Introduction Who We Serve The Needs in Our Community Priorities Our Plan... 7

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1 Community Health Needs Assessment Implementation Plan November 2013

2 Table of Contents Introduction... 3 Who We Serve... 4 The Needs in Our Community... 5 Priorities... 6 Our Plan... 7 Page 2

3 Introduction Founded in 1886 as an orphanage for children who had been left behind by society, Clarity Child Guidance Center (Clarity CGC) is the premiere resource for children in need of mental health treatment in San Antonio and Central Texas. Clarity CGC is staffed with over 250 professionals dedicated to the mission of helping children and families suffering from mental illness. Our treatment team consists of psychiatrists, psychologists, licensed professional counselors, caseworkers, therapeutic recreation specialists, and nurses. Southwest Psychiatric Physicians is our onsite team of doctors providing outpatient and inpatient care. They represent the largest group of child and adolescent psychiatrists in South Texas as well as the largest group of bilingual psychiatrists in all of Texas. Today, Clarity CGC is the only nonprofit in the region providing a continuum of mental health care for children aged 3-17 suffering from serious disorders. Clarity CGC services include assessments (psychiatric, developmental, and neuropsychological) and individual, family and group therapy. Intensive services include day treatment and acute inpatient care at our children s 52-bed psychiatric hospital. Wraparound supports include case management for families as well as education continuation for our patients via our on-campus school. Art, music, and play therapy are also integrated into our treatment plans. Mission To help children, adolescents, and families cope with the disabling effects of mental illness and improve their ability to function successfully at home, at school, and in the community. As a result of our mission, we help heal young minds and hearts. Values Respect: we believe in the value and dignity of every child and every family and put their needs before ours. Compassion: we believe that understanding children and caring for them unconditionally and consistently are the most powerful agents of change. Openness: we believe in the importance of collaboration, in learning from one another, and in change. Commitment: we find meaning in our work and we believe in individual responsibility, in work done with enthusiasm, perseverance, and great care in every task. Page 3

4 Innovation: we believe in always learning and improving our methods and services and in the development of best practices. Purpose We exist to transform the lives of children and families. Who We Serve Clarity Child Guidance Center is dedicated to children ages 3 through 17 and their families. Our center serves the diverse community of South Texas. While 80% of our patients live in Bexar County, where the county seat is San Antonio, the other 20% reside in surrounding rural counties and as far south as the border regions. The rural and border regions are seeking treatment at our center due to the lack of local mental health resources. A detailed description of our community is included in the Community Health Assessment we conducted prior to developing this plan. Here are some of the key facts: Bexar County children s population is projected to grow by 6.9% by 2017 to reach 511,067, slightly under the overall Texas growth but 2.5 points faster that the U.S. growth. In Bexar County, the Hispanic community is the fastest growing group and will account for 69% of the children s population in Anglos will represent 19% and African Americans 6.7%. 24.4% of children live in poverty in Bexar County, compared to an average rate of 20% in the U.S. In 2011, there were 5,915 incidences of child abuse in Bexar County; these children are very likely to suffer from trauma and mental health problems. 40% of Bexar County children live in a single-parent households, compared to 32% for the U.S. Single parenthood (90% of which is comprised of mothers) is a high predictor of poverty since 41.5% of single mothers in the U.S. live in poverty compared to 8.7% of married couples. Children receiving welfare and living with a never-married caregiver are five-times more likely to have elevated scores for mental health risks. Based on the rate of uninsured children in Texas, 40,710 children in Bexar County are not insured. If Medicaid expansion is ever implemented in Texas, the current enrollment of Medicaid and CHIP children would grow by 20%. Page 4

5 The Needs in Our Community Here again, the needs in our community are incorporated in the Community Health Needs Assessment we conducted prior to developing this plan. Here are some of the key facts: One in five children has one or more mental, emotional, or behavioral disorders, resulting in an estimated 40,000 to 80,000 children in need of services in the Bexar County area alone. One in 10 children has a mental health problem serious enough to impair how they function at home, at school, or in their community. Only 20% of children with a mental health condition receive services. The lack of access is caused by stigma, lack of providers or services, poverty, under and uninsured children, and the complexity of the system of care. Texas ranks last when it comes to State expenditures for children s mental health; with a budget per capita that s one-fourth the average spending of other states. It takes three to six months to schedule a first appointment with a child psychiatrist in Bexar County, a trend that is not unique to our community. As a result of the lack of services, an increasing number of children end up in the emergency room (ER) when they have a mental health crisis. An ER setting is not designed to treat these conditions. The average wait in an ER for a child suffering from a mental illness who presents in an ER setting is 10 to 12 hours. Hospitals have coined the term boarding to describe the wait for services for children with a psychiatric condition. Less than half of them receive follow-up outpatient mental health treatment. Bexar County has four facilities that provide children s psychiatric beds for acute level of care. A 2010 study conducted by Methodist Healthcare Ministries demonstrated a deficit of 65 beds in our community. At Clarity CGC we experience it firsthand when we have to turn away families due to extremely high census rates. Half the children who are not treated drop out of high school (50%), they are twice as likely to start using alcohol and drugs to self-medicate, and some will end up in juvenile detention or dead. High school attrition rates in Bexar County are 37% compared to 27% for Texas. The population in juvenile facilities has grown by 39% between 2000 and 2010, and the number of deaths (all ages) due to drugs and alcohol has grown by 67% in the last 10 years. A 2012 survey conducted with San Antonio medical and mental health providers showed that, out of 189 respondents: o 59% thought that there were not enough mental health facilities to meet the needs of children o 70% thought we should increase the availability of outpatient clinical services o 64% thought we should create a regional psychiatric ER for children Page 5

6 Priorities As a non-profit private hospital, Clarity CGC has the capability and capacity to the following: Partner with the community to receive funding from individuals, corporations, foundations and the local United Way. Re-invest funds directly into our services rather than a dividend/shareholder. Ability to recruit top professionals at competitive costs, particularly due to our affiliation with the University of Texas Health Science Center at San Antonio (UTHSC-SA). In return, with a strong and unwavering focus on our mission, we have a responsibility to: Meet the need of any family regardless of their ability to pay. Make treatment increasingly accessible. Provide the best services possible by optimizing the use of resources. Educate the community. In evaluating the results of our key stakeholder interviews and survey respondents, we ranked the opportunities identified in the following manner: Does the opportunity align with our values, our mission and our vision? Is it a core competency currently? If not, is it a complementary core competency that strengthens our value proposition? Is there another organization or entity that could better address the need versus Clarity CGC? Is there a viable funding stream for sustainability purposes? Does the opportunity create the foundation to impact improvements in other areas of need, if implemented? What are the benefits in quantifiable terms of implementing the opportunity? Conversely, what consequences occur if it s not implemented? Leadership and staff evaluated the opportunities revealed in the Community Health Needs Assessment and with the guidance of the Board of Directors, developed a three-year strategic plan to address gaps in the community. Items prioritized for immediate development were the following: 1. Increase physical access to outpatient psychiatric services 2. Implement technology based solutions to increase access to outpatient services 3. Increase access for acute care Page 6

7 4. Reduce the number of children going to a local ER setting for a mental health crisis where no care is available Our Plan Based on the priorities described above our plan is as follows: 1. Deploy neighborhood based clinics over a period of 3-5 years to expand access to mental health care, alleviating wait times for initial care and transportation issues. The treatment model at the clinic will expand traditional longer-term outpatient therapy to include a brief psychotherapy model. Also included in the treatment model will be medication management and day treatment, which is more formally known as partial hospitalization. 2. Implement the technology infrastructure for telepsychiatry at the first Clarity Child Guidance Clinic. This infrastructure will also be implemented at the main campus, creating a hub and spoke approach to increasing access to outpatient care. The infrastructure will be in place in 2014, with piloting and testing of telepsychiatry approaches in following years. 3. Expand our current 52-bed hospital by 14 beds, effectively creating another unit to provide acute services for children at risk of harm to self or others. Construction will begin in early 2014, and the bed expansion portion of our construction timeline will conclude by early During our bed expansion, create another six beds that are designated as a regional children s psychiatric emergency service. This reduces the number of children presenting at busy local emergency rooms that lack psychiatric care, while increasing access to acute care, due to a 65 bed shortage. The first Clarity Child Guidance Clinic will open in early 2014 and will be located in the west side of San Antonio. This area was chosen because of its fast growing population, which also includes one of the largest concentrations of Medicaid enrolled children in the county. Once the model is proven with this location, we will look to expand to the south, east, and north sides of San Antonio over subsequent years. The expansion of 14 acute care beds and the addition of six beds for a regional children s psychiatric emergency service creates a ripple effect across the campus. Because of the increased number of patients, we also need to expand other services, from day treatment, therapeutic recreation, to the on-site school and dining hall. During this period of construction, we will also move our current outpatient campus from a center 1.5 miles away on Babcock road to our main campus on Tom Slick road to leverage the synergies within our continuum of care. UTHSC-SA s Division of Child and Adolescent Psychiatry will be moving into Page 7

8 this facility, furthering the partnership between our two organizations. The blueprint of the future facility follows. The total cost of this expansion is $15 million. Page 8

9 Needs Not Addressed The remaining items identified in the Community Health Needs Assessment surveys and interviews are in research mode to determine if they can be queued in priority to be implemented following these four major initiatives. Items such as a lack of parent/guardian knowledge about pathways and bridging disparate health systems could be resolved with the implementation of Patient Navigator professionals, who work closely with the family to ensure successful entry to care and the necessary after care which helps to prevent costly and traumatic readmissions. Once the clinics and main campus expansion have been completed, Clarity CGC can also look at offering additional levels of care, such as an after school care option, preschool program, or respite care. Implementation of these additional items requires first the deployment of the aforementioned prioritized items and additional research, funding, and Board approval. Monitoring and evaluation Clarity CGC utilizes the Child and Adolescent Service Intensity Instrument (CASII) and the Child Global Assessment Scale (C-GAS) to monitor a child s progress and record in our electronic medical records system. The CASII has been developed over the past two decades by the American Academy of Child and Adolescent Psychiatry (AACAP). The CASII is currently used as a core measure in the public mental health systems in several states. We will measure success through admission and census reports that are prepared and reported monthly through our leadership team. Further, the Quality Assurance team (composed of senior leaders at Clarity CGC) and the Board of Directors will monitor key performance indicators related to financials, voice of the consumer, process efficiency, and other metrics. In closing We live in difficult yet hopeful times concerning children s mental health. The difficulty in children s mental health relates to the immense need for care, with the combination of stigma, lack of funding and psychiatrists, that often leads to non-treatment. However, hope abounds as public awareness is growing - which could yield an increase in funding and support from the community. Hope also resides within our treatment team, who believes strongly that every child has the opportunity to improve as a result of our care. Our job is to continue to provide excellent services to the families we serve, and to create more capacity so that the treatment needed by children is much more accessible. As a result of our services, we help heal young minds and hearts. Page 9

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