1 World Café Summary Report Department of Children

1 World Café Summary Report Department of Children and Families, Circuit 4 Substance Abuse and Mental Health Office Prepared by the Health Planning Council of Northeast Florida June 30, 2009 Health Planning and Community Organizing: It’s what we do every day

Table of Contents 1 Who is the Health Planning Council of Northeast Florida 3 World Café Assessment Introduction and Background 8 Assessment Methodology 10 Summary of Findings by County 12 Circuit Wide Comparisons 25 Debrief Summaries by County 30 Health Planning and Community Organizing: It’s what we do every day

Who is the Health Planning Council? 1 • One of 11 Local Health Councils created by state statute 408. 033 in 1982 • Manage the Certificate of Need process for hospitals and nursing homes located in Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties • The only health planning organization to collect, analyze, and warehouse real-time health care utilization data submitted by hospitals and nursing homes in the 7 county northeast Florida region • The only non-partisan / non-profit planning organization mandated to dedicate resources and expertise to regional health planning and community organizing on health disparities and healthcare issues (State Statute 408. 033) • Trained to execute cultural competent health planning models such as the World Cafe’, Community Based Participatory Research (CBPR), Community Based Participatory Marketing (CBPM), Social Marketing, Empowerment Evaluation, Strategic Framework Prevention (SPF), Mobilizing for Action through Planning and Partnerships (MAPP), Planned Approach to Community Health (PATCH) * Competency within these models are highly recommended by all major federal and state funding agencies • Conducts SPSS data analysis for reliable health planning analysis • HPCNEF reviews and provides input on Development of Regional Impact pre-applications via the Northeast Florida Planning Council Health Planning and Community Organizing: It’s what we do every day

What We Do 1 Health Planning Collects monthly hospital utilization statistics, monthly emergency department statistics, and quarterly nursing home utilization statistics from the providers in the seven counties of northeast Florida (over 100 providers) for Agency of Health Care Administration (AHCA) Provides subscription-driven hospital data clearinghouse Develops annual county profiles and regional health plans on hospital utilization rates, health disparities, health care work force capacity, regional development impact studies, health care funding equity Performs theory-based community health needs assessments Facilitates community organizing and convening activities to discuss health disparities and healthcare issues Health Planning and Community Organizing: It’s what we do every day

What We Do 1 Advocacy Facilitates community forums on Medicaid Reform and Florida Kid. Care Provides leadership and advocacy for the uninsured and underinsured Contributes to the development of the Jacksonville and Northeast Florida Healthcare Guide (the green pages) Develops the Guide to Assisted Living Facilities in Northeast Florida Develops influencing plans for the health advocates and coalitions Serve on many regional Boards and Advisory council to advocate for cultural competent health planning and health care advocacy Health Planning and Community Organizing: It’s what we do every day

What We Do 1 Health Promotion and Evaluation Provides flu, pneumonia and hepatitis vaccinations to high risk, minority populations thru churches, community centers, and homeless shelters in Duval County Conducts social marketing training to regional community based organizations Administers and serves as an AIDS Insurance Continuation Program enrollment site Supports the St. Johns River Rural Health Network’s diabetes disease management program for Baker, Clay, Nassau, Bradford and Union counties Conducts program evaluation for small community based organizations Health Planning and Community Organizing: It’s what we do every day

What We Do 1 Non-Profit and Coalition Support Provides fiscal and administrative support to the local non-profits and coalitions including the St. Johns River Rural Health Network and the Healthy Start Coalition of Northeast Florida. Provides fiscal and administrative support for Ryan White Title II, general revenue funded HIV/AIDS Network in for Volusia and Flagler counties, Provides fiscal and administrative support for Housing Opportunities for People with AIDS (HOPWA) for Volusia and Flagler counties Provides staff support and technical assistance to the Duval County Immunization Task Force Health Planning and Community Organizing: It’s what we do every day

Assessment Introduction and Background 1 The Department of Children and Families (DCF), Circuit 4 (Clay, Duval, and Nassau counties) is reviewing its strategic plan for the long term future and success of the Circuit. As part of the process, leaders from Circuit 4 contracted with the Health Planning Council of Northeast Florida (HPC) to plan, coordinate, facilitate four World Café dialog meetings in each county located within the Circuit: Clay County- 31 people in attendance Hilltop Country Club- Orange Park Thursday May 21, 2009 2: 00 PM - 5: 00 PM Duval County- 34 people in attendance Three Layers Cake- Downtown Jacksonville Friday May 22, 2009 9: 00 AM -12: 00 PM Nassau County- 9 people in attendance Hampton Inn and Suites- Fernandina Beach Friday May 22, 2009 2: 00 PM - 5: 00 PM Nassau County- 3 RSVP’s – meeting cancelled County Inn and Suites- Yulee Thursday, June 18, 2009 2: 00 PM – 5: 00 PM Health Planning and Community Organizing: It’s what we do every day

Assessment Introduction and Background 1 The purpose of the World Café was to engage community stakeholders and provide them an opportunity to share their thoughts on the effectiveness of the system of care (infrastructure and service delivery) within the substance abuse and mental health services, offer ideas for integrating our services, and to help the Circuit prioritize substance abuse and mental health services. *Over 70 individuals attended one of the three World Cafés meetings where they were asked to discuss the following five questions: 1. 2. 3. 4. 5. How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders? Prioritize our Circuits services. Assess the effectiveness and quality of our system of care. If additional dollars come into Circuit 4, what substance abuse and mental health services would you like to see expanded or created? In other words, where would you like the money to go? How do we integrate our substance abuse and mental health services into our child welfare system? At the end of each meeting, all participants were asked to debrief about their experience in a “Town Hall” setting Health Planning and Community Organizing: It’s what we do every day

Assessment Methodology 1 Three weeks prior to the scheduled World Café meeting dates, the HPC sent electronic invitations to community leaders, advocates, providers, the judicial system, law enforcement, school board members, academic institutions, and elected officials. Recipients of the electronic invitation were encouraged to forward their electronic invitation to other constituents who would see value in attending. Each of the four World Café meetings were held in Circuit 4’s respective counties eliminating the participants from having to drive more than 15 -20 miles from their service area to attend a meeting. By request, a forth World Café meeting in Nassau County was added to provide west Nassau County stakeholders a closer venue. This venue was cancelled due to the low number of RSVPs (3). World Café locations (Hilltop Country Club, Three Layers, Hampton Inn and Suites, and Country Inn and Suites) were selected because of their café style environments. This relaxing and inviting environment is one of the pillars of the World Café dialog model. RSVP lists for each of the four meetings were managed by using a computer based polling program called doodle. com. Health Planning and Community Organizing: It’s what we do every day

Assessment Methodology 1 Attendees participating in each World Café meeting were presented with the same *five questions in order to capture consistent data from each of the three World Café meetings. It is important to recognize that each person had the opportunity to give multiple responses to each question. Notes recorded on table-top paper were also included in the analysis. The HPC collected all of the data from each World Café meeting and synthesized the data according to each county. Major themes emerged in the responses to each question, and they, along with un-coded responses are reported in the summary of findings by county and then by Circuit. Themes are presented in the order of magnitude. Rounding is used in the display of percentages, so totals may fall within +/- 1% of 100. * Due to World Café requirements, the attendees participating in the Nassau County World Café’ in Fernandina Beach were presented with three questions rather than five questions. Low attendance (20 RSVPs; 9 people in attendance) restricted the HPC from introducing additional meaningful questions. An additional meeting was scheduled in Nassau county (Yulee) however, due to low RSVP numbers, this meeting was cancelled. Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Clay 1 Question 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders? 4 major themes emerged from a total of 29 responses. Collaboration and integration of services 52% Education and cross training of providers 24% Innovation, electronic medical records and data sharing 7% Develop social change awareness 9% Creative funding, demand evidence-based intervention 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Duval 1 Question 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders? 6 major themes emerged from a total of 21 responses. Education and cross training of providers 29% Collaboration and integration of services 19% Prevention and early intervention 14% Provide choice of services 14% Improve funding 9% Develop social change awareness 9% Improve communications among providers 1 response Health Planning and Community Organizing: It’s what we do every day

Summary of Findings by County- Nassau 1 Question 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders? 6 major themes emerged from a total of 40 responses. Collaboration and integration of services 60% Innovation / electronic medical records 8% Improved funding 8% Enhanced professional workforce 8% Education and cross training of providers 5% Improved communications among providers 5% Commitment / ownership of issues at all levels, HIPPA / FERPA issues, Annual community assessments 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Clay 1 Question 2: Prioritize the Circuit’s services 7 major themes emerged from a total of 22 responses Integration of services and care coordination 18% Self directed care 14% Improve funding streams 9% Prevention, education and early intervention 9% Housing 9% Community education and social change 9% Demand evidence-based intervention, needs assessments and data 9% Transportation, medication, access to insurance and homeless 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Duval 1 Question 2: Prioritize the Circuit’s services 9 major themes emerged from a total of 35 responses Centralized access, mental health authority, instant access, integration of services & coordination 19% Self directed care 17% Improve funding streams- “braiding” 11% Family services 11% Transportation 6% 24 hour helpline 6% Housing 6% Discharge planning/ safe placement 6% Early intervention, medication, school based programs, data sharing 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings by County- Nassau 1 Question 2: Prioritize the Circuit’s services 9 major themes emerged from a total of 35 responses Transportation 19% Emergency psychiatric services 16% Housing 14% Centralized assessment / linkage/ integrated services 12% Early intervention / prevention 7% Residential substance abuse 5% School based services 5% Outpatient services 5% Medication, policy, HIPPA, indigent, aftercare and home based care 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Clay 1 Question 3: Assess the effectiveness and quality of our systems of care 3 major themes emerged from a total of 21 responses Fragmentation / lack of integration of services 38% Poor housing options 19% Fragmented funding streams 10% Lack of awareness in community, no money for medication, all parallel counseling, poor professional workforce, no evidence based treatment 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Duval 1 Question 3: Assess the effectiveness and quality of our systems of care 5 major themes emerged from a total of 44 responses Fragmentation / lack of integration of services/ data sharing 25% Treatment inadequacies (i. e. access, waiting list etc…) 23% Prevention starts too late 14% Limited transportation 11% Professional training is poor 7% Funding is poor, parent engagement needs to improve and better community stewardship is needed 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings by County- Nassau 1 Question 3: Assess the effectiveness and quality of our systems of care 8 major themes emerged from a total of 30 responses Services and treatment inadequacies (i. e. access, waiting list etc…) 30% Limited transportation 13% Location of services is challenging 13% Professional training is poor 13% Funding is poor 13% Physical care and effectiveness is good 6% Need to improve collaboration 6% More local control, gaps in housing, no socialization 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Clay 1 Question 4: If additional dollars came into Circuit 4, what substance abuse and mental health services would you like to see expanded or created? 7 major themes emerged from a total of 23 responses Expand to the underserved 22% Expand self directed care 17% Improve access to care via better transportation 15% Mental health court 8% Medications 8% Evidence based services 8% School based programs, housing, family support, expand awareness 1 response each Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Duval 1 Question 4: If additional dollars came into Circuit 4, what substance abuse and mental health services would you like to see expanded or created? 8 major themes emerged from a total of 52 responses Central access/ integration of services 12% Self directed care, peer support, Club House, consumer choice 12% 24 hour emergency service 12% Treatment (i. e. detox, case management, counseling) 10% Employment opportunities for clients 10% Expand to underserved 8% Increase awareness and education 8% Housing 8% Increase salaries, medication, respit, prevention, recreation services, standards, 1 or 2 responses only Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Clay 1 Question 5: How do we integrate our substance abuse and mental health services into our child welfare system? 2 major themes emerged from a total of 13 responses Access schools 38% Service integration 31% Evidenced based, family preservation, cross training, improved workforce, mentoring, incentives and FIS 1 response only Health Planning and Community Organizing: It’s what we do every day

Summary of Findings By County- Duval 1 Question 5: How do we integrate our substance abuse and mental health services into our child welfare system? 4 major themes emerged from a total of 34 responses Access schools 29% Service integration 23% Evidence-based only 14% Cross training 9% Access, discharge, standards, leverage funding, awareness 1 response each Health Planning and Community Organizing: It’s what we do every day

Circuit Wide Comparison 1 Question 1 : How do we blend our substance abuse and mental health services into services for clients with co-occurring disorders? Clay Duval Nassau 1 Collaboration and integration of services Education and cross training of providers Collaboration and integration of services 2 Education and cross training of providers Collaboration and integration of services Innovation / electronic medical records 3 Innovation, electronic medical records and data sharing Prevention and early intervention Improved funding 4 Develop social change awareness Provide choice of services Enhanced professional workforce Improve funding Education and cross training of providers 5 Health Planning and Community Organizing: It’s what we do every day

Circuit Wide Comparison 1 Question 2 : Prioritize the Circuit’s services Clay 1 2 3 4 5 Duval Nassau Integration of services and care coordination Centralized access, mental Transportation health authority, instant access, integration of services & coordination Self directed care Emergency psychiatric services Improve funding streams“braiding” Housing Prevention, education and early intervention Family services Centralized assessment, linkage, integrated services Housing Transportation Early intervention, prevention Health Planning and Community Organizing: It’s what we do every day

Circuit Wide Comparison 1 Question 3 : Assess the effectiveness and quality of our systems of care Clay 1 2 3 4 5 Duval Nassau Fragmentation / lack of integration of services Fragmentation / lack of Services and treatment integration of services/ data inadequacies (i. e. access, sharing waiting list etc…) Poor housing options Treatment inadequacies (i. e. Limited transportation access, waiting list etc…) Fragmented funding streams Prevention starts too late Location of services is challenging Limited transportation Professional training is poor Funding is poor Health Planning and Community Organizing: It’s what we do every day

Circuit Wide Comparison 1 Question 4 : If additional dollars came into Circuit 4, what substance abuse and mental health services would you like to see expanded or created? Clay 1 2 3 4 5 Duval Expand to the underserved Central access/ integration of services Expand self directed care Self directed care, peer support, Club House, consumer choice Improve access to care via better transportation 24 hour emergency service Mental health court Treatment (i. e. detox, case management, counseling) Medications Nassau Employment opportunities for clients Health Planning and Community Organizing: It’s what we do every day

Circuit Wide Comparison 1 Question 5 : How do we integrate our substance abuse and mental health services into our child welfare system? Clay 1 2 3 4 Duval Access schools Service integration Nassau Service integration Evidence-based only Cross training Health Planning and Community Organizing: It’s what we do every day

Debriefing- Clay 1 • More specific training is needed for staff, CBC’s, teachers etc… • Align Baker Act and Marchman Act with each other better • Lack of continuity of care • Silo’s in funding • Fragmentation of system • Transportation- rural communities have unique needs • Education the community on services available • There is a lot of duplicated people • Prevention education is needed • Gaps in services • Develop the concept of “no wrong door” • Work better with the criminal justice system • Staff retention is awful • Share! Health Planning and Community Organizing: It’s what we do every day

Debriefing- Duval 1 • A lot of work to be done • Need more community engagement • There is no community ownership • Consistent training and standards are needed • Streamline processes • Centralized assessments are necessary • Need a quality work force • There is a willingness and desire to work together • 24/7 services • Combine physical heath and behavior health • Self directed care works Health Planning and Community Organizing: It’s what we do every day

Debriefing- Nassau 1 • Transportation is a big issue • Services do not match the treatment needed • Very positive results in providing intervention and prevention in Nassau county schools • Surprised to hear about the great work being done in the schools • Surprised to hear about how the female gangs are outnumbering the male gangs • Substance Abuse Prevention Coalition is working Health Planning and Community Organizing: It’s what we do every day

World Café Findings 1 This report is intended to provide an executive level overview of the findings from the three World Café meetings. Copies of the hand written synthesis and illustrations of the collapsing process of the data is available by written request. All information contained in this report is owned by the Health Planning Council of Northeast and can not be reproduced without their permission. Furthermore, any of the findings listed in this report must be cited and or referenced in all public documents including web site postings. For further information, please contact Dawn Emerick, Executive Director of the Health Planning Council of Northeast Florida. 904 -723 -2162 Health Planning and Community Organizing: It’s what we do every day