Equity for All Behavioral Health Equity and Same

Equity for All: Behavioral Health Equity and Same Day Access System. LEAD 2018

Virginia is for LEADERS Brigette Pride Central State Hospital Dennis Riddick DBHDS Central Office Angela Torres DBHDS Central Office Holly Valiulis Loudoun County CSB Amber Vernon RBHA

OUR GOALS 1. Learn more about STEP-VA & Same Day Access 2. Provide helpful recommendations to CSBs 3. Based on principles of behavioral health equity The lens we look through determines what we will see…

Research Questions • How are various CSBs implementing or preparing to implement Same Day Access (SDA)? • Will CSBs be prepared for people seeking SDA that have Limited English Proficiency (LEP), vision impairments, lack of transportation, and other social determinants of behavioral health? • Can all people truly access the CSB on the same day?

Agenda 1. 2. 3. 4. Literature Review/Introduction Methodology Research Data and Conclusions Recommendations

Behavioral Health Equity • WHO: Health Equity • The fair opportunity for everyone to attain their full health potential regardless of demographic, social, economic or geographic strata 1 • SAHMSA: Behavioral Health Equity • Expands the definition of health equity to include “specific attention to mental health and substance use conditions and disorders” 2 1 World Health Organization 2 https: //www. samhsa. gov/behavioral-health-equity

Behavioral Health Equity Continued… • Civil Rights Act (1964) • Americans with Disabilities Act (1990) • U. S. Department of Health and Human Services CLAS Standards (2004)

Behavioral Health Equity at DBHDS • DBHDS created the Office of Health Equity Advancement in April 2018 • Focus on policy, system, and environmental changes related to meeting CLAS standards and addressing behavioral health disparities

Why Behavioral Health Equity and SDA? • Behavioral Health Equity • Social Disparities: Differences in health status of various groups based on factors that lead to higher rates of certain diseases compared to others 1 • SDA is • First contact with CSBs • Main access point for entering services • Initial assessment for services 1 https: //medlineplus. gov/healthdisparities. html

STEP-VA: System Transformation Excellence and Performance • Uniform set of required services for individuals with behavioral health disorders in Virginia • Same Day Access (SDA) and primary health integration are the first “steps” in STEP-VA • As of September 2018: • 25 CSBs implemented same day access • 9 scheduled to go live with same day access by the end of 2018 • 6 CSBs will go live by June 30, 2019

Research Process Initial Consultations • Stacy Gill, Assistant Commissioner for Community Behavioral Health • Glencora Gudger, Behavioral Health Equity Consultant Health Planning Region 4 • Website Reviews • Site Visits All Virginia CSBs/BHAs • Online Survey

HPR-4 Websites

HPR-4 Website Reviews CSB CSB A B C D E F G Mentions SDA Provides SDA hours Lists items needed for SDA Downloadable forms Translation widget Written materials already in Spanish X X X X

HPR-4 Site Visits

General Observations at CSBs • Accessibility • Signs in other languages • Bathrooms (gender neutral, baby changing) • Children areas • Security • Waiting room size/comfort • Location to bus line

Positive Aspects of SDA CSB CSB A B C D E F G More collaboration Staff like it Reduced hospitalization/crisis contact Faster link to services Reduced no-show rates Improved public perception Quickly complete some evaluations X X X X X X

Challenges of SDA CSB CSB A B C D E F G More like crisis More screens required Issues with staffing Transportation Increased numbers Unequal coverage within CSB X X X X X

Online Survey of all 40 CSBs/BHAs

Knowledge About Behavioral Health Equity 25% 15% 60% Slightly Knowledgeable Very Knowledgeable Moderately Knowledgeable

Priority Agency Gives Behavioral Health Equity 5% 5% 26% 11% 53% Do Not Know Moderately Important Not Important Very Important Minimally Important Extremely Important

W er O th nd s rie /F ily te rs re rp In te rs te re rp n la tio ra ns In te Fa m on e le ph Te de o xt T ta ff al S re te r s ay rm Fo Aw rp te In lin gu Bi Te Vi d Ba se eb - d ie tif er ge / gn a rn t r te rp re nt e Tu r. I m en w kn o nt no t po i Ap fo Si et ur n C R ui re eq R o D Same Day Access for Limited English Proficiency Consumers 18 16 14 12 10 8 6 4 2 0

Written Materials Through Reading Level Analysis 5% 20% 15% 40% Do not know Yes, but unsure of reading level Yes, 6 th grade or higher No Yes, 5 th grade or lower

Resources Available for Consumers with Limited Eye Sight 8 7 6 5 4 3 2 1 0 Nothing Magnifiers Reading Glasses Reading Lights Larger Font Software Magnify Paper Reads Text Computer Intake Screen Forms Other

Same Day Access Resources for Those with Hearing Impairment 10 9 8 7 6 5 4 3 2 1 0 Volume Ampilfiers Universal Hearing Aids Talk to Text Other

Same Day Access Resources for Consumers with Minor Children 16 14 12 10 8 6 4 2 0 Special Lobby with Changing TV with Child Area Children Tables Kids' Items Shows Interview Agency On Site Staff Area Kid Provided Earphones Childcare Supervise Items Tablet Kids Other

N o o N en t nt te nt in rti si ng , i ad ve rs re ac h O ut g, no rti si n ad ve er rtn Pa ie Fl es / Ad s ia ls er c ite eb s R ad io m C om oc hu r Br TV W pe rs sp a ew N ed ia So ci al M Same Day Access Advertising 16 14 12 10 8 6 4 2 0

Same Day Access within 1/2 Mile of Bus Stop 20% 60% Do Not Know No Yes for at Least One Location

Do You Believe That Any Population is Not Given Equal Access? 5% 35% 60% Do Not Know No, Everyone Has Equal Access

Conclusions • Most CSBs followed a similar SDA intake process • Inconsistency in how various populations are served • Positive aspects of SDA • Challenges related to SDA

Conclusions Continued… • Most survey respondents • Had familiarity with behavioral health equity and • Saw behavioral heath equity as being an important priority for their agency • And yet… • 60% reported that everyone did have equal Same Day Access

Conclusions Continued… • Populations facing barriers to SDA: • Those in rural settings far from SDA sites • Those facing transportation issues • Those with Limited English Proficiency (including hearing impaired populations) • Those with child care challenges • Those who are transgender or gender expansive • Those with intellectual/developmental disabilities

Given the identified behavioral health disparities, what can be done to increase equity for all Virginians in the context of SDA? Recommendations

Low Cost/No Cost Embed translation widget on website Run website and printed SDA materials through reading level analysis Solicit children’s items (donated) from CSB staff Print and post signs of inclusion Print and post interpreter rights and language identification Print and post inclusive restroom sign(s) Free Utilizing IT staff time already budgeted Free Utilizing supplies already budgeted

Moderate Cost: Purchases Print standard business cards (2 -sided)with SDA information Vistaprint 500 in English 500 in Spanish Reading glasses (reusable) Dollar Tree 6 pairs of varying strength Clorox wipes Amazon 12 containers Lens/screen cleaners Amazon 200 individual wipes Jumbo magnifying glass Amazon 2 items Single use earbuds Amazon 50 items Pocketalker Ultra Duo Pack Amplifier Williams Sound 1 item Fire 7 Tablet with kid-proof case Amazon 1 item One Ride Plus (solo ride, one direction with connection) GRTC Transit System 100 passes $497. 60 $33. 29 $6. 00 $30. 18 $19. 99 $25. 90 $29. 95 $97. 30 $79. 99 $175. 00

Moderate Cost: Training Review Robert Wood Johnson Foundations’s Health Equity Report https: //www. rwjf. org/content/dam/farm/reports/issue_briefs/2017/rwjf 437393 Watch RWJF’s accompanying video series ‘Your Path to Health’ https: //www. rwjf. org/en/library/features/achieving-health-equity. html Subscribe to the monthly Office of Behavioral Health Equity’s newsletter Watch LSNJ’s You. Tube video ‘Working with an Interpreter’ https: //www. youtube. com/watch? v=p. Vm 27 HLLii. Q Review APS’ Practice Guide for working with an interpreter http: //www. mhima. org. au/pdfs/APS-Working-with-Interpreters-Practice-Guide-for. Psychologists 2013. pdf • No cost for educational materials • Requires staff time • Could be included in group supervision/team meetings

Higher Cost • Development and implementation of targeted advertising campaign • Provision of targeted training to address known disparities in each HPR • Exploration of regional/statewide partnerships • In-person interpretation • Telephone interpretation • Transportation

Thank you!