v. calculating population to provider ratios mental v-1

V. CALCULATING POPULATION TO PROVIDER

RATIOS

Mental

V-1

CALCULATING POPULATION TO PROVIDER RATIOS

Objective:

Participants will understand how to:

1) Identify mental health providers

2) Calculate Full-Time-Equivalency (FTE) rates, and

3) Determine the population to provider ratios for mental health geographic and population designations

(MENTAL)

V-2

Mental Designations

1) Psychiatrists Only, or

2) Core Mental Health Providers (CMHP)1, including

Psychiatrists

Clinical Psychologists

Clinical Social Workers

Psychiatric Nurse Specialists

Marriage and Family Therapists

¹ - Must include all of these for this type of designation V-3

Geographic Area A rational service area - MSSA, combine 1 or more MSSAs, or whole

county

> 30,000:1 psychiatrists, or

> 9,000:1 CMHP including psychiatrists, or

> 6,000:1 CMHP including psychiatrists and > 20,000:1 psychiatrists

Population to Provider Ratios Needed for Designation

(MENTAL)

V-4

Population to Provider Ratios Needed for Designation (Continued)

V-5

Geographic Area w/Unusually High Needs

A rational service area plus one of the following:

a) 20% or more of the population is < 100 % of the poverty level, or

b) The youth ratio (# of persons < 18 to the # of adults ages 18 - 64) is greater than 0.6, or

c) The elderly ratio (# of persons > 65 to the # of adults ages 18 - 64) is greater than 0.25, or

d) Alcohol or substance abuse prevalence data showing the area to be in the worst quartile of the nation, state, or region




Low-Income Population




Number of individuals in the service area that are at or below 200% of the Federal poverty level

Must be >30% of the population in the service area

Source: 2007 Claritas Population Estimates

V-6

Contiguous Areas Are Overutilized if:

> 20,000:1 psychiatrists,

or


V-7

POPULATION SIDE OF THE RATIOPOPULATION SIDE OF THE RATIO

(SAME AS PRIMARY HEALTH CARE)

V-8

________________

:

PROVIDER SIDE OF THE RATIO

V-9

:____

1) Identify all mental health providers for the type of designation being sought in the area to be designated.

2) Determine the number of hours each provider works inpatient care (office and follow-up hospital inpatientcare) serving the population to be designated.

3) Calculate the FTE for each mental health providerserving the population to be designated.

4) Calculate the population to provider ratio.

STEPSSTEPS

V-10

IdentifyIdentify all all mental health providersmental health providers for for the type of designation being sought in the type of designation being sought in the area to be designated.the area to be designated.

STEP 1STEP 1

V-11

Core Mental Health Providers(CMHP)

Includes:

1. Psychiatrists

2. Clinical Psychologists

3. Clinical Social Workers

4. Psychiatric Nurse Specialists

5. Marriage and Family Therapists V-12

1. Psychiatrist

A doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who:

a) is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, is “board eligible” (i.e. has successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry); and

b) practices patient care psychiatry or child psychiatry and is licensed to do so if required by the State of practice.

V-13

2. Clinical Psychologist

a) An individual with a doctorate in psychology who is practicing as a clinical or counseling psychologist and is licensed or certified to do so by their State of practice; or

b) if licensure or certification is not State required, the individual must have a doctorate in psychology and two years of supervised clinical training or counseling experience (excluding school psychologists).

V-14

3. Clinical Social Worker (CSW)

a) Is certified as a CSW by the American Board of Examiners in Clinical Social Work; or is listed on the National Association of Social Workers’ Clinical Register; or has a masters degree in social work and two years of supervised clinical experience; and

b) is licensed to practice as a social worker if required by the State of practice.

V-15

4. Psychiatric Nurse Specialist

A registered nurse who:

a) is certified by the American Nurses Association as a psychiatric and mental health clinical nurse specialist; or has a masters degree in nursing with a specialization in psychiatric/mental health and two years of supervised clinical training; and

b) is licensed to practice as a psychiatric or mental health nurse specialist (if required by the State of practice).

V-16

5. Marriage and Family Therapist (MFT)

a) An individual with a masters or doctoral degree in marriage and family therapy and at least two years of supervised clinical experience who is practicing as a MFT and is licensed to do so if required by the State of practice; or

b) if licensure or certification is not State required, is eligible for clinical membership in the American Association for MFT.

V-17

List all Psychiatrists or CMHPs who:

Provide mental health care in the service area

Provide direct care or consultation and supervision

Practice in ambulatory or other short term care

settings1

1

Usually defined as < 2 weeks average length of stay.

V-18

Include:

All psychiatrists or CMHPs (including psychiatrists) who provide patient care in the service area, including those who:

1) Serve in State Scholarship or Loan Repayments Programs

2) Serve at Indian Health Clinics and are not Federal providers

3) Plan on retiring but are still seeing patients

V-19

FTE Exclusions from Survey:

Mental health providers engaged solely in research, administration, or teaching

Mental health hospital staff involved exclusively in inpatient or emergency room care

Mental health providers with full-time staff positions in correctional institutions, youth detention facilities, residential treatment centers for children with emotional or developmental disabilities, and inpatient units of State or County mental hospitals

Psychiatrists who are suspended under provisions of the Medicaid- Medicare Anti-Fraud and Abuse Act for 18 months or more

V-20

Include in Survey, but Exclude in FTE:

V-21

Note: All providers who meet these qualifications should be listed, even if their FTE will be 0.

Mental health providers who serve in the NHSC Scholarship or Loan Repayment Programs (FTEs will include State Loan Repayment Program recipients)

Physicians who are graduates of foreign medical schoolwho are not citizens or lawful permanent residents(including those with J-1or H-1B visas)

Mental health providers who are Federal providers

Mental health providers who are planning on retiring but are still seeing patients

Note: All providers who meet these qualifications should be listed, even if their FTE will be 0.

V-22

Include in Survey, but Exclude in FTE (continued):

Sources of Provider Data

State Licensure Lists: http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup

National, State, and Local Professional Association Directories

Medicare and Medicaid Practitioner Lists

Local Telephone Directory Yellow Pages

Commercially Developed Listings

www.vitals.com

V-23

http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup

http://www.vitals.com/

STEP 2STEP 2

Determine the number of hours eachDetermine the number of hours eachprovider works in out-patient care provider works in out-patient care (this includes office visits and follow-(this includes office visits and follow-up hospital in-patient care) serving up hospital in-patient care) serving the population to be designated.the population to be designated.

V-24

Designation Types and Whom to Include in the

Provider Count

COUNT ALL MENTAL HEALTHPROVIDERS WHO SERVE ALL PERSONS:

Geographic in the service area

Low-Income Population in the service area that have incomes

< 200% of the Federal poverty level (Medicaid and Posted Sliding Fee)

Medicaid-Eligible Population in the service area that are Medicaid-enrolled

Homeless Population in the service area that are homeless

Migrant Farmworker Population in the service area that are migrant farmworkers

Native American/ Native Alaskan

in the service area that are Native American or Native Alaskan

DESIGNATION TYPE:

V-25

Providers

Location of Hours of Direct

Provider Name Specialty Practice/CT Pt. Care/Week1

1) S. Freud, M.D. Psychiatry 5 Oedipal Lane 20

City, CA 90001

2) C. Jung, M.D. Psychiatry 11 Dream Drive 40City, CA 90001

3) H. Lecter, Ph.D. Clinical 6 Can Street 26 Psychology City, CA 90021

4) M. Houlihan, R.N. Psychiatric 1400 Captain Avenue 55

Nursing City, CA 90003

5) R. Weisheimer, M.S. Marriage & Fam. 69 Shex Street 10 Counseling City, CA. 90009

6) L. Schlessinger, M.S.W. Clinical Social 1 Radio Road 6 Work City, CA 90006

Total Psychiatrists: 2Total Core Mental Health Providers: 6

1 - Must include hospital hours

V-26

STEP 3

Calculate the FTE for each mental healthCalculate the FTE for each mental healthprovider serving the population to beprovider serving the population to bedesignated.designated.

V-27

FTE Calculation

40 hours = 1.0 FTE

Every 4 hours (½ day) is counted as 0.1 FTE.

A provider serving more than 40 hours a week is counted as 1.0 FTE.

Only the Total (or Low-Income) FTE is rounded to the nearest tenth of a percent:

Examples: 0.875= 0.9 0.817= 0.8 0.83 = 0.8 0.85 = 0.9

Interns and residents are counted as 0.5 FTE (40 hours = 0.5 FTE)

Note:The FTE for low-income population designations is based on the average number of hours per week spent with Medicaid and Sliding Fee Scale (SFS) patients. It is not based on whether the provider is accepting new Medicaid patients.

For each physician, include the number of hours of direct patient care provided (office and hospital inpatient) in the service area:

V-28

FTEs Geographic DesignationFTEs Geographic Designation

Provider Name Specialty Location of Practice Hours of Direct

Pt. Care/Week1

FTE Based on Hours

Total FTE

S. Freud, M.D. Psychiatry 5 Oedipal LaneCity, CA 90001

20 0.5

(20/40=.5)

0.5

C. Jung, M.D.2 Psychiatry 11 Dream DriveCity, CA 90001

40 0.5

(40/40=1.0

1.0/.5=.5)

0.5

H. Lecter, Ph.D. ClinicalPsychology

6 Can Street City, CA 90021

26 .65

(26/40=.65)

0.65

M. Houlihan, R.N. PsychiatricNursing

1400 Captain Avenue City, CA 90003

55 1.375

(55/40=1.375)

1.0

R. Weisheimer, M.F.T.

Marriage/FamilyCounseling

69 Shex StreetCity, CA 90009

10 .25

(10/40=.25)

0.25

L. Schlessinger, M.S.W.

Clinical Social Work

1 Radio RoadCity, CA 90006

6 0.15

(6/40=.15)

0.15

Total Psychiatrists: 2 Total Psychiatrist FTE: 1.0

Total Core Mental Health Providers: 6 Total Core Mental Health FTE: 3.05=3.1¹ - Must include hospital hours (for psychiatrist only)² - Dr. Jung is in his last year of residency and is therefore counted as 0.5

V-29

FTEs Low-Income Designation

Provider Name Specialty Location of Practice

Hours of Direct

Pt. Care/Week

FTE Based on Hours

%

Medi-Cal

%

SFS

% of

L-I

Total L-I

FTE

S. Freud, MD Psychiatry 5 Oedipal LaneCity, CA 90001

20 0.5 0% 0% 0% 0.0

C. Jung, M.D. Psychiatry 11 Dream Drive

City, CA 90001

40 0.5 30% 15% 45% .225

H. Lecter,Ph.D. Clinical

Psychology

6 Can Street

City, CA 90021

26 .65 0% 85% 85% .55

M. Houlihan, R.N. Psychiatric

Nursing

1400 Captain Avenue

City, CA 90003

55 1.0 50% 10% 60% .60

R. Weisheimer,M.S. Marriage/Fam.

Counseling

69 Shex Street

City, CA 90009

10 .25 25% 5% 30% 0.075

L. Schlessinger, M.S.W.

Clinical Social Work

1 Radio Road

City, CA 90006

6 0.15 0% 10% 10% .015

Total Psychiatrists: 2 Total L-I Psychiatrist FTE: 0.225=.2

Total Core Mental Health Providers: 6 Total L-I Core Mental Health FTE: 1.465=1.5

(20/40=.5)

(40/40=1=.5) (30%+15%=45%)

(.45x.5=.225)

(26/40=.65) (.85x.65=.55)

(55/40=1.37=1) (50%+10%=60%) (.60x1.0=.60)

(10/40=.25) (25%+5%=30%) (.30x.25=.075)

(6/40=.15) (.10x.15=.015)

V-30

Survey Providers

Survey all mental health providers in the servicearea for the type of designation being sought

(psychiatrists only or all CMHPs):

Must include hospital hours (psychiatrist)

Minimum two-thirds response rate required

V-31

Calculate Non-Responders

Use survey average (minimum two-thirds response rate required)

Example: Sacramento, California - 80 providers

60 - respond to survey

20 - no response after repeated telephone calls

(Response rate = 60/80 = 75%)

Total FTE for the 60 responders = 28 FTEs

1) Divide FTE of responders (28) by the number of responders (60) for the average FTE of responders (.46)

2) Multiply number of non-responders (20) by the average FTE of responders (.46) for FTE of non-responders (9.3)

3) Add FTE of responders (28) and non-responders (9.3) for total FTE = 38.0

V-32

STEP 4

Calculate the population to provider Calculate the population to provider ratio.ratio.

V-33

Population to Provider Ratio

2 Possible Ratios: Psychiatrists

Core Mental Health Providers

Step 1: Determine if area has high need

Youth ratio: 5,881/11,483 = .51 (min. > = .6)

Elderly ratio: 3,681/11,483 = .32* (min. > = .25)

* Indicates High Need

V-34


V-35

Geographic Mental HPSA

Civilian Population Ratio:Civilian Population = 20,900Psychiatrist FTE = 1 (20,900 / 1 = 20,900:1)Psychiatrist Ratio: 20,900:1

CMHP FTE = 3.1(20,900 / 3.1 = 6,742:1)CMHP Ratio: 6,742:1


Geographic Mental HPSA with High Needs

Civilian Population (High Needs) Ratio:Civilian Population = 20,900 Psychiatrist FTE = 1(20,900 / 1 = 20,900:1)Psychiatrist Ratio: 20,900:1

CMHP FTE = 3.1(20,900 / 3.1 = 6,742:1)CMHP Ratio: 6,742:1

V-36

Low-Income Mental HPSA

Low-Income Population (200% Poverty) Ratio:Low-Income Population = 10,137 (49.47%)Psychiatrist FTE = 0.2(10,137 / 0.2 = 50,685:1)Psychiatrist Ratio: 50,685:1

CMHP FTE = 1.5(10,137 / 1.5 = 6,758:1) CMHP Ratio: 6,758:1


V-37

What to Include in the Population Provider Ratio Section of Your Application

Population:

Cover letter with summary findings

Total adjusted population

Source of data

List of Providers:

Include the following for each provider: Name

Location:

- Non-metro areas – name of town

- Metro areas – complete address with zip code and CT (if available)

Degree (M.D., MFT, R.N., M.S.W., etc.)

Average # of hours/week of patient care in area

Verification that hospital hours are included

% of practice Medicaid (for low-income and Medicaid-eligible designations)

% of practice Sliding Fee Scale (for low-income designations)

FTE total for each provider rounded to the nearest tenth of a percent

Description of how information was obtained (source, method)

V-38

Totals and Ratio

Total number of providers

Total FTE

Explanation of any high need indicators

Population to provider ratio

V-39

What to Include in the Population Provider Ratio Section of Your Application (continued)

What Not to Include in Your Application

Information on the weather or climate

Information on road conditions, construction, or number of avalanches

Personal statements of driving time

Average number of funerals

History of the early settlers of the area

Newspaper articles

Pictures of the mayor

General information on access issues that is not specific to the area or population

Copies of old applications

V-40

Contiguous Area ResourcesContiguous Area Resources

V-41

Contiguous Area ResourcesContiguous Area Resources

Objective:

Participants will understand how to identify contiguous areas, determine if they have resources, and if the resources are excessively distant, overutilized, or inaccessible to the population of the area proposed for designation.

Purpose of Contiguous Area Analysis:

To identify nearby sources of care and determine if they are

inaccessible to the population in the proposed service area

V-42

STEPS

1) Identify the boundaries of eachcontiguous area

2) Evaluate each area to determine availability of resources

V-43

1) Identify the Boundaries of Each Contiguous Area

A. Identify on a map the boundaries and population center of theproposed service area.

B. Determine the contiguous areas in all directions within 40 minutes from the proposed area’s population center.

C. Map the boundaries of each contiguous area in all directions (North, East, South, & West).

Boundaries The boundaries of each contiguous area may be based on:

• Travel time (40 minutes)• Socio-economic/demographic characteristics• Established neighborhoods• Physical barriers• Designated HPSA

The boundaries of contiguous areas are often (not always) based on the same census delineation as the proposed area:

Proposed service area = whole countyContiguous areas = whole counties

Proposed service area = census tracts (MSSA)Contiguous areas = census tracts (MSSA)

V-44

2) Determine Availability of Resources

A. Check the HPSA list to determine if any of the contiguous areas are designated as HPSA and therefore considered inaccessible.

If it is not inaccessible HPSA, then

B. Determine if there are significant socio-economic/demographic disparities or physical barriers.

If there are not significant socio-economic/demographic disparities orphysical barriers, then

C. Determine if the contiguous area’s providers are located > 40 minutes away from the population center of the proposed area and are therefore inaccessibledue to excessive distance. (30% or more disparity between the service area and the contiguous area)

If they are not excessively distant, then

D. Determine if the resources in the contiguous area exceed the population-to-provider ratio and are therefore overutilized.

If they are not overutilized, this area cannot be designated.

(Consider a different kind of designation.)

V-45

Check the HPSA Status of Each Contiguous Area and Determine if This Type of HPSA Is Inaccessible to the Proposed Area

If the proposed service Then the contiguous area area is: is inaccessible if it is a:

Geographic without high needs Geographic HPSA

Geographic with high needs Geographic HPSA, Low-Income HPSA (based on 100% poverty indicator)

Low-Income HPSA Geographic HPSA, Low-Income HPSA

Medicaid Eligible HPSA Geographic, Low-Income, or Medicaid Eligible

Poverty Population HPSA Geographic, Low-Income, Medicaid Eligible or Poverty HPSA

V-46

Determine If Providers Are Excessively Distant

1) Develop a list of providers in the contiguous area 2) Map their office locations 3) Determine the travel time from the proposed area’s population center to the contiguous area

Providers > 40 minutes from the population center are excessively distant

Mental: > 40 minutesInterstate Roads - 30 miles X 1.33 = 40 minutesPrimary Roads - 25 miles X 1.6 = 40 minutesSecondary Roads - 20 miles X 2.0 = 40 minutes

V-47

Determine If Providers Are Excessively Distant (continued)

Inner Portions of Metropolitan Areas:

Distance is based on time using public transportation* during non-rush hour.

Bus routes and schedules must be described (provide narrativedescription and include bus schedule if possible).

*Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is ≥ 20%, or for Population designations regardless of the 100% poverty rate.

V-48

Determine if Contiguous Areas Are Overutilized

Calculate FTE - use same method as used for the proposed service area.

If needed, survey providers and determine FTE serving the population. Use same surveying method as used for the proposed service area.

Explain how the information was obtained and calculated, and include population, total FTE, and population to provider ratio.

Population to Provider Ratios:

MENTAL: > 20,000:1 psychiatrist or > 3,000:1 CMHP and > 10,000:1 psychiatrist

V-49

ExampleExample

Whole County

ASAPS Map AnalysisLooking at Whole County

Designation for Del Norte County

V-50

ASAPS Mapping - we zoom in to county and keep zooming in to get to the MSSA layer

V-51

Once we have zoomed into the MSSA layer, then we define the proposed area. The purple area is the proposed area, Del Norte County.

100% and 200% poverty rate

V-52

All the contiguous areas touching the proposedCounty must be analyzed by following the federalcriteria.

*Note contiguous areas located near CA boarder (Curry & Josephine County) must be analyzed/included in application.

V-53

List of all the contiguous areas and a closer look at the contiguous areas.

On this map I am showing theContiguous areas that are HPSADesignated – but always double check on theHRSA website database for designations.

V-54

Defining ASAPS Maps

• Black Polygon around the proposed area

is a 5 miles radius for Primary Care and 7 miles radius is for Dental and Mental Health

• Green Polygon around the proposed area

is a 30 minutes and 40 minutes is for Dental & Mental Health

• Purple dots you see on the ASAPS map is the provider locations

• Lines going diagonally means that the MSSA is a designated HPSA (\\\\ this means LI) (////// means Geo)

• On some of the Frontier area maps you will see the black Polygon only , which mean the proposed area doesn’t have any contiguous areas

V-55

Defining ASAPS Maps

• If using the public transportation in a inner Metro area for your HPSA designation, you only analyze the areas that are in the black Polygon (5 mile or 7 mile radius ) – this rule applies to Los Angeles, San Francisco, and parts of Fresno, etc. Inner Metro area is defined through ASAPS when creating maps for a particular MSSA. Please call SDP staff when beginning your application process.

• When using public transportation, the 100% poverty level must be > 20%

V-56

Whole CountyWhole County

Summary: Total Pop: 24,115

White Pop: 91.97%Black Pop: 4.99%Hispanic Pop: 17.62%Below 200% Pov: 44.50%Below 100% Pov: 20.03%65 year or older Pop: 13.28%Elderly Ratio: .18%Youth Ratio: .35%

* Based on Total Population (Not Civilian Pop.)

Proposed Area: Del Norte County (Crescent City)

V-57

Sample HPSA Worksheets

V-58

Del Norte County Area

Determine the Nearest Source of Non-Designated Care

Needed for HPSA score:

Cannot be a HPSA (of any type) Cannot have significant socio-economic/demographic differences or physical barriers Can be excessively distant Can be overutilized

For all applications:

Provide a road map with the proposed service area and contiguous areas outlined. On the map, indicate the population center of the proposed service area, the nearest

source of care, and the route between these points. Provide the name and address of the nearest source of care, route, miles, and minutes.

For inner portions of metropolitan areas, include:

Bus route information from the population center of the proposed area to the nearest source of care, and

Miles and minutes of travel time

V-65

Time Saving Tips

Survey providers only if necessary:

In contiguous areas, calculate the population to provider ratio counting each provider as 1.0 FTE. If area meets ratio of > 20,000:1, don’t survey (Geographic only).

Collect all possible information in one survey (e.g., Medicaid and sliding fee scale even for an area designation).

Work with State licensing department to obtain information on providers.

Use claims data for Medicaid FTE (works only in fee-for-service Medicaid).

V-66

What to Include in the Contiguous Area Resources Section of Your Application

Map with Census Delineations

Name and boundaries of proposed service area Name and boundaries of contiguous areas Population center for the proposed service area Helpful: current designation status of each of the contiguous areas

Road Map

Outline of proposed area boundaries Location of nearest source of non-designated care For automobile transportation - start, end, and route For public transportation - start and end points of route

V-67

For Contiguous Areas that are not Excluded with Current Designations and Whose Providers are Excessively Distant

Travel time to closest provider from population center of service area, including miles, route, and type of road; or public transportation information, including bus routes, start/end points, miles, minutes, and source; include bus schedule if available.

For Contiguous Areas that are not Excluded with Current Designations and have Access Barriers

Description of any significant socio-economic/demographic disparities (e.g. demographic data on racial/ethnic composition or income levels comparing proposed service area population to population in the contiguous area, and source of data), or Description of any significant physical barrier

For Contiguous Areas that are not Excluded with Current Designations and are Overutilized

Population to provider ratios Description of how information was obtained

V-68

For All Designation Requests:

Address of nearest source of non-designated, accessible care, including address, miles, and minutes via public transportation if metropolitan area Location of nearest source on road map (see above)

For Public Transportation Routes*:

Travel time, based on non-rush hour bus schedules Start/End point of route Include time waiting for transfers while in route Map showing proposed area boundaries, start and end points of bus route Bus schedules, if available Cite source of information

*Public Transportation can be used only in Inner City/Metro areas for Geographic designations, where the 100% poverty rate is ≥ 20%, or for Population designations regardless of the 100% poverty rate.

V-69

WebsitesBay Area Public Transit (San Francisco):http://transit.511.org/index.asp

Southern California Public Transit (San Diego):http://www.sdcommute.com/

Los Angeles County Metropolitan Transportation Authorityhttp://www.metro.net/default.asp

2000 CT Locator:http://www.ffiec.gov/Geocode/default.aspx

U.S. Census Bureau – American Factfinderhttp://factfinder.census.gov/home/saff/main.html?_lang=en

Alcohol and Drug Substance Abusehttp://www.adp.ca.gov/Prevention/risk_indicators.shtml

V-70

http://factfinder.census.gov/home/saff/main.html?_lang=en

http://www.adp.ca.gov/Prevention/risk_indicators.shtml

Geographic Mental Physician Survey

Entire Del Norte County Del Norte

V-71

APPLY FOR DESIGNATION

1 or morecontiguous areaconditions met

No contiguousarea conditions

met

EvaluateContiguous Area

1 or more HighNeed Indicators

Present

NOHigh-NeedIndicators

Present

Evaluate Service Area for High-Need Indicators

STOP:Area Not Qualified

For Designation

Calculate Population-to-CMHP & Population-to-

PsychRatio

Define Rational ServiceArea

Determine Core MentalHealth Profession

(CMHP) FTEs

Determine Service AreaPopulation

Evaluate Contiguous Area


For Designation

APPLY FOR DESIGNATION


For Designation

1 or more HighNeed Indicators

Present

No contiguousarea conditions

met

Process Model for Mental Health Professional Shortage Area DesignationProcess Model for Mental Health Professional Shortage Area Designation

To Use: Follow arrows. Numbers are reference citations only. Refer to correspondingly numbered pages following for additional information on steps in numbered boxes

CHMP = Core Mental Health ProfessionalPsych = Psychiatrist

POP:CMHP > 4500:1 andPOP:Psych > =15000:1

POP:CMHP > =6000:1

or

POP:Psych > =20000:1

or


POP:CMHP > =9000:1


or

or


POP:CMHP > =6000:1


or

or

2

3

4

5

7

8

1

8

6

5

8

7

V-74

v. calculating population to provider ratios mental v-1

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