They are an insurance company worried about saving money and not serving youth.
67 setting up better agreements with DSS and other community partnerships 10/14/2016 2:48 PM
68 lack of services for autism/MH,especially for teens people turning 18 and losing their Medicaid are dropping out of 10/14/2016 2:37 PM
care and becoming unstable there are just not enough Spanish-speaking therapist and there will probably never be
enough to keep up with the demand;there needs to be a consideration of better interpreter services this needs to be
considered for Spanish-speaking,Burmese and Karen as well
48 /48