Co-occurring MH/SA Disorders

Transcription

1 Maine Behavioral Health Data Forum Co-occurring MH/SA Disorders Data about Screening, Prevalence & Service Use January 5, 2012 Helen Hemminger, Quality Reporting Manager APS HealthCare 1

2 Introduction Introduction: What are co-occurring disorders? Why are co-occurring disorders important? What are the national statistics about co-occurring disorders? Screening: AC-OK screening data for FY 2011 Prevalence & Diagnosis: APS co-occurring diagnosis data for FY 2011 Service Outcomes: Service Use History (APS reviewed services) Are people with co-occurring disorders are more likely to be admitted to residential care, inpatient psychiatric and inpatient substance abuse treatment? 2

3 Introduction: What is co-occurring disorder? For the purposes of the discussion today, the definition of co-occurring disorders that we will be using is: BOTH At least one type of substance use diagnosis AND At least one type of mental health diagnosis Other definitions of co-occurring disorders could be for mental health and intellectual disabilities, or even more broadly, to indicate the presence of two or more health conditions. 3

4 Why is integrated treatment important? According to multiple sources, integrated treatment for persons with co-occurring disorders works best. Addressing mental and substance use conditions at the same time is associated with lower costs and better outcomes. It leads to Improved quality of life Improved psychiatric symptoms and functioning Reduced substance use Decreased hospitalization Increased housing stability Fewer arrests 4

5 Prevalence of Co-occurring Disorders in USA According to SAMHSA, the national Substance Abuse and Mental Health Services Administration in United States: Nearly 10 million people have co-occurring disorders; that is, they have both mental and substance use disorders. SAMHSA cites 3 sources for its prevalence estimates: 1. National Survey on Drug Use and Health (NSDUH) 2. National Comorbidity Survey Replication (NCS-R) 3. Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions 5

6 More national data on prevalence According to the National Survey on Drug Use and Health: Four percent of all adults have co-occurring disorders 1. Adults with any mental illness and substance use disorder 9.8 million (19.7% of all 45.1 million adults with any mental illness) 2. Adults with serious mental illness and substance use disorder 2.8 million (25.7% of all 11 million adults with serious mental illness) 3. Among adults with any substance use dependence 8.9 million (42.8% of all 20.8 million adults with substance abuse dependence) had cooccurring mental illness 6

7 National data on access to treatment According to the National Survey on Drug Use and Health: Among the 2.8 million adults with co-occurring substance use disorder and a serious mental illness (SMI): 62% received substance use and/or mental health treatment 38% did not receive any treatment. Among the 8.9 million adults with substance use dependence and mental illness: 44% received substance use treatment or mental health treatment 14% received both mental health treatment and substance use treatment 32% did not receive any treatment. 7

8 Screening for Co-occurring Disorders in Maine The AC- OK is a preliminary screening tool that indicates who may benefit from a more comprehensive assessment for cooccurring disorders and/or for trauma. As of October 2009, for MaineCare members the AC-OK is the screening tool to be used unless an exception is made. See The AC-OK results are entered into APS CareConnection System as part of the continued stay review process for services authorized by APS. AC-OKs completed & entered in APS System Service Type FY 10 FY 11 Increase % Increase Adult Community Integration (CI) 2,779 4,718 1,939 70% Child & Adult Outpatient Services 2,508 6,250 3, % 8

9 The AC-OK Questions about Substance Abuse 10. Have you been preoccupied with drinking alcohol and/or using other drugs? 11. Have you experienced problems caused by drinking alcohol and/or using other drugs, and you kept using? 12. Do you, at times, drink alcohol and/or use other drugs more than you intended? 13. Have you needed to drink more alcohol and/or use more drugs to get the same effect you used to get with less? 14. Do you, at times, drink alcohol and/or use other drugs to alter the way you feel? 15. Have you tried to stop drinking alcohol and/or using other drugs, but couldn t? 9

10 Screening Results from AC-OKs in APS System The data for AC-OK screenings entered into APS system are compiled separately for Child & Adult Outpatient Therapy Adult Community Integration Services (CI) For each service, APS computed: # AC-OKs entered into APS system. # of AC-OK with positive screen for- mental health substance abuse trauma 10

11 Positive screen for substance-abuse on AC-OKs CI Female (2862 AC-OKs) 56% CI Male (1856 AC-OKs) 62% Outpatient Female (3773 AC-OKs) 58% Outpatient Male (2477 AC-OKs) 65% 0% 20% 40% 60% 11

12 Positive screen for substance-abuse in Outpatient Services Under 12 (598 AC-OKs) 26% (805 AC-OKs) 48% (405 AC-OKs) 67% (595 AC-OKs) 70% (3790 AC-OKs) 67% Over 65 (57 AC-OKs) 54% 0% 10% 20% 30% 40% 50% 60% 70% 12

13 Positive screen for SA in Adult OP Services & in CI 80% 60% 79% 65% Outpatient AC-OK % SA CI AC-OK % SA 74% 72% 69% 68% 66% 57% 53% 52% 65% 62% 63% 65% 40% 20% 0% Aroostook Hancock, Washington, Penobscot & Piscataquis Kennebec & Somerset Knox, Lincoln, Sagadahoc & Waldo Androscoggin, Franklin & Oxford Cumberland York 13

14 Estimated Rates of co-occurring disorders in Maine FY 2010 MaineCare Claims data: MaineCare members in case management or other community support services or residential treatment including psychiatric hospitals who have co-occurring disorders FY 2011 APS MaineCare Authorization data MaineCare members in any APS reviewed service, including outpatient services, who have co-occurring disorders Rate of Co-occurring Disorders FY 2010 Maine Care Claims Members in intensive MH or SA services FY 2011 MaineCare APS Authorization Members in an APS reviewed MH/SA Service Adults 23.1% 21.7% Children 2.9% 2.9% Total # with cooccurring disorders 8,764 11,098 14

15 APS Rates of Co-occurring Disorders by Gender & Age Female (n= 5619) 14.7% Male (n= 5478) 17.5% Children (n=24489) 2.9% Adults (n=44843) 23.1% Ages (n= 8964) 8.0% Ages (n=4127) 13.9% Ages (n=4434) 20.5% Ages (n=35003) 24.9% Ages 65+ (n= 1279) 14.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 15

16 APS Rate of Co-occurring Disorders by SMI Service Adults who used an SMI service (n=14125) 37% Adults who did not use an SMI service (n=29773) 20% CI (n= 13028) 35% ACT (n =1073) 63% 0% 10% 20% 30% 40% 50% 60% 7 16

17 APS Rate of Co-occurring Disorders by Regions Aroostook County (n=3912) Washington & Hancock Counties (n=3551) Piscataquis & Penobscot Counties (n=9082) 14% 14% 16% Androscoggin, Franklin & Oxford Counties (n=11354) 23% Knox, Lincoln, Sagadahoc & Waldo Counties n= 7230) Kennebec & Somerset Counties (n=12022) 13% 13% Cumberland County (n=11941) 16% York County (n=8956) 15% 0% 5% 10% 15% 20% 25% 17

18 Service Use and Co-occurring Disorders How does the presence of co-occurring disorders affect the outcomes of treatment? 1. Children in Home & Community Based Treatment (HCT) 2. Children in Targeted Case Management (TCM) 3. Adults in Assertive Community Treatment (ACT) 4. Adults in Community Integration (CI) 18

19 Outcomes among Youth with Co-occurring Disorders Youth in HCT with co-occurring disorders are twice as likely to go to inpatient and three times more likely to enter residential treatment. Though only 4% of those in TCM have co-occurring, disorders those youth are four times more likely to go to residential treatment and three times more likely to enter the hospital. HCT in FY 2011 # in HCT % in HCT w. cooccurring # inpatient MH admission % HCT w. inpatient MH admission # to Child PNMI % HCT to PNMI Co-occurring 206 5% 54 26% 32 16% Not co-occurring % % 239 6% HCT Total 4, % % TCM in FY 2011 # in TCM % in TCM w. cooccurring # inpatient MH admission % TCM w. inpatient MH admission # to Child PNMI % TCM to PNMI Co-occurring 427 4% % 69 16% Not co-occurring % 677 7% 431 4% TCM Total 10, % % 19

20 Outcomes for adults with co-occurring disorders The 1/3 of the population in CI that has co-occurring account for 54% of the inpatient psych admissions and all of the inpatient SA. For those in ACT with the most serious mental illnesses, cooccurring status does not affect rates for inpatient psych. CI Service FY 2011 # in CI % in CI w. cooccurring # inpatient MH admission % CI w. inpatient MH admission # Inpatient SA % CI w. inpatient SA admission Co-occurring 4,527 35% % 221 5% Not co-occurring 8,501 65% 572 7% 0 0% Total CI 13, % % ACT service FY 2011 # in ACT % in ACT w cooccurring # inpatient MH admission % ACT w. inpatient MH admission # Inpatient SA % ACT w. inpatient SA admission Co-occurring % % 68 10% Not co-occurring % % 0 0% Total ACT 1, % % 20

21 Co-occurring Disorders in CI by County Percent of people in CI with co-occurring disorder York Kennebec Somerset Washington Knox Sagadahoc Penobscot Cumberland Androscoggin Median Hancock Aroostook Piscataquis Lincoln Oxford Waldo Franklin 21% 29% 27% 26% 26% 25% 32% 32% 32% 35% 34% Median Line 38% 38% 38% 41% 41% 41% 0% 10% 20% 30% 40% 21

22 Geographic variation in co-occurring disorders & in overall rates of inpatient admissions Percent of people in CI with Co-occurring Disorders & Percent of all people in CI with an inpatient psych admission by County 50% % People in CI with Co-occurring 20.0% 40% 30% % all people in CI w. an inpatient admission 34% 35% 32% 32% 29% 25% 26% 26% 38% 38% 38% 41% 41% 41% 15.0% 10.0% 20% 21% 10% 5.0% 0% 0.0% 22

23 Outcomes for people in CI with co-occurring The Coastal Region of Lincoln, Waldo & Knox has higher inpatient admissions rates than the other counties in Maine. Most of the rural counties have inpatient admission rates that are half those in the coastal counties. 23

24 Outcomes of people in CI without co-occurring 24

25 Discussion questions Does the screening and prevalence data for cooccurring disorders surprise you in any way? While people in CI with co-occurring disorders have higher rates of inpatient psych admissions, than others in CI, that does not explain why some counties have higher rates of inpatient admissions. What other factor might be important? How is your organization working with people with co-occurring disorders to improve outcomes? Helen Hemminger APS Healthcare Quality Improvement Manager 25