The "Story Behind the Curve" helps us better understand data associated with a specific result we want to achieve. When we look closely at data and engage partners that can provide context to positive or negative factors that influence the data's trajectory, we can better identify strategies and interventions that can turn the (data) curve in the direction that improves the well-being for those in our community.
Cabarrus County has one hospital system, Atrium Health, with three Emergency Department locations: Concord, Kannapolis, and Harrisburg. As we work collaboratively to improve the mental and behavioral health of those that live, work, play and pray in Cabarrus County, we need to monitor and assess access to care. Often times an individual cannot access appropriate mental health services in a timely manner, leaving them or their loved ones with nowhere else to turn for help but the emergency department.
What's helping? These are the positive factors or influences hat are working in our community.
What's hurting? These are the negative factors or influences that are working in our community.
What is to come? Any anticipated community or environmental influences that could impact work in our community.
As of September 1, 2021, Cabarrus County will complete its Local Management Entity (LME)/Managed Care Organization (MCO) transition from Cardinal Innovations Healthcare to Partners Behavioral Health. NC Department of Health and Human Services contracts with LMEs/MCOs to manage behavioral health care services paid with federal, state and local taxes, including Medicaid, as well as state and local grant funds. While there are clearly defined roles and responsibilities for MCO's, they do have the option to operate as an 'open' or 'closed' network provider. In an “open” network, care is authorized to be provided by any provider who is willing and able to provide the care. In a closed network, only those providers who have contracted with a Managed Care Organization will be authorized and paid by that organization to provide care. Cardinal Innovations has operated in Cabarrus County as a "closed" network provider, which has limited the number of providers available to the public. Partners Behavioral Health is an "open" network provider, we hope to see an increase in provider access (1.7 behavioral health providers per 10,000 population), leading to a decrease in ED psychiatric admissions.
Suicide - Cabarrus County, 5-Year Rate | |
5-Year Rage Range | Rate per 100,000 Population |
2010-2014 | 15.1 |
2011-2015 | 15.7 |
2012-2016 | 15.0 |
2013-2017 | 13.8 |
2014-2018 | 13.3 |
Source: NC DHHS, NC Injury and Violence Prevention Branch - NC Violent Death Reporting System
The list of governmental and community based organizations below are actively engaged in the development and implementation of the Community Health Improvement Plan addressing emergency department admissions for behavioral health patients, as well as providing wrap around supports for those who were previously incarcerated or have experienced trauma.
Alternative Destination Transport program provides pathways of care other than transport to the emergency department for 9-1-1 patients. This strategy would include transport of patients with low acuity medical conditions to urgent care centers and clinics for treatment, the transport of medically stable intoxicated patients directly to the detoxification center, and the transport of medically stable psychiatric patients directly to mental health facility for medical clearance and admission.
Co-responder Models for Individuals in Behavioral Health Crisis enhance law enforcement’s capacity to develop an immediate and targeted response to acute and non-acute situations. At its core, the co-responder framework typically features a specially trained team that includes at least one law enforcement officer and one mental health or substance abuse professional responding jointly to situations in which a behavioral health crisis is likely to be involved, often in the same vehicle, or arriving on scene at generally the same time.
Crisis Intervention Team Training and programs create connections between law enforcement, mental health providers, hospital emergency services and individuals with mental illness and their families. Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis and ensures officer and community safety.
Mental Health First Aid (MHFA) is a training course to help laypeople know how to assist individuals with mental health problems or at risk for problems such as depression, anxiety, and substance use disorders. Courses last 8 to 12 hours and include information about signs and symptoms of mental health problems and appropriate responses, as well as interactive activities using MHFA’s five-step action plan: assess risk of self-harm, listen non-judgmentally, reassure and share information, encourage self-help, and encourage professional help.
Question, Persuade and Refer (QPR) is intended to reduce suicidal behaviors and save lives by providing innovative, practical and proven suicide prevention training for general community members. The skills and techniques taught during this 1-hour training empowers all people, regardless of their background, to make a positive difference in the life of someone they know.
Peer Supports placed within the Emergency Department, assist individuals with the develop of crisis plans, support patients during their hospital stay if admitted to inpatient service, educate them on harm reduction, and link them with community-based resources after discharge.
RECONNECT for Resilience trainings are trauma-informed and resiliency-focused, and offer practical strategies that individuals, organizations, and whole communities can use to promote balance and wellbeing. Attendees are taught about trauma, the brain, and the human nervous system in a way that participants of all ages, educations, or backgrounds can understand. Our simple, teachable format is designed for anyone to learn. The 14-hour Reconnect training is a strengths-based, somatic program. Through demonstrations and group practice, participants are given the “owner’s manual” to the body’s safety and threat management system and learn to use their own natural ability to find balance.
School-based social and emotional instruction (SEL) focuses on five core competency areas: self-awareness, self-management, social awareness, relationship skills, and responsible decision making1. Such instruction typically includes efforts to develop skills such as recognizing and managing emotions, setting and reaching goals, appreciating others’ perspectives, establishing and maintaining relationships, and handling interpersonal situations constructively. Skills may be modeled, practiced, and then applied throughout the school day.
Telemental health services are mental health care services provided over a distance via telephone or videoconference. Services can include psychotherapy, counseling, supplemental support services accompanying face to face therapy, and self-directed services such as online cognitive behavioral therapy. Patients can receive care via their home computer through services such as Skype or be hosted at clinics or hospitals where telemedicine equipment is housed.
Trauma Informed Communities (TIC) includes the use a comprehensive, multi-stakeholder, and multilevel approach to support and strengthen traumatized and distressed residents and communities and address the effects of unresolved community trauma such as historical community disinvestment, poverty, inadequate and insufficient housing, violence, social isolation, and structural racism.
A Mental Health Action Planning retreat was held by Healthy Cabarrus virtually, due to COVID-19 restrictions, on January 28, 2021. During the retreat, a multi-sectoral group of community partners and individuals with lived experience were convened to review the Community Needs Assessment findings and identify strategies, partnerships or new initiatives that could address factors that are driving up psychiatric ED admissions and limiting individual's access to mental and behavioral health services. The discussion led to three main themes for the Mental Health Advisory Board and the associated task forces to focus on:
The table below outlines strategies identified to improve the mental and behavioral health of individuals in Cabarrus County. Lead agencies and recommended performance measures are also included. It should be noted that as interventions are implemented and data is shared across agencies, modifications may be necessary to best capture appropriate performance measures to highlight impact of efforts.
Strategy
Name & Brief Description
|
Lead Agency / Responsible Partners
|
Performance Measures:
How much will you do?
|
Performance Measures:
How well will you do it?
|
Performance Measures:
Is anybody better off?
|
Level(s) of Intervention:
|
Alternative Destinations for Mental and Behavioral Health Patients
|
Cabarrus County EMS, Daymark Recovery Services
|
Number of patients transported to a BH facility via EMS transport
|
Percent of patients admitted to the BH facility following EMS transport
|
Percent of patients who were not readmitted within 30 days
Patients that have continued engagement in treatment/services 3 months after
|
Policy, New, Organization
|
Evidence Based Mental Health Treatment and Support Services
|
Cabarrus Health Alliance
|
Number of low income or uninsured individuals served
Number of total patient appointments
|
Percent of patients who complete recommended treatment plan
|
Percent of patients who report that services met their mental health needs
|
Program, New, Individual
|
Stepping Up Initiative |
Cabarrus County Sheriffs' Office, Cabarrus County DHS
|
Number of Individuals screen for MH or SU disorders
|
Percent of those screened for MH or SU disorder who receive support services while incarcerated
|
Percent of individuals who make their first appointment post release
|
Program, Continuing, Individual
|
Co-Responder Models for Behavioral Health Crisis
|
Cabarrus County EMS – Community Paramedics, Cabarrus County DHS, Cabarrus County Sheriffs’ Department, Concord Police Department, Kannapolis Police Department
|
Number of times co-response team (Community Paramedics, DHS – LCSW) dispatched to a call/scene
|
Percent of calls resulted were deescalated with no law enforcement involvement
|
Percent of individuals were connected to and received appropriate MH or BH services |
Program, New, Organization |
Peer Support Specialists co-located within Emergency Department
|
Atrium Health Cabarrus, S&H Youth and Adults Services
|
Number of patients linked to a peer support specialist while hospitalized
|
Percent of patients linked to a peer support specialist while hospitalized
|
Percent of patients who report improved linkages to services and outcomes after working with a peer support |
Program, New, Individual |
Crisis Intervention Team (CIT) Training
|
Cabarrus County Sheriffs’ Department, Concord Police Department, Kannapolis Police Department
|
Number of officers trained in Crisis Intervention Team
|
Percent of officers from each agency (CCSO, CPD, KPD) trained in CIT
|
Percent of officers that report using skills learned in CIT in the field |
Program, Continuing, Greater Community |
Additional Community Interventions and Strategies