- April 18, 2024
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In 2022, the health departments in Volusia and Flagler counties collaborated for the first time to identify key public health concerns in the community. That assessment has now led to a new roadmap to address those concerns.
On April 11, DOH-Volusia and DOH-Flagler announced their joint 2023-2025 Community Health Improvement Plan, in collaboration with AdventHealth, Halifax Health, Flagler Cares, One Voice for Volusia, Flagler County, Volusia County, the Early Learning Coalition of Flagler and Volusia and SMA Healthcare. The plan, known as CHIP, outlines initiatives to address the three health priorities identified in last year's assessment: Access to behavioral health services, economic and social barriers and system infrastructure.
"There were a lot of bright minds and great effort by the health are professionals in our two communities putting this together," said Bob Snyder, administrator of the Department of Health in Flagler County.
DOH-Volusia Administrator Stephen Civitelli said in a news release that he was thankful for the collaboration from residents and stakeholders who provided feedback on local health priorities. According to the CHIP, 1,115 people in Volusia and 615 people in Flagler responded to the community surveys, in addition to the 50 stakeholder interviews conducted and 150 people who took part in 14 focus groups.
“The completion of the CHIP is an important step for the department of health and our community partners to evaluate the strengths of our local public health systems and opportunities for advancing health priorities," Civitelli said.
While the new CHIP is the first to encompass both counties' needs, both Flagler and Volusia have had past individual health improvement plans in place. Access to behavioral health services has been a key need for a long time, said Carrie Baird, CEO of Flagler Cares.
"Definitely, for both communities, substance use and mental health have been ongoing concerns," Baird said.
Among the shared priorities outlined in the plan in respect to behavioral health include mental health outpatient services for both adults and children, including those with special needs; initiatives to prevent suicide among target populations such as youths; substance use disorder treatment programs; and improving mental health and substance use disorder transition care for released inmates.
In our care here in Flagler, our opioid mortality rate is the eighth highest in the state of Florida. So this has been this reoccurring issue that keeps popping up, that needs to be addressed." — Bob Snyder, administrator of the Department of Health in Flagler County.
According to the collaborative community health assessment, Flagler County has 25% of coverage by licensed psychologists — 5.3 per 100,000 people — in comparison to the state's average of 23.4 per 100,000; Volusia has half of the statewide rate, at 11.2 per 100,000. The assessment also reported that there are fewer licensed clinical social workers in both counties compared to the statewide average.
Additionally, Fentanyl-related overdose death rates increased by 768% in Flagler between 2013 and 2019, and by over 250% in Volusia.
"In our care here in Flagler, our opioid mortality rate is the eighth highest in the state of Florida," Snyder said. "So this has been this reoccurring issue that keeps popping up, that needs to be addressed."
The CHIP identifies three strategies — each broken down by smaller objectives — to address the current need. The first is to continue to implement the Coordinated Opioid Recovery (CORe) model in both counties, with the most immediate targets being to enroll 50 people in medication assisted treatment in Flagler County and help 50 others in Volusia through the Drug Abuse Response Team Outreach by June.
I think in the past, we maybe shied away from tackling any of the big issues head-on. We tried to do things that felt more comfortable, more like activities that we were already working on, but I really do think that this plan that we've presented for Volusia and Flagler, we're taking some of those big issues and we're effectively directly trying to work on them in a collaborative way." — Carrie Baird, CEO of Flagler Cares
"The plan is technically active since the beginning of this year," said Ethan Johnson, assistant director of DOH-Volusia. "Every single objective in there is almost on a different timeline, in terms of when it's being completed. So the workout outline in the plan is happening right now."
The CORe grant, Snyder said, is an example of coordinated action taking place between the counties to address opioid use disorders. He also highlighted that SMA Healthcare opened a new care center in Bunnell.
When it comes to economic and social barriers, affordable housing was a common need between the two counties.
That's a big problem to tackle, Snyder said.
"Affordable housing is lacking in both Volusia and Flagler County," Snyder said.
The community assessment reported that 35.8% of Flagler homeowners and 33.3% of Volusia homeowners are considered "cost-burdened," meaning they spend over 30% of their household income on household costs. When it came to renters, that percentage increased to 54.7% and 56.6% in Flagler and Volusia, respectively.
Every single objective in there is almost on a different timeline, in terms of when it's being completed. So the workout outline in the plan is happening right now." — Ethan Johnson, assistant director of DOH-Volusia.
The CHIP aims to add 150 affordable housing units in Volusia County by December 2025, an effort the plan states will be led by the county in partnership with the Volusia-Flagler Coalition for the Homeless.
Other Volusia-specific priorities included were initiatives to support households living in poverty and increasing the percentage of people with health insurance. Childcare was identified as a need for both counties.
The third priority, system infrastructure, is new to CHIP — at least in the way the plan dives into specifics, Baird said.
"We've talked about the idea that the way our helping safety net systems are set up oftentimes is as much of a problem as the problem that people are trying to seek help for," Baird said.
The CHIP tackles that head-on, she said, to look at how people access services, support and information. The system of care should exist for the convenience of the customer, not the other way around, she added.
What does that look like in both counties? In Flagler, the priority is to create initiatives to make the community aware of the available health care resources. In Volusia, it's addressing the systemic barriers to health insurance — the assessment reported 11.5% of adult residents are estimated to have had no health insurance between 2015-2019, according to census data. In Volusia children, the percentage was 6.4%.
Both counties identified the need for systems to improve the sharing of information between schools, the judicial system, health care providers and public health departments
Johnson said that the CHIP advocates for the implementation of an initiative to create a "no wrong door" community, meaning a goal that health care and community service staff are able to provide support and direction to the people they encounter.
"I think that's really connected to this huge turnover that's happening in the social service, human service, health service industry with frontline staff," Johnson said. "We have a lot of new people, a lot of young people, a lot of people who've retired within the last three years, so we're going through ... a retraining of how the work happens at the local level."
Baird said she was pleased with the different perspective taken in developing the plan.
"I think in the past, we maybe shied away from tackling any of the big issues head-on," Baird said. "We tried to do things that felt more comfortable, more like activities that we were already working on, but I really do think that this plan that we've presented for Volusia and Flagler, we're taking some of those big issues and we're effectively directly trying to work on them in a collaborative way."
Baird said that sometimes that can prove to be challenge — getting several agencies to work together on the same issue — but that it's the kind of work all of the partners and agencies should be doing.
For every objective in the plan, there is a lead organization and partnering group assigned to seeing that work progress, Johnson said.
"It's almost an account of its accountability," Johnson said.
If there's an entity or organization that has services or an interest in any of the outlined areas, Snyder said he would love to have them onboard.
"We would welcome their input and welcome their energy and ideas on how we can better address these three priority areas," Snyder said.
