Project 1: The “assess the situation” project

Most of the time somebody uses a health care provider, that visit is paid for by insurance and data on that visit are collected. The Health Insurance Portability, Access and Accountability Act (HIPAA) means that health visits are reported in the aggregate. You can’t see whether a particular person got care, but you can know how many women aged 30–39 got care, for example. Getting access to health information is harder than other data, because laws and policies see this information as sensitive in part due to the enduring stigma about mental illness. It is also cumbersome for many kinds of health providers to manage billing insurance companies for care, so they make the patient file the claim.

No single number will give you a complete picture of a community’s health. But by gathering multiple data sources and tracking them over time, you should be able to get an idea of how much medical and dental care insecurity there is in your community. Here’s your list:

• Available data: Your state Public Health Department and Human Services Department should have aggregate data for the whole state and maybe some by county.
• Sources of care: Locate sources of health care, both private and public including emergency rooms, urgent care centers, doctor’s offices, hospitals, community health centers, free clinics, school clinics, pastoral counseling centers, social workers and psychiatrists.
• Access limitations: Determine the operating hours and eligibility requirements for every source and determine if they take Medicaid, Medicare or self-pay patients. Do you have to be a US citizen to get care?
• ER data: How many patients does the hospital emergency department serve each year? How many of them are transported by ambulance?
• Community health center: Does your community have one? Does a federally-qualified health center or tribal health center have a fully-functioning health staff?
• Free clinic data: Does your community have a free clinic? How many patients can it handle on average? Is care restricted to certain age groups or other populations?
• Faith-based: Many clergy provide initial counseling for health concerns and support to their members. You may have to call pastors/faith-based organization leaders. Note how many sessions they offer on average.
• Elder service agencies: How many have social workers or other health care providers on staff? Who is eligible for care?
• School districts: Is there a school-based health center in your community? What services are provided, what age group(s) do they serve? How many visits occur in an average month? Do your schools have volunteer or paid school nurses on staff?
• Homeless shelters: Many serve substance-using or mentally ill clients routinely. Who do they call when they can’t manage a client with health or addiction issues?
• Domestic violence shelters: They may track visits to additional care that the shelter program supports. Maybe take a snapshot once per month and track over time.
• Child welfare data: While not easy to acquire, there may be a way to assess data on adult and child clients needing medical and dental health care.
• American Community Survey: The ACS is an ongoing survey that provides vital information on a yearly basis about the United States and its people. Information from the survey generates data that help determine how more than $675 billion in federal and state funds are distributed each year.

As mentioned, this won’t be as simple an assessment as those for some other sectors, but if you get these numbers, you should at least be able to tell if the situation in your community is going in a good or bad direction. In this project, you will be gathering as much data as you can to paint a picture of local behavioral health care: the first step in identifying challenges.