2013 Manatee Glens Community Needs Assessment

2013
             Manatee Glens
Community Needs Assessment

               Mary Ruiz, President and CEO
               Manatee Glens Corporation
               12/1/2013

Description of the Community Served
Overview

For almost 60 years, Manatee Glens has transformed the lives of hundreds of thousands of
individuals, enabling them to become more independent and reach their goal of a better future.
Born out of the concern for a healthier community and the desire to ensure that every family has
a place to turn in times of crisis, Manatee Glens was established to provide quality care in the
field of behavioral health. Over the past decade, Manatee Glens has helped 103,000 families
quietly yet dramatically improve their lives. But with almost 58 million Americans experiencing
mental health disorder in a given year, we must do a great deal more to stop this waste of life and
human potential.

The need is urgent. According to the Center of Mental Health Statistics, mental illness,
including suicide, accounts for over 15 percent of the burden of disease in established market
economies, such as the United States. This is more than the disease burden caused by all
cancers. Major depression ranked second only to ischemic heart disease in magnitude of disease
burden. Schizophrenia, bipolar disorder, obsessive-compulsive disorder, panic disorder, and
post-traumatic stress disorder also contributed significantly to the total burden of illness
attributable to mental disorders. The projections show that with the aging of the world population
and the conquest of infectious diseases, psychiatric and neurological conditions could increase
their share of the total global disease burden by almost half, from 10.5 percent to the total burden
to almost 15 percent in 2020.

Community Profile

Manatee Glens Specialty Hospital and Outpatient Practice is a nonprofit 501(c) 3 agency
headquartered on the west coast of Florida in Bradenton. We provide direct inpatient and
outpatient mental health and addictions treatment to individuals primarily in Manatee and
Sarasota Counties.

Manatee County is located roughly midway along Florida’s west coast and is bordered by the
Gulf of Mexico and Hillsborough, Hardee, DeSoto, and Sarasota Counties. The County has six
municipalities comprised of diverse communities, each with its own particular character and
identity. The six municipalities are: Anna Maria, Bradenton Beach, Bradenton, Holmes Beach,
Longboat Key and Palmetto. (Manatee County 2012)

Bordering to the north of Sarasota County is Manatee County, to the south is Charlotte County,
to the east is DeSoto County, and to the west is the Gulf of Mexico. Considered part of the
Sarasota, Bradenton, Venice Metropolitan area, the County’s incorporated municipalities include
the cities of Sarasota, Venice, North Port, and the southern portion of the town of Longboat Key.
According to the United States Census Bureau State, and County Quick Facts, Sarasota County
has a total area of 571.55 square miles. Based upon 2010 U.S. Census data, the total population
of Sarasota County is 379,448, an increase of 16.4 percent since the 2000 Census data was
reported.

Population data was gathered from the U.S. Census for the years 1900-2010 for Manatee County
and incorporated communities. Like much of South Florida, Manatee County has seen strong
continuous growth. Over the past century, the County’s population has grown from 4,663 people
in 1900 to 322,833 at the time of the 2010 Census. The County’s population is projected to
continue its strong growth and increase in population by approximately 95,000 residents during
the next 20 years. In addition to its permanent population, Manatee County has a significant
seasonal influx that increases its population during the November to April season of an estimated
30%. (Manatee County 2012)

Manatee County’s population has a much older age structure than the United States or the State
of Florida. In 2010, the County’s median age was 45.7 years, as compared to 37.2 years for the
Nation and 40.7 years for Florida. Manatee County had 30.5% of its population over the age of
60, while the U.S. was half that rate at 18.5%, and Florida as a whole was at 23.4%. In 2012,
Sarasota County reported 32.5% of its population was over the age of 65.

According to the 2010 U.S. Census, approximately 81.9% of the population reported their race as
White and approximately 8.7% of the population reported their race as African American. This
accounts for the mass majority of Manatee County’s population (90.6). The 2010 U.S. Census
reports 91.2% of the Sarasota County population to be White, 8.4% Hispanic and 5% to be
African American.

Manatee and Sarasota Counties’ income statistics are comparable to the State. According to the
2010 U.S. Census, Manatee County’s median household income is $47,827, Sarasota County’s
median household income is $49,212 while Florida’s was $48,181. As compared to the national
household income, Manatee County, Sarasota County and Florida reported just under the
National Median Income of $51,914.

Low income is defined as those who have an income of less than 50% of Area Median Income.
According to the 2010 American Community Survey three-year estimates, the poverty rate for all
individuals in Manatee County in 2010 was 13.6% and Sarasota County reported 11% as
compared to 15.0% for Florida and 14.4% for the U.S. The most alarming statistic is the high
rate of poverty among families headed by women with children living in the home (25.1%).
Equally disturbing is the high rate of poverty among children (40.6% for all children under 17).

Community Need

In January 2006, Manatee and Sarasota Counties had an unemployment rate of 2.9%. That
number peaked in January of 2010 at 12.75%. Since 2010 the unemployment rate has slowly
declined and in January 2012 Manatee and Sarasota Counties’ unemployment rate was 9.6%.

Florida was first in and last out of the economic downturn and Florida communities were hard hit
due to our reliance on the housing industry. For the first time, stable, working families found
themselves in dire straits. Former donors became patients. Since the recession, charity care for
all ages at Manatee Glens Hospital has spiked from $13 million a year to $16.4 million a year.

The Department of Housing and Urban Development, in the Comprehensive Housing
Affordability Strategy manual, defines severe mental illness as a persistent mental or emotional
impairment that significantly limits a person’s ability to live independently. According to the
national statistics, approximately 1% of the adult population meets the definition of severely
mentally ill on the basis of diagnosis, duration, and disability. According to the 2010 U.S.
Census, Manatee and Sarasota Counties have an adult population, over 18 years of age, of
approximately 579,659 persons, with 1% of this population totaling 5,797 persons.

Alcohol and other drug abuse are defined as having an excessive and impairing use of alcohol or
other drugs, which includes addiction. The National Survey on Drug Use and Health (NSDUH)
provides national and state-level data on the use of tobacco, alcohol, illicit drugs (including non-
medical use of prescription drugs), and mental health in the United States. In the most recent
Survey, 7.8 percent of Florida residents reported using illicit drugs. The national average was
8.02 percent. Additionally, 3.5 percent of Florida residents reported using an illicit drug other
than marijuana with the national average of 3.58 percent. (Substance Abuse and Mental Health
Services Administration) With the population of Manatee and Sarasota Counties making up
3.6% of the population of the State of Florida, estimates are 54,245individuals use illicit drugs in
the areas served by Manatee Glens. Florida drug-induced deaths (16.1 per 100,000 population)
exceeded the national rate (12.7 per 100,000 population).

In the Suncoast region of Florida, the city of Sarasota has the second highest incidence of babies
born with exposure to substance use. According to the Sarasota County Sarasota Community
Services Administration, prevalence rates for children under age nine in Sarasota County with a
mental health condition include 1,886 children with a severe emotional disturbance, 2,514 with a
mild to moderate emotional disorder, and 4,400 with a diagnosable psychiatric disorder.

Recovery and healing are journeys that are personal and tailored to the needs of each person and
family. Manatee Glens has been charged with providing quality behavioral healthcare for more
than 55 years. Children, teens, adults and seniors who face trauma, major life changes,
addictions, psychiatric illnesses and emotional disorders come to Manatee Glens to quietly, yet
dramatically, improve their lives. We offer hope.

The Obstacles

The major obstacle to meeting the needs of these groups include continued on-going cut-backs in
Federal and State funding for local programs to serve these groups. Manatee County is limited
to a 15% cap to fund public services. These public services are essential in providing basic
needs of this population.

We are deeply committed to reaching thousands more, giving them—along with health and
wellness—the gift of dignity and hope. Paying for health and wellness, even under the best of
circumstances, can be a major challenge. But when a family loses their way due to addiction or
behavioral health issues, the financial demands can become even more daunting, especially if the
family does not have adequate means.

Untreated mental health and addictions contributes to the number two (addiction) and number
four (mental illness) reasons for morbidity worldwide, according to the World Health
Organization. In America two out of three adults and three out of four children who need
behavioral health treatment do not receive it. Manatee Glens demonstrates daily that treatment
works and access to treatment can reverse these negative health trends.

Our organization envisions a future where everyone understands that behavioral health is
essential to overall health and the quality of life. We work for a world where mental illness and
addiction are prevented, treated or cured. We hold out hope that full participation in the life of
the community is possible. We envision our impact expanding through our training programs to
address the nationwide shortage of psychiatric physicians with the support of donations and
foundations’ grants.

Description of the process and methods used to conduct the CHNA.
Manatee Glens works closely with the Manatee County Government which provided much of the
statistical data provided in this report through their Five-Year Consolidated Plan 2012-2017.
Research was also used from sources such as the U.S. Census Bureau and the Sarasota County
Sarasota Community Services Administration

An organizational climate survey was conducted by Behavioral Pathway Systems. Each person
surveyed was asked to indicate candid agreement or disagreement specific statements with an
opportunity to share specific comments which provided feedback to the organization. The
responses were completely anonymous.

In addition, surveys are completed on a routine basis providing numerical outcomes for the
services provided by Manatee Glens by the Central Florida Behavior Health Network.

Manatee Glens annually evaluates through its Performance Improvement (PI) Program, quality
controls and customer satisfaction.

Quality control continues to be essential to demonstrate staff competence, instrument reliability
and equipment performance. Quality control reporting is submitted to the Corporate
Environment of Care Committee. Quarterly reports from external companies (radiology and
laboratory) are submitted to the Medical Staff Performance Improvement Committee.

Joint Commission ORYX Performance Measure Results for 2012:

   1. Rate your willingness to return for treatment - average Mean 4.38, out of 5
   2. How well did services meet your needs, average Mean 4.37, out of 5
   3. 30 day Readmissions Hospital – 111 out of 1,306 admissions – 8.5%
   4. 30 day Readmissions Crisis Center – 146 out of 1,295 admissions – 11.2%
   5. Seclusion & Restraint Episodes including therapeutic holds – 76 out of 3,030 admissions,
      2.5% of total
   6. Seclusion & Restraint justification documented – 74 out of 76 – 97%

Customer satisfaction surveys within the organization are collected through a variety of surveys,
e.g. internal surveys, state surveys, and some through Joint Commission’s ORYX initiative.
Results are reported to the Corporate Performance Improvement Committee and the appropriate
performance improvement subcommittees on a regular basis. Areas covered in our corporate-
wide core measures include: degree to which treatment helped client deal with situation,
appropriate therapies and interventions offered, client’s willingness to return for treatment,
degree of confidentiality, client’s opportunity to participate in decisions about treatment, ability
of services to meet client needs, and attention given to privacy.

                     Corporate Satisfaction Survey Results July 2012 - June 2013
                                        Total surveys – 6,591

 4.7

 4.6

 4.5

 4.4

 4.3

 4.2

 4.1

   4
         Q1        Q2        Q3            Q4         Q5       Q6         Q7        Q8   Q9        Q10

                              Qtr 3 2012        Qtr 4 2012   Qtr 1 2013    Qtr 2 2013

Q1 – Evaluate the degree to which treatment helped you deal with your situation.
Q2 – Were appropriate therapies and interventions offered?
Q3 – Rate your willingness to return for treatment.
Q4 – Rate the degree of confidentiality.
Q5 – Rate the cleanliness of the facility.
Q6 – Rate the opportunity to participate in decisions about your treatment.
Q7 – Rate the ability of services to meet your needs.
Q8 – Rate the attention given to your privacy.
Q9 – Rate the safety of the environment
Q10 - Overall, how would you evaluate the quality of services?

Identity of any and all organizations with which the organization collaborated
and third parties that it engaged to assist with the CHNA.

Manatee Glens Staff involved in conducting the Community Needs Assessment included:

Mary Ruiz, President and CEO
Janet Ginn, Chief Development Officer
Heidi Blair, Vice President of Administration
Linda Transue, Compliance Manager
Connie Insley, Clinical System Analyst

Manatee Glens participated in and used data from the Manatee County Consolidated Plan. In
accordance with 24 CFRE Section 91.105, the Manatee County Neighborhood Services
Department prepared a Citizen Participation Plan to explain the opportunity all residents have to
participate in the process of preparing the Consolidated Plan. The Manatee County
Neighborhood Services Department is responsible for administering the Citizen Participation
Plan. At each stage of the development of the Manatee County Consolidated Plan, public
hearings were conducted with proper notice given and a 30-day comment period offered.

Also considered was information from:
       Sarasota County Sarasota Community Services Administration (formerly the Health and
       Human Services agency), which includes the DOH
       DCF
       Sarasota YMCA (privatized child welfare)
       Sarasota Memorial Hospital Bayside Center
       School Boards of Manatee and Sarasota Counties

Description of how the organization considered the input of persons
representing the community (e.g., through meetings, focus groups, interviews,
etc.) who those persons are and their qualifications.

Input was obtained from a wide range of residents and providers which included but is not
limited to clients; hospitals, health departments; law enforcement; social service agencies; school
boards; universities; faith-based programs, and the judicial system.

Prioritized description of all the community needs identified by the CHNA
and an explanation of the process and criteria used in prioritizing such needs.
Based on the results of the community needs assessment conducted by Manatee Glens, four
distinct community needs were identified that Manatee Glens has selected as priorities to
address:

Community Needs One—Expand Access to Care: Only one out of three adults and one out of
four children who needs mental health treatment actually receives it. For alcohol and drug
patients it is only two out of ten with access to care. Manatee Glens is dedicated to expanding
access to care through healthcare workforce training, innovative delivery systems, collaborative
partnerships and integration with primary care.

Goal: Implement adult psychiatric residency program in 2014

Untreated mental illness and addictions contribute to the number two (addiction) and number
four (mental illness) reasons for morbidity worldwide according to the World Health
Organization. In America, two out of three adults and three out of four children who need
behavioral health treatment do not receive it. Manatee Glens demonstrates daily that treatment
works and access to treatment can reverse these negative health trends. At Manatee Glens, we
also understand that we cannot respond to these unmet needs without addressing the nationwide
shortage of qualified psychiatric healthcare professionals. The implementation of the Affordable
Healthcare Act will not increase access to care for behavioral health patients if there are no
trained practitioners available to treat them.

The American Osteopathic Association has approved the Lake Erie College of Osteopathic
Medicine (LECOM)/Manatee Glens Hospital Psychiatry Residency program, the first private,
non-profit psychiatric hospital to have its own medical residency program. It is one of only
seven such Osteopathic programs in the country. The first three residents will begin in the
summer of 2014 and will stay for four years. Manatee Glens will add residents each year until
there are 12 total.

Under the leadership of Dr. Jose Zaglul, MD, the program will meet all requirements for a four
year rotation leading to completion of training in the specialty of adult psychiatry. The rotation
schedule reflects our aim to provide a rich, diverse and comprehensive training environment
while fully accommodating the requirements for residency set forth by the American Osteopathic
Association.

Manatee Glens Residency Program in General Psychiatry will focus on development of core
competencies for its residents as its primary programmatic goal. Residents will be:

   1. Encouraged to develop an empathetic approach to care that is effective in treatment of

individuals suffering from the symptoms of mental illness. This includes advocating for
        the patient in a broader service delivery system and helping the individual patients
        overcome the bio-psychosocial challenges to their recovery.
   2.   Assisted in obtaining a definite understanding of osteopathic philosophy and principles
        and how such principles can be applied to quality patient care.
   3.   Guided in developing a demonstrable and quantifiable knowledge of medical, clinical,
        psychiatric and social sciences, and applying that knowledge effectively to patient care.
   4.   Mentored in maintaining a professional and therapeutic relationship with their patients,
        peers, coworkers, and all multidisciplinary members of the patient’s treatment team.
   5.   Taught to seek out and implement evidence-based methods to investigate, evaluate, and
        improve their patient care practices. This effort should become an ongoing and lifelong
        practice pattern, as the information for best clinical practice is perpetually evolving and a
        healthy knowledge base is required for effective patient care.
   6.   Charged with maintaining laudable professional conduct at all times. Such conduct
        includes maintaining a high level of ethical behavior, integrity, honesty, empathy, respect
        and confidentiality in the delivery of patient services.
   7.   Aided in developing working knowledge of the diverse systems involved in treating
        patients throughout the lifespan and understanding how to mobilize such systems as part
        of a comprehensive treatment plan. This will include consultation with all patient
        stakeholders, following best practice guidelines and engagement of community support
        structures.

Manatee Glens’ distinguished history as a training institution for psychiatric medical and
counseling disciplines assures our ability to develop and sustain an excellent psychiatric
residency program. In addition to our partnership with LECOM Osteopathic Postdoctoral
Training Institution, we also have written agreements for the residency program with the
Roskamp Institute of Sarasota, Florida known for its neurological research on Alzheimer’s and
other brain disorders. Our hospital partner is Northside Hospital of St. Petersburg, Florida a
member of the HCA national health system.

Community Needs Two—Implement Solutions for Community Concerns: Manatee Glens
has served our community for more than half a century. It is our calling to provide solutions to
community problems such as homelessness, rape, child abuse and neglect, diversion from the
criminal and juvenile justice system, emergency room overcrowding and failure to succeed in
school. Manatee Glens is a catalyst for positive community and statewide change.

Goal: Expand The Manatee Glens Children’s Community Action Treatment (CAT) Team

Manatee Glens treats over 4,200 children a year who have been diagnosed with a serious
emotional and/or drug problem. According to a recent Florida Youth Substance Abuse Survey,

statistics show a high correlation with youth that use alcohol and/or drugs to other behavioral
issues.

A child with a serious emotional disorder is more than twice as likely to also have an alcohol and
drug problem. Yet most public funding sources for youth address mental health or addiction, but
not both. Families who are overwhelmed by raising a challenging youngster do not feel
adequately supported in their struggle to raise their child at home. As a last resort, some families
turn to the juvenile justice or foster care system to get the care their child needs.

The Manatee Glens Children’s Community Action Treatment (CAT) Team serves families with
children ages 5-21. The children served may have a mental health disorder and/or an addiction
disorder. This program was expanded in 2013 to have offices in Manatee and Sarasota Counties.

The ultimate goal of the Manatee Glens CAT Team is to provide comprehensive services so
families can develop the strengths needed to provide a supportive and healthy home to at-risk
children with multiple needs. By utilizing a holistic approach, the CAT Team, available 24/7,
arranges or provides all services needed to address the issues. The team provides family-
centered, culturally competent services individualized according to the strengths and needs of
each child and his/her family.

Community Needs Three— Maintain Commitment to Community Care:

Manatee Glens provides more than $16 million in charity care annually. Our Board maintains
this level of service despite the economic downturn, funding reductions, increased uninsured and
the prescription pain pill epidemic. Manatee Glens knows that our care allows families and
individuals to keep jobs, maintain marriages, raise children, continue education, maintain health
and succeed in life. We also understand that with rapid growth in our service areas, the number
of those who need assistance will increase. Manatee Glens currently serves one in every thirty
families in our community.

Goal One: Implement behavioral health services in a primary care practice

Manatee Glens has begun providing behavioral health services in collaboration with the Sarasota
Health Department near the North Port Health Center. Manatee Glens first became aware of the
lack of mental health and addictions services in that community as a result of our work with
foster care children in the Safe Children Coalition. We have received a Medicaid provider
number to expand our license to that location and have begun psychiatric physician services.
Demand for services appears to be very strong.

Manatee Glens is partnering with the Sarasota Health Department to support their needs for
behavioral health support in their new Federally Qualified Health Center in North Sarasota

County. We also are working with applicants for a statewide COOP plan, a federally sponsored
nonprofit health plan, and a Medicare Advantage HMO for services in Manatee and Sarasota.

At the regional level, Manatee Glens is an owner in Florida Health Partners, a for-profit concern
founded in 1994 by nonprofit behavioral health providers and Value Options, a national for-
profit managed care company, to hold capitated Medicaid contracts for mental health treatment.
Value Options is currently negotiating with national medical company with the goal of
contracting with Florida Health Partners in an integrated medical model.

At the statewide level, the Florida Council for Community Mental Health has sponsored the
creation of Premier in which Manatee Glens is a shareholder which aspires to create an
opportunity for a special Medicaid plan for disabled mentally ill as an alternative for our clients
to Medicaid Reform options.

Locally, Manatee Glens representatives are active participants in the Chamber Healthcare
Community, the nonprofit Healthcare Alliance and on the Blake Hospital Board.

Conclusion
Founded in 1955, today Manatee Glens is recognized as one of the foremost nonprofit mental
health and addiction centers in the country leading the field in the implementation of co-
occurring mental health and addiction treatment and trauma-informed care in Florida. Manatee
Glens also has launched a number of behavioral health service delivery innovations providing
the first 24-hour access center, outpatient detox, walk-in clinic and children’s “hospital without
walls” in Florida.

Manatee Glens is accredited by the Joint Commission. Our psychiatrists, psychologists, nurses
and counselors specialize in difficult to treat mental health and addictions disorders including:
Depression and Anxiety; Bipolar and Schizophrenia Disorders; Obsessive Compulsive
Disorders; Attention Deficit and Hyperactivity; Alcohol and Drug Addiction; and Prescription
Pain Medication Abuse

We believe in strategic partnerships with law enforcement, medical colleges, public schools,
other nonprofits and government agencies. The results are reduced crime and incarceration,
improved medical education, increased success rates of adoptions, reduced juvenile addictions
and suicides, and enhanced services for victims of abuse and neglect.