New Mexico Behavioral Health Collaborative. New Mexico Behavioral Health Consumer, Family/Caregiver Satisfaction Project

Transcription

1 New Mexico Behavioral Health Collaborative New Mexico Behavioral Health Consumer, Family/Caregiver Satisfaction Project 2014

2 A Collaborative effort by: The Human Services Department: Behavioral Health Services Division, Office of Peer Recovery and Engagement, Medical Assistance Division; Children Youth and Families Department; Blue Cross/Blue Shield, Molina Healthcare, OptumHealth New Mexico, Presbyterian/Magellan, United Healthcare; New Mexico Behavioral Health Consumers, Families, Children, Youth and The Consortium for Behavioral Health Training and Research.

3 Table of Contents Introduction A Year in Transition Survey Highlights Adult Domain: Access Domain: Participation in Treatment Domain: Improved Functioning Domain: Social Connectedness Domain: Outcomes Domain: Quality & Appropriateness Domain: Satisfaction Other Areas Survey Highlights - Child Family/ Caregivers Survey Domain: Access Domain: Participation in Treatment Planning Domain: Improved Functioning Domain: Social Connectedness Domain: Outcomes Domain: Cultural Sensitivity Domain: Satisfaction Other Areas Acknowledgements

4 FY2014 Consumer Family/Caregiver Report What is the Consumer Satisfaction Project? The New Mexico Consumer, Family/Caregiver and Youth Satisfaction Project (CFYP) is a yearly effort to survey the satisfaction of New Mexico Adult individuals, Family/Caregivers and Youth receiving state funded mental health and substance abuse treatment and support services. The CFYP surveys serve two purposes: To inform a quality improvement process to strengthen services in New Mexico; and, To fulfill federally mandated data reporting requirements. Adults, family members and youth answer the survey through face-to-face or telephone interviews. Provider locations for face-to-face interviews are pre-selected each year. Telephone interviews were pulled from a pool of randomly selected individuals or families who received services from OptumHealth New Mexico during the first six months (July-December 2013) of the state fiscal year. The Youth Report is covered in a separate report : A Year in Transition There were some significant changes in New Mexico s behavioral health care environment during the period in which individuals were receiving care and surveyed (July 2013 through June, 2014.) From July December, 2013, all individuals received their behavioral health care managed under a single statewide entity OptumHealth-New Mexico. In January, 2014, New Mexico launched its new Medicaid program, Centennial Care, which manages both behavioral health and primary care services. At that point, all Medicaid eligible individuals and families had to enroll in one of four managed care companies. While the Medicaid benefit packages are primarily identical, each MCO offers some value added services that vary. All Medicaid-eligible members were contacted to determine whether they would qualify for a more intense service - Care Coordination designed to assist those with complex needs. A new emphasis on integrated behavioral and physical care was introduced. There was a significant change in the behavioral health provider delivery system during the period July through December, Several large providers closed and many individuals care was transitioned to new providers in their local communities. While the potential for improvements were on the horizon, there was also a lot of turmoil as members enrolled under new insurance systems and in some cases, with new providers of care. This may have influenced the participants satisfaction with their care during this time of change. What we ask about: The surveys contain questions that come from the Mental Health Statistics Improvement Program (MHSIP). The New Mexico Behavioral Health Collaborative added additional questions including questions related to the 1 P a g e

5 National Outcome Measures System. This report will provide highlights separately from the Adult Survey and then from the Child & Family/Caregiver Survey. Findings from the Youth Survey are available at There are seven subscales within the survey that are used nationally. This provides a helpful benchmark for our state s performance. Each of those scales is presented below. Each graph includes the three year trend for New Mexico. A red dotted line shows what the US average was in 2013 for that measure. The specific questions that make up the scale are listed below the graph with the proportion of positive responses for that item. Survey Highlights- Adult Who we surveyed -Adults Our sample was drawn from those individuals who had received care during the first 6 months prior to the implementation of Medicaid s Centennial Care Program. However, we actually surveyed individuals in the Spring of 2014, after many individuals had made their transitions to their new insurance coverage. For the 2014 survey, we heard from 1,485 adults respondents. Females (61%) were slightly overrepresented in the sample. The majority of adults were White (86%). Native Americans (4.3%) and African Americans (2.2%) were underrepresented as compared with the population in treatment. For those who responded (73%) to the question, individuals were evenly split between Hispanic and non-hispanics. The age groups are reflected below: Adult Respondents by Age % % (N=1405) % % 2 P a g e

6 Domain: Access Definition: Entry into behavioral health services is quick, easy and convenient. Observations: The average proportion of positive responses for was 85%. This meets the national average of 85%, and maintains the prior year s performance of 86%. Respondents were least satisfied with access to their Psychiatrist, as reflected in their comments. Consumer Comments about Access: if I could see my doctor more than once a month - - the doctor only comes to town monthly. hard time getting a ride to town. "I only get to see my therapist once a year." Items for Access 5. Staff were willing to see me as often as I felt it was necessary. 7. Services were available at times that were good for me. 4. The location of services was convenient (parking, public Transportation, distance, etc.). 8. I was able to get all the services I thought I needed. 6. Staff returned my call in 24 hours. 9. I was able to see a psychiatrist when I wanted to P a g e

7 Domain: Participation in Treatment Definition: Adults feel that they are a part of their treatment team. Observations: The average proportion of positive responses for Participation in Treatment was 87%. This is well above that national average of 81%, and sustains the prior year s performance of 88%. While adults were generally satisfied asking questions about their treatment or medications, they were notably less satisfied about their setting their treatment goals. Consumer Comments about Participation in Treatment: I want to feel more understood. Would also like people to be more patient with me. When I ask for a change in my treatment it takes longer than I d like to get approved "I switched psychiatrists and it is getting better." Items for Participation in Treatment 11. I felt comfortable asking questions about my treatment and medication. 17. I, not staff, decided my treatment goals P a g e

8 Domain: Improved Functioning Definition: Adults feel they can manage their daily activities better. Observations: The average proportion of positive responses for Improved Functioning was 73%. This is above the national average of 70%, but is down from the prior year s performance of 81%. In particular, adults were less satisfied about being able to handle things when they went wrong and about doing what they wanted to do. Consumer Comments about Improved Functioning When I was forced to go to this place because of parole, I didn't know that it would've helped as much as it did. Without this facility, I honestly feel that I would not be alive today. I have been given tools and options for handling crises." Items for Improved Functioning 30. I am better able to take care of my needs. 29. I do things that are more meaningful to me. 31. I am better able to handle things when they go wrong. 32. I am better able to do things that I want to do. 28. My symptoms are not bothering me as much P a g e

9 Domain: Social Connectedness Definition: Adults feel they are connected in their family and friends, have social supports and belong to their community. Observations: The average proportion of positive responses for Social Connectedness was 83%. This is well above that national average of 70%, but is down from the prior year s performance of 88%. The area in which adults were less satisfied had to do with their sense of belonging in their community. Consumer Comments about Social Connectedness: I can see the differences the services have made for me and my family. "I am a volunteer now in the schools. This gives me satisfaction, and I feel better." Items for Social Connectedness 36. In a crisis, I would have the support I need from family or friends. 34. I have people with whom I can do enjoyable things. 33. I am happy with the friendships I have. 35. I feel I belong in my community P a g e

10 Domain: Outcomes Definition: The extent to which services provided to individuals with behavioral health needs have a positive or negative effect on their well-being, life circumstances, and capacity for self-management and recovery. Observations: The average proportion of positive responses for Outcomes was 75%. This is slightly above that national average of 71%, but is down from the prior year s performance of 85%. Satisfaction was notably lower in the areas of work, housing, symptom management and handling social situations. Consumer Comments about Outcomes: My provider was very helpful in many parts of my life. "This program is outstanding and helped me keep clean and sober." "I was doing ok, but I had to stop all my mental health services because I can't pay for the medication and the therapy." Items for Outcomes 21. I deal more effectively with daily problems. 22. I am better able to control my life. 23. I am better able to deal with crisis. 24. I am getting along better with my family. 26. I do better in school and/or work. 27. My housing situation has improved. 25. I do better in social situations. 28. My symptoms are not bothering me as much P a g e

11 Domain: Quality & Appropriateness Definition: Services ae individualized to address the consumer s strengths and needs, cultural context, preferences and recovery goals. Observations: The average proportion of positive responses for Quality & Appropriateness was 88%. This meets the national average of 88%, but is down from the prior year s performance of 91%. Adults were less satisfied with staff s encouragement to use consumer-run programs, and for help in watching out for side effects in their care. Consumer Comments about Quality & Appropriateness Not personal anymore - factory like setting, in and out. I need help in a one-onone situation." Having a bilingual therapist was really helpful to my services. "I would like to see more female providers." Items for Quality and Appropriateness 16.Staff respected my wishes about who is and who is not to be given information about my treatment. 13. I was given information about my rights. 18. Staff were sensitive to my cultural background (race, religion, language, etc.) 19. Staff helped me obtain the information I needed so that I could take charge of managing my illness. 12. I felt free to complain. 14. Staff encouraged me to take responsibility for how I live my life. 10. Staff here believed that I can grow, change and recover. 15. Staff told me what side effects to watch out for. 20. I was encouraged to use consumer-run programs (support groups, drop-in centers, crisis phone line, etc.) P a g e

12 Domain: Satisfaction Definition: Adults are generally happy with the services they are provided. Observations: The average proportion of positive responses for Satisfaction was 89%. This is slightly higher than the national average of 88%, and is the same as the prior year s performance of 88%. Consumer Comments about Satisfaction: I am grateful for the services that you have been provided and it is making a difference in my life." I waited 3 months for counseling and therapy. Otherwise, I feel this is a vital service. Items for Satisfaction 1. I like the services that I received here. 3. I would recommend this agency to a friend or family member. 2. If I had other choices, I would still get services from this agency "My medication caused me to shake a lot. It is so bad that it is causing me to get a second opinion from another provider." 9 P a g e

13 Other Areas Housing and Employment: These two support areas tend to rate the lowest in the overall survey. Almost all adult respondents (87%) very strongly indicated (95%) that housing was important to their mental health/recovery. However, when asked whether their housing needs where addressed and solved, they rated this area notably lower at only 70%. About two-thirds of the adults respondents (62%) also strongly indicated (80%) that work, either paid or volunteer, was important to their mental health/recovery. And when asked whether their work needs were addressed or solved, their average proportion positive responses was 79% Substance Abuse: About half of the adult respondents rated the substance abuse questions positively. When asked whether they had reduced or eliminated their drug use, and had the tools to understand and prevent relapse, the average proportion of positive responses was 85%. This is slightly down from the 2012 average of 90%. Medications: Medication issues are clearly relevant to most of the respondents. Almost all respondents feel very comfortable (92%) asking questions about their treatment and medication. And most feel satisfied that staff help them learn about their side effects (84%). Respondents were slightly less positive about their medication helping them control symptoms that used to bother them (79%). And finally, 60% of those responding agreed that they had experienced harmful medication side effects. Care Coordination: We asked two questions to see if respondents were satisfied with how their behavioral health and medical care providers worked together. Eight-one percent (81%) of responses were positive about them working together with me to figure out my needs. Seventy-nine percent (79%) of responses were positive about them working together with me to develop a plan to meet those needs. Consumer Comments about Care Coordination: "My behavioral health provider does not communicate with my doctor." "The two providers refused to communicate with each other, and it caused me a lot of anguish trying to get them to understand what the other had said." "My doctor won't help me. My caseworker gave me a number to get a doctor to help me with anxiety." 10 P a g e

14 Survey Highlights- Child Family/ Caregivers Survey Who we surveyed- Child Family/Caregivers Our sample was drawn from those children who had received care during the first 6 months prior to the implementation of Medicaid s Centennial Care Program. However, we actually surveyed their families in the Spring of 2014, after many individuals had made their transitions to their new insurance coverage. Ninety-five percent (95%) of the children were Medicaid eligible. For the 2014 survey, we heard from 1,085 Family/Caregiver respondents. Fifty-nine percent (59%) of those children were males and 41% females; this is the same ratio as the population in treatment. The vast majority of the children were White (86%). Native Americans (42.4%) were underrepresented and African Americans (3.7%) were overrepresented as compared with the population in treatment. For those who responded (71%) to the question, almost two-thirds (62%) were Hispanic which reflects the population in treatment. The age groups are reflected below: 11 P a g e

15 Domain: Access Definition: Entry into behavioral health services is quick, easy and convenient. Observations: The average proportion of positive responses for was 89%. This exceeds the national average of 85%, as well as the prior year s performance of 88%. Consumer Comments about Access: Best thing about is the convenient location and have always been able to help us with everything. They have been able to get us in the same day or next. Items for Access 9. Services were available at times that were convenient for us. 8. The location of services was convenient for us Through these services, I have had so much help. There have been times where I have made appointments in an emergency. They always return calls within 24 hours and they are very helpful. I love them. 12 P a g e

16 Domain: Participation in Treatment Planning Definition: Families feel that they are a part of their child s treatment team. Observations: The average proportion of positive responses for Participation in Treatment was 92%. This is notably above the national average of 88% as well as the prior year s performance of 89%. Families feel very positive about being part of their child s treatment team. Consumer Comments about Participation in Treatment Planning: "Sometimes I feel like I'm just going to appointments and in the dark. I would like to know what goals are and how we are going to achieve them." Items for Participation in Treatment Planning 6. I participated in my child s treatment. 3. I helped to choose my child s treatment goals. 2. I helped to choose my child s services "We need more communication about what I need to do as a parent and more realistic goals that I can do and meet to help my child." 13 P a g e

17 Domain: Improved Functioning Definition: Families feel their child is better able to do the things they want to do, and have someone with whom they can enjoy things. Observations: The average proportion of positive responses for Improved Functioning was 81%. This is significantly above the national average of 69%, but is slightly down from the prior year s performance of 84%. While generally satisfied, families are less positive about their child being better able to do what he/she wants to do. Consumer Comments about Improved Functioning: My child is able to communicate with me when he has a problem. Items for Improved Functioning 26. My child has people with whom he/she can do enjoyable things. 22. My child is better able to do things he/she wants to do Just how to deal with the outbursts and things like that. They gave me the tools of how to handle it at home, how to cope with it and how to keep moving forward. My son's mental stability has been really improving and he is gaining a lot of understanding and he has learned a lot about himself. 14 P a g e

18 Domain: Social Connectedness Definition: Families feel they have the social supports to listen to them when they need to talk and have help to deal with their child s problems or crises. Observations: The average proportion of positive responses for Social Connectedness was 93%. This is well above that national average of 85%, and is slightly higher than the prior year s performance of 92%. Families feel very satisfied with this area. Consumer Comments about Social Connectedness: Just getting knowledge and knowing how to work with him after he has been done with therapy. They have given us tools and techniques on how to control his behavior. The counselor that my daughter has has changed not only my daughter s life but has changed mine. I quit drinking alcohol and my daughter has improved monumentally. I have been able to participate more in my daughter s life and learned to be a better mother Items for Social Connectedness 24. I have people that I am comfortable talking with about my child s problems. 25. In a crisis, I would have the support I need from family or friends. 23. I know people who will listen and understand me when I need to talk P a g e

19 Domain: Outcomes Definition: The extent to which services provided to families with behavioral health needs have a positive or negative effect on their child s ability to get along with family and friends, do better in school, handle daily activities and cope with problems. Observations: The average proportion of positive responses for Outcomes was 81%. This is significantly above that national average of 68%, but is down from the prior year s performance of 85%. Satisfaction was notably lower in the areas of school and coping when things went wrong. Consumer Comments about Outcomes: More goals for her [would help her improve] the outcomes. There was not enough aftercare. They would listen and let her express herself. But they didn't work on helping her control her temper as much as I thought they would. Items for Outcomes 21. I am satisfied with our family life right now. 17. My child gets along better with family members. 16. My child is better at handling daily life. 18. My child gets along better with friends and other people. 19. My child is doing better in school and/or work. 20. My child is better able to cope when things go wrong Communication: we have learned how to communicate better. Being aware of trigger has been helpful overall. Understanding boundaries Everything about the counseling has been fantastic. I need help with him in school the school doesn't listen to me, nobody listens to me. 16 P a g e

20 Domain: Cultural Sensitivity Definition: The extent to which services provided to families are delivered in a manner that is respectful of cultural background, language and spiritual beliefs. Observations: The average proportion of positive responses for Cultural Sensitivity was 96%. This is above that national average of 93%, and the same as the prior year s performance of 96%. Families are extremely satisfied with staff s respect for and sensitivity to the family s cultural background and spiritual beliefs. They also felt they were spoken to in a way they understood. Consumer Comments about Cultural Sensitivity: She would notice things that were uncomfortable talking about. My daughter had an issue with sexual issues, and the therapist was able to address it. She fought for my daughter. It was really great to have someone helping me out. Items for Cultural Sensitivity 14. Staff spoke with me in a way that I understood. 13. Staff respected my family s religious/spiritual beliefs. 12. Staff treated me with respect. 15. Staff was sensitive to my cultural/ethnic background The most important is that they were able to have us explain things to him in a way he could understand how to control and resolve his behaviors. 17 P a g e

21 Domain: Satisfaction Definition: Families are generally happy with the services that are provided to their child. Observations: The average proportion of positive responses for Satisfaction was 88%. This is slightly higher than the national average of 86%, and slightly higher than the prior year s performance of 86%. While families were very satisfied with the services their child received, they were less so with the amount of help they felt they needed. Consumer Comments about Satisfaction: I think the understanding and the consulting from the therapist was really good - and he likes them, which makes a big difference. The consistency that they are here whenever I need them. I can call in the middle of the night if I need to and she will be right there and talk to me or her on the phone. Items for Satisfaction 1. Overall, I am satisfied with the services my child received. 7. The services my child and/or family received were right for us. 4. The people helping my child stuck with us no matter what. 5. I felt my child had someone to talk to when he/she was troubled. 10. My family got the help we wanted for my child. 11. My family got as much help as we needed for my child I would like more support for my daughter as a single parent to be more able to cope on a daily basis. 18 P a g e

22 Other Areas Housing: This is an important area for all families. Almost all Family respondents (90%) very strongly indicated (98%) that housing was important to their child s mental health/recovery. However, when asked whether their housing needs where addressed and solved, they rated this area notably lower at only 79%. While they are satisfied (87%) that their housing needs are included in their child s treatment plan, notably fewer responses (74%) felt the staff helped them improve their situation. Substance Abuse: Very few of the families responded to the substance abuse questions (from 13%-19%.) For those who did respond, the average positive response was 79%. Specifically, among responding families, 73% responded positively that their child had stopped using drugs and/or alcohol. However, families were more satisfied (85%) that their child had the tools he/she needed to understand and prevent relapse. Medications: Only about one-third of families responded to the questions related to Medication. Of those responding, families were fairly satisfied (80%) that the medications their child was taking helped them control symptoms that used to bother them. However, sixty 60% of the responses indicated that their child experienced harmful medication side effects. Care Coordination: We asked two questions to see if respondents were satisfied with how their behavioral health and medical care providers worked together. Ninety percent (90%) of responses were positive about my child s medical staff works with me to identify all my child s health needs. A lower proportion (83%) of responses were positive about their behavioral health and medical care providers work together with me to develop a plan to meet those needs. Consumer Comments about Care Coordination: I think again it's back to better communications between the staff. Between the residential treatment center and the day treatment center, there seems to be a disconnect there, sometimes. Better communication between all staff and medical staff. More consistent visitations between the CSS workers and my child. Community support specialist only met with child for less than 10 minutes and did not help them. More consistent communicators. The fact that they work together. Makes it easier to manage my child s health. 19 P a g e

23 Acknowledgements There are many individuals who assisted in obtaining the information for this survey and it is impossible to mention everyone by name. The Project Steering Committee would like to extend their gratitude to all of the workers, volunteers, family members, and other stakeholders who participated. Consumer/Family/Youth Satisfaction Project Steering Committee Monica Miura, Family Advocate Martha Cooke, Adult Advocate Children, Youth and Families Department: Erica Padilla, Youth Specialist Jeff Tinstman Medical Assistance Division, HSD Cynthia Keiser, Quality Bureau Behavioral Health Services Division, HSD Leon Lopez Deborah Fickling Steven Flint Cindy Romero Rosangela Ortiz Behavioral Health Collaborative Betty Downes, Quality & Evaluation Consultant Managed Care Companies: Blue/Cross/Blue Shield: Jessica Moriarty & Lisa Mortensen Molina Healthcare: Donald Hume & Loretta Cordova Presbyterian Health/Magellan: Pilo Bueno United HealthCare: Russell Liles & Tracy Townsend Special Thanks to : Falling Colors: Pam Koster & Mindy Hale New Mexico Access to Recovery Technology (ART), Lisa Olguin Families ASAP The Life Link 20 P a g e