Mapping Changed This County's Approach to Behavioral Health

San Bernardino County

San Bernardino County


Connecting state and local government leaders

San Bernardino County once thought consumers avoided services because of the stigma attached.

San Bernardino County, like all California counties, is required to have a mental health plan for consumers with severe, persistent mental illnesses and substance use disorders. Only recently, in 2014, did federal and state policy allow expansion of that plan to encompass consumers with mild to moderate behavioral health conditions, largely due to the stigma surrounding them.

“There has been a general belief that people don’t want to access behavioral health services because of the stigma,” Sarah Eberhardt-Rios, deputy director of program support services at the county Department of Behavioral Health, told Route Fifty in an interview.

Though that’s still “somewhat true,” she said, mapping consumer population data has shown DBH many do want to seek treatment—if only they understood the services available and how to access them.

The large county covers about 20,000 square miles with a population of 2.1 million people, just over 500,000 of which are Medi-Cal consumers. Overlay a map of enrollees separated by income levels with clinic resources, and you begin to get a picture of where services are scarce and why consumers aren’t accessing them.

DBH’s Research and Evaluation team works with Cary, North Carolina-based data analytics software company SAS to do just that. SAS manages identified datasets for analysis of health outcomes, a once-difficult task because state policies and internal checks make it tough to couple behavioral health with physical medical data in a timely fashion.

“This area has not benefited from the traditional ways we’d look at data,” said Steve Kearney, SAS medical director for state and local government. “We try to let the data tell the story.”

Data-sharing limitations have kept consumers from services, but GIS mapping is changing that—showing the county who is accessing the behavioral health system and where.

Treatment data previously reviewed manually is now modeled instantly, allowing the county to relocate services where there are more community partners like school districts, hospitals, emergency rooms, and correctional facilities. Planning can be informed and adjusted and clinics concentrated strategically, perhaps near transportation hubs.

Patterns of re-hospitalization have emerged monitoring how long consumers are in care, the health systems they come from and the services they use.

“Hospitalizations often rely on the level of social support in a person’s life, and if that level is low they might be at risk for more hospitalizations,” Eberhardt-Rios said. “The social determinants of health are considered more.”

The knowledge that people aren’t always avoiding treatment has led the county to change the way it talks about connecting consumers with outpatient services to engage them more effectively. If cancer patients can be “survivors,” why can’t behavioral health patients?

A new outcomes-based regime has taken hold that prioritizes keeping consumers out of hospitals if possible and tracking what happens after they’re discharged.

San Bernardino County determines the outcomes it wants to measure like improving families’ behavioral health knowledge.

“Engagement and outpatient services went up 700 percent in some cases,” said Dr. Joshua Morgan, DBH chief of behavioral health informatics.

The county’s success can be replicated with other datasets like pharmacy, arrest and foster care data, Kearney said.

Eberhardt-Rios would like to take a deeper look into intervention issues of the brain and show, through data, the behavioral health gains the county is making in consumers’ lives.

“We want to utilize our relationships and data gathered to work collaboratively on an integrated approach with other health care providers,” she said.

Dave Nyczepir is a News Editor at Government Executive’s Route Fifty and is based in Washington, D.C.

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