WACGC will improve and enhance its current slate of CCBHC services to 505 new clients in the target population - children (0+) with SED and persons of all ages who are at risk of: 1) SMI 2) SUD, 3) COD and 4) individuals with mental health issues also at risk for chronic health conditions in their 6-county catchment area in Western Arkansas. Specific attention will be given to individuals who identify as veteran or minority (race, ethnicity, gender, and economic).
WACGC CCBHC serves 6 counties in the western most portion of Arkansas: Crawford, Franklin, Logan, Polk, Scott, and Sebastian. Most of the diverse geographic area is extremely rural with the urbanization concentrated in Fort Smith, the 3rd largest city in Arkansas (Population 88,404; U.S. Census, 2022). All 6 counties are HRSA-designated Medically Underserved Areas and Health Professional Shortage Areas in the primary health and behavioral health domain. The 6-county catchment area is 79% Non-Hispanic White, 11% Hispanic, 4% Non-Hispanic Black / African American, 2% Asian, 2% Native American, and 3% Multiracial. Over 18,000 (7%) veterans are in the catchment area. Across the 6 counties, about 16% of people are in poverty, 14% are experiencing severe housing problems, 24% of children are in poverty and 72% are eligible for free or reduced lunch (County Rankings, 2022). Further, 15% drink alcohol excessively, 19% are food insecure, 26% are in poor to fair health, 17% experience frequent physical duress, 20% experience frequent mental duress, and 13% are uninsured (2022 County Rankings).To meet the continued needs of the clients of the WACGC CCBHC we have identified 4 main goals. Goal 1: Improve and enhance the current slate of services for the target population in the catchment area through targeted behavioral health equity activities including the retention of PCC staff (Y1-4) and the mobile behavioral health unit (Y1-4). We will increase the provision and scope of services offered by WACGC to the target population through PCC, ACT, and mobile crisis teams (Y1-4). Provide additional and on-going EBP training, including trauma informed care, recovery care, targeted case management, SUD treatment to all clinical staff involved in the care of the target population (Y1-4). Goal 2: Expand PCP services at the Fort Smith campus by 10%, to children ages 5+ (Y2-4), to include general wellness exams for clients (Y2-4) and to include assessing for, and treatment of, chronic health conditions for clients 5+ (Y2-4). Goal 3: Increase accessibility for historically underrepresented and under resourced communities through mobile behavioral care coordination and services by using the mobile health unit 3 days per week (Y1-4) in targeted catchment areas to create a continuum of care. Goal 4: Identify and improve underlying social determinants of health (SDOH) for target population through the implementation of assessment of SDOH (Y1-4), risk stratification (Y2-4) and Care Pathways (CPW) (Y2-4). We will implement risk stratification procedures to address identified gaps in SDOH and CPWs to individually address SDOH and create care plans for clients at greatest risk. Finally, we will raise awareness about the social challenges that our clients are facing and action that can be taken to create more supportive environments for health across our catchment area and the State. Finally, to sustain our CCBHC we are implementing more EBPs for the reduction of costly resources, hospitalizations, and jail time for clients using the most behavioral health services. Risk stratification reduces use of resources through optimizing care for individuals based on their risk levels. CPWs optimize resource allocation and are cost-effective as they provide more streamlined approaches to target individual's healthcare needs while eliminating unnecessary procedures.