A healthy collaboration

Volusia and Flagler’s joint Community Health Plan outlines ways to tackle priority issues.

Jarleene Almenas

Senior Editor

In 2022, the health departments in Volusia and Flagler counties collaborated for the first time to identify key public health concerns in the community. Now, they have 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 care 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 community surveys. There were also 50 stakeholder interviews, and 150 people 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.

A

Reoccurring Issue

While the new CHIP is the first to encompass both counties’ needs, Flagler and Volusia have had individual health improvement plans in the past. 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 behavioral health priorities outlined in the plan are 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.

According to the collaborative community health assessment, Flagler County has 5.3 licensed psychologists per 100,000 people — 25% the statewide rate of 23.4 per 100,000. Volusia has about half the statewide rate, at 11.2 per 100,000. The assessment also reported that the number of licensed clinical social workers in both counties is lower than the statewide average.

Fentanylrelated overdose death rates increased by 768% in Flagler between 2013 and 2019, and by over 250% in Volusia.

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 eighthhighest 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 into smaller objectives — to address the need. The first is to continue to implement the Coordinated Opioid Recovery (CORe) model in both counties, with the immediate target of enrolling 50 people in medication-assisted treatment in Flagler County and helping 50 others in Volusia through the Drug Abuse Response Team Outreach by June.

“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 between the counties to address

“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, Flagler Cares

opioid use disorders. He also noted that SMA Healthcare has opened a new care center in Bunnell.

THE HOUSING PROBLEM

A lack of affordable housing presents an economic and social barrier in both 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 “costburdened,” spending over 30% of their household income on household costs. For renters, that percentage increased to 54.7% in Flagler and 56.6% in Volusia.

The CHIP aims to add 150 affordable housing units in Volusia County by December 2025. The effort will be led by the county in partnership with the Volusia-Flagler Coalition for the Homeless, according to the plan. Other Volusia-specific priorities include initiatives to support households living in poverty and increase the percentage of people with health insurance. Childcare was identified as a need for both counties.

SYSTEMIC CHANGES

The third priority, system infrastructure, is new to CHIP — at least in the plan’s 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 available health care resources. In Volusia, it’s addressing the systemic barriers to health insurance: The assessment reported that an estimated 11.5% of adult residents had no health insurance between 2015-2019, according to census data. For Volusia children, the percentage was 6.4%.

Both counties identified the need for systems to improve information sharing between schools, the judicial system, health care providers and public health departments.

Johnson said the CHIP advocates for an initiative to create a “no wrong door” community, meaning that health care and community service staff can 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.”

NEW STRATEGIES

Baird said she was pleased with the different perspectives involved 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 it’s sometimes challenging to get several agencies to work together on the same issue — but that’s the kind of work all of the partners and agencies should be doing.

A lead organization and partnering group has been assigned for every objective in the plan, Johnson said. If other organizations offer services or have an interest in any of the outlined areas, Snyder said, he would

Food Insecure Population In 2019

71,190, or 13.3%

17,820 or 18.7%

Total population Children

13,350, or 12.2%

3,430 or 18.2%

Volusia Flagler

Data from the U.S. Department of Agriculture

Suicide Rates

The suicide rate in Flagler County from 2018 to 2020 was higher than the statewide average, at 21.6 deaths per 100,000, compared to 14.3 statewide.

Volusia's suicide rate was 19.9 for 2018-2020.

love to have them join.

“We would welcome their input and welcome their energy and ideas on how we can better address these three priority areas,” Snyder said.

“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, Florida Department of Health in Flagler County