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2016 Alaska Behavioral Health Systems Assessment Final Report

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2016 Alaska Behavioral Health Systems Assessment Final Report Alaska Behavioral Health Systems Assessment Final Report Prepared by Agnew::Beck Consulting, LLC and Hornby Zeller Associates, Inc. “When we initiated this effort, we had high hopes for what we were going to get out of it; and I think, honestly, not only have we achieved what we wished to get out of it, in many respects, I think we've exceeded that. The insights provide us with an opportunity to have a comprehensive plan and to make continuous progress to move the system forward. It's a tremendous gain for us. It's probably one of the biggest and best things we've done to make long-term system change.” - Russ Webb, Chair of the Board of Trustees, Alaska Mental Health Trust Authority “The Behavioral Health Systems Assessment provides a foundation for us to understand the continuum of Alaskans’ behavioral health needs at many levels (e.g., individual, community, and professional). With such rich data, these findings and recommendations offer many opportunities to inform systems change, maximize resources, and enhance collaborations, all in the name of improving the health of Alaskans statewide. This is the only statewide behavioral health assessment that has included firsthand input from the Tribal Behavioral Health Aides; their voice is represented here and it is our duty to follow their lead and ensure a better behavior health system in our state.” - Laura Baéz, Director of Behavioral Health, Alaska Native Tribal Health Consortium “‘In a time where data is needed to inform every step of transformation, building the analytic capacity of the system is critical. The groundwork laid by this project creates the road map for building analytic capacity and producing regular (annual) behavioral health systems assessments.’ (Page 3) I found myself often recalling and reflecting on this statement while reviewing this report. The recurring thought was that this is just the beginning… The Alaska Behavioral Health System is complex and it is evolving. One snapshot does not do it justice or capture all the nuances. Quite the contrary, it points out where data refinement is needed and that we need to evaluate transformation in order to inform future decisions and directions.” - Jerry Jenkins, President of the Alaska Behavioral Health Association and Chief Executive Officer of Anchorage and Fairbanks Community Mental Health Services “The information gathered in this assessment will be invaluable to the Division of Behavioral Health as we move toward a future in which all Alaskans live in healthy communities and have access to the care they need – high-quality, person-centered, culturally relevant, and as close to home as possible. Supporting Alaska’s behavioral health system will always be a team effort. This assessment is a great tool to help us move forward, together.” - Albert E. Wall, Director, Division of Behavioral Health “Questions remain as to who this will go to and how they will best understand it. That said, this is a remarkable achievement! I am thrilled with all of the information compiled, and I already know certain ways I can use it. I applaud each of the people who worked on this, and I look forward to continued discussions on this assessment!! Thank you for all of the hard work!!!” - Lance Johnson, Behavioral Health Services Director, Norton Sound Health Corporation “I think the report is wonderful – it is nicely comprehensive, very clear to understand, and provides such great data and information. I look forward to our continued dialogue… on how we can work together to see the recommendations realized.” - Melissa Kemberling, Director of Programs, Mat-Su Health Foundation TABLE OF CONTENTS Acknowledgements .................................................................................................................................................. x Project Sponsors ......................................................................................................................................... x A Note from the Consultant Team ......................................................................................................... xi Project Leadership .................................................................................................................................... xii Qualitative Data Support ........................................................................................................................ xiv Quantitative Data Support .................................................................................................................... xviii Final Draft Review Team ......................................................................................................................... xx Executive Summary................................................................................................................................................ 1 Introduction ............................................................................................................................................................ 6 Project History and Purpose ..................................................................................................................... 6 Calls to Action ............................................................................................................................................. 8 Summary of Methodology ......................................................................................................................... 9 Report Organization ................................................................................................................................. 14 1. What is Behavioral Health, What is the State-funded System, and What Forces Influence its Capacity? ......... 15 What is Behavioral Health?...................................................................................................................... 15 What is the State-funded Behavioral Health System? .......................................................................... 15 State-funded Behavioral Health Services Outside of the Community Behavioral Health System ............................................................................................................................................ 24 Leadership of the State-funded Behavioral Health System ................................................................ 30 Alaska Tribal Behavioral Health System ................................................................................................ 33 What Forces Influence System Capacity? .............................................................................................. 42 2. What is the Prevalence of Behavioral Health Issues in Alaska? ...................................................................... 51 Key Findings .............................................................................................................................................. 52 Prevalence of Behavioral Health Issues Among Alaska Adults ......................................................... 54 Prevalence of Behavioral Health Issues Among Alaska Youth ......................................................... 59 3. Who are the Current Users? .......................................................................................................................... 74 Key Findings .............................................................................................................................................. 74 Total Unique Clients ................................................................................................................................. 76 Utilization of Behavioral Health Services by Alaska Adults ............................................................... 78 Utilization of Behavioral Health Services by Alaska Youth ............................................................... 85 4. Where are Clients Being Served and by Whom? ............................................................................................. 95 Key Findings .............................................................................................................................................. 95 Service Settings and Provider Types: ..................................................................................................... 97 Report Updated on 1.22.2016 i Patterns of Use: Can Clients Access Services in Their Home Regions or Do They Need to Travel Outside Their Regions for Services? ....................................................................... 101 Alaska’s Behavioral Health Workforce ............................................................................................... 102 Position Types and Associated Credentialing Requirements .......................................................... 107 5. Which Services Do Clients Use? ................................................................................................................. 135 Key Findings: .......................................................................................................................................... 136 Community-Based Treatment and Medicaid Billable Services ........................................................ 138 Alaska’s Behavioral Health Continuum of Care ................................................................................ 139 6. Are State-funded Behavioral Health Services Effective? ............................................................................... 160 Overview of
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