Of the three “Priority Issues” identified by the Pinal County 2020 Community Health Improvement Plan (CHIP) “Substance Misuse and Dependency” is described as the first priority, and “Mental Health” is described as the second priority. These issues are met with limited resources, with the dominant FQHC in Pinal County offering only limited mental health and SUD (including MOUD) treatment services. Other providers ensure a degree of access, but that access is limited, caseloads are large, and wait times to see a provider are long. With limited resources, FQHCs must prioritize where to invest funding, but the evidence indicates that the need for new investment is in the areas of expanding access to multi-dimensional behavioral health and SUD services. In 2023 alone, Pinal County experienced 265 “Verified Non-Fatal Opioid Overdose Events” and Arizona experienced 1,924 “Confirmed Opioid Deaths.” Additionally, CHIP describes mental health disorders as the number one “most significant” untreated health condition in the county while simultaneously indicating that Pinal County’s provider to patient ratio is more than double the state average. Desert Senita, experienced in providing behavioral health and SUD services in the Ajo service area, is new to Pinal County, but the Health Center’s Strategic Plan identifies both the need for expanded services and a program to address that need, including the opening of two new facilities in Pinal County in 2024. Desert Senita currently offers outpatient behavioral health services in Arizona City, but those services are limited (both in scope and capacity) due to budgetary constraints, and the primary modality has been tele-health with 8 in-person visits, 244 virtual visits, and a total of 58 Pinal County mental health patients served reported in UDS in 2023. Desert Senita primary care providers are trained in MOUD, but limited capacity resulted in limited uptake in 2023 with only 4 patients participating in
any form of MOUD. Desert Senita does have the medical and pharmacy capacity to effectively provide outpatient MOUD services in a comprehensive manner but lacks similar and equally critical mental health and outpatient SUD treatment capacity. With year one funding in the amount of $600,000, Desert Senita proposes to substantially expand in-person behavioral health/SUD treatment services by adding new professional and para-professional FTEs, specifically a Psychiatrist, a Psychiatric Mental Health Nurse Practitioner, a Clinical Psychologist, licensed mental health clinicians with specific training in the treatment of SUD, and three clinical case managers. This capacity increase will ensure access to care across the Arizona City, Stanfield, and Coolidge service areas. Services will be across the lifespan in all cases and provided in a community-centric responsive manner designed to ensure access to all community members. Desert Senita will offer mental health and SUD treatment services to students and families of three school districts, including the direct provision of mental health services on school campuses. The added disciplines described as well as the addition of in-home and school-based services will increase the capacity of the program to diagnose, treat, and case manage complex and chronic mental illness and SUD in both children and adults. Additionally, through close collaboration with both Desert Senita and other FQHC primary care providers with limited behavioral health and MOUD capacity, Desert Senita providers will ensure additional access to MOUD through a multidisciplinary approach including primary care, psychiatry, and clinical pharmacy. These new approaches and expanded capacities are predicted to result in a substantial increase in the uptake of behavioral health and SUD treatment services with a predicted 750 new behavioral health/SUD patients and a similar greater than ten-fold increase (from 4 to 50 or more) MOUD patients in the first year
of the project.