Chapter Six, Mid-Hudson DSRIP Region Needs Assessment

Chapter Six

Mid-Hudson DSRIP Region Needs Assessment

New York State Office of Mental Health

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

Population Socioeconomic Characteristics The Mid-Hudson region includes Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester counties. Nearly 2.3 million people live in the region and all counties, except Sullivan, are designated urban. The population’s socioeconomic characteristics are less indicative of need than those in other DSRIP regions. The region’s median household income of $72,658 is the second highest in any DSRIP region. Eleven percent of the population live below the poverty level, 2% are on cash public assistance, 8% receive food stamps/SNAP benefits, and 12% of adults are without a high school diploma.

More than a quarter (28%) of the population are on some type of public health insurance, 19% are Medicaid beneficiaries and 10% have no health insurance coverage. Special populations include 10% that are disabled and 7% that are Veterans. Among all DSRIP regions, the Mid-Hudson region has the second highest percentages of the population that are foreign born (18%), speak a primary language other than English (26%), and speak English less than “very well” (10%).

Health Care Resources Maldistributions and shortages of health care providers in the Mid-Hudson region are recognized by federal Health Resources and Services Administration (HRSA) health professional shortage area (HPSA) designations. All counties, except Dutchess and Putnam, have primary health care Medically Underserved Area/Population (MUA/P) designations. In Orange, Rockland and Sullivan counties the Medicaid eligible populations are designated primary health care MUPs. Sullivan County has a whole county mental health (MH) professional shortage designation, and all counties, except Putnam, have MH professional MUA/P designations. The Medicaid eligible populations in Rockland and Westchester counties are designated MH professional MUPs.

The region has 11,855 licensed MH professionals or 51 per 10,000 population, which is the highest ratio in any DSRIP region. Westchester County has 66 licensed MH professionals per 10,000 (the second highest rate in any NYS county), and Sullivan County has only three psychiatrists.

Total psychiatric bed capacity in the region is 64 per 100,000 adults (the second highest rate in all DSRIP regions) and 67 per 100,000 children (the highest rate in all DSRIP regions). The total average daily census (ADC) per 100,000 adults is 49 (the second highest rate in any DSRIP region), and the total ADC per 100,000 children is 30. The acute care hospitals in Sullivan and Putnam counties have no chemical dependence rehab or detox beds.

All counties in the region have inpatient SUD crisis programs (n=13) and residential programs (n=28). Inpatient rehabilitation programs (n=14) are located all counties, except Sullivan. These SUD programs have a total capacity of eight per 10,000 and an average daily enrollment (ADE) of seven per 10,000, which are the second highest rates in all DSRIP regions.

Health Status Challenges Among all DSRIP regions, the Mid-Hudson region has the second highest: 1) Average rate of drug-related hospitalizations. 2) Average death rate due to pneumonia. 3) Average percentage of adults that reported housing insecurity.

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Compared to all DSRIP regions, the region has the third highest average rate of asthma hospitalizations and average case rates of HIV and AIDS. Among all NYS counties, Sullivan County has the second highest percentage of premature deaths.

Unmet Service Needs Measures of behavioral health medication management suggest unmet need in the region. Seventy percent of adults with schizophrenia adhere to anti-psychotic medications (30% do not). Region-wide, 53% of individuals with major depression remain on anti-depressant medication during the entire acute treatment phase and 38% remain on these medications during continuation phase treatment (62% do not). More than half (61%) of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication. Sixty-eight percent of children with a new prescription for ADHD medication remain on the medication for seven months and/or have at least two follow-up visits in the nine month period after the initiation phase.

Follow-up care after hospitalization for mental illness and engagement in alcohol and other drug dependence (AOD) treatment also suggest unmet need. After hospitalization for a mental illness, 46% of individuals have follow-up care within 7 days of discharge (54% do not) and 62% follow-up within 30 days. Less than a third (27%) of individuals engage in AOD treatment within 30 days after initiation (73% do not).

Consumer and Provider Input Mid-Hudson region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to crisis services and transportation are issues that need attention for the populations with mental health and/or chemical dependency concerns.

Clinics in in the Mid-Hudson region surveyed 160 consumers and 72 providers to assess local needs. The needs most frequently reported by both consumers and providers include: reduced wait times for appointments; transportation to health care services; assistance with paying for services; intensive outpatient/partial hospital program; mobile crisis and crisis respite services; cultural and language sensitive services; and access to services for incarcerated and homeless individuals.


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I. Description of Communities to Be Served

1. Geographic Service Area The Mid-Hudson DSRIP region is in southeastern New York State and is immediately north of New York City. It includes seven counties: Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.

Approximately 2.3 million people live in the region (Table 1). Estimated county populations range from a low of 77,437 in Sullivan County to a high of 946,646 in Westchester. Only Sullivan County has been designated rural by the U.S. Office of Management and Budget (OMB).1 Population density per square mile ranges from a low of 80 in Sullivan County to a high of 2,198.9 in Westchester County.

Table 1. Mid-Hudson Region: Population Size, Density and Urban/Rural County Designations

County US Census ACS 2010-2014 Est.

Population

Population Density per Square Mile

OMB Urban/Rural

Designation1

Dutchess 296,793 373.0 Urban Orange 371,979 458.3 Urban Putnam 99,642 432.6 Urban Rockland 309,737 1,784.7 Urban Sullivan 77,437 80.0 Rural Ulster 182,526 162.4 Urban Westchester 946,646 2,198.9 Urban

Totals 2,284,760 503.9 Data is from the U.S. Department of Health and Human Services, Health Resources Services Administration Data Warehouse. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/ tools/analyzers/geo/Rural.aspx

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2. Population Characteristics

A. Gender, Race, Ethnicity and Age In the Mid-Hudson region, slightly more than half (51%) of the population are female (Table 2). County percentages of females range from a low of 49% in Sullivan to a high of 52% in Westchester.

Table 2. Mid-Hudson Region: Gender, Race/Ethnicity and Age


Population

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

Male Female White African

American Asian Other*

Hispanic or Latino Ethnicity

19 and Under

65 and Over

Dutchess 296,793 50% 50% 79% 10% 4% 7% 10% 26% 13% Orange 371,979 50% 50% 77% 10% 2% 11% 18% 30% 11% Putnam 99,642 50% 50% 90% 2% 2% 6% 12% 26% 12% Rockland 309,737 49% 51% 73% 12% 6% 8% 16% 31% 13% Sullivan 77,437 51% 49% 82% 9% 2% 8% 14% 25% 14% Ulster 182,526 50% 50% 88% 6% 2% 5% 9% 23% 14% Westchester 946,646 48% 52% 67% 14% 5% 13% 22% 26% 14%

Totals 2,284,760 49% 51% 74% 11% 4% 10% 17% 27% 13% *Other includes American Indian and Alaska Native, Native Hawaiian and other Pacific Islander, some other race, and two or more races

The region has the most racially and ethnically diverse population in New York State outside of New York City. Approximately three quarters are White, 11% are African American, 4% are Asian, and 10% are some other race. Percentages of Whites vary from a low of 67% in Westchester County to a high of 90% in Putnam. The two most densely populated urban counties are the most racially diverse. For example, African Americans are 14% of the population in Westchester County and 12% of the population in Rockland County, compared to 2% of the population of Putnam County.

Seventeen percent of the population in the Mid-Hudson region are of Hispanic or Latino ethnicity, which is the highest percentage in any DSRIP region other than New York City. The highest percentages of Hispanic or Latino ethnicity are in Westchester (22%), Orange (18%), and Rockland (16%) counties and the lowest are in Ulster (9%) and Dutchess (10%).

More than a quarter of the Mid-Hudson region’s population are age 19 and under and 13% are age 65 and over. The largest percentages of persons age 19 and under are in Rockland (31%) and Orange (30%) counties.



B. Income, Education, Unemployment and Poverty The median household income in the Mid-Hudson region is $72,658 (Table 3), which is higher than the New York State median household income of $58,687.2 Median household incomes range from a low of $48,387 in Sullivan County to a high of $93,713 in Putnam County, the second highest in any NYS county. Compared to all DSRIP regions, the Mid-Hudson region has the second highest median household income.

Table 3. Mid-Hudson Region: Income, Education, Unemployment and Poverty


Population

American Community Survey Data 2010-2014

Median Household

Income

Educational Attainment1 Unemployment and Indicators of Poverty

Less than High School

Bachelor's Degree or Higher Unemployed2 Below Poverty

Level On Cash Public

Assistance On Food Stamps/

SNAP Benefits

Dutchess 296,793 71,493 11% 32% 5% 9% 2% 7% Orange 371,979 70,356 13% 29% 5% 13% 2% 9% Putnam 99,642 93,713 7% 39% 4% 6% 1% 3% Rockland 309,737 84,795 12% 41% 5% 14% 1% 8% Sullivan 77,437 48,387 16% 21% 6% 18% 3% 12% Ulster 182,526 58,502 12% 30% 5% 12% 3% 10% Westchester 946,646 81,361 13% 45% 5% 10% 2% 7%

Totals 2,284,760 72,658 12% 34% 5% 11% 2% 8% 1 Educational attainment are calculated based on population 25 years and older. 2 Unemployment data is the average for 2015 and is from the NYS Department of Labor.

Twelve percent of the Mid-Hudson region population age 25 and older do not have a high school diploma and 34% of this population have a bachelor’s degree or higher, which is the second highest percentage in any DSRIP region. Educational attainment varies by county. Adults without a high school diploma range from a low of 7% in Putnam County (the lowest percentage in any NYS county) to a high of 16% in Sullivan County. Adults with a bachelor’s degree or more range from a low of 21% in Sullivan County to a high of 45% in Westchester.

The Mid-Hudson region has a 5% unemployment rate, 11% of the region’s population live below the poverty level, 2% are on cash public assistance, and 8% receive food stamps/SNAP benefits. In the region, Sullivan County has the highest percentages of residents living below the poverty level (18%), on cash public assistance (3%) and on food stamps/SNAP benefits (12%). Among all NYS counties, Putnam County has the lowest percentages of residents living below the poverty level (6%), on cash public assistance (1%) and on food stamps/SNAP benefits (3%).

C. Health Insurance Status In the Mid-Hudson region, 28% of the population are on some type of public health insurance3 and 10% of the population have no health insurance coverage (Table 4). Percentages of the population on public health insurance range from a low of 20% in Putnam County (the lowest percentage in any NYS county) to a high of 39% in Sullivan County. Those with no health insurance range from a low of 9% each in Dutchess and Putnam counties to a high of 13% in Sullivan County.



Table 4. Mid-Hudson Region: Health Insurance Status


Population

American Community Survey Data 2010-2014

Public Health

Insurance1

Coverage

No Health Insurance Coverage

Unemployed w/Public Health

Insurance

Unemployed w/No Health Insurance

Dutchess 296,793 26% 9% 21% 35% Orange 371,979 29% 10% 23% 33% Putnam 99,642 20% 9% 15% 31% Rockland 309,737 32% 10% 22% 32% Sullivan 77,437 39% 13% 30% 40% Ulster 182,526 32% 11% 29% 30% Westchester 946,646 26% 11% 19% 33%

Totals 2,284,760 28% 10% 21% 28% 1 Public coverage includes Medicare, Medicaid and other federal medical assistance programs; VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans.

Among the region’s unemployed, 21% are on public health insurance (the lowest percentage in any DSRIP region) and 28% have no health insurance. While the rates of the unemployed on public health insurance are less than those of the general population, the rates of the unemployed with no health insurance are nearly three times as high as those in the general population (28% compared to 10%).

Medicaid Population Nearly one fifth (19%) of the estimated population in the Mid-Hudson region are Medicaid beneficiaries (Table 5), which is the second lowest percentage in any DSRIP regions.

By county, Medicaid beneficiaries range from a low of 7% of the population in Putnam County to a high of 28% of the population in Sullivan County. Putnam County has the lowest percentage of Medicaid beneficiaries in any NYS county.

Table 5. Mid-Hudson Region: Medicaid Beneficiaries as Percentage of Total Population

County US Census

ACS 2010-2014 Est. Population

Total # Medicaid Beneficiaries

% Est. Population Receiving Medicaid

Dutchess 296,793 43,049 15% Orange 371,979 79,773 21% Putnam 99,642 6,868 7% Rockland 309,737 81,278 26% Sullivan 77,437 21,938 28% Ulster 182,526 36,739 20% Westchester 946,646 168,171 18%

Totals 2,284,760 437,816 19% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About



In the Mid-Hudson region, 61% of Medicaid beneficiaries are adults and 39% are children, which is the highest percentage of children on Medicaid in any DSRIP region (Table 6). Rockland County has the highest percentage of child Medicaid beneficiaries (46%) in any NYS county. Adult Medicaid beneficiaries range from a low of 54% in Rockland County to a high of 68% in Ulster County.

Table 6. Mid-Hudson Region: Medicaid Beneficiaries by Population and Eligibility Type

County All Medicaid Beneficiaries

Medicaid Population Eligibility Type

Adults Children Medicaid Only Dual Medicaid and Medicare

# # % # % # % # % Dutchess 43,049 27,966 65% 15,083 35% 34,708 81% 8,341 19% Orange 79,773 44,318 56% 35,455 44% 70,033 88% 9,740 12% Putnam 6,868 4,537 66% 2,331 34% 5,180 75% 1,688 25% Rockland 81,278 43,535 54% 37,743 46% 72,309 89% 8,969 11% Sullivan 21,938 13,583 62% 8,355 38% 18,309 83% 3,629 17% Ulster 36,739 24,887 68% 11,852 32% 29,634 81% 7,105 19% Westchester 168,171 106,970 64% 61,201 36% 139,605 83% 28,566 17%

Totals 437,816 265,796 61% 172,020 39% 369,778 84% 68,038 16% Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 12, 2016 from https://health.data.ny.gov/ Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid beneficiaries include individuals that receive Medicaid only and dual-eligible individuals that receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes.4 In the Mid-Hudson region, 84% of Medicaid beneficiaries receive Medicaid only and 16% are dual-eligible. Medicaid only beneficiaries range from a low of 75% in Putnam County to a high of 89% in Rockland County.

D. Special Populations, Foreign Born and Primary Language In the Mid-Hudson region, 10% of the population are disabled and 7% are Veterans (Table 7). Percentages of individuals with disabilities range from a low of 8% in Rockland County (the lowest percentage in any NYS county) to a high of 16% in Sullivan (the highest percentage in any NYS county). Veterans range from a low of 5% in Rockland County to a high of 10% in Sullivan.

There are 1,471 children 19 years and younger in foster care and 2,867 individuals in jail the region. Eighteen percent of the population is foreign born. Counties with the largest percentages of foreign born are Rockland (22%) and Westchester (25%). The region’s percentage of foreign born5 is the highest in any DSRIP region other than NYC.



Table 7. Mid-Hudson Region: Special Populations and Foreign Born


Population

American Community Survey Data 2010-2014 Special Populations

Foreign Born Disabled Veterans In Foster

Care1 In Jail2

Dutchess 296,793 13% 8% 298 247 12% Orange 371,979 12% 9% 334 606 11% Putnam 99,642 10% 7% 19 101 12% Rockland 309,737 8% 5% 74 182 22% Sullivan 77,437 16% 10% 82 157 10% Ulster 182,526 14% 9% 124 362 7% Westchester 946,646 9% 6% 540 1,212 25%

Totals 2,284,760 10% 7% 1,471 2,867 18% 1 Foster care data includes individuals 19 and under during the 2014 calendar year and is from the NYS Office of Children and Families. 2Jail data is for 2014 calendar year and is from the NYS Division of Criminal Justice Services.

Table 8 describes the primary languages spoken at home and those who speak English less than ”very well” in the population aged five years and older. In the Mid-Hudson region, 74% of this population speak English as their primary language (the second lowest percentage in any DSRIP region),14% speak Spanish, 9% speak other Indo-European languages, 3% speak Asian and Pacific Islander languages, 1% speak some other language and 10% speak English less than “very well” (the second highest percentage in any DSRIP region).

Table 8. Mid-Hudson Region: Primary Language Spoken at Home

County

US Census ACS 2010-2014 Est. Population 5

Years and Older

American Community Survey Data 2010-2014 Language Spoken at Home Speak English

less than "very well"

English Spanish Other Indo-European

Asian and Pacific

Other

Dutchess 281,851 85% 7% 5% 2% 1% 5% Orange 346,528 77% 13% 8% 1% 1% 9% Putnam 94,733 83% 8% 7% 1% 0% 5% Rockland 288,233 63% 13% 18% 4% 2% 16% Sullivan 72,802 85% 9% 5% 1% 0% 5% Ulster 173,480 88% 6% 4% 1% 0% 4% Westchester 893,459 68% 19% 9% 3% 1% 12%

Totals 2,151,086 74% 14% 9% 3% 1% 10%

Percentages of the population aged five and over that speak English as their primary language range from a low of 63% in Rockland County to a high of 88% in Ulster County. Those who speak English less than “very well” range from a low of 4% in Ulster County to a high of 16% in Rockland County.



1 Urban areas (metro areas) are geographic entities defined by the U.S. Office of Management and Budget (OMB) for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. An urban area includes one or more counties containing a core urban area of 50,000 or more people, together with any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core. The OMB defines rural as all counties outside metropolitan areas based on 2010 census data. There are currently 24 counties designated rural in New York State. Retrieved April 14, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx 2 Retrieved April 14, 2016 from http://www.census.gov/quickfacts/table/RHI225214/36 3 Public coverage includes the federal programs Medicare, Medicaid and other medical assistance programs, VA Health Care; the Children’s Health Insurance Program (CHIP); and individual state health plans. Retrieved April 14, 2016 from https://www.census.gov/hhes/www/hlthins/methodology/definitions/acs.html4 In this analysis dual status was based upon the last month of enrollment/eligibility during the year. If the Medicaid beneficiary was indicated as being eligible for Part A, B, C or D Medicare services they are classified as dual eligible. The dual-eligible Medicare and Medicaid population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy. Retrieved May 12, 2016 from http://www.medpac.gov/documents/data-book/january-2015-medpac-and-macpac-data-book-beneficiaries-dually-eligible-for-medicare-and-medicaid.pdf 5 The Long Island DSRIP region also has a foreign born population of 18%.


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

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

http://www.census.gov/quickfacts/table/RHI225214/36

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


II. Physical and Behavioral Health Care Resources

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

Physical Health Care Resources

1. Inpatient Physical Health Care Facilities The Mid-Hudson DSRIP region has 31 acute care hospitals and 100 nursing homes that provide inpatient health care (Table 1).

Table 1. Mid-Hudson Region: Inpatient Physical Health Care by Certified Beds

County

Acute Care Hospitals Nursing Homes

# Hospitals

# Certified Beds # Nursing

Homes

# Certified Beds Total # All Bed Types

Chemical Dependence

Rehab

Chemical Dependence

Detox Psychiatric Total Beds

BH Intervention Beds

Dutchess 3 676 50 10 40 15 1,092 0 Orange 5 710 15 7 54 10 1,318 0 Putnam 1 164 0 0 20 2 160 0 Rockland 3 791 20 27 26 11 1,215 0 Sullivan 1 154 0 0 18 4 435 0 Ulster 2 300 10 10 40 11 980 20 Westchester 16 3,458 160 72 562 47 4,787 0

Totals 31 6,453 255 126 760 100 9,987 20 Acute care hospital data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Health-Facility-General-Information/vn5v-hh5r . Nursing home data is from the NYS Open Data Nursing Home Profile dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/Nursing-Home-Profile/dypu-nabu

In the region, all counties have at least one acute care hospital, with the greatest concentration in Westchester County (n=16). The region has a total of 6,453 beds where physical health care is the primary type of care provided. Among those beds are 760 psychiatric beds, 255 chemical dependence rehab beds, and 126 chemical dependence detox beds.

The region’s 100 nursing homes have a total of 9,987 beds, which includes 20 behavioral health intervention beds located in Ulster County.1 All counties in the region have nursing homes.



2. Outpatient Physical Health Care Facilities In the Mid-Hudson region, all counties except Putnam provide home health care (Table 2). All of these counties have both certified home health care facilities (n=24) and long-term home health care facilities (n=11). All counties, except Sullivan, have at least one ambulatory surgical center (n=25).

Table 2. Mid-Hudson Region: Outpatient Physical Health Care

County

Home Health Care Ambulatory

Surgical Centers

Primary Health Care

Certified Home Health

Long-term Home Health

School-based Health Centers

Diagnostic and Treatment Centers

Federally Qualified

Health Centers

# Facilities

Dutchess 3 1 7 0 10 9 Orange 3 1 3 1 10 15 Putnam 0 0 1 0 4 1 Rockland 3 1 2 1 8 7 Sullivan 1 1 0 2 3 3 Ulster 2 2 4 0 4 8 Westchester 12 5 8 16 23 12

Totals 24 11 25 20 62 55 Ambulatory surgical center data is from the NYS HCRA Provider List dataset. Retrieved April 12, 2016 from https://www.health.ny.gov/regulations/hcra/provider/provamb.htm. Federally qualified HC data is from the HRSA Data Warehouse. Retrieved April 21, 2016 from http://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=60#. All other data is from the NYS Open Data Health Facility General Information dataset. Retrieved April 12, 2016 from https://health.data.ny.gov/Health/ Health-Facility-General-Information/vn5v-hh5r .

There are three types of institutional providers that provide primary care: school-based health centers, diagnostic and treatment centers,2 and federally qualified health centers.3 Orange, Rockland, Sullivan and Westchester counties collectively have 20 school-based health centers, 16 of which are located in Westchester. All counties in the Mid-Hudson region have diagnostic and treatment centers (n=62) and federally qualified health centers (n=55).

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

Primary Care Providers In the Mid-Hudson region, family medicine providers include 1,050 physicians and a total of 425 nurse practitioners and physician assistants (Table 3). The number of family medicine providers of all types is lowest in Putnam County (n=26) and highest in Westchester (n=539). Family medicine health care providers are the smallest group of primary care providers in the region.



Internal medicine providers include 3,188 physicians and a total of 275 nurse practitioners and physician assistants. The number of internal medicine physicians is highest in Westchester County (n=1,683) and lowest in Sullivan County (n=92). Internal medicine nurse practitioners and physician assistants are found in the greatest numbers in Orange County (n=77) and the fewest are in Sullivan County (n=8).

Table 3. Mid-Hudson Region: Primary Care Providers

County US Census


Family Medicine

Internal Medicine

Pediatrics Total

Total per 10,000

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

Dutchess 296,793 180 83 351 70 339 57 1,080 36 Orange 371,979 188 86 542 77 295 29 1,217 33 Putnam 99,642 16 10 141 12 73 13 265 27 Rockland 309,737 61 22 260 28 264 14 649 21 Sullivan 77,437 41 31 92 8 38 1 211 27 Ulster 182,526 154 64 119 33 94 16 480 26 Westchester 946,646 410 129 1,683 47 1,048 31 3,348 35

Totals 2,284,760 1,050 425 3,188 275 2,151 161 7,250 32 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/ medicaid/redesign/providernetwork/

Throughout the Mid-Hudson region, there are 2,151 physicians providing pediatric care and 161 pediatric nurse practitioners and physician assistants. The number of pediatric health providers is highest in Westchester County (n=1,079) and lowest in Sullivan County (n=39).

The maldistribution of primary care providers in the Mid-Hudson region is made clearer by looking at the number of providers per 10,000 population in the region’s counties. Sullivan County has 21 primary care providers per 10,000 population, while Dutchess County has 36.

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



Table 3a. Mid-Hudson Region: HRSA Federal Primary Care Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Low Income Population

Dutchess Orange Yes Yes Putnam Rockland Yes Yes Sullivan Yes Yes Ulster Yes Westchester Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx

All counties in the region, except for Dutchess and Putnam, have a census tract, population or facility designated as a primary care Medically Underserved Area/Population (MUA/P). In Orange, Rockland and Sullivan counties the Medicaid eligible populations have also been designated primary care MUPs.

Physical Health Medical Specialists The Mid-Hudson region has a total of 3,834 physical medical health specialists or 16 providers per 10,000 population, which is the second highest concentration in any DSRIP region (Table 4).

Table 4. Mid-Hudson Region: Physical Medical Specialists

County US Census ACS

2010-2014 Est. Population

Allergy and Immunology

Cardiology and Other Cardiology

Specialties

Endocrinology and Other Endocrinology Related Specialties

Obstetrics and Gynecology

General Surgery Total

Total per 10,000

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

Dutchess 296,793 19 0 112 15 24 0 115 20 101 64 470 16 Orange 371,979 22 1 236 10 22 1 190 31 110 10 633 17 Putnam 99,642 1 0 69 2 10 0 37 3 35 11 168 17 Rockland 309,737 15 1 149 9 16 0 107 6 85 10 398 13 Sullivan 77,437 3 1 34 2 11 1 38 5 21 2 118 15 Ulster 182,526 5 0 84 0 5 0 45 7 50 12 208 11 Westchester 946,646 75 0 598 12 77 0 559 8 495 15 1,839 19

Total 2,284,760 140 3 1,282 50 165 2 1,091 80 897 124 3,834 17 MD=medical doctor; DO=doctor of osterpathy; NP=nurse practitioner; PA=physician assistant. Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

Allergy and immunology providers (n=143) and endocrinology providers (n=167) are in shortest supply, while those in cardiology (n=1,332) are most prevalent, followed by obstetrics and gynecology (n=1,171) and general surgery (n=1,021). The number of medical specialists is highest in Westchester County (n=1,839) and lowest in Sullivan County (n=118). Rockland and Ulster counties each has 11 physical medical specialists per 10,000 population, while Westchester County has 19.



Dentists In the Mid-Hudson region there is a total of 1,459 dentists serving the population of approximately 2.3 million residents (Table 5). The number of dentists ranges from a low of 13 in Putnam County to a high of 507 in Westchester County. Region-wide there are six dentists per 10,000 population, the second highest concentration of dentists in any DSRIP region.

Table 5. Mid-Hudson Region: Dentists

County US Census


Number of Dentists Per 10,000 Population

General Dentist

Specialist Dentist

Total

Dutchess 296,793 134 47 181 6 Orange 371,979 251 95 346 9 Putnam 99,642 8 5 13 1 Rockland 309,737 202 67 269 9 Sullivan 77,437 46 10 56 7 Ulster 182,526 71 16 87 5 Westchester 946,646 347 160 507 5

Totals 2,284,760 1,059 400 1,459 6 Data is from the DSRIP Managed Care Provider Network Database. Retrieved April 21, 2016 from https://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

Physical Rehabilitation Specialists In the Mid-Hudson region there is a total of 2,064 physical rehabilitation specialists serving the population of approximately 2.3 million residents (Table 6).

Table 6. Mid-Hudson Region: Physical Rehabilitation Specialists


Population

Occupational Therapy

Physical Therapy

Speech Therapy

Total Total per

10,000 population

Dutchess 296,793 40 245 9 294 10 Orange 371,979 30 221 43 294 8 Putnam 99,642 5 71 4 80 8 Rockland 309,737 34 276 33 343 11 Sullivan 77,437 7 58 5 70 9 Ulster 182,526 17 96 10 123 7 Westchester 946,646 27 777 56 860 9

Totals 2,284,760 160 1,744 160 2,064 9 Data is from the DSRIP Managed Care Provider Network Database. Retrieved Aprilhttps://www.health.ny.gov/health_care/medicaid/redesign/providernetwork/

21, 2016 from



In the region, speech and occupational therapists (n=160 each) are in shortest supply, while physical therapists are most prevalent (n=1,744). The number of physical rehabilitation specialists ranges from a low of 70 in Sullivan County to a high of 860 in Westchester County. Region-wide there are nine physical rehabilitation specialists per 10,000 population.

Behavioral Health Care Resources

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

Mental Health Inpatient Facilities The Mid-Hudson region has a total of 1,059 adult psychiatric beds and 417 psychiatric beds for children (Table 7).5 Adult psychiatric beds are located in all counties. Psychiatric beds for children are located in all counties except Orange, Sullivan and Ulster.

Table 7. Mid-Hudson Region: Total Psychiatric Inpatient Bed Capacity by Provider County and Average Daily Census by Patient County of Residence

County

- Adults - - Children -Total

Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC2,3

Total ADC

per 100,0004

Total Inpatient

Beds1

Total Bed Capacity per

100,000

Total Inpatient

ADC

Total ADC

per 100,0004

Dutchess 40 18 77 35 20 26 24 32 Orange 54 21 129 50 0 0 30 26 Putnam 20 27 20 28 14 54 7 25 Rockland 394 184 180 84 29 30 26 27 Sullivan 18 31 32 56 0 0 9 46 Ulster 40 29 57 41 0 0 11 27 Westchester 493 71 320 46 354 141 79 32

Totals 1,059 64 814 49 417 67 186 30 Notes: 1. Includes General Hospital, Private Psychiatric Hospital and State Psychiatric Centers’ budgeted capacity for the county of the providers. Children’s capacity includes residential treatment facility (RTF) beds for the county of the providers. 2. Average Daily Census (ADC) covers General, Private Psychiatric, State Psychiatric hospital and RTF (children only). 3. ADC is shown for patient county of residence. 4. The ADC per 100,000 population of adults or children as indicated. Data Sources: Capacity -- General Hospital and Private Psychiatric Hospital current capacity: NYSOMH CONCERTS database, 10/2015. Current capacity includes all beds licensed for operation as of that date. State Psychiatric Center budgeted capacity: NYSOMH MHARS EHR, 10/2015. RTF capacity: NYSOMH CAIRS database, 10/2015. US Census 2014 Est. Populations. Average Daily Census -- General Hospital (Art. 28): SPARCS, CY 2014. Private Psychiatric Hospital (Art. 31): Medicaid, CY 2014. Institutional Cost Report (ICR), CY 2014: county distribution using the 2013 Patient Characteristics Survey (PCS). State Psychiatric Centers: MHARS, CY 2014. RTF: CAIRS, CY 2014. US Census 2014 estimates.



Westchester County has the largest number of adult beds (n=493), while Sullivan has the fewest (n=18). Westchester County also has the largest number of beds for children (n=354), while Orange, Sullivan and Ulster have none. Total psychiatric bed capacity in the region is 64 per 100,000 adults (the second highest rate in all DSRIP regions) and 67 per 100,000 children (the highest rate in all DSRIP regions).

In the Mid-Hudson region the total inpatient average daily census (ADC) for adult beds is 814, while the ADC for child beds is 186. Westchester County has the highest total ADC for adults (n=320) and Putnam County has the lowest (n=20). Similarly, Westchester County has the highest total ADC for children (n=79) and Putnam County has the lowest (n=7).

In the region the total ADC per 100,000 adults is 49, which is the second highest rate in any DSRIP region, while the total ADC per 100,000 children is 30. For adults the total ADC per 100,000 adults is highest for residents of Rockland County (n=84) and lowest for residents of Putnam County (n=28). In comparison, the total ADC per 100,000 children is highest for residents of Sullivan County (n=46) and lowest for residents of Putnam (n=25).

Substance Use Disorder Inpatient Programs In New York State, substance use disorder (SUD) inpatient programs include crisis, inpatient rehabilitation, and residential programs.6 In the Mid-Hudson region (Table 8) there are SUD crisis programs (n=13) in all of the region’s counties; inpatient rehabilitation programs (n=14) in all counties except Sullivan; and residential programs (n=28) in all counties.

Table 8. Mid-Hudson Region: Substance Use Disorders Inpatient Program Capacity

County

US Census ACS 2010-2014 Est.

Population

Inpatient Programs Total

Capacity per 10,000

Crisis Inpatient

Rehabilitation* Residential Total

Capacity

# Programs Capacity # Programs Capacity # Programs Capacity

Dutchess 296,793 3 28 2 140 7 246 414 14 Orange 371,979 2 22 2 63 2 64 149 4 Putnam 99,642 2 31 1 120 1 28 179 18 Rockland 309,737 2 14 3 83 3 50 147 5 Sullivan 77,437 2 16 – – 4 171 187 24 Ulster 182,526 1 10 2 45 7 443 498 27 Westchester 946,646 1 72 4 159 4 58 289 3

Totals 2,284,760 13 193 14 610 28 1,060 1,863 8Notes and Data Sources: *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016. More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps/state/CD_descriptions.cfm



The region’s crisis capacity is 193, inpatient rehabilitation capacity is 610 and its residential capacity is 1,060. The regional capacity per 10,000 for all SUD inpatient programs is eight, the second highest rate in all DSRIP regions.

Table 9 describes the average daily enrollment (ADE) in these programs.

Table 9. Mid-Hudson Region: Substance Use Disorders Inpatient Program Average Daily Enrollment

County


Population

Inpatient Programs

Crisis Inpatient

Rehabilitation* Residential

Total Avg. Daily

Total Avg. Daily

Enrollment

# Programs Avg. Daily Enrollment



Enrollment per 10,000

Dutchess 296,793 3 23 2 115 7 216 354 12 Orange 371,979 2 16 2 51 2 51 118 3 Putnam 99,642 2 26 1 105 1 24 155 16 Rockland 309,737 2 9 3 70 3 44 123 4 Sullivan 77,437 2 10 – – 4 160 170 22 Ulster 182,526 1 7 2 46 7 351 405 22 Westchester 946,646 1 50 4 139 4 64 253 3

Totals 2,284,760 13 141 14 526 28 910 1,577 7 *Includes State Addiction Treatment Centers. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

The ADE in the region for crisis is 141, inpatient rehabilitation is 526 and residential is 910. Westchester County had the highest ADE for crisis (n=50) and inpatient (n=139), while Ulster County had the highest residential ADE (n=351). The regional ADE per 10,000 for these programs is seven, the second highest rate in all DSRIP regions.

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

Mental Health Outpatient and Clinic Programs

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

In the region outpatient programs (other than clinic) are located in all counties. Outpatient program capacity is largest in Westchester County (n=706 slots) and smallest in Sullivan (n=70 slots). There are a total of 2,217 non-clinic outpatient program slots in the region or 134 slots per 100,000 adults, the second highest rate in any DSRIP region.



Clinics may be locally- or state-operated. All counties in the Mid-Hudson region have locally-operated clinics. These clinics served a total of 14,391 adult Medicaid recipients and 7,808 adult non-Medicaid recipients. The largest numbers of adult Medicaid recipients (n=6,277) and adult non-Medicaid recipients (n=4,584) were served in Westchester County. In comparison, the smallest numbers of adult Medicaid recipients (n=332) were served in Putnam County and adult non-Medicaid recipients (n=216) were served in Sullivan County.

Table 10. Mid-Hudson Region: Adult Mental Health Outpatient Capacity and Service Use by Provider County

County

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

Clinics: Total Number of Adults

Locally Operated Clinics Recipients in

State-operated

Clinics4

Clinic Treatment per 100,000

Adults5Capacity1

(Slots)

Slots per 100,000

Adults5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Dutchess 527 241 2,871 1,196 240 1,969 Orange 223 87 2,535 556 795 1,507 Putnam 130 177 332 356 304 1,353 Rockland 408 191 886 596 516 935 Sullivan 70 122 494 216 148 1,497 Ulster 153 110 996 304 315 1,166 Westchester 706 102 6,277 4,584 1,511 1,793

Totals 2,217 134 14,391 7,808 3,829 1,578 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of persons served annually. 1. Includes the total capacity for Partial Hospitalization (PH), Intensive Psychiatric Rehabilitative Treatment (IPRT), Continuing Day Treatment (CDT), Personalized Recovery-Oriented Services (PROS) and Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes adults and children enrolled in Medicaid and served annually in non-State clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of adults not receiving Medicaid and served in non-State clinics during the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes adults served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

The Mid-Hudson region has state-operated clinics in all counties which together served 3,829 adults.

In the region 1,578 adults received clinic treatment per 100,000 adults. Dutchess County’s rate of 1,969 adults per 100,000 adults is the highest in region. Rockland County’s service rate of 935 adults per 100,000 adults is the lowest in the region.

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

In the region there are child outpatient programs other than clinic in all counties except Putnam. Capacity is largest in Westchester County (n=306 slots). There are a total of



666 non-clinic outpatient program slots in the region or 107 slots per 100,000 children, which is the second highest rate in any DSRIP region.

All counties in the Mid-Hudson region have locally-operated clinics. These clinics served a total of 5,060 child Medicaid recipients and 3,868 child non-Medicaid recipients. The largest number of child Medicaid recipients (n=2,967) was served in Westchester County and the smallest number (n=58) was served in Putnam. In comparison, the largest number of child non-Medicaid recipients (n=2,256) was served in Westchester County and the smallest number (n=100) was served in Sullivan.

Table 11. Mid-Hudson Region: Child Mental Health Outpatient Capacity and Service Use by Provider County

County

Outpatient Programs (PH, DT, ACT)

Clinics: Total Number of Children Locally Operated Clinics

Recipients in State-operated

Clinics4

Clinic Treatment per 100,000

Children5Capacity1

(Slots)

Slots per 100,000

Children5

Medicaid

Recipients2

Non-Medicaid

Recipients

(Estimated #)3

Dutchess 248 325 1,055 572 ─ 2,132 Orange 44 39 555 248 72 776 Putnam ─ ─ 58 136 ─ 753 Rockland 16 17 82 272 ─ 370 Sullivan 16 82 125 100 49 1,412 Ulster 36 85 218 284 68 1,345 Westchester 306 122 2,967 2,256 64 2,100

Totals 666 107 5,060 3,868 253 1,471 Notes and Data Sources: Clinics are not licensed for specific slot capacities, therefore size is measured by estimated total number of children served annually. 1. Includes the total capacity for Partial Hospitalizations (PH), Day Treatment (DT) and Children's Assertive Community Treatment (ACT) (Data Source: New York State Office of Mental Health (NYSOMH) CONCERTS database, 10/2015). 2. Includes children enrolled in Medicaid and served annually in locally-operated (non-State) clinic programs (Data Source: Medicaid, CY 2014). 3. Includes annual estimate of children not receiving Medicaid and served in locally-operated (non-State) clinics during the week of the NYSOMH 2013 Patient Characteristics Survey (PCS). 4. Includes children served annually in State-run clinics (Data Source: NYSOMH MHARS database, CY 2014). 5. US Census ACS 2010-2014 Est. Population.

The Mid-Hudson region has state-operated clinics serving children in all counties except Dutchess, Putnam and Rockland. Together, the clinics served 253 children.

In the Mid-Hudson region 1,471 children received clinic treatment per 100,000 children. Dutchess County’s rate of 2,132 children per 100,000 children is the highest in the region, while Rockland’s service rate of 370 children per 100,000 children is the lowest.



Mental Health Emergency and Community Support Programs

Adults Table 12 describes the Mid-Hudson region’s service use in adult mental health emergency and community support programs. A total of 197 adults were served in emergency programs located in all counties except Ulster. In the region, 12 adults received emergency services per 100,000 adults . In comparison, there are adult community support programs (e.g., vocational, self-help and care coordination) in all Mid-Hudson region counties, which collectively served 3,702 adults. In the region, 224 adults per 100,000 adults received services from community support programs. In the counties, service rates per 100,000 adults ranged from a low of 146 in Rockland County to a high of 500 in Sullivan County.

Table 12. Mid-Hudson Region: Adult Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs Community Support Programs

# Adults Served # Served per

100,000 Adults # Adults Served

# Served per 100,000 Adults

Dutchess 17 7 544 231 Orange 88 32 655 235 Putnam 7 9 174 222 Rockland 34 14 344 146 Sullivan 22 37 298 500 Ulster ─ ─ 349 238 Westchester 29 4 1,338 178

Totals 197 12 3,702 224 Data Sources: Includes adults receiving emergency services and support services (e.g., vocational, self-help, care coordination) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Children The Mid-Hudson region’s service use in child mental health emergency and community support programs is presented in Table 13. Sixty seven children received emergency services from programs in all counties except Ulster. In the region, 11 children received emergency services per 100,000 children.

Community support programs for children (e.g., vocational, home-based family treatment, and residential treatment facility transition) are located in all counties in the Mid-Hudson region and together served 448 children. These programs served 72 children per 100,000 children, which is the second lowest rate in any DSRIP region. In the counties service rates per 100,000 children ranged from a low of 52 each in Rockland and Westchester counties to a high of 268 in Ulster County.



Table 13. Mid-Hudson Region: Child Mental Health Emergency Programs and Community Support Programs by Provider County

County Emergency Programs

Community Support Programs

# Children Served

# Served per 100,000 Children

# Children Served

# Served per 100,000 Children

Dutchess 10 16 61 99 Orange 7 7 59 60 Putnam 3 14 46 219 Rockland 2 2 46 52 Sullivan 6 37 30 184 Ulster ─ ─ 91 268 Westchester 39 18 115 52

Totals 67 11 448 72 Data Sources: Includes children receiving emergency services and support services (e.g., vocational, home-based family treatment, residential treatment facility transition) as reported by the New York State Office of Mental Health 2013 Patient Characteristics Survey (PCS). US Census ACS 2010-2014 Est. Population. Service use is reported because there are no licensed capacities for nearly all of these programs.

Behavioral Health Housing Programs

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

These adult housing services in the Mid-Hudson region are described in Table 14. In the region licensed family care beds (n=225) are located in all counties except Putnam, and congregate treatment beds (n=560) and apartment treatment beds (n=530) are located in all counties. Unlicensed housing support program beds (n=295) are located in in Dutchess, Orange, Rockland and Sullivan counties, and unlicensed supported housing beds (n=1,920) are available in all counties.

The housing capacity per 100,000 adults in the region is 214. In the counties housing capacity per 100,000 adults ranged from a low of 168 in Putnam County to a high of 285 in Rockland County.


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


Table 14. Mid-Hudson Region: Adult Behavioral Health Community-Based Housing Capacity by Provider County

County

Licensed Beds Unlicensed Beds Housing

Family Care

Congregate Treatment

Apartment Treatment

Housing Support

Programs

Supported Housing

Capacity per 100,000 Adults

Dutchess 48 128 36 78 238 241 Orange 120 61 82 36 286 227 Putnam ─ 14 40 ─ 69 168 Rockland 14 162 94 160 179 285 Sullivan 25 24 28 ─ 66 249 Ulster 11 26 87 21 171 228 Westchester 7 145 163 ─ 911 178

Totals 225 560 530 295 1,920 214 Data Sources: Licensed and unlicensed beds: New York State Office of Mental Health CONCERTS database; data as of 10/2015. US Census ACS 2010-2014 Est. Population.

Children In New York State, child behavioral health housing services are provided in licensed beds in teaching family homes and child and youth community residences, and in home and community-based services (HCBS). These child housing services in the Mid-Hudson region are described in Table 15.

The region has no teaching family home beds. Licensed child and youth community residence beds (n=25) are located in Orange and Westchester counties. The Mid-Hudson region has a capacity of four child and youth community residence beds per 100,000 children, which is the second lowest rate in any DSRIP region.

All counties in the region have HCBS slots (n=195) ranging from a high of 66 in Westchester County to a low of 12 each in Putnam and Sullivan counties. The region’s HCBS slots serve 31 children per 100,000 children, which is the lowest rate in any DSRIP region. In the counties, HCBS slots per 100,000 children ranged from a low of 24 each in Dutchess and Orange counties to a high of 71 in Ulster County.



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

County

Number of Licensed Housing Beds HCBS Slots

Teaching Family Home

Child & Youth Community Residence

Capacity per 100,000

Children

Number of Slots

Slots per 100,000 Children

Dutchess ─ ─ ─ 18 24 Orange ─ 8 7 27 24 Putnam ─ ─ ─ 12 47 Rockland ─ ─ ─ 30 31 Sullivan ─ ─ ─ 12 62 Ulster ─ ─ ─ 30 71 Westchester ─ 17 7 66 26

Totals ─ 25 4 195 31 Data Sources: New York State Office of Mental Health databases. Licensed housing capacity: CONCERTS, 10/2015. Home & Community-based Services (HCBS): CAIRS, CY 2014. US Census ACS 2010-2014 Est. Population.

Substance Use Disorder Outpatient Programs New York State has a variety of substance use disorder (SUD) outpatient programs including clinic and rehabilitation. In the Mid-Hudson region all counties have SUD outpatient programs. The average daily enrollment (ADE) in these programs (n=4,894) is described in Table 16.

Table 16. Mid-Hudson Region: Substance Use Disorders Outpatient Program Average Daily Enrollment

County US Census ACS

2010-2014 Est. Population

Outpatient Avg. Daily Enrollment

Total Per 10,000

Dutchess 296,793 567 19 Orange 371,979 935 25 Putnam 99,642 318 32 Rockland 309,737 620 20 Sullivan 77,437 229 30 Ulster 182,526 334 18 Westchester 946,646 1,892 20

Totals 2,284,760 4,894 21 Notes and Data Sources: Outpatient programs (OP) include Medically Supervised Outpatient, Outpatient Rehabilitation, Specialized OP – Traumatic Brain Injury, Outpatient Chemical Dependency for Youth, Specialized OP – Mobile, and Specialized Services OP Rehabilitation. Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.



In the region, Westchester County has the highest ADE (n=1,892), while Sullivan has the lowest (n=229). Region-wide, these SUD programs have an ADE of 21 per 10,000, which is the lowest rate in any DSRIP region. In the counties ADE per 10,000 ranged from a low of 18 in Ulster County to a high of 32 in Putnam County.

New York State also has outpatient opioid treatment programs (Table 17). The Mid-Hudson region has nine opioid treatment programs located in all counties except Putnam and Sullivan. These programs have a combined capacity of 2,935 and an ADE of 2,558. Region-wide these programs have a capacity of 13 per 10,000 and an ADE of 11 per 10,000, which are the second highest rates in any DSRIP region. Westchester County has the highest number of opioid treatment programs (n=5), and also the largest capacity (n=1,785) and ADE (n=1,509).

Table 17. Mid-Hudson Region: Substance Use Disorders Outpatient Opioid Treatment Program Capacity and Average Daily Enrollment

County US Census


Number of Programs

Opioid Treatment (Methadone) Capacity Avg. Daily Enrollment

Total Per 10,000 Total Per 10,000

Dutchess 296,793 1 250 8 249 8 Orange 371,979 1 450 12 387 10 Putnam 99,642 – – – – – Rockland 309,737 1 250 8 214 7 Sullivan 77,437 – – – – – Ulster 182,526 1 200 11 198 11 Westchester 946,646 5 1,785 19 1,509 16

Totals 2,284,760 9 2,935 13 2,558 11 Notes and Data Sources: Outpatient programs include the Average Daily Enrollment for Medically Supervised Outpatient, Outpatient Rehabilitation, Specialized OP – Traumatic Brain Injury, Outpatient Chemical Dependency for Youth, Specialized OP – Mobile, and Specialized Services OP Rehabilitation.Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Provider Directory System. Includes programs that were operational as of April 2, 2016.

6. Care Coordination New York State’s Medicaid health home initiative is designed to expand and improve care management for beneficiaries with intensive, high-cost service needs. The health home model provides the basis for unified systems of care to coordinate and integrate physical and behavioral health care, and social services provided to health home members. In the Mid-Hudson region there are three Health Home providers. Each county is served by two providers (Table 18), except for Ulster County which is served by one provider.



Table 18. Mid-Hudson Region: Health Homes Serving Medicaid Enrollees by County

County Total # Health Homes

Serving Region # Health Homes Serving County

Dutchess

3

2 Orange 2 Putnam 2 Rockland 2 Sullivan 2 Ulster 1 Westchester 2 Data is from the NYS Department of Health Designated Health Homes Web page. Retrieved May 4, 2016 from https://www.health.ny.gov/health_care/ medicaid/program/medicaid_health_homes/contact_information/list_by_county.htm #clinton

7. Behavioral Health Care Practitioners

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

Table 19. Mid-Hudson Region: Licensed Mental Health Professionals

County


Population

Psychiatrists Psychologists LCSWs LMSWs Mental Health

Counseling

Nurse Practitioner -

Psychiatry *Other Total Per 10,000

Dutchess 296,793 68 166 513 383 91 33 36 1,290 43 Orange 371,979 52 96 438 355 102 18 29 1,090 29 Putnam 99,642 15 53 181 130 37 10 27 453 45 Rockland 309,737 135 204 566 495 91 18 48 1,557 50 Sullivan 77,437 3 17 76 63 26 4 4 193 25 Ulster 182,526 33 99 395 229 90 18 41 905 50 Westchester 946,646 714 1,211 2,169 1,725 259 70 219 6,367 67

Totals 2,284,760 1,020 1,846 4,338 3,380 696 171 404 11,855 52 Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. *Other category includes marriage and family therapists, psychoanalysts, and creative arts therapists.

The Mid-Hudson region has a total of 11,855 licensed MH professionals or 52 per 10,000 population, which is the highest rate in any DSRIP region. There are maldistributions of MH professionals across the region’s counties. Sullivan County has the lowest county distribution of MH professionals ─ 25 per 10,000 compared to



Westchester County which has the highest ─ 67 per 10,000, which is the second highest rate in any NYS county.

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

Table 19a. Mid-Hudson Region: HRSA Federal Mental Health Professional Shortage Designations

County Whole County Census tract,

populations or facilities

Medicaid Eligible population

Dutchess Yes Orange Yes Putnam Rockland Yes Yes Sullivan Yes Yes Ulster Yes Westchester Yes Yes HRSA federal shortage designations retrieved March 17, 2016 from http://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx

In the Mid-Hudson region Sullivan County has a whole county MH professional shortage designation (Table 19a). All counties in the region, except Putnam, have a census tract, population or facility designated as a MH Medically Underserved Area/Population (MUA/P). In addition, the Medicaid eligible populations in Rockland and Westchester counties have been designated MH MUPs.

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



Table 20. Mid-Hudson Region: Certified and Credentialed Substance Use Disorder Professionals

County US Census


Physicians Counselors

Total Per 10,000 PopulationBoard Certified

Addiction Medicine

Authorized for Buprenorphine

Prescription

Credentialed Alcoholism and Substance Abuse

Certified Rehabilitation

Dutchess 296,793 4 29 135 9 173 6 Orange 371,979 3 48 164 9 221 6 Putnam 99,642 3 11 48 5 64 6 Rockland 309,737 5 45 86 15 146 5 Sullivan 77,437 0 15 55 4 74 10 Ulster 182,526 4 42 120 8 170 9 Westchester 946,646 15 173 350 45 568 6

Totals 2,284,760 34 363 958 95 1,416 6 Data is from the NYS Office of Alcoholism and Substance Abuse Services (OASAS) Human Resources Office and is as of May 13, 2016.

SUD physicians include those board certified in addiction medicine and those authorized to prescribe buprenorphine to treat opioid addiction. In the Mid-Hudson region there are 34 physicians certified in addiction medicine, but none in Sullivan County. All counties have physicians authorized to prescribe buprenorphine.

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

Overall, the Mid-Hudson region has a total of 1,416 certified and credentialed SUD professionals or six per 10,000 population, which is the highest rate in any DSRIP region. Rockland County has the lowest county distribution of SUD professionals ─ five per 10,000, while Sullivan County’s rate of 10 per 10,000 is the highest in any NYS county.

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

1 NYS Nursing Home Behavioral Intervention Services: This program must include a discrete unit with a planned combination of services with staffing, equipment and physical facilities designed to serve individuals whose severe behavior cannot be managed in a less restrictive setting. The program’s services are directed at attaining or maintaining the individual at the highest practicable level of physical, affective, behavioral and cognitive functioning. Retrieved April 21, 2016 from https://www.health.ny.gov/facilities/nursing/all_services.htm . 2 Diagnostic and Treatment Centers provide a comprehensive range of primary health care services to a population that includes uninsured individuals.3 Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and


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


Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, and provide comprehensive services. 4 A primary care HPSA is a collection of census tracts that has been designated as having a shortage of primary care health professionals. HRSA uses two methodologies to determine whether there are adequate health care resources for specific geographical areas. Aggregate ZIP codes or census tracts can be designated as a Medically Underserved Area/Population (MUA/P) based on an analysis of four criteria: the ratio of primary care medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or over. A medically underserved population faces economic barriers (e.g. low-income or Medicaid-eligible populations), or cultural and/or linguistic access barriers to primary medical care services, and population specific information is assessed according to the above criteria to achieve MUP designation. 5 In this report adults are individuals aged 20 and older and children are individuals aged 19 and younger. 6 More information about OASAS inpatient programs is available at http://www.oasas.ny.gov/hps /state/CD_descriptions.cfm 7 Licensed Mental Health Workforce Data Sources and Limitations: Data for psychiatrists is from the American Board of Psychiatry and Neurology, Inc. and was retrieved from https://application.abpn.com/verifycert/verifycert.asp on July 15, 2014. Data for all other professions is as of June 2, 2014 and was provided by the Office of the Professions at the New York State Education Department. Licensees must be registered in order to practice and use a professional title in NYS; being registered, however, does not necessarily mean the licensee is actively engaged in practice. In addition, NYS licensing data show only “nurse practitioners-psychiatry” as a BH-psychiatric nurse specialty. All other nursing specialties that contribute to the licensed BH workforce are combined in the general category of “nurse” in the NYS licensing data and are not counted in the licensed BH workforce described here. This limitation also extends to other data sources such as professional nursing organizations, which also combine a l l nursing specialties in a general category of “nurse” in their data collection processes.8 HRSA Guidelines for Mental Health HPSA Designation. Retrieved May 24, 2016 from http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsaguidelines.html


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

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

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


III. Health Status

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

1. Disease Prevalence Chronic Health Conditions In the Mid-Hudson region, Sullivan and Dutchess counties have the highest percentages of adults with diabetes (10% each) and high blood pressure (29% each) (Table 1). Sullivan County has the highest percentage of adults that are overweight or obese (65%) and Sullivan and Orange counties have the highest percentage with asthma (10% each). Ulster County has the highest percentage with angina, heart attack or stroke (9%).

Table 1. Mid-Hudson Region: Prevalence of Chronic Health Conditions Among Adults

County

Age-adjusted Percentage of Adults

With physician diagnosed diabetes

With physician diagnosed

angina, heart attack or

stroke

Ever told they have high

blood pressure

Overweight or obese

(BMI 25 or higher)

With current asthma

Dutchess 10 7 29 63 7 Orange 7 6 26 64 10 Putnam 6 6 27 58 9 Rockland 8 6 26 60 7 Sullivan 10 8 29 65 10 Ulster 8 9 24 60 9 Westchester 7 5 23 59 9 Region Average 8 7 26 61 9

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

In the region, Putnam County has the lowest percentage of adults with diabetes (6%, the lowest percentage in any NYS county); Westchester County has the lowest percentages of adults with angina, heart attack or stroke (5%, the lowest rate in any NYS county) and high blood pressure (23%, the lowest percentage in any NYS county); Putnam County has the lowest percentage that are overweight or obese (58%); and Dutchess and Rockland counties have the lowest percentages of adults with asthma (7% each).

Among all DSRIP regions, the Mid-Hudson region has the lowest percentage of adults with angina, heart attack or stroke (7%).



AIDS, HIV and Cancer Among all DSRIP regions, the Mid-Hudson region has the third highest average case rates per 100,000 of HIV (n=6) and AIDS (n=4) (Table 2). The HIV case rate per 100,000 ranges from four each in Sullivan and Ulster counties to a high of 11 in Westchester County. The AIDS case rate per 100,000 ranges from two in Sullivan County to seven in Westchester County. The cancer rate per 100,000 in the region is 497, and is lowest in Sullivan County (n=476) and highest in Putnam (n=516).

Table 2. Mid-Hudson Region: Rates of HIV, AIDS, and Cancer

County

Age-adjusted case rate per 100,000

Age-adjusted all cancers incidence rate

per 100,000 HIV AIDS

Dutchess 6 4 499 Orange 5 5 506 Putnam 5 4 516 Rockland 8 5 507 Sullivan 4 2 476 Ulster 4 3 480 Westchester 11 7 494

Region Average 6 4 497 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

Among all DSRIP regions, the Mid-Hudson region’s cancer incidence rate is third lowest.

2. Health Behaviors and Risk Factors In the Mid-Hudson region, rural Sullivan County has the highest percentages of adults that report food (26%) and housing insecurity (49%, the highest percentage in any NYS county) in the past 12 months, poor health (5%), and current smoking (25%) (Table 3). Orange and Putnam counties have the highest percentages that report binge drinking (17% each), while Putnam and Ulster counties have the highest percentages reporting poor mental health for 14 or more days in the last month (17% each). Putnam County has the highest percentage of adults that did not receive medical care because of cost in the past 12 months (16%). Cigarette smoking among those that report poor mental health is highest in Orange County (38%).

Ulster County has the lowest percentage of adults that reported binge drinking (10%). Food (20%) and housing (35%) insecurity in the past 12 months are reported least frequently in Westchester County. Rockland County has the lowest reported percentages of poor health (2%, the lowest percentage in any NYS county), current



smoking (10%, the lowest percentage in any NYS county) and poor mental health for 14 or more days in the last month (8%). Sullivan has the lowest percentage of adults that reported not receiving medical care because of cost (10%).

Table 3. Mid-Hudson Region: Adult Self-Reported Health Behaviors and Risk Factors

County Survey

Sample Size

Percentage of Adults Who Self-Reported:

Binge drinking

during past month

Food insecurity in

past 12 months

Housing insecurity in

past 12 months

Poor health Current smoker

Did not receive medical care

because of cost in past 12 mos

Poor mental health for 14 or more days in last month

Cigarette smoking among those who report poor mental

health

Dutchess 3,614 14% 21% 38% 4% 16% 12% 11% 31% Orange 3,592 17% 26% 37% 5% 16% 11% 9% 38% Putnam 3,155 17% 23% 45% 3% 14% 16% 17% 19% Rockland 3,407 13% 26% 43% 2% 10% 14% 8% * Sullivan 2,750 13% 26% 49% 5% 25% 10% 10% * Ulster 3,091 10% 25% 44% 4% 21% 11% 17% * Westchester 4,986 16% 20% 35% 4% 12% 12% 10% 24% Region Total/Avg. 24,595 14% 24% 42% 4% 16% 12% 12% 28% *Suppressed due to small sample size. Data is from the CDC Expanded Behavioral Risk Factor Surveillance System (BRFSS) 2013-14 Survey. Retrieved April 27, 2016 from https://health.data.ny.gov/Health/Expanded-Behavioral-Risk-Factor-Surveillance-Surve/jsy7-eb4n?_sm_au_=iVVnMrPRnsfs8P5M

Compared to all other DSRIP regions, the Mid-Hudson region had the second highest average percentages of those with housing insecurity (42%) and not receiving medical care because of cost in the past 12 months (12%), and the lowest average percentage of binge drinking (14%).

3. Hospitalization Rates by Disease or Cause In the Mid-Hudson region, Sullivan County has the highest rates per 10,000 of drug-related hospitalizations (n=46) and hospitalizations due to self-inflicted injury (n=10) (Table 4). Orange County has the highest hospitalization rate for cardiovascular disease (n=163) and diabetes (n=15). Westchester has the highest hospitalization rate for asthma (n=14). Ulster County has the highest hospitalization rate for stroke (n=29), and the highest newborn drug-related diagnosis rate (81 per 10,000 newborn discharges).

Table 4. Mid-Hudson Region: Hospitalization Rates by Disease or Cause

County

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

newborn discharges

Total hospitalizations

Cardiovascular disease

Cerebrovascular disease (stroke)

Diabetes (primary

diagnosis) Asthma

Self-inflicted injury

Drug-related

Dutchess 1,066 125 24 13 11 7 29 72 Orange 1,246 163 26 15 13 7 30 71 Putnam 994 121 21 9 9 6 18 49 Rockland 1,131 117 25 13 12 5 22 26 Sullivan 1,253 152 22 14 9 10 46 46 Ulster 1,177 145 29 13 10 5 28 81 Westchester 1,108 131 22 14 14 5 24 53

Region Average 1,139 136 24 13 11 6 28 57 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi



In the region Putnam County has the lowest rates per 10,000 of hospitalizations for stroke (n=21), diabetes (n=9), and asthma (n=9), and the lowest rate of drug-related hospitalizations (n=18). Rockland County has the lowest rate for cardiovascular disease (n=117) and newborn drug-related diagnoses (n=26).

Among all DSRIP regions the Mid-Hudson region has the second highest average rate of drug-related hospitalizations (n=28), the third highest average rate of asthma hospitalizations (n=11), and the lowest rate for newborn drug-related diagnoses (n=57).

4. Mortality Rates Premature Mortality In the Mid-Hudson region, Sullivan County has the highest percentage of premature deaths (50%), which is the second highest percentage among all NYS counties. In the region, Sullivan County also has the highest premature death rates per 100,000 from cardiovascular disease (n=152) and Sullivan and Ulster counties have the highest rates of premature death from stroke (n=12 each) (Table 5). Ulster County has the highest rate of alcohol related motor vehicle injuries and deaths (n=62).

Table 5. Mid-Hudson Region: Percentage and Rates of Premature Death and Alcohol Related Motor Vehicle Injuries and Deaths

County

Percentage

premature deaths

(aged less than 75

years)

Rate per 100,000

Premature Death (aged 35-64 years) Alcohol related

motor vehicle

injuries and deaths Cardiovascular

disease

Cerebrovascular

disease (stroke)

Dutchess 40 95 10 44 Orange 44 88 7 46 Putnam 43 62 6 51 Rockland 37 70 8 40 Sullivan 50 152 12 48 Ulster 43 99 12 62 Westchester 33 76 9 31 Average % or Rate 41 92 9 46 Data Source is the NYS Department of Health Community Health Indicator Reports (CHIRS): Latest Data. Retrieved May 2, 2016 from https://health.data.ny.gov/Health/Community-Health-Indicator-Reports-CHIRS-Latest-Da/54ci-sdfi

In the region Westchester County has the lowest percentage of premature deaths (33%, the second lowest in any NYS county) and the lowest rate of alcohol related motor vehicle injuries and deaths (n=31). Putnam County has the lowest rates of premature death due to cardiovascular disease (n=62, the lowest rate in any NYS county) and stroke (n=6).



Compared to all other DSRIP regions the Mid-Hudson region has the second lowest average rates of premature deaths due to cardiovascular disease (n=92) and stroke (n=9).

Top Ten Causes of Death Among all DSRIP regions, the Mid-Hudson region has the lowest average death rate per 100,000 due to malignant neoplasms (n=137), the second lowest average death rate due to diabetes (n=13), and the second highest average death rate due to pneumonia (n=17). Heart disease is the number one cause of death in all counties in the region (Table 6).

Table 6. Mid-Hudson Region: 2014 Top Ten Causes of Death — Rates* per 100,000 Population by Resident County

County Heart

Disease Malignant

Neoplasms Cerebrovascular Disease (Stroke)

AIDS Pneumonia

Chronic Lower

Respiratory Disease

Accidents Diabetes Mellitus

Homicide or Legal

Intervention

Cirrhosis of Liver

Suicide

Dutchess 163 139 27 2 13 27 27 14 3 6 11 Orange 169 145 33 1 17 35 30 15 3 6 7 Putnam 160 114 30 0 16 21 20 5 0 7 7 Rockland 138 109 24 1 18 22 17 8 1 4 7 Sullivan 201 170 18 3 17 44 43 19 4 10 15 Ulster 167 156 30 1 20 28 24 18 2 5 8 Westchester 136 129 21 1 16 20 19 10 2 5 6 Region Average 162 137 26 1 17 28 26 13 2 6 9

Data is from the NYS Department of Health. Retrieved April 26, 2016 from https://www.health.ny.gov/statistics/vital_statistics/2014/table40.htm *Age-Sex adjusted rates are directly standardized using the age-sex distribution for the United States 2000 Census.

Sullivan County has the highest death rates for all causes listed, except for pneumonia and cerebrovascular disease, for which it has the lowest rate (n=18). Rockland County has the lowest death rates for malignant neoplasms (n=109, which is the lowest rate in any NYS county), accidents (n=17) and cirrhosis of the liver (n=4). Westchester has the lowest death rates for heart disease (n=136), chronic lower respiratory disease (n=20) and suicide (n=6). Putnam County has the lowest death rate due to diabetes (n=5) and AIDS (n=0), and Dutchess County has the lowest death rate due to pneumonia (n=13).

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

Chronic Health Conditions Overall, smoking (25%), obesity (16%) and high blood pressure (15%) are the leading chronic health conditions for the public mental health population in the Mid-Hudson region (Table 7).



Table 7. Mid-Hudson Region: Chronic Health Conditions Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served with Chronic Health Conditions

Current Smokers

Diabetes Obesity High Blood Pressure

Hyperlipidemia Had a Heart

Attack Had a Stroke

Under 21 5 1 6 0 1 0 0 21-64 32 12 19 18 13 1 1 65+ 21 18 15 38 26 3 2 Total Average 25 9 16 15 11 1 1 Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among all DSRIP regions, the Mid-Hudson region has the lowest percentage of smokers (25%) and the second lowest percentage of patients with diabetes (9%).

Among patients under the age of 21, the region has the second lowest percentage that are current smokers (5%) in all DSRIP regions.

For patients ages 65 and older, the Mid-Hudson region has the lowest percentages of those that have diabetes (18%), had a heart attack (3%) or stroke (2%) in all DSRIP regions.

Behavioral Health Diagnoses Overall, schizophrenia and other psychotic disorders (25%), depressive disorders (24%) and co-occurring disorder (22%) are the leading behavioral health diagnoses for the public mental health population in the region (Table 8).

Table 8. Mid-Hudson Region: Behavioral Health Diagnoses Among Those Served in the NYS Public Mental Health System

Age Group

Percentage of Patients Served by Diagnostic Category

Anxiety Disorder

Bipolar and related Disorders

Depressive Disorders

Disruptive Impulse Conduct Disorder

Neurodevelop-mental

Disorders

Schizophrenia Spectrum & other

Psychotic Disorders

Trauma Stress or Adjustment

Not a Mental Illness

With a Co-Occuring Disorder

Under 21 13 13 22 10 20 3 16 3 4 21-64 7 18 25 1 1 32 7 2 29 65+ 6 13 29 1 0 39 3 2 15 Total Average 8 17 24 3 5 25 9 2 22

Data is from the NYS Office of Mental Health 2015 Patient Characteristics Survey. Data retrieved April 28, 2016.

Among patients under the age of 21, the Mid-Hudson region has the highest percentage of those with a co-occurring disorder (4%), and the second highest percentages of those with anxiety disorders (13%) and those with disruptive impulse conduct disorder (10%) in all DSRIP regions.



Among patients ages 21-64, the region has the second lowest percentage of those with anxiety disorders (7%) in all DSRIP regions.

For patients ages 65 and older, the Mid-Hudson region has the second highest percentage of those with a co-occurring disorder (15%), the lowest percentage of those with an anxiety disorder (6%), and the second lowest percentage of those with trauma stress or adjustment disorder (3%) in all DSRIP regions.



IV. Behavioral Health Care Utilization

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

1. Medicaid Beneficiaries with Mental Health Diagnoses

Mental Health Diagnosis Inpatient Admissions Table 1 describes the number of Medicaid beneficiaries in the Mid-Hudson region with inpatient hospital admissions (n=32,625) by mental health diagnosis. By county, admissions ranged from a high of 13,137 in Westchester to a low of 603 in Putnam. Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (43%), followed by other mental health diagnoses (16%), schizophrenia (15%), chronic stress and anxiety diagnoses (13%), bi-polar disorder (10%), and PTSD (3%).

Table 1. Mid-Hudson Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Mental Health Diagnosis

County

Bi-Polar Disorder Depressive Disorders

Schizophrenia Chronic Stress and Anxiety Diagnoses

Post Traumatic Stress Disorder

Other Mental Health Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries MH Inpatient

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

Dutchess 653 13% 2,105 41% 741 14% 640 12% 185 4% 845 16% 5,169 Orange 524 10% 2,355 44% 753 14% 732 14% 132 2% 840 16% 5,336 Putnam 49 8% 283 47% 102 17% 102 17% 0 0% 67 11% 603 Rockland 320 9% 1,471 43% 698 20% 463 13% 30 1% 461 13% 3,443 Sullivan 118 8% 672 47% 244 17% 207 14% 24 2% 163 11% 1,428 Ulster 314 9% 1,483 42% 380 11% 554 16% 163 5% 615 18% 3,509 Westchester 1,340 10% 5,619 43% 2,111 16% 1,431 11% 288 2% 2,348 18% 13,137

Totals 3,318 10% 13,988 43% 5,029 15% 4,129 13% 822 3% 5,339 16% 32,625 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

In the region, the percentages of Medicaid beneficiaries hospitalized for mental health diagnoses were highest by diagnosis in the following counties: bipolar disorder in Dutchess County (13%, highest in any NYS county), depressive disorders in Putnam and Sullivan counties (47% each), schizophrenia in Rockland County (20%), chronic stress and anxiety diagnoses in Putnam County (17%), PTSD in Ulster County (5%), and other mental health diagnoses in Ulster and Westchester counties (18% each).

Table 2 describes the number of Medicaid inpatient hospital admissions in the Mid-Hudson region (n=67,209) by mental health diagnosis. By county, admissions ranged from a high of 27,642 in Westchester County to a low of 1,210 in Putnam.



Table 2. Mid-Hudson Region: Number of Medicaid Inpatient Hospital Admissions by Mental Health Diagnosis

County Bi-Polar Disorder


Schizophrenia Chronic Stress

and Anxiety Diagnoses


Other Mental Health

Diagnoses

Total Number of

MH

Number of Admissions Admissions

Dutchess 1,433 4,277 1,506 1,260 407 1,823 10,706 Orange 1,099 4,783 1,442 1,485 245 1,805 10,859 Putnam 109 557 216 197 0 131 1,210 Rockland 704 2,932 1,383 932 71 1,117 7,139 Sullivan 270 1,316 477 398 62 362 2,885 Ulster 644 2,781 709 1,084 327 1,223 6,768 Westchester 3,086 11,710 4,325 2,712 621 5,188 27,642

Totals 7,345 28,356 10,058 8,068 1,733 11,649 67,209 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Depressive disorders accounted for the largest number of inpatient admissions in all counties and were highest in Westchester (n=11,710). Across counties, admissions were highest in Westchester County for all diagnoses.

Mental Health Diagnosis Emergency Room Visits Table 3 describes the total number of Medicaid beneficiaries in the Mid-Hudson region with emergency room visits (n=62,595) by mental health diagnosis. By county, ER visits ranged from a high of 21,787 in Westchester to a low of 3,834 in Sullivan. Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (37%), followed by other mental health diagnoses (21%), schizophrenia and chronic stress and anxiety diagnoses (14% each), bi-polar disorder (10%), and PTSD (4%).

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by diagnosis in the following counties: depressive disorders in Orange County (39%), bipolar disorder in Dutchess County (12%, the highest in any NYS county), schizophrenia in Rockland County (17%), chronic stress and anxiety diagnoses in Putnam and Ulster counties (16% each), and PTSD in Ulster County (6%), and other mental health diagnoses in Putnam, Ulster and Westchester counties (22% each).



Table 3. Mid-Hudson Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Mental Health Diagnosis



Schizophrenia Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses Total Medicaid

BeneficiariNumber/Percentage of Medicaid Beneficiaries

es with MH ER Visit

# % # % # % # % # % # % Dutchess 1,224 12% 3,812 36% 1,490 14% 1,432 14% 439 4% 2,192 21% 10,589 Orange 1,042 10% 4,142 39% 1,506 14% 1,565 15% 397 4% 2,088 19% 10,740 Putnam 117 9% 492 37% 172 13% 215 16% 43 3% 293 22% 1,332 Rockland 561 10% 2,058 36% 998 17% 842 15% 114 2% 1,134 20% 5,707 Sullivan 359 9% 1,413 37% 599 16% 594 15% 115 3% 754 20% 3,834 Ulster 762 9% 3,135 36% 932 11% 1,393 16% 494 6% 1,890 22% 8,606 Westchester 2,132 10% 8,191 38% 3,126 14% 2,796 13% 766 4% 4,776 22% 21,787

Totals 6,197 10% 23,243 37% 8,823 14% 8,837 14% 2,368 4% 13,127 21% 62,595Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Table 4 describes the total number of Medicaid ER visits in the Mid-Hudson region (n=206,468) by mental health diagnosis. By county, ER visits ranged from a high of 66,737 in Westchester County to a low of 3,976 in Putnam.

Table 4. Mid-Hudson Region: Number of Medicaid Emergency Room Visits by Mental Health Diagnosis


Depressive Disorders Schizophrenia

Chronic Stress and Anxiety Diagnoses


Other Mental Health Diagnoses

Total Number of ER Visits

Number of ER Visits

Dutchess 5,138 14,080 5,165 5,180 1,696 7,791 39,050 Orange 4,241 14,667 5,155 5,704 1,560 7,618 38,945 Putnam 342 1,486 537 614 143 854 3,976 Rockland 1,888 5,592 2,848 2,273 374 3,257 16,232 Sullivan 1,270 4,298 1,802 1,828 433 2,338 11,969 Ulster 2,809 10,313 3,114 4,558 1,941 6,824 29,559 Westchester 7,773 24,173 9,456 8,135 2,503 14,697 66,737

Totals 23,461 74,609 28,077 28,292 8,650 43,379 206,468 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Depressive disorders accounted for the largest number of ER visits in all counties and were highest in Westchester (n=24,173). Across counties, ER visits were highest in Westchester County for all diagnoses.

Medicaid Mental Health Beneficiaries Compared to All Medicaid Beneficiaries Table 5 describes Medicaid mental health beneficiaries compared to all Medicaid beneficiaries in the Mid-Hudson region. In the region, 7% of all Medicaid beneficiaries had a mental health inpatient hospital admission and 14% had a mental health ER visit. By county, Dutchess had the highest percentage of Medicaid beneficiaries with a mental health inpatient admission (12%), while Rockland had the lowest (4%). Similarly,



Dutchess County had the highest percentage of Medicaid beneficiaries with a mental health ER visit (25%) and Rockland County had the lowest (7%).

Table 5. Mid-Hudson Region: Percentage of Medicaid Population with Mental Health Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with MH Inpatient Admission

Medicaid Beneficiaries with MH ER Visit

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Dutchess 43,049 5,169 12% 10,589 25% Orange 79,773 5,336 7% 10,740 13% Putnam 6,868 603 9% 1,332 19% Rockland 81,278 3,443 4% 5,707 7% Sullivan 21,938 1,428 7% 3,834 17% Ulster 36,739 3,509 10% 8,606 23% Westchester 168,171 13,137 8% 21,787 13%

Totals 437,816 32,625 7% 62,595 14% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

2. Medicaid Beneficiaries with Substance Use Disorders

Substance Use Disorder Inpatient Admissions Table 6 describes the total number of Medicaid beneficiaries in the Mid-Hudson region with inpatient hospital admissions (n=12,150) by substance use disorder (SUD). By county, admissions ranged from a high of 5,278 in Westchester to a low of 268 in Putnam. Region-wide, the largest percentage of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (31%), followed by opioid use disorder (22%), drug abuse: cannabis/NOS/NEC (20%), cocaine use disorder (14%), and other SUD diagnoses (13%).

In the region, the percentages of Medicaid beneficiaries hospitalized for SUDs were highest by disorder in the following counties: alcohol use disorder in Rockland County (45%), opioid use disorder in Dutchess, Sullivan and Ulster counties (27% each), drug abuse: cannabis/NOS/NEC in Putnam County (22%), cocaine use disorder in Westchester County (17%), and other SUD diagnoses in Orange and Putnam counties (16% each).



Table 6. Mid-Hudson Region: Number of Medicaid Beneficiaries with Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder

Drug Abuse: Cannabis/ NOS/NEC

Other SUD Diagnoses

Total Medicaid Beneficiaries with

Number/Percentage of Medicaid Beneficiaries Admission SUD Inpatient

# % # % # % # % # %

Dutchess 304 15% 555 28% 545 27% 316 16% 286 14% 2,006 Orange 309 13% 640 27% 531 23% 500 21% 379 16% 2,359 Putnam 21 8% 82 31% 65 24% 58 22% 42 16% 268 Rockland 46 7% 284 45% 122 19% 106 17% 68 11% 626 Sullivan 58 11% 156 29% 148 27% 111 21% 67 12% 540 Ulster 79 7% 388 36% 295 27% 195 18% 116 11% 1,073 Westchester 882 17% 1,703 32% 922 17% 1,104 21% 667 13% 5,278

Totals 1,699 14% 3,808 31% 2,628 22% 2,390 20% 1,625 13% 12,150 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export

Table 7 describes the number of Medicaid inpatient hospital admissions in the Mid-Hudson region (n=30,354) by substance use disorder. By county, admissions ranged from a high of 13,682 in Westchester County to a low of 705 in Putnam.

Alcohol use disorder accounted for the largest number of inpatient admissions in all counties, and were highest in Westchester (n=1,703). Across counties, admissions for all disorders were highest in Westchester County.

Table 7. Mid-Hudson Region: Number of Medicaid Inpatient Hospital Admissions by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of SUD

Admissions Number of Admissions

Dutchess 304 555 545 316 286 5,048 Orange 309 640 531 500 379 5,629 Putnam 21 82 65 58 42 705 Rockland 46 284 122 106 68 1,549 Sullivan 58 156 148 111 67 1,152 Ulster 79 388 295 195 116 2,409 Westchester 882 1,703 922 1,104 667 13,862

Totals 1,699 3,808 2,628 2,390 1,625 30,354 Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export



Substance Use Disorder Emergency Room Visits Table 8 describes the total number of Medicaid beneficiaries in the Mid-Hudson region with emergency room (ER) visits (n=21,219) by substance use disorder. By county, ER visits ranged from a high of 8,242 in Westchester to a low of 421 in Putnam. Region-wide, the largest percentage of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (27%), followed by drug abuse: cannabis/NOS/NEC (23%), opioid use disorder (19%), other SUD diagnoses (17%), and alcohol use disorder (14%).

Table 8. Mid-Hudson Region: Number of Medicaid Beneficiaries with Emergency Room Visits by Substance Use Disorder

County

Cocaine Use Disorder

Alcohol Use Disorder

Opioid Use Disorder


Other SUD Diagnoses

Total Medicaid

Beneficiaries with SUD ER

Visit

Number/Percentage of Medicaid Beneficiaries

# % # % # % # % # %

Dutchess 785 24% 484 15% 520 16% 833 26% 590 18% 3,212 Orange 903 24% 510 14% 768 20% 921 24% 670 18% 3,772 Putnam 133 32% 42 10% 75 18% 106 25% 65 15% 421 Rockland 477 30% 195 12% 266 17% 348 22% 303 19% 1,589 Sullivan 332 22% 184 12% 297 20% 391 26% 274 19% 1,478 Ulster 759 30% 248 10% 424 17% 655 26% 419 17% 2,505 Westchester 2,258 27% 1,299 16% 1,762 21% 1,574 19% 1,349 16% 8,242

Totals 5,647 27% 2,962 14% 4,112 19% 4,828 23% 3,670 17% 21,219 Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

In the region, the percentages of Medicaid beneficiaries with ER visits were highest by disorder in the following counties: cocaine use disorder in Putnam County (32%), alcohol use disorder (16%) and opioid use disorder (21%) in Westchester County, drug abuse: cannabis/NOS/ NEC in Dutchess, Sullivan and Ulster counties (26% each), and other SUD diagnoses in Rockland and Sullivan counties (19% each).

Table 9 describes the number of Medicaid ER visits in the Mid-Hudson region (n=83,291) by substance use disorder. By county, ER visits ranged from a high of 32,102 in Westchester County to a low of 1,553 in Putnam. Cocaine use disorder accounted for the largest number of ER visits in all counties, except Dutchess and Sullivan, and were highest in Westchester (n=8,929). In Dutchess and Sullivan counties drug abuse: cannabis/NOS/ NEC accounted for the largest number of ER visits. Across counties, ER visits for all disorders were highest in Westchester County.



Table 9. Mid-Hudson Region: Number of Medicaid Emergency Room Visits by Substance Use Disorder

County

Cocaine Use

Disorder

Alcohol Use

Disorder

Opioid Use

Disorder


Other SUD Diagnoses

Total Number of ER Visits

Number of ER Visits

Dutchess 3,104 2,267 2,398 3,398 2,870 14,037 Orange 3,759 2,290 3,142 3,555 2,730 15,476 Putnam 460 152 285 401 255 1,553 Rockland 1,666 691 871 1,149 1,093 5,470 Sullivan 1,004 531 890 1,253 805 4,483 Ulster 2,810 971 1,969 2,596 1,824 10,170 Westchester 8,929 5,092 6,245 5,895 5,941 32,102

Totals 21,732 11,994 15,800 18,247 15,518 83,291Data is from the NYS Department of Health Medicaid Chronic Conditions and Emergency Room Visits database, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/wybq-m39t

Medicaid Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Table 10 describes Medicaid SUD beneficiaries compared to all Medicaid beneficiaries in the Mid-Hudson region. In the region, 3% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 5% had a SUD ER visit. By county, Dutchess County had the highest percentage of Medicaid beneficiaries with a SUD inpatient admission (5%), and Rockland had the lowest (1%). Dutchess, Sullivan, and Ulster counties had the highest percentage of Medicaid beneficiaries with a SUD ER visit (7% each) and Rockland County had the lowest (2%).

Table 10. Mid-Hudson Region: Percentage of Medicaid Population with Substance Use Disorder Inpatient Hospital Admission or Emergency Room Visit

County All Medicaid

Medicaid Beneficiaries with SUD Inpatient Admission

Medicaid Beneficiaries with SUD ER Visit

Beneficiaries Number/Percentage of Medicaid Beneficiaries

N % N %

Dutchess 43,049 2,006 5% 3,212 7% Orange 79,773 2,359 3% 3,772 5% Putnam 6,868 268 4% 421 6% Rockland 81,278 626 1% 1,589 2% Sullivan 21,938 540 2% 1,478 7% Ulster 36,739 1,073 3% 2,505 7% Westchester 168,171 5,278 3% 8,242 5%

Totals 437,816 12,150 3% 21,219 5% Data is from the NYS Department of Health Medicaid Chronic Conditions and Inpatient Admissions data base, 2012 data. Retrieved May 4, 2016 from https://health.data.ny.gov/ Health/Medicaid-Chronic-Conditions-Inpatient-Admissions-a/2yck-xisk#Export



3. Medicaid Beneficiary Hospital Inpatient Admissions and Emergency Room Visits

Medicaid Beneficiaries by Eligibility Type In the Mid-Hudson region 19% of the estimated population are Medicaid beneficiaries (Table 11). By county, Medicaid beneficiaries range from a high of 28% of the estimated population in Sullivan County to a low of 7% of the estimated population in Putnam.

Medicaid beneficiaries include individuals that receive only Medicaid and individuals that are dually-eligible for Medicare and Medicaid benefits because of their age or disability and low incomes.1 In the Mid-Hudson region, 84% of Medicaid beneficiaries receive Medicaid only and 16% are dual-eligible. Medicaid only beneficiaries range from a low of 75% in Putnam County to a high of 89% in Rockland.

Table 11. Mid-Hudson Region: Medicaid Beneficiaries by Eligibility Type

County


Population

Total Medicaid Beneficiaries

Medicaid Only Dual Medicaid and Medicare

# %

Total Pop # % Total Medicaid

Bene. #

% Total Medicaid

Bene.

Dutchess 296,793 43,049 15% 34,708 81% 8,341 19% Orange 371,979 79,773 21% 70,033 88% 9,740 12% Putnam 99,642 6,868 7% 5,180 75% 1,688 25% Rockland 309,737 81,278 26% 72,309 89% 8,969 11% Sullivan 77,437 21,938 28% 18,309 83% 3,629 17% Ulster 182,526 36,739 20% 29,634 81% 7,105 19% Westchester 946,646 168,171 18% 139,605 83% 28,566 17%

Totals 2,284,760 437,816 19% 369,778 84% 68,038 16%

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

Medicaid Beneficiary Hospital Inpatient Admissions Medicaid beneficiary hospital inpatient admissions in the Mid-Hudson region are described in Table 12.2 In the region, 11% of Medicaid only beneficiaries and 17% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Percentages of Medicaid only beneficiaries with hospital inpatient admissions ranged from a high of 13% in Putnam County (the highest in any NYS county) to a low of 11% in all other counties except Ulster. In comparison, hospital inpatient admissions in the dual-eligible Medicaid/Medicare population ranged from a low of 14% in Putnam County to a high of 18% in Westchester.



Table 12. Mid-Hudson Region: Total Medicaid Inpatient Hospital Admissions by Type of Beneficiary

County

Number of Beneficiaries Number of Beneficiaries

with Inpatient Admissions Total Inpatient

Hospital Admissions

Medicaid Only

Dual Medicaid and Medicare


Medicaid Only


# # # % # % # #

Dutchess 34,708 8,341 3,951 11% 1,403 17% 5,745 1,863 Orange 70,033 9,740 7,741 11% 1,697 17% 10,272 2,375 Putnam 5,180 1,688 696 13% 229 14% 976 306 Rockland 72,309 8,969 8,247 11% 1,530 17% 10,208 2,168 Sullivan 18,309 3,629 2,042 11% 555 15% 2,778 749 Ulster 29,634 7,105 3,431 12% 1,202 17% 5,099 1,709 Westchester 139,605 28,566 15,618 11% 5,040 18% 21,994 7,106

Totals 369,778 68,038 41,726 11% 11,656 17% 57,072 16,276 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About

Medicaid Beneficiary Emergency Room Visits Emergency room (ER) visits among Medicaid beneficiaries in the Mid-Hudson region are described in Table 13.3 In the region, 26% of Medicaid only beneficiaries and 19% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

Percentages of Medicaid only beneficiaries with ER visits ranged from a low of 17% in Rockland County to a high of 32% in Ulster. In comparison, ER visits for the Medicaid/Medicare dual-eligible population ranged from a low of 17% each in Putnam, Rockland and Westchester counties to a high of 25% in Ulster.

Table 13. Mid-Hudson Region: Medicaid Emergency Room Visits by Beneficiary Type

County

Number of Beneficiaries Number of Beneficiaries

with ER Visits Total ER Visits



Medicaid Only


# # # % # % # #

Dutchess 34,708 8,341 10,587 31% 1,666 20% 23,140 3,884 Orange 70,033 9,740 16,257 23% 2,295 24% 32,897 5,955 Putnam 5,180 1,688 1,297 25% 294 17% 2,418 558 Rockland 72,309 8,969 11,941 17% 1,544 17% 19,073 2,903 Sullivan 18,309 3,629 5,621 31% 781 22% 11,193 1,626 Ulster 29,634 7,105 9,424 32% 1,755 25% 20,151 4,098 Westchester 139,605 28,566 39,799 29% 4,844 17% 75,290 9,621

Totals 369,778 68,038 94,926 26% 13,179 19% 184,162 28,645 Data is from the NYS Department of Health’s Medicaid Beneficiaries Inpatient Admissions and Emergency Room Visits data base; 2012 data. Retrieved May 11, 2016 from https://health.data.ny.gov/Health/Medicaid-Beneficiaries-Inpatient-Admissions-and-Em/m2wt-pje4#About



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

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


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


V. Unmet Service Needs

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

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

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

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

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

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

For adults with schizophrenia in the Mid-Hudson region, 70% adhere to antipsychotic medications (30% do not). Among all DSRIP regions, the region has the highest medication adherence percentage for adults with schizophrenia. The percentage with adherence to antipsychotic medications ranges from a low of 64% in Dutchess County to a high of 83% in Rockland (Table 1).

In the region, 53% of individuals remain on antidepressant medication during the acute phase and 38% remain on antidepressant medication during the continuation phase (62% do not). Among all DSRIP regions, the Mid-Hudson region has the second highest adherence to antidepressants for the continuation phase.



Adherence to antidepressants is lowest in Sullivan County (49%) for the acute phase and in Sullivan and Westchester counties (36% each) for the continuation phase. In comparison, the highest rates of adherence are in Putnam and Rockland counties (57% each, acute phase; 44% each, continuation phase).

Table 1. Mid-Hudson Region: Mental Health Medication Adherence and Management

County Adherence to Antipsychotic

Medications for Individuals with Schizophrenia

Antidepressant Medication Management

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

Dutchess 64% 55% 39% Orange 66% 53% 38% Putnam 73% 57% 44% Rockland 83% 57% 44% Sullivan 72% 49% 36% Ulster 80% 54% 37% Westchester 65% 50% 36%

Region Avg. % 70% 53% 38% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

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

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

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

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

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

In the Mid-Hudson region, 46% of individuals follow-up after hospitalization for mental illness within seven days (54% do not) and 62% follow-up within 30 days (Table 2). In the region, Rockland County has both the lowest seven day follow-up percentage after hospitalization for mental illness (34%) and 30 day follow-up percentage (49%). Westchester County has the highest seven day follow-up percentage (51%) and



Sullivan and Westchester counties have the highest 30 day follow-up percentage (65% each).

Table 2. Mid-Hudson: Mental Health Follow-Up Care

County

Follow-up After Hospitalization for Mental Illness

Follow-Up Care for Children Prescribed ADHD Medication

Within 7 Days Within 30 Days Initiation Phase Continuation Phase

Dutchess 44% 59% 54% 65% Orange 40% 62% 54% 63% Putnam 48% 57% 69% * Rockland 34% 49% 57% 65% Sullivan 45% 65% 57% 66% Ulster 48% 63% 55% 68% Westchester 51% 65% 73% 77%

Region Avg. % 46% 62% 61% 68% *Sample Size Too Small to Report. Notes and Data Sources: Data is from the NYS Department of Health -Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2014 data.

In the Mid-Hudson region, 61% of children prescribed ADHD medication have follow-up care during the initiation phase and 68% have follow-up care during the continuation phase. These are the second highest rates in any DSRIP region. The percentage of children prescribed ADHD medication with follow-up care is lowest in Dutchess and Orange counties for the initiation phase (54% each) and in Orange County for the continuation phase (63%). Westchester County has the highest percentages for both the initiation (73%) and continuation (77%) phases in any NYS county.

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

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

The Engagement measure is the percentage of members who engage in treatment within 30 days after initiation.

In the Mid-Hudson region, 52% of individuals initiate AOD treatment within 14 days of diagnosis and 27% of individuals engage in AOD treatment within 30 days after initiation (73% do not) (Table 3). Among all DSRIP regions, the region has the second highest percentage of engagement in AOD treatment.

In the region, Ulster County has the lowest percentage of initiation of AOD treatment (47%) and Putnam has the highest (57%). Sullivan and Ulster counties have the lowest



percentage of engagement in AOD treatment (23% each) and Orange, Putnam, and Rockland counties have the highest (30% each).

Table 3. Mid-Hudson Region: Alcohol and Other Drug Dependence Treatment

County Alcohol and Other Drug Dependence Treatment

Initiation Engagement

Dutchess 51% 24% Orange 55% 30% Putnam 57% 30% Rockland 54% 30% Sullivan 48% 23% Ulster 47% 23% Westchester 53% 28%

Region Avg. % 52% 27% Notes and Data Sources: Data is from the NYS Department of Health - Medicaid clinical metrics for Clinical Improvement Projects (Domain 3) of the DSRIP Program database, measurement year 2013 data.

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

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

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

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

Diabetes Chronic Conditions In Mid-Hudson region’s Medicaid only population, Sullivan County has the highest observed to expected ratio for diabetes short-term complications (161/128) and Orange County has the highest ratio for long-term complications (124/117) (Table 4a). The rest of the counties have lower observed than expected rates for diabetes short-term complications, and Sullivan County has the lowest ratio for long-term complications (32/130).



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

County

Diabetes Short-term Complications Diabetes Long-term Complications



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 83 126 64 110 102 128 201 324 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual population, Putnam County has the highest observed to expected ratio for diabetes short-term complications (106/98), and the rest of the counties have lower observed than expected rates. All counties in the region have lower observed than expected rates for diabetes long-term complications in the dual population. Among all DSRIP regions, the Mid-Hudson region has the lowest observed to expected ratios for diabetes short-term complications in the Medicaid only population (83/126) and the dual population (64/110).

Table 4b describes uncontrolled diabetes and lower-extremity amputation rates among patients with diabetes. In the Medicaid only population, Westchester County has the highest observed to expected ratio for uncontrolled diabetes (36/29), and the rest of the counties have lower observed than expected rates. For lower-extremity amputations in this population, Ulster County has the highest observed to expected ratio (20/14), and the rest of the counties have lower observed than expected rates.



Table 4b. Mid-Hudson Region: Diabetes Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Uncontrolled Diabetes Lower-Extremity Amputation

among Patients with Diabetes



Rates per 100,000

Observed Expected Observed Expected Observed Expected Observed Expected


Totals 12 23 42 46 7 13 37 47 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the dual population, Putnam County has the highest observed to expected ratio for uncontrolled diabetes (53/37) and Sullivan County has the lowest (zero). Putnam County also has the highest ratio for lower-extremity amputation among patients with diabetes (106/38) in the dual population and Sullivan County has the lowest (zero). Among all DSRIP regions, the Mid-Hudson region has the lowest observed to expected ratio (7/13) for lower extremity amputation in the Medicaid only population.

Cardiac Chronic Conditions In the Medicaid only population in the Mid-Hudson region (Table 5a), Orange County has the highest observed to expected ratios for hypertension (92/51) and Sullivan County has the highest ratio for angina without procedure (24/15). In this population all counties have a lower observed than expected rate for heart failure.

In the dual Medicaid and Medicare population, Putnam County has the highest observed to expected ratio for hypertension (159/99) and Rockland County has the lowest ratio (49/145). In this population, all counties have a smaller observed than expected rate for both heart failure and angina without procedure.



Table 5a. Mid-Hudson Region: Cardiac Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Hypertension Heart Failure Angina Without Procedure




Rate per 100,000

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

Dutchess 44 58 106 111 115 147 393 704 10 16 11 27 Orange 92 51 174 121 116 126 698 743 19 14 28 28 Putnam 0 50 159 99 85 123 265 671 0 15 0 24 Rockland 32 56 49 145 121 138 520 853 13 14 20 29 Sullivan 24 53 76 100 113 142 533 664 24 15 25 28 Ulster 67 51 101 95 74 136 443 654 4 15 25 25 Westchester 46 77 117 172 132 190 778 930 17 19 20 32

Total 44 57 112 120 108 143 518 746 12 15 18 28 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

Asthma Chronic Conditions Asthma chronic conditions are described in Table 5b. Dutchess County has the highest observed to expected ratio for asthma in younger adults in the Medicaid only population (132/108) and Ulster County has the lowest (33/95). In the dual population, all counties have lower observed than expected rates for asthma.

Table 5b. Mid-Hudson Region: Asthma Chronic Conditions Inpatient Prevention Quality Indicators by Medicaid Eligibility

County

Asthma in Younger Adults


Rate per 100,000

Observed Expected Observed Expected

Dutchess 132 108 0 197 Orange 105 105 181 219 Putnam 58 97 0 161 Rockland 46 105 0 217 Sullivan 53 100 0 163 Ulster 33 95 127 162 Westchester 110 138 257 306

Total 77 107 81 204 Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



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

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

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

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

In the Mid-Hudson region’s Medicaid only population, Orange County has the highest observed to expected ratios for the overall composite (1,114/1,050) and chronic composite (853/753) indicators, and Dutchess County has the highest ratio for the acute composite indicator (330/290). The lowest observed to expected ratios for these indicators are in Putnam County (overall composite, 507/1,070 and chronic composite, 304/778; both lowest in any NYS county) and Sullivan County (acute composite, 185/296). Among all DSRIP regions, the Mid-Hudson has the lowest observed to expected ratios for the overall and chronic composites in the Medicaid only population.

Table 6. Mid-Hudson Region: Prevention Quality Overall, Acute, and Chronic Composite Indicators by Medicaid Eligibility

County

Overall Composite Acute Composite Chronic Composite




Rate per 100,000


Dutchess 1,052 1,144 2,592 3,410 330 290 1,073 1,197 722 854 1,519 2,214 Orange 1,114 1,050 3,084 3,554 261 276 982 1,250 853 773 2,111 2,304 Putnam 507 1,070 2,594 3,304 203 293 1,112 1,281 304 778 1,482 2,023 Rockland 684 1,059 2,657 3,844 207 277 1,098 1,346 477 782 1,559 2,499 Sullivan 860 1,148 1,776 3,328 185 296 507 1,139 675 852 1,268 2,189 Ulster 904 1,125 3,256 3,284 313 294 1,445 1,191 591 831 1,812 2,094 Westchester 1,126 1,349 3,551 4,103 316 325 1,211 1,383 811 1,024 2,340 2,721

Totals 892 1,135 2,787 3,547 259 293 1,061 1,255 633 842 1,727 2,292Notes and Data Source: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn



In the Mid-Hudson region’s dual population, all counties in the region have lower observed than expected rates for the overall composite and chronic composite indicators. Ulster County has the highest ratio for the acute composite (1,445/1,191), and all other counties in the region have lower observed than expected rates. Among all DSRIP regions, the Mid-Hudson region has the lowest observed to expected ratios in the dual population for the overall (2,787/3,547), acute (1,061/1,255) and chronic (1,727/2,292) composite indicators.

Table 7 describes the all diabetes, circulatory and respiratory composite indicators. In the Mid-Hudson region’s Medicaid only population, all counties in the region have lower observed than expected rates for the all diabetes composite indicator. Orange County has the highest observed to expected ratios for the all circulatory composite (227/190) and all respiratory composite (362/313) indicators, and all other counties have lower observed than expected rates for both indicators. Among all DSRIP regions, the Mid-Hudson region has the lowest all diabetes composite observed to expected ratio in the Medicaid only population (204/290).

Table 7. Mid-Hudson Region: Prevention Quality All Diabetes, Circulatory, and Respiratory Composite Indicators by Medicaid Eligibility

County

All Diabetes Composite All Circulatory Composite All Respiratory Composite




Rate per 100,000


Dutchess 236 298 276 530 169 220 510 841 317 342 744 861 Orange 264 276 349 534 227 190 899 891 362 313 881 898 Putnam 101 266 424 438 85 188 424 794 118 329 741 806 Rockland 162 277 363 562 166 208 588 1,028 151 303 627 929 Sullivan 201 295 101 530 161 211 634 792 314 352 533 887 Ulster 184 290 367 477 145 203 570 774 274 344 874 860 Westchester 277 330 527 614 195 286 915 1,134 345 415 911 993

Total 204 290 344 526 164 215 649 894 269 343 759 891Notes and Data Sources: Data is from the NYS Department of Health Quality Prevention Quality Indicators – Adult (AHRQ PQI) for Medicaid Enrollees database, discharge year 2014 data. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/6kjt-7svn

In the Mid-Hudson region’s dual population, all counties in the region also have lower observed than expected rates for the all diabetes composite indicator. In this population, Orange County has the highest all circulatory composite ratio (899/891) and Ulster County has the highest all respiratory composite ratio (874/860). For both of these indicators, the remaining counties have lower observed than expected rates. Among all DSRIP regions, the Mid-Hudson region has the lowest observed to expected ratios for the all diabetes (344/526), all circulatory (649/894) and all respiratory (759/891) composite indicators in the dual population.



3. Potentially Avoidable Emergency Room Visits In the Mid-Hudson region, Sullivan county has the highest observed to expected ratio (31/21) of potentially preventable ER visits (Table 8). Westchester County has the lowest ratio (13/23).

Table 8. Mid-Hudson Region: All Payers Potentially Preventable Emergency Room Visits

County ER Discharges 2013: Rate per 100,000

Observed Expected

Dutchess 20 21 Orange 15 22 Putnam 17 18 Rockland 17 21 Sullivan 31 21 Ulster 22 20 Westchester 13 23

Total 19 21 Notes and Data Sources: Data is from the NYS Department of Health All Payer Potentially Preventable Emergency Visit (PPV) database. Rates by patient county, SPARCS data 2013. Retrieved May 6, 2016 from https://health.data.ny.gov/Health/All-Payer-Potentially-Preventable-Emergency-Visit-/f8ue-xzy3#About

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

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

Mental Illness Population High Needs In the Mid-Hudson region mental illness population, the largest rates of high need vary by age group. Among youth (<21) the area of highest need is access to crisis services followed by treatment services and transportation. For adults (21+) the area of highest need is access to supported housing followed by access to crisis services, transportation, and home and community-based services.



Chemical Dependency Population High Needs In the Mid-Hudson region chemical dependency population the largest rates of high need also vary by age group. Among youth (<21) the areas of highest need are access to prevention and crisis services followed by workforce recruitment and retention and access to treatment services and transportation. For adults (21+) the areas of highest need are access to supported housing followed by access to crisis services, transportation, and home/community-based services and workforce recruitment and retention.

Table 9. Mid-Hudson Region: Assessment of Needs by Population and Issue Assessment of Local Need (N=7 Counties)

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

Moderate Need

Low Need

Missing High Need

Moderate Need

Low Need

Missing

Selected Issues Mental Illness Population Access to Prevention Services 29% 43% 14% 14% 29% 29% 29% 14% Access to Crisis Services 71% 14% 14% 0% 57% 29% 14% 0% Access to Treatment Services 57% 29% 0% 14% 14% 71% 0% 14% Access to Supported Housing 29% 0% 57% 14% 71% 29% 0% 0% Access to Transportation 57% 14% 29% 0% 57% 29% 14% 0% Access to Home/Community-based Services 29% 29% 29% 14% 57% 14% 29% 0% Access to Other Support Services 29% 29% 43% 0% 29% 57% 14% 0% Workforce Recruitment and Retention 14% 29% 29% 29% 43% 29% 29% 0% Coordination/Integration with Other Systems 14% 29% 57% 0% 29% 14% 57% 0% Selected Issues Chemical Dependency Population Access to Prevention Services 71% 14% 14% 0% 14% 29% 43% 14% Access to Crisis Services 71% 0% 29% 0% 71% 0% 29% 0% Access to Treatment Services 57% 14% 29% 0% 43% 0% 43% 14% Access to Supported Housing 43% 0% 43% 14% 86% 14% 0% 0% Access to Transportation 57% 14% 29% 0% 57% 0% 43% 0% Access to Home/Community-based Services 43% 0% 57% 0% 57% 0% 43% 0% Access to Other Support Services 43% 29% 29% 0% 29% 43% 29% 0% Workforce Recruitment and Retention 57% 14% 14% 14% 57% 29% 14% 0% Coordination/Integration with Other Systems 29% 29% 43% 0% 29% 14% 57% 0%



VI. Consumer and Provider Input

This section summarizes the Mid-Hudson region consumer and provider input regarding community behavioral health needs. Input for this region was collected by two clinics: Bikur Cholim, Inc. (BCI), which serves Rockland County, and Saint Joseph’s Medical Center (SJMC), which serves Westchester County.

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

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

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

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

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

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

Participant Descriptions and Demographics Demographics and information about participating consumers and providers are reported in Tables 1 and 2 respectively. A total of 160 consumers and 72 providers were surveyed by the two participating clinics.



BCI surveyed 50 consumers and 39 providers. BCI consumer respondents were all White and included 2% under age 18 and 98% ages 18-64. Twelve percent of BCI respondents are not BCI patients and 15% of BCI provider respondents practice at secondary related agencies.

SJMC surveyed 110 consumers and 33 providers. SJMC consumer respondents included 7% under age 18, 90% ages 18-64 and 3% ages 65 and older. SJMC consumer respondents include 59% White, 21% Black/African American, 3% Asian and 17% of Hispanic or Latino ethnicity. Six percent of SJMC respondents were not SJMC patients and 24% of SJMC provider respondents practice at secondary related agencies.

Table 2. Mid-Hudson Region: Provider Input

Participant Information BCI

(n=39) SJMC (n=33)

% Survey Participants 100% 100% Focus Group Participants 0% 0% Do not practice at the clinic 15% 24% Practice within the clinic county 95% 85% Have a Master’s degree or higher 95% 82%

Table 1. Mid-Hudson Region: Consumer Input – Consumer Demographics

Category BCI

(n=50) SJMC

(n=110) %

Participant Information Survey Participants 100% 100% Focus Group Participants 0% 0% Not patients at the Clinic 12% 6% Live in the Clinic county 86% 95% Age Under 18 2% 7% 18-64 98% 90% 65 or older 0% 3% Gender (n=46) Male 33% 55% Female 67% 45% Race/Ethnicity* (n=46) White 100% 59% Black/African-American 0% 21% Asian 0% 3% Native-American 0% 0% Other Race 0% 0% Hispanic/Latino Ethnicity 0% 17% *The race/ethnicity question was asked only in the survey, not in the focus groups. Participants were instructed to select all that apply. Percentage is the number within each group divided by the number who responded to the question.

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

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

2. Scope of Services in Treatment 3. Provider Training Needs 4. Participants Feel Welcome where they Receive Services

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

A. Service Utilization Table 3 shows the distribution of behavioral health services that respondents reported using (question 6, consumer survey). The most frequently reported services received



include outpatient mental health services (BCI, 58%; SJMC, 85%), medication for mental health problems (BCI, 26%; SJMC, 79%), and mental health inpatient treatment (BCI, 16%; SJMC, 43%).

Table 3. Mid-Hudson Region: Consumer Survey Input – Behavioral Health Serviced Used

Service Category BCI

(n=50) SJMC

(n=110) Mental Health Services % a. Outpatient mental health services - (e.g., outpatient clinic) 58% 85% b. Inpatient treatment 16% 43% c. Medication for mental health problems 26% 79% d. Residential treatment 2% 16% Substance Use Disorder Services e. Outpatient substance use disorder services (e.g., outpatient clinic) 2% 30% f. Inpatient rehabilitation 0% 15% g. Detoxification 0% 14% h. Residential treatment 0% 11% i. Medication for substance use problems (e.g., methadone or buprenorphine to treat opioid addiction) 0% 10% Other Services j. Case managers or providers who will meet individuals outside of an agency setting (e.g., in the home, church, school, homeless shelter, foster care setting, ER, recreational facility, jail) if necessary 2% 42% k. Providers who will meet with patients via phone or webcam 0% 23% l. Help with finding or maintaining employment 2% 28% m. Help with advancing education or seeking job training 2% 29% n. Help with finding, maintaining, or improving housing 2% 35% o. Education about mental health and substance use issues 6% 45% p. 24-hour crisis phone line 10% 21% q. 24-hour mobile crisis teams 2% 21% r. Peer delivered services (services provided by people who have experienced behavioral health problems and who work to help others with behavioral health problems; e.g., self-help groups, warmlines, and peer specialist services) 4% 29% s. Education and supports (e.g., support groups) for families of individuals in behavioral health treatment 6% 19% *These service categories are not mutually exclusive; one individual could be receiving more than one service.

The least frequently reported services received include SUD medications (BCI, 0%, SJMC, 10%), SUD residential treatment (BCI, 0%, SJMC, 11%), SUD detoxification (BCI, 0%, SJMC, 15%), and SUD inpatient rehabilitation (BCI, 0%, SJMC, 15%). At least 2% of BCI consumers and 30% of SJMC consumers received some form of SUD services.



B. Perceived Service Needs Consumers reported the following unmet service needs (consumer survey, question 9):

More Yiddish speaking therapists (BCI, n=3) Play therapy and child therapy (BCI, n=2) Detox services for prescription pain medication and Access VR services are not

available in Yonkers (SJMC, n=1 each)

Providers reported the following types of behavioral health services that they thought would be beneficial in their communities, but are currently unavailable (provider survey, question 7). For providers, the survey administrator at Bikur Cholim noted, “There was very strong feedback and pleas from the respondents on this”.

Intensive Outpatient/Partial Hospital Program (BCI, n=20) Mobile Crisis (BCI, n=7) Cultural/language sensitive treatment (Yiddish/Jewish) (BCI, n=6)

o Substance Abuse Treatment/Culturally sensitive to Jewish and Yiddish (BCI, n=11)

o Psychological/Neurospych Testing/Language (Yiddish) evaluation (BCI, n=9)

o Supportive Housing/culturally sensitive (BCI, n=4) In-home services (BCI, n=5) Treatment for co-occurring disorders (Substance or Developmental Disability)

(BCI, n=4) Teletherapy/MH/psychiatry (BCI, n=3) Outpatient MH capacity (SJMC, n=5) Residential treatment for SUD and co-occurring SUD/SMI adults (SJMC, n=5) MH or SUD services for children/adolescents (SJMC, n=4) Housing for SMI population (SJMC, n=3) ER triage to divert inpatient MH admissions (SJMC, n=2) Crisis Respite Services (BCI, n=11; SJMC, n=2)

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

The three most frequently reported barriers by providers at both BCI and SJMC are waiting too long to get an appointment (95% and 45% respectively), problems paying for services (59% and 48% respectively), and problems with transportation (56% and 64% respectively). Providers at both clinics also reported service providers not speaking the patient’s preferred language (54% and 39% respectively) and provider hours not being convenient (33% and 45% respectively) as barriers.



Table 4a. Mid-Hudson Region Consumer and Provider Input -- Barriers to Behavioral Health Treatment

Perceived Barrier

BCI SJMC Consumers

(n=50) Providers

(n=39) Consumers

(n=110) Providers

(n=33)

Percentage that selected barrier

Took too long to get an appointment 20% 95% 15% 45% Problems paying for services 4% 59% 9% 48% Problems with transportation 4% 56% 11% 64% Service providers don’t speak my (or the patient’s) preferred language 6% 54% 0% 39% Provider hours are not convenient 8% 33% 6% 45% Service providers are not sensitive to other cultures 2% 21% 1% 15% Nearest service provider is too far away 2% 3% 2% 15% Services were not accessible to people with disabilities 0% 5% 3% 15% No service provider in the area 2% 3% 8% 6% Local provider does not serve individuals with these particular problems 6% * 7% * Services were not available to children or the elderly 4% * 1% * Services were not available to Veterans or members of the armed forces 0% * 0% * Other 2% 5% 0% 42% *Provider responses to questions about access for particular demographic groups are reported in Table 4b

The most frequently reported barrier by consumers at both BCI and SJMC is waiting too long to get an appointment (20% and 15% respectively). BCI consumers also reported provider hours are not convenient (8%) as a barrier, while SJMC consumers reported problems with transportation (11%) as a barrier.

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

Table 4b. Mid-Hudson Region: Provider Input -- Access to Behavioral Health Services by Special Populations

Special Population

BCI SJMC

Total # Respondents

% Answered

"No"* Total #

Respondents

% Answered

"No"*

Veterans or members of the armed forces 33 33% 33 6% Children 37 0% 33 12% Children in foster care 37 5% 33 12% Elderly 37 0% 33 3% Homeless 35 46% 33 3% Incarcerated 35 74% 33 36% *Percentage is the number who responded "No" divided by the number of respondents.

Both BCI and SJMC reported incarcerated individuals as the special population for whom behavioral health services are most frequently not available (BCI, 74%, SJMC, 36%). BCI also reported behavioral health services are frequently not available for homeless individuals (46%) and Veterans or members of the armed forces (33%). In



comparison, SJMC reported services are frequently not available for children and children in foster care (12% each).

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

Table 5. Mid-Hudson Region: Consumer Survey Input -- Scope of Services in Treatment

Provider Service BCI SJMC

Total # Respondents

% Answered "Yes"*

Total # Respondents

% Answered "Yes"*

a. Screen for history of traumatic life events or abuse? 51 80% 77 49% b. Screen for depression, anxiety, substance abuse, or another behavioral health problem? 44 95% 0 0% c. Screen for physical health problems? 51 82% 95 63% d. Assess your strengths, abilities, preferences, and goals? 50 80% 91 67% e. Talk with other providers about your care? 47 79% 90 68% f. Talk to you about the relationship between thoughts, behaviors, and feelings? 49 88% 99 72% g. Provide clear information about:

i. How to get treatment for mental health and substance use issues? 40 88% 82 73%

ii. How to cope with mental health and substance use issues? 41 90% 82 71% iii. Crisis management? 43 84% 81 62%

h. Met all of your health care needs? 32 63% 92 75% *Percentage is the number that responded "Yes" divided by the total number of respondents.

At BCI, consumers reported the most frequently provided services are screening for depression, anxiety, substance abuse or another behavioral health problem (95%), talking about the relationship between thoughts, behaviors, and feelings and how to cope with mental health and substance use issues (88% each). BCI consumers also reported the least frequently provided service is having all of your healthcare needs met (63%).

At SJMC, consumers reported the most frequently provided services are having all your health care needs met (75%) and information about how to get treatment for mental health and substance use issues (73%). SJMC consumers also reported the least frequently provided services are screening for depression, anxiety, substance abuse or another behavioral health problem (0%) and screening for history of traumatic life events or abuse (49%).



3. Provider Training Needs All providers at both clinics endorsed additional training and, most specifically, training in evidence-based treatments (provider survey, question 6). In addition, providers at both clinics made the following training suggestions:

Trauma-focused Cognitive Behavioral Therapy (CBT)/Trauma informed (n=23) Cognitive Behavioral Therapy / Dialectical Behavioral Therapy (n=12) Child-specific interventions (n=4) Motivational Interviewing (n=3) The role of Peer Specialists (n=2) Use of clinical metrics and outcomes (n=2)

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

Table 6. Mid-Hudson Region: Consumer Input -- Feeling Welcome where you Receive Behavioral Health Services

BCI SJMC Total #

Respondents % Answered

"No"* Total #

Respondents % Answered

"No"*

38 3% 89 8% *Percentage is the number who responded "No" divided by the number of respondents.

Things that consumers reported that make them feel welcome are listed below. Friendly, nice, positive, pleasant, non-judgmental, caring, professional staff

(n=42) Peer support (n=6) Knowledgeable, helpful staff and Private/Confidential (n=4 each) Clean, safe environment (n=3) Flexible scheduling (n=2)

Summary The Mid-Hudson region’s two clinics surveyed 160 consumers and 72 providers. Feedback was also obtained from secondary related agencies. For both consumers and providers, the most frequently reported needs included: Reduced wait times for appointments Transportation to health care services Assistance with paying for services Intensive Outpatient/Partial Hospital Program Mobile Crisis and Crisis Respite Services Cultural/language sensitive treatment (Yiddish/Jewish) Services for incarcerated and homeless individuals



Appendix A. Highlights of Mid-Hudson Region Needs Assessment Findings Appendix A summarizes needs assessment findings that may impact providers meeting the health care service needs of the target consumer population in the Mid-Hudson region.

I. Population Characteristics Summary Highlights

Mid-Hudson Region: Population Characteristics Characteristic Region Region Comparison Median household income

$72,658 Compared to New York’s other DSRIP regions, the Mid-Hudson region has the 2nd highest median household income.

Education 12% of adults in region are without a high school diploma

34% have a bachelor’s degree or higher ─ the 2nd

highest percentage of college graduates across DSRIP regions.

Poverty 11% of region’s population live below poverty level

2% of the region’s population are on cash public assistance and 8% receives food stamps/SNAP benefits.

Public Health Insurance/ Medicaid/ Beneficiaries/ No Health Insurance

28% of region’s population are on public health insurance, 19% are Medicaid beneficiaries and 10% have no health insurance.

39% of Medicaid beneficiaries are children, which is the highest percentage in any DSRIP region

Special Populations 10% of the region’s population are disabled and 7% are Veterans.

Foreign Born 18% of the population are foreign born.

The percentage of foreign born is the highest in NYS outside of NYC.

Primary Language other than English

26% of the region’s population speak a primary language other than English

The percentage of those that speak a primary language other than English are the highest in NYS outside of NYC.

10% speak English less than “very well” (the 2nd highest percentage in any DSRIP region).

II. Health Care Resources Summary Highlights

A. Mid-Hudson Region: Health Care Professional Supply and Shortages Domain Region Region/County Comparison Supply of Primary Health Care Providers

1. The region has 7,250 primary care providers or 31 per 10,000 population.

1. There is a mal-distribution of these providers (see HPSAs below)

2. 2nd highest ratio in any DSRIP region. Supply of Physical Health Care Specialists

1. The region has 3,834 physical medical health specialists or 16 providers per 10,000 population.

1. 2nd highest ratio in any DSRIP region.

Supply of Licensed 1. The region has 11,855 licensed 1. Highest ratio in any DSRIP region. Mental Health (MH) MH professionals or 51 per 2. There is a mal-distribution of these providers Professionals 10,000 population. (see HPSAs below).

3. Westchester County which has the highest ─ 66 per 10,000, which is the 2nd highest rate in any NYS county. Sullivan County has only 3 psychiatrists.

Substance Use Disorder 1. The region has a total of 1,416 1. There is no physician certified in addiction (SUD) Professionals cert if ied and credentialed

SUD professionals or six per 10,000 population.

medicine in Sullivan County.



Appendix A. Highlights of Mid-Hudson Region Needs Assessment Findings A. Mid-Hudson Region: Health Care Professional Supply and Shortages Domain Region Region/County Comparison

Region’s HPSA County Designations

Federal Health Professional Shortage Areas (HPSAs)

Primary Health Care: All counties except Dutchess and Putnam have Medically Underserved Area/Population (MUA/P) designations. In Orange, Rockland and Sullivan counties the Medicaid eligible population has been designated a MUP. Mental Health Professionals: Sullivan County has a whole county shortage designation. All counties except Putnam have a Medically Underserved Area/Population (MUA/P). In addition, the Medicaid eligible populations in Rockland and Westchester counties have also been designated MUPs.

B. Mid-Hudson Region: Facility- and Program-based Health Care Supply, Service Rates and Constraints Facility/Program Region Region Comparison Physical Health AcuteCare Hospitals

1. The region’s nursing homes have 20 behavioral health intervention beds located in Ulster County.

Mental Health Inpatient Facilities

1. Total psychiatric bed capacity in the region is 64 per 100,000 adults and 67 per 100,000 children.

1. Total psychiatric bed capacity for adults is the 2nd highest in all DSRIP regions and the capacity for children is the highest in all DSRIP regions.

Substance Use Disorder (SUD) InpatientPrograms

1. In the region, there are SUD crisis programs (n=13) in all the region’s counties; inpatient rehabilitation programs (n=14) that are located all counties except Sullivan; and residential programs (n=28) located all the region’s counties.

1. Collectively, for all SUD inpatient programs the total capacity per 10,000 is eight, the 2nd highest rate in all DSRIP regions.

2. The total average daily enrollment (ADE) per 10,000 for these programs is seven, the 2nd highest in all DSRIP regions.

Mental Health Outpatient and Clinic Programs

1. Adult outpatient programs (other than clinic) are in all counties. There is a total of 2,217 non-clinic outpatient program slots in the region or 134 slots per 100,000 adults.

2. There are locally-operated and state-operated clinics serving adults in all counties.

3. In the region, there are child outpatient programs other than clinic in all counties except Putnam. There is a total of 666 non-clinic outpatient program slots in the region or 107 slots per 100,000 children.

4. The region has locally-operated clinics serving children in all counties, and state-operated clinics serving children in all counties except Dutchess, Putnam and Rockland.

1. This is the 2nd highest rate in any DSRIP region.

3. This is the 2nd highest rate in any DSRIP region.

MH Emergency and Community Support Programs

1. In the region emergency programs are in all counties except Ulster and 12 adults received emergency services per 100,000 adults. In addition, 11 children received emergency services per 100,000 children.



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

2. In the region, 224 adults per 100,000 received services from community support programs located in all counties.

3. Community support programs in the region served 72 children per 100,000.

3. The child community support program service rate is the 2nd lowest in any DSRIP region.

SUD Outpatient Programs

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

2. The region has 9 opioid treatment programs located all counties except Putnam and Sullivan. Region wide the opioid treatment programs have a capacity of 13 per 10,000 and an ADE of 11 per 10,000.

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

2. These are the 2nd highest capacity and ADE rates in any DSRIP region.

III. Health Status Mid-Hudson Region: Health Status Challenges/Strengths Domain Region/County Comparison Disease Prevalence Among all DSRIP regions, the region has the lowest percentage of adults with angina, Chronic Health heart attack or stroke. Conditions Among all DSRIP regions, the region has the 3rd highest average case rates per

100,000 of HIV and AIDS. Health Behaviors and Compared to all other DSRIP regions, the Mid-Hudson region had the 2nd highest Risk Factors average percentages of those with housing insecurity and not receiving medical care

because of cost in the past 12 months, and the lowest average percentage of binge drinking.

Hospitalization Rates by Disease or Cause

Among all DSRIP regions the region has the 2nd highest average rate of drug-related hospitalizations, the 3rd highest average rate of asthma hospitalizations, and the lowest rate for newborn drug-related diagnoses.

Mortality Sullivan County has the 2nd highest percentage of premature deaths among all NYS counties.

Compared to all other DSRIP regions the region has the 2nd lowest average rates of premature deaths due to cardiovascular disease and stroke.

Among all DSRIP regions, the region has the lowest average death rate per 100,000 due to malignant neoplasms, the 2nd lowest average death rate due to diabetes, and the 2nd highest average death rate due to pneumonia.

Rockland County has the lowest death rate for malignant neoplasms among all NYS counties.

Patients in the Public Mental Health System

Chronic Health Conditions: Among all NYS DSRIP regions, the region has the lowest percentage of smokers and the 2nd lowest percentage of patients with diabetes.



Appendix A. Highlights of Mid-Hudson Region Needs Assessment Findings

IV. Behavioral Health Care Utilization A. Mid-Hudson Region: Medicaid Beneficiary Health Care Utilization by Behavioral Health Diagnosis Domain Utilization by Diagnosis Region

Medicaid Inpatient Admissions

Mental Health Diagnosis Region-wide, the largest percentages of Medicaid beneficiaries with a mental health inpatient hospital admission had depressive disorders (43%), followed by other mental health diagnoses (16%), schizophrenia (15%), chronic stress and anxiety diagnoses (13%), bi-polar disorder (10%), and PTSD (3%). Substance Use Disorder Region-wide, the largest percentage of Medicaid beneficiaries with a SUD inpatient hospital admission had alcohol use disorder (31%), followed by opioid use disorder (22%), drug abuse: cannabis/NOS/NEC (20%), cocaine use disorder (14%), and other SUD diagnoses (13%).

Medicaid Emergency Room Visits

Mental Health Diagnosis Region-wide by diagnosis, the largest percentages of Medicaid beneficiaries with a mental health ER visit were for depressive disorders (37%), followed by other mental health diagnoses (21%), schizophrenia and chronic stress and anxiety diagnoses (14% each), bi-polar disorder (10%), and PTSD (4%). Substance Use Disorder Region-wide, the largest percentage of Medicaid beneficiaries with a SUD ER visit were for cocaine use disorder (27%), followed by drug abuse: cannabis/NOS/NEC (23%), opioid use disorder (19%), other SUD diagnoses (17%), and alcohol use disorder (14%).

B. Mid-Hudson Region: Medicaid Mental Health and Substance Use Disorder Beneficiaries Compared to All Medicaid Beneficiaries Domain Utilization MH Medicaid In the region, 7% of all Medicaid

beneficiaries had a mental health inpatient hospital admission and 14% had a mental health ER visit.

SUD Medicaid In the region, 3% of all Medicaid beneficiaries had a SUD inpatient hospital admission and 5% had a SUD ER visit.



Appendix A. Highlights of Mid-Hudson Region Needs Assessment Findings C. Mid-Hudson Region: Medicaid Beneficiary Health Care Utilization by Eligibility Type Domain Utilization by Eligibility Region Medicaid Inpatient Admissions

In the region 11% of Medicaid only beneficiaries and 17% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one hospital inpatient admission.

Medicaid Emergency Room Visits

In the region 26% of Medicaid only beneficiaries and 19% of Medicaid/Medicare dual-eligible beneficiaries experienced at least one ER visit.

V. Unmet Service Needs Mid-Hudson Region: Summary Highlights of Unmet Service Needs in Behavioral Health Treatment Domain Measure Region/County Comparison

Mental Health Medication Adherence and Management

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

1. Region-wide b70% of adults with schizophrenia are adhering to their medications (30% do not).

Among all DSRIP regions, the region has the highest medication adherence percentage for adults with schizophrenia.

2. Antidepressant medication management effective acute phase treatment.

2. Region-wide 53% of individuals remain on their medication during the entire acute treatment phase.

3. Antidepressant medication 3. Region-wide 38% of individuals remain on their management effective medication during continuation phase treatment continuation phase treatment. (62% do not).

Among all DSRIP regions, the Mid-Hudson region has the 2nd highest adherence to antidepressants for the continuation phase.

Mental Health Follow-up Care

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

1. Region-wide, 46% of individuals follow-up after hospitalization for mental illness within seven days (54% do not) and 62% follow-up within 30 days.

2. Follow-up care for children prescribed ADHD medication initiation phase.

2. Region-wide 61% of children prescribed ADHD medication have one follow-up visit with a practitioner within 30 days after starting the medication.

3. Follow-up care for children 3. Region-wide 68% of children with a new prescription prescribed ADHD medication for ADHD medication remain on the medication for 7 continuation and months and/or have at least 2 follow-up visits in the maintenance phase. 9-month period after the initiation phase.

Westchester County has the highest percentages for both the initiation (73%) and continuation (77%) phases in any NYS county.

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

1. AOD Initiation 1. Region-wide 52% of individuals initiate AOD treatment within 14 days of diagnosis.

Among all DSRIP regions, the Mid-Hudson region has the 2nd highest percentage of initiation of AOD treatment.

2. AOD Engagement 2. Region-wide 27% of individuals engage in AOD treatment within 30 days after initiation (73% do not).

Among all DSRIP regions, the Mid-Hudson region has the highest percentage of engagement in AOD treatment.



Appendix A. Highlights of Mid-Hudson Region Needs Assessment Findings

VI. Consumer and Provider Input Mid-Hudson region counties’ surveys of consumer and provider stakeholders to assess local needs indicate that access to crisis services and transportation are issues that need attention for the populations with mental health and/or chemical dependency concerns.

Clinics in in the Mid-Hudson region surveyed 160 consumers and 72 providers. The needs most frequently reported by both consumers and providers include: reduced wait times for appointments; transportation to health care services; assistance with paying for services; intensive outpatient/partial hospital program; mobile crisis and crisis respite services; cultural and language sensitive services; and access to services for incarcerated and homeless individuals.


Chapter Six, Mid-Hudson DSRIP Region Needs Assessment

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Transcript of Chapter Six, Mid-Hudson DSRIP Region Needs Assessment