Mental Health, Substance Use, and Interpersonal Violence in Baltimore EMA Agencies

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Explore the use of screening tools in Baltimore EMA agencies to ensure appropriate processes for addressing mental health, substance use, and interpersonal violence. Emphasis on reliability, validity, and data collection methods through a survey conducted across various agencies in the area.

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Mental Health, Substance Use, and Interpersonal Violence Audrey Denakpo, LBSW and Linda Knapp, PhD Prevention and Health Promotion Administration Center for HIV Prevention and Health Services May 21, 2019

Prevention and Health Promotion Administration MISSION AND VISION MISSION The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community-based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations. VISION The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well-being. 2

Mental Health, Substance Use, and Interpersonal Violence Purpose Explore screening tools used across agencies in the Baltimore EMA Overall goal is to ensure an appropriate process is used across the EMA Importance of Reliability and Validity Reliability is the extent to which an experiment, test, or measuring procedure yields the same results on repeated trials Validity ensures screening tools used within EMA measure what they are intended to measure HRSA guidelines for Outpatient Ambulatory Health Services state that age appropriate, standardized tools be used for depression screenings Standardized tools are designed so the questions, conditions for administering, scoring procedures, and interpretations of the results are consistent and are administered and scored in a predetermined, standard manner. 3

Data Collection Survey Monkey Sent Received 30 agencies in the Baltimore EMA: Local Health Departments Medical Clinics Specialty Clinics Support Services Housing Services 40 total responses, 2 were duplicates (N=38) 25 different agencies responded Asked that survey be shared with anyone within the agency who might be best at answering the questions multiple responses from a single agency were possible 4

Mental Health, Substance Use, and Interpersonal Violence Who Administers the Tool? Medical Healthcare Professionals Allied Healthcare Professionals Client Self Administered Other (peer counselors, front end staff, advocacy counselors) Who Gets Screened? All Clients Only RW Clients Only Medical Case Management Only Nonmedical Case Management Only New Clients

Mental Health Screening Does your Agency screen for Mental Health? N=38 35 35 people responded to this question 30 25 20 15 10 5 0 Yes No No Answer

Mental Health Standardized Tool Use Standardized Tool None A total of 21 sites use a standardized screening tool Standardized Tool AND Other 13 sites do not use ANY standardized screening tool Other (Biopsychosocial, EMR Generated, Intake Questionnaire) Some sites use multiple screening tools - 17 sites use AT LEAST one standardized tool Standardized Tool 0 5 10 15 20 25

Mental Health Screening Frequency How frequently is the screen performed? N=38 Every 3 Years Based on Clinical Judgement At Intake Only At Intake, then as needed At Intake, Then Annually Annually Every 6 Months Every 3 Months Every Month Every Visit 0 1 2 3 4 5 6 8

Mental Health Limited English Proficiency For clients with limited English proficiency, how does your Agency screen for mental health? N=38 Bilingual Staff Phone AND Family Tool Translation with Bilingual Staff Phone Interpreter AND Bilingual Staff In Person Translator AND Video Phone Interpreter AND In-Person Translator Phone Interpreter 0 1 2 3 4 5 6 9

Substance Use Does your agency screen for substance use? N=38 Screening 35 32 people responded to this question 30 25 20 15 10 5 0 Yes No No Answer

Substance Use Standardized Tool Standardized Tool Use None A total of 17 sites use a standardized screening tool Standardized Tool AND Other 13 sites do not use ANY standardized screening tool Other (Agency Developed, EMR Generated, Intake Questionnaire) Some sites use multiple screening tools - 15 sites use AT LEAST one standardized tool Standardized Tool 0 5 10 15 20

Substance Use Screening Frequency How frequently is the screen performed? N=38 Unknown/Unsure Every 3 Years Based on Clinical Judgement At Intake Only At Intake, then As Needed At Intake, then Annually Annually Every 6 Months Every Month Every Visit 0 1 2 3 4 5 6 7 8 9 12

Substance Use Limited English Proficiency For clients with limited English proficiency, how does your Agency screen for mental health? N=38 Bilingual Staff Phone AND Family Phone AND Bilingual Staff In Person AND Video Phone AND In Person Phone Interpreter 0 1 2 3 4 5 6 7 8 9 10 13

Interpersonal Violence Does your agency screen for substance use? N=38 Screening 31 people responded to this questions No Answer No Yes 0 5 10 15 20 25 30

Interpersonal Violence Standardized Tool Use Standardized Tool None A total of 4 sites use a standardized screening tool Other 23 sites do not use a screening tool Standardized Tool 0 5 10 15 20 25

Interpersonal Violence Screening Frequency How frequently is the screen performed? N=38 Unknown/Unsure Every 3 Years Based on Clinical Judgement At Intake Only At Intake, then As Needed At Intake, then Annually Annually Every 6 Months Every Month Every Visit 0 1 2 3 4 5 6 7 8 9 16

Interpersonal Violence Limited English Proficiency For clients with limited English proficiency, how does your Agency screen for mental health? N=38 Bilingual Staff Phone AND Family Phone AND Bilingual Staff In Person AND Video Phone AND In Person Phone Interpreter 0 1 2 3 4 5 6 7 8 9 10 17

Summary Variation in practices and tools used: 1. Within the EMA 2. Within each agency Is the Planning Council satisfied with this level of variability within Baltimore EMA? 18