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Monterey County Behavioral Health Bureau Health Equity Report Fiscal Year

Monterey County Behavioral Health Bureau Health Equity Report Fiscal Year The aim of this report is to provide a comprehensive analysis of Medi-Cal eligible Monterey County Behavioral Health (MCBH)
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Monterey County Behavioral Health Bureau Health Equity Report Fiscal Year The aim of this report is to provide a comprehensive analysis of Medi-Cal eligible Monterey County Behavioral Health (MCBH) clients who received mental health services in Fiscal Year 17/18, and to promote health equity within the county mental health system. The report addresses the health equity goal for MCBH, that is, to increase the Hispanic/Latino clients served by seven percentage points, by the end of FY 19/20. Health inequities refer to inequalities that are deemed to be unfair, unjust, avoidable, or unnecessary, that can be reduced or remedied through policy action which includes improving access to resources and health outcomes. 1 To quantify mental health disparities, we have used Medi-Cal eligible population of Monterey county as a benchmark, to compare the socio-demographic factors of our MCBH clients. We define a service gap percentage as the remediable difference among groups of people that leads to health inequity. The key social determinants of health addressed in this report include racial/ethnic population, age, gender, Preferred spoken language, and region of residence. The average Medi-Cal enrollees for Monterey county in the year 2017 was about 188,847, among who, 76% were Hispanic/Latino. The median age of residents was about 34 years. The prevalence of mental illness among medi-cal eligible population of Monterey County in the year 2017 was approximately 6.7%. MCBH functions as the safety net mental health provider for the county. We served about 12,714 clients in FY 2017/18, among whom 70 percent were Medi-Cal eligible clients. Over the last decade, we have seen a steady increase in the number of clients served especially since FY 2013/14 but the percentage Hispanic/Latino clients have remained steady at 54%. 2 There has been approximately 37% increase in the number of clients accessing emergency room(er) at Natividad Medical Centre for crisis intervention services in the last 3 years. 62% of those seeking care in ER were Hispanic/Latino clients. Early access to services, can help reduce the needless expenses, severity of illnesses and wait-times in ER to those in true need. Hence, community solutions targeted towards increasing awareness and seeking help for mental illness will provide the best clinical outcome for clients and best economical outcome for MCBH. Figure 1: Average Service Value per Medi-Cal eligible MCBH Client in FY 17/18 1. World Health Organization. Equity D3-Data Driven Decisions FY 17/18. AGE DISTRIBUTION The average age of our clients has remained at approximately 29 years of age, in the last 5 years. The average age of Hispanic/Latino clients in FY 17/18 was at least 9 years lower than the mean age of Non- Hispanic/Latino clients. The MCBH client age-group composition in FY 17/18 when compared to that of the Medi-Cal eligible population of Monterey county, showed gaps in services to under 5years old and above 60 years old age-groups (Figure 2). In the 60 years or older age-group, there were 15% more White/Caucasian clients than Hispanic/Latino clients, and received approximately 40 percent more services than the younger ones. The figure 3, shows the age-wise disparity in service delivery to Hispanic/Latino MCBH Medi-Cal clients in FY 17/18. Interestingly, the large service gap among Hispanic/ Latino clients is contributed by older clients not availing sufficient services from our Bureau. Figure 2: Service Gap in Age Category among Medi-Cal MCBH Clients in FY 17/18 Figure 3:Age Distribution of Hispanic/Latino MCBH Medi-Cal Clients in FY 17/18 Under 5 years age-group: Total number of clients served: 375 Female MCBH Clients percentage: 41% Under-serving Female clients by 9 percentage points Preferred spoken language among MCBH Clients: 41% Spanish and 56% English Under-serving Spanish-speaking clients by 6 percentage points Percentage of Hispanic/Latino MCBH Clients: 68% Under-serving the Hispanic/Latino population by 4 percentage points Under-serving the Salinas Valley Region 6-15 years age-group: Total number of clients served: 1999 Comprised 12% of the ER crisis services in FY 17/18 Female MCBH Clients percentage: 44% Under-serving Female clients by 5 percentage points Preferred spoken language among MCBH Clients: 23% Spanish and 73% English Under-serving Spanish-speaking clients by 14 percentage points Percentage of Hispanic/Latino MCBH Clients: 70% Under-serving the Hispanic/Latino population by 16 percentage points Under-serving the Salinas Valley and North County Regions 16-25 years age-group: Total number of clients served: 1628 Comprised 26% of the ER crisis services in FY17/18 Female MCBH Clients percentage: 54% Under-serving Female clients by 1 percentage points Preferred spoken language among MCBH Clients: 10% Spanish and 86% English Under-serving Spanish-speaking clients by 37 percentage points Percentage of Hispanic/Latino MCBH Clients: 68% Under-serving the Hispanic/Latino population by 13 percentage points Under-serving the North County Region 26-59 years age-group: Total number of clients served: 4207 Comprised 56% of the ER crisis services in FY17/18 Female MCBH Clients percentage: 55% Under-serving Female clients by 2 percentage points Preferred spoken language among MCBH Clients: 14% Spanish and 83% English Under-serving Spanish-speaking clients by 33 percentage points Percentage of Hispanic/Latino MCBH Clients: 48% Under-serving the Hispanic/Latino population by 24 percentage points Under-serving the South and North County Regions 60+ years age-group: Total number of clients served: 574 Comprised 6% of the ER crisis services in FY17/18 Female MCBH Clients percentage: 60% Under-serving Male clients by 3 percentage points Preferred spoken language among MCBH Clients: 16% Spanish and 81% English Under-serving Spanish-speaking clients by 19 percentage points Percentage of Hispanic/Latino MCBH Clients: 30% Under-serving the Hispanic/Latino population by 24 percentage points Under-serving the South and North County Regions GENDER: Even though approximately 52% of our clients are Females, the average cost of service per client was $730 less for female clients compared to male clients in FY 17/18. There was no statistically significant difference in the overall service utilization among men and women clients; though the female clients are engaged more in the short-term care via Access to treatment programs and that the male clients were enrolled in the high-cost long term care. RACE/ETHNICITY: The race/ethnicity composition of Medi-Cal eligible MCBH clients is 56% Hispanic/Latino, 22% White, 5% African American, 3% Asian/Pacific Islander and 14% Others. Comparing this race distribution with that of Monterey county Medi-Cal eligible population, helps us visualize the gap in services with respect to race/ethnicity index. About 56% of our Medi-Cal eligible MCBH clients in FY 17/18 were Hispanic/Latinos, and this percentage has remained steady for the last decade. Even with most of the MCBH clients being Hispanic/Latino, we are under-serving the Hispanic/Latino population by 19 percentage points (Figure 4). Hence, the need for innovative projects and programs that focus on the Latino engagement. Figure 4: Service Gap in Race Category among Medi-Cal MCBH Clients in FY 17/18 PREFERRED SPOKEN CLIENT LANGUAGE: Even though 56 percent of our clients were Hispanic/Latino, only 17 percent of clients said they prefer Spanish as their Preferred spoken language. We have observed a service gap of about 26% among Spanish speaking clients. This is one area where we can help make our Hispanic/Latino Spanish speaking clients feel more welcome. At MCBH, we make efforts to match clients to the staff who speak the client s preferred spoken language. We have language translation services available for all clients. In FY 17/18, 95% of the clients were matched to clinicians who spoke/understood client language. Roughly 4.3% (n=303) of the clients who preferred Spanish as their spoken language were assigned to staff who were not bilingual. Figure 5: Service Gap in Language category among Medi-Cal MCBH Clients in FY 17/18 REGION OF CLIENTS RESIDENCE: The county boundary is geographically divided into 4 different regions- Salinas Valley, South County, North County and Coastal Region. About 48% of our clients come from Salinas Valley Region, 19% from South County, 22% from Coastal Region and 9% from North County. In the last couple of years, we have made a conscious effort to increase and improve our services to the South County region. These efforts have led to decrease in the service gap in South County region by 3 percentage points in FY 17/18. Figure 6: Under-served Zip codes and region of Monterey County Medi-Cal MCBH Clients in FY 17/18 The table below shows the corresponding zip codes that fall under each of the four regions. The zip codes that are printed in red ink, are the under-served areas where the Hispanic/Latino penetration rates have been poor or less than the FY 17/18 average of 3.64%. Region Zip code City Region Zip code City 93943* Monterey Spreckels 93944* Monterey Salinas Seaside Chualar Big Sur Salinas Marina Salinas Gonzales Coastal Monterey Valley Salinas Region Carmel Valley Salinas Monterey Salinas Carmel By The Sea Salinas Pacific Grove Salinas Carmel Jolon Carmel Greenfield Watsonville King City Castroville South San Ardo North Moss Landing County San Lucas County Aromas San Miguel Prunedale Lockwood *No Medi-Cal or MCBH client from here Bradley FOOD STORES: We have identified key food stores in Salinas and other areas of the county where the food stamps were used by people. Places near these food stores can indicate areas of higher poverty levels. 7-eleven, Safeway, CVS, La Princesa Market, Lucky, Peninsula Petroleum, Quik Stop, Walgreens, Walmart and target were most commonly visited shops by those using food-stamps. The most commonly visited zip codes were 93905, 93906, 93955, 93901, 93933, 93940, 93927, 93960, 93930, and ADULT MCBH MEDI-CAL CLIENTS WITH DISABILITY AID-CODE: Total number of Monterey County Adult Medi-Cal enrollees with disability: 9620 Total number of Adult MCBH Medi-Cal clients with disability: 1714 (18% of Medi-Cal enrollees) Hispanic Adult MCBH Medi-Cal clients with disability: 642 (37% of overall clients with disability) Adult Medi-Cal MCBH clients with disability had a higher average cost of service per client by approximately $5219 compared to those without disability. The Hispanic/Latino Adult MCBH Medi-Cal clients with disability (mean: 44yrs, SD: 14yrs) seem to be a younger population than non-hispanic/latino Adult MCBH Medi-Cal clients with disability (mean: 49yrs, SD: 13yrs). A Hispanic/Latino adult enrolling in Medi-Cal due to disability is 1.7 times more likely to be from South County, 25% less likely to be from North County, and 88% less likely to be from Coastal Region compared to Salinas Valley Region. We need to increase the services to South and North county regions. As seen across all MCBH programs, the biggest service gap in the race/ethnicity category of Adult MCBH Clients with disability was amongst the Hispanic/Latino clients (negative 13 percentage points). Figure 7: Service Gap in Regional Distribution of Adult Disabled Eligibility Category of Medi-Cal MCBH Clients in FY 17/18 CONCLUSION: We need to explore the reasons contributing to the health disparities, and find innovative solutions to increase the mental health services to Monterey County Medi-Cal eligible MCBH clients who are: 1. Hispanic/Latino 2. Females 3. Elderly 4. Clients with Disability 5. South and North County
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