Facility-Based Physical and Mental Health Services
Multnomah County’s Health Department and Department of County Human Services (DCHS) provide physical and mental health services to thousands of county residents. The Health Department provides services directly at health clinics and at Women, Infants and Children (WIC) offices. DCHS contracts with hospitals and community mental health and addictions treatment agencies to provide services at agency-owned or operated facilities. DCHS also provides direct mental health services at school-based locations.
We compared WIC locations to maps of vital statistical data on pregnant women eligible for WIC in FY 2014 to those who received WIC in FY 2014. We also compared maps of primary care health clinics and dental clinics to maps of American Community Survey (ACS) data on poverty and on means-tested public health insurance (primarily Medicaid)—a proxy for Oregon Health Plan members, who along with uninsured people, are the clinics’ primary clients. WIC offices, primary care health clinics and dental services appeared to be reasonably well placed to provide access to intended clients.
For mental health services, we compared outpatient locations to the zip codes of individuals receiving services in FY 2014, membership data from the County’s mental health insurance plan, as well as ACS poverty data and means-tested public health insurance data. Mental Health outpatient clinics were not as well placed as physical health clinics, in terms of proximity to the eligible population, primarily Oregon Health Plan members.
In addition to comparing maps of school-based physical and mental health services to ACS public health insurance data, we compared these maps to Oregon Department of Education data on Free and Reduced Price Lunch eligibility, a proxy for childhood poverty. School-based mental health locations fit target populations more closely than school-based physical health clinics, at least in part because the County has more flexibility in establishing the sites, they require less physical space and cost less for associated districts. School-based physical health clinics require a significant amount of space at schools as they are fully equipped clinics with four or more staff members each.
Examples of efforts to reach intended service recipients
- The Health Department uses a site selection process for its new dental and primary care clinics that includes a variety of data on poverty (such as Census poverty data and Free and Reduced Price Lunch eligibility data), as well as data on medically underserved populations, medically underserved areas and health professional shortage areas.
- The WIC program used data from the State of Oregon for women who gave birth in 2010 and who participated in WIC during pregnancy that year to help estimate areas of greatest demand for WIC services. While WIC offices are relatively well placed with regard to the eligible population, transportation to WIC offices can be problematic for many clients. This led the WIC program to create ways its clients can fulfill the program’s educational requirements without necessarily visiting a WIC clinic. For example, clients may attend classes at community locations, such as libraries, or can participate online.
- The DCHS Mental Health and Addiction Services Division (MHASD) uses data from sources such as Health Share of Oregon and its own mental health insurance plan to analyze the proximity of its contracted outpatient clinics to its health plan members (those that have used outpatient mental health services and those that are eligible for those services).
Examples of barriers
A significant barrier facing these departments with their facility-based services is that they lack flexibility in adapting to changes in the concentrations of their intended client populations.
- The Health Department established La Clinica de Buena Salud primarily to serve the Latino community in the NE Portland Cully Neighborhood. The concentration of this population declined in Cully, but the Department could not easily relocate its established medical facility. As a result, the clinic expanded its intended client population to include other vulnerable populations, including Somali and Russian immigrant families in that neighborhood.
- MHASD’s contracted facility-based services are also dependent on the locations of contractor facilities. While the contracting process allows MHASD to encourage service providers to locate in specific areas of the County by allocating funding according to geographic service coverage, it does not require providers to be located in specific regions of the County.
- Some County programs reported that it can be difficult to get a facility sited where it would best meet client needs. Community partners, such as schools, may not have the space or resources required for a program. Other facilities may be difficult to site due to community concerns. For example, it is difficult for the Health Department to locate needle exchange sites for its programs.
Home and Community-Based Physical and Mental Health Services
The lack of a nearby facility does not necessarily mean that the County is not providing services in a specific area; County programs provide many services in clients’ homes or other community locations. The Health Department has four home visiting programs for pregnant women and young children meeting specific criteria, such as those at risk for premature or low birth weight infants. The Mental Health and Addiction Services Division (MHASD) provides in-home and community based services directly and through contractors to Oregon Health Plan members and their families, as well as private insured or indigent clients, with serious mental health diagnoses. The MHASD crisis system is another service delivery system with mobile components. Anybody in the County can access the Crisis Call Center and its related services, and Project Respond is a mental health crisis service that is dispatched to any location within the County.
Generally, the intended recipients of home and community-based programs are the same as those for the physical and mental health facility-based programs, and we represented these populations through ACS means-tested public health insurance data. We compared the data to MHASD’s mental health visits by zip code, and found that MHASD’s mental health home and community based visits generally matched concentrations of the Medicaid populations. We also compared Early Childhood Services’ Healthy Birth Initiative (HBI) and Nurse Family Partnership (NFP) home visit data to vital statistical data. Early Childhood Services visits matched concentrations of their intended recipients: first births to African American families for HBI, and first births to low-income families for NFP.
Examples of efforts to reach intended service recipients
Mobile programs need to identify and connect with individuals who are eligible and who are most likely to benefit from services. Making this connection requires outreach to individuals and community partners who are in the position to provide referrals. These referrals not only identify potential clients, but can act to reduce barriers related to trust of program staff coming into clients’ homes.
- The Health Department’s sexually transmitted disease/HIV unit uses epidemiological data to identify individuals and groups of individuals with specific diseases and conditions to direct their outreach efforts.
- Early Childhood Services staff members market their programs to physicians who routinely treat Oregon Health Plan members, as well as social service agencies and culturally specific organizations. They also use GIS to compare birth statistics to their current caseloads as a way of determining if they are not connecting with potential clients and if there are areas of the County that would benefit from greater outreach efforts.
- The Environmental Health Division’s Healthy Homes and Families programs provide a variety of home visits. For example, they provide home inspections and a range of services for individuals with asthma as well as for individuals with high exposure to lead. The programs receive referrals from a network of community partners throughout the County, such as WIC offices, Head Start centers and health clinics. In the case of lead exposure, they also monitor state data on blood test lead levels. For the asthma program, staff compare epidemiological data to caseloads to identify areas or populations that require increased outreach efforts.
Examples of barriers
- Resource limitations impact mobile physical and mental health programs to varying degrees. For example, funding for outreach efforts is limited. Without outreach, physicians and community agencies may not know they can refer eligible clients for services.